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Cited by 148Statistical Methods in EpidemiologyObesity, Physical Activity, DietCancer Risks and Factors

Estimating population attributable fractions to quantify the health burden of obesity

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Flegal, Katherine M., Panagiotou, Orestis A., Graubard, Barry I.·2015·Annals of Epidemiology
DOI 10.1016/j.annepidem.2014.11.010PMC PMC4383168
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Abstract

Purpose Obesity is a highly prevalent condition in the United States and elsewhere and is associated with increased mortality and morbidity. Here, we discuss some issues involved in quantifying the health burden of obesity using population attributable fraction (PAF) estimates and provide examples. Methods We searched PubMed for articles reporting attributable fraction estimates for obesity. We reviewed eligible articles to identify methodological concerns and tabulated illustrative examples of PAF estimates for obesity relative to cancer, diabetes, cardiovascular disease, and all-cause mortality. Results There is considerable variability among studies regarding the methods used for PAF calculation and the selection of appropriate counterfactuals. The reported estimates ranged from 5% to 15% for all-cause mortality, -0.2% to 8% for all-cancer incidence, 7% to 44% for cardiovascular disease incidence, and 3% to 83% for diabetes incidence. Conclusions To evaluate a given estimate, it is important to consider whether the exposure and outcome were defined similarly for the PAF and for the relative risks, whether the relative risks were suitable for the population at hand, and whether PAF was calculated using correct methods. Strong causal assumptions are not necessarily warranted. In general, PAFs for obesity may be best considered as indicators of association.

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  • Pediatric obesity has long-term health consequences, contributing to at least 5% of all-cause mortality in the United States.

    “Pediatric obesity has long-term health consequences [1], contributing to at least 5% of all-cause mortality in the United States [2].”

    From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [2]

    The Total mortality section (page not provided) reports U.S. estimates of approximately 5% of deaths attributable to obesity. It does not establish a minimum of 5%, or attribute that share specifically to pediatric obesity; the paper also cautions that attributable fractions need not imply causation. (LLM, conf=0.87)

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Authors
Flegal, K. M., Panagiotou, O. A., & Graubard, B. I.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • National Cancer Institute (US)
ORCID
Venue
Annals of Epidemiology
Publisher
Elsevier BV
Published
2015-03
Volume
25
Issue
3
Pages
201-207
ISSN
1047-2797 (ISSN-L)
DOI
10.1016/j.annepidem.2014.11.010
PMC
PMC4383168
OpenAlex
W2091065416
Cited by
148
References
10
Citations by year
2026: 5 · 2025: 11 · 2024: 18 · 2023: 8 · 2022: 10 · 2021: 20 · 2020: 16 · 2019: 17 · 2018: 16 · 2017: 10 · 2016: 9 · 2015: 7 · 2014: 1
FWCI
1.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (Z99 CA999999)
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
obesity, population attributable fraction, health burden, cancer incidence, diabetes incidence, cardiovascular disease incidence, all-cause mortality, counterfactual assumptions, relative risk, causal assumptions
MeSH terms
Body Weight, Epidemiologic Methods, Humans, Male, Obesity, Population Surveillance, Risk, Risk Factors, United States, Body Mass Index, Incidence, Prevalence, Cost of Illness

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