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Random Quote "When one by one our ties are torn, and friend from friend is snatched forlorn; When man is left alone to mourn, oh! then how sweet it is to die!" Anna Letitia Barabauld
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Obesity in adulthood and its consequences for life expectancy: a life-table analysis.
Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L; NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Department of Public Health, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands. peeters@mgz.fgg.eur.nl BACKGROUND: A study published in the January 7, 2003 issue of the Annals of Internal Medicine showed large decreases in life expectancy in overweight and obese individuals. A representative from the American Heart Association commented on this study by stating that overweight people lose three years of life expectancy, while obese individuals die six to seven years prematurely. The conclusion by the authors of the study concluded that life expectancy seen in the obese are "similar to those seen with smoking". This study showed that people who smoke and are obese die almost 14 years sooner than normal weight nonsmokers. Overweight and obesity in adulthood are linked to an increased risk for death and disease. Their potential effect on life expectancy and premature death has not yet been described. OBJECTIVE: To analyze reductions in life expectancy and increases in premature death associated with overweight and obesity at 40 years of age. DESIGN: Prospective cohort study. SETTING: The Framingham Heart Study with follow-up from 1948 to 1990. PARTICIPANTS: 3457 Framingham Heart Study participants who were 30 to 49 years of age at baseline. MEASUREMENTS: Mortality rates specific for age and body mass index group (normal weight, overweight, or obese at baseline) were derived within sex and smoking status strata. Life expectancy and the probability of death before 70 years of age were analyzed by using life tables. RESULTS: Large decreases in life expectancy were associated with overweight and obesity. Forty-year-old female nonsmokers lost 3.3 years and 40-year-old male nonsmokers lost 3.1 years of life expectancy because of overweight. Forty-year-old female nonsmokers lost 7.1 years and 40-year-old male nonsmokers lost 5.8 years because of obesity. Obese female smokers lost 7.2 years and obese male smokers lost 6.7 years of life expectancy compared with normal-weight smokers. Obese female smokers lost 13.3 years and obese male smokers lost 13.7 years compared with normal-weight nonsmokers. Body mass index at ages 30 to 49 years predicted mortality after ages 50 to 69 years, even after adjustment for body mass index at age 50 to 69 years. CONCLUSIONS: Obesity and overweight in adulthood are associated with large decreases in life expectancy and increases in early mortality. These decreases are similar to those seen with smoking. Obesity in adulthood is a powerful predictor of death at older ages. Because of the increasing prevalence of obesity, more efficient prevention and treatment should become high priorities in public health.
Public health officials and organizations have disseminated health messages regarding the dangers of
obesity, but these have not produced the desired effect. OBJECTIVE: To estimate the expected number
of years of life lost (YLL) due to overweight and obesity across the life span of an adult. DESIGN,
SETTING, AND SUBJECTS: Data from the (1) US Life Tables (1999); (2) Third National Health and
Nutrition Examination Survey (NHANES III; 1988-1994); and (3) First National Health and Nutrition
Epidemiologic Follow-up Study (NHANES I and II; 1971-1992) and NHANES II Mortality Study (1976-1992)
were used to derive YLL estimates for adults aged 18 to 85 years. Body mass index (BMI) integer-defined
categories were used (ie, <17; 17 to <18; 18 to <19; 20 to <21; 21 to 45; or > or =45). A BMI of 24 was
used as the reference category. MAIN OUTCOME MEASURE: The difference between the number of years of
life expected if an individual were obese vs not obese, which was designated YLL. RESULTS: Marked race
and sex differences were observed in estimated YLL. Among whites, a J- or U-shaped association was found
between overweight or obesity and YLL. The optimal BMI (associated with the least YLL or greatest
longevity) is approximately 23 to 25 for whites and 23 to 30 for blacks. For any given degree of
overweight, younger adults generally had greater YLL than did older adults. The maximum YLL for white
men aged 20 to 30 years with a severe level of obesity (BMI >45) is 13 and is 8 for white women. For
men, this could represent a 22% reduction in expected remaining life span. Among black men and black
women older than 60 years, overweight and moderate obesity were generally not associated with an
increased YLL and only severe obesity resulted in YLL. However, blacks at younger ages with severe
levels of obesity had a maximum YLL of 20 for men and 5 for women. CONCLUSION: Obesity appears to
lessen life expectancy markedly, especially among younger adults.
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