Mortality attributable to obesity among middle-aged adults in the United States

Demography. 2009 Nov;46(4):851-72. doi: 10.1353/dem.0.0077.


Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Body Mass Index
  • Confidence Intervals
  • Confounding Factors, Epidemiologic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity / complications
  • Obesity / epidemiology
  • Obesity / mortality*
  • Proportional Hazards Models
  • Risk
  • Socioeconomic Factors
  • United States / epidemiology