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Cited by 1,542Obesity, Physical Activity, DietCancer Risks and FactorsObesity and Health Practices

Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity

Flegal, Katherine M., Graubard, Barry I., Williamson, David F., Gail, Mitchell H.·2007·JAMA
DOI 10.1001/jama.298.17.2028
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Abstract

CONTEXT: The association of body mass index (BMI) with cause-specific mortality has not been reported for the US population. OBJECTIVE: To estimate cause-specific excess deaths associated with underweight (BMI <18.5), overweight (BMI 25-<30), and obesity (BMI > or =30). DESIGN, SETTING, AND PARTICIPANTS: Cause-specific relative risks of mortality from the National Health and Nutrition Examination Survey (NHANES) I, 1971-1975; II, 1976-1980; and III, 1988-1994, with mortality follow-up through 2000 (571,042 person-years of follow-up) were combined with data on BMI and other covariates from NHANES 1999-2002 with underlying cause of death information for 2.3 million adults 25 years and older from 2004 vital statistics data for the United States. MAIN OUTCOME MEASURES: Cause-specific excess deaths in 2004 by BMI levels for categories of cardiovascular disease (CVD), cancer, and all other causes (noncancer, non-CVD causes). RESULTS: Based on total follow-up, underweight was associated with significantly increased mortality from noncancer, non-CVD causes (23,455 excess deaths; 95% confidence interval [CI], 11,848 to 35,061) but not associated with cancer or CVD mortality. Overweight was associated with significantly decreased mortality from noncancer, non-CVD causes (-69 299 excess deaths; 95% CI, -100 702 to -37 897) but not associated with cancer or CVD mortality. Obesity was associated with significantly increased CVD mortality (112,159 excess deaths; 95% CI, 87,842 to 136,476) but not associated with cancer mortality or with noncancer, non-CVD mortality. In further analyses, overweight and obesity combined were associated with increased mortality from diabetes and kidney disease (61 248 excess deaths; 95% CI, 49 685 to 72,811) and decreased mortality from other noncancer, non-CVD causes (-105,572 excess deaths; 95% CI, -161 816 to -49,328). Obesity was associated with increased mortality from cancers considered obesity-related (13,839 excess deaths; 95% CI, 1920 to 25,758) but not associated with mortality from other cancers. Comparisons across surveys suggested a decrease in the association of obesity with CVD mortality over time. CONCLUSIONS: The BMI-mortality association varies by cause of death. These results help to clarify the associations of BMI with all-cause mortality.

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  • An important analysis of cause-specific excess deaths associated with underweight, overweight, and obesity in the general population found that obesity was associated with an increased mortality from cancers considered obesity-related but not with mortality from other cancers.

    “An important analysis of cause-specific excess deaths associated with underweight, overweight, and obesity in the general population found that obesity was associated with an increased mortality from cancers considered obesity-related but not with mortality from other cancers (463).”

    From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [463]

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Authors
Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H.
Affiliations
Centers for Disease Control and Prevention (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2007-11-07
Volume
298
Issue
17
Pages
2028
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.298.17.2028
OpenAlex
W2039063847
Cited by
1,542
References
62
Citations by year
2026: 10 · 2025: 21 · 2024: 45 · 2023: 37 · 2022: 49 · 2021: 72 · 2020: 47 · 2019: 63 · 2018: 61 · 2017: 74 · 2016: 93 · 2015: 112 · 2014: 120 · 2013: 134 · 2012: 145
FWCI
108.46
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
body mass index, underweight, overweight, obesity, cause-specific mortality, excess mortality, cardiovascular mortality, cancer mortality, diabetes mortality, kidney disease mortality, NHANES, United States adults, mortality risk factors, sex differences in mortality, socioeconomic status, health insurance status
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, Female, Humans, Male, Middle Aged, Neoplasms, Nutrition Surveys, Obesity, Risk, Thinness, United States, Body Mass Index, Proportional Hazards Models, Overweight

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