Objective: To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000.
Design: World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modeling techniques were used for the uncertainty analysis.
Setting: South Africa.
Subjects: Adults >or= 30 years of age.
Outcome measures: Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers.
Results: Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI >or= 21 kg/m2. Excess body weight is estimated to have caused 36,504 deaths (95% uncertainty interval 31,018 - 38,637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462,338 DALYs (95% uncertainty interval 396,512 - 478,847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males.
Conclusions: This study shows the importance of recognizing excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight.