This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (485)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Obesity  • Alert me on articles by topic  Social Bookmarking   What's this?

Kevin R. Fontaine, PhD; David T. Redden, PhD; Chenxi Wang, MD; Andrew O. Westfall, MS; David B. Allison, PhD

JAMA. 2003;289:187-193.

Context  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 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.

Author Affiliations: Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md (Dr Fontaine) and Department of Biostatistics (Drs Redden, Wang, and Allison and Mr Westfall), Section on Statistical Genetics, Clinical Nutrition Research Center (Drs Wang and Allison), University of Alabama, Birmingham.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTERS

Obesity and Years of Life Lost
John W. Beasley
JAMA. 2003;289(14):1777.
EXTRACT | FULL TEXT  

Obesity and Years of Life Lost
Lewis H. Kuller
JAMA. 2003;289(14):1777.
EXTRACT | FULL TEXT  

Methods of Estimating Years of Life Lost Due to Obesity
Anna Peeters, Luc Bonneux, Jan Barendregt, and Wilma Nusselder
JAMA. 2003;289(22):2941.
EXTRACT | FULL TEXT  

Methods of Estimating Years of Life Lost Due to Obesity—Reply
David B. Allison, Andrew O. Westfall, David T. Redden, Chenxi Wang, and Kevin R. Fontaine
JAMA. 2003;289(22):2941-2942.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Obesity in the United States: A Fresh Look at Its High Toll
JoAnn E. Manson and Shari S. Bassuk
JAMA. 2003;289(2):229-230.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiologists and abdominal obesity: lost in translation?
Poirier
Heart 2009;95:1033-1035.
FULL TEXT  

Anemia After Bariatric Surgery: More Than Just Iron Deficiency
von Drygalski and Andris
Nutr Clin Pract 2009;24:217-226.
ABSTRACT | FULL TEXT  

Results of Roux-en-Y Gastric Bypass in Morbidly Obese vs Superobese Patients: Similar Body Weight Loss, Correction of Comorbidities, and Improvement of Quality of Life
Suter et al.
Arch Surg 2009;144:312-318.
ABSTRACT | FULL TEXT  

Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese, Hospitalized Adults
Anderegg et al.
JPEN J Parenter Enteral Nutr 2009;33:168-175.
ABSTRACT | FULL TEXT  

Current pharmacotherapeutic concepts for the treatment of obesity in adults
Idelevich et al.
Ther Adv Cardiovasc Dis 2009;3:75-90.
ABSTRACT  

Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents
Inge et al.
Pediatrics 2009;123:214-222.
ABSTRACT | FULL TEXT  

Surgery for obesity in older women
Miller and Kral
Menopause Int 2008;14:155-162.
ABSTRACT | FULL TEXT  

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass: An Underrecognized Cause of Irreversible Renal Failure
Nasr et al.
CJASN 2008;3:1676-1683.
ABSTRACT | FULL TEXT  

Design considerations and rationale of a multi-center trial to sustain weight loss: the weight loss maintenance trial
Brantley et al.
Clin Trials 2008;5:546-556.
ABSTRACT  

The WORD (Wholeness, Oneness, Righteousness, Deliverance): A Faith-Based Weight-Loss Program Utilizing a Community-Based Participatory Research Approach
Kim et al.
Health Educ Behav 2008;35:634-650.
ABSTRACT  

Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline
Rosenzweig et al.
J. Clin. Endocrinol. Metab. 2008;93:3671-3689.
ABSTRACT | FULL TEXT  

Food Security, Maternal Stressors, and Overweight Among Low-Income US Children: Results From the National Health and Nutrition Examination Survey (1999-2002)
Gundersen et al.
Pediatrics 2008;122:e529-e540.
ABSTRACT | FULL TEXT  

Risk factors associated with obesity in children of different racial backgrounds
Urrutia-Rojas et al.
Health Education Journal 2008;67:121-133.
ABSTRACT  

Obesity and risk of job disability in male firefighters
Soteriades et al.
Occup Med (Lond) 2008;58:245-250.
ABSTRACT | FULL TEXT  

The Hope and Fear of Rimonabant
Rumsfeld and Nallamothu
JAMA 2008;299:1601-1602.
FULL TEXT  

Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Petry et al.
Psychosom. Med. 2008;70:288-297.
ABSTRACT | FULL TEXT  

I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health
Muennig et al.
Am. J. Public Health 2008;98:501-506.
ABSTRACT | FULL TEXT  

Body mass index and cognitive decline in a biracial community population
Sturman et al.
Neurology 2008;70:360-367.
ABSTRACT | FULL TEXT  

The Changing Relationship of Obesity and Disability, 1988-2004
Alley and Chang
JAMA 2007;298:2020-2027.
ABSTRACT | FULL TEXT  

Review: Obesity and cardiometabolic syndrome in children
Velasquez-Mieyer et al.
Ther Adv Cardiovasc Dis 2007;1:61-81.
ABSTRACT  

Toward the Rational and Equitable Use of Bariatric Surgery
Flum et al.
JAMA 2007;298:1442-1444.
FULL TEXT  

Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Sjostrom et al.
NEJM 2007;357:741-752.
ABSTRACT | FULL TEXT  

Obesity, Waist Circumference, Weight Change, and the Risk of Psoriasis in Women: Nurses' Health Study II
Setty et al.
Arch Intern Med 2007;167:1670-1675.
ABSTRACT | FULL TEXT  

Diagnosis of Obesity by Primary Care Physicians and Impact on Obesity Management
Bardia et al.
Mayo Clin Proc. 2007;82:927-932.
ABSTRACT | FULL TEXT  

Meta-analysis: The Effect of Dietary Counseling for Weight Loss
Dansinger et al.
ANN INTERN MED 2007;147:41-50.
ABSTRACT | FULL TEXT  

Obesity Risk for Female Victims of Childhood Sexual Abuse: A Prospective Study
Noll et al.
Pediatrics 2007;120:e61-e67.
ABSTRACT | FULL TEXT  

Less weight or more hype with {blacktriangledown}rimonabant?
DTB 2007;45:41-44.
ABSTRACT | FULL TEXT  

{gamma}-Linolenate Reduces Weight Regain in Formerly Obese Humans
Schirmer and Phinney
J. Nutr. 2007;137:1430-1435.
ABSTRACT | FULL TEXT  

Biomarkers of Obesity and Subsequent Cardiovascular Events
Musaad and Haynes
Epidemiol Rev 2007;0:mxm005v1.
ABSTRACT | FULL TEXT  

Issues for DSM-V: Should Obesity Be Included as a Brain Disorder?
Volkow and O'Brien
Am. J. Psychiatry 2007;164:708-710.
FULL TEXT  

Body Mass Index and Mortality in Patients With Idiopathic Pulmonary Fibrosis
Alakhras et al.
Chest 2007;131:1448-1453.
ABSTRACT | FULL TEXT  

Heterogeneity in the Prevalence of Risk Factors for Cardiovascular Disease and Type 2 Diabetes Mellitus in Obese Individuals: Effect of Differences in Insulin Sensitivity
McLaughlin et al.
Arch Intern Med 2007;167:642-648.
ABSTRACT | FULL TEXT  

The Effect of Sibutramine on Energy Expenditure and Body Composition in Obese Adolescents
Van Mil et al.
J. Clin. Endocrinol. Metab. 2007;92:1409-1414.
ABSTRACT | FULL TEXT  

Diseases Associated with Childhood Obesity
Choudhary et al.
Am. J. Roentgenol. 2007;188:1118-1130.
ABSTRACT | FULL TEXT  

Challenges and Strategies in Managing Cardiometabolic Risk
Repas
JAOA: Journal of the American Osteopathic Association 2007;107:S4-S11.
ABSTRACT | FULL TEXT  

Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis
Christensen et al.
Ann Rheum Dis 2007;66:433-439.
ABSTRACT | FULL TEXT  

Aging, Adiposity, and Calorie Restriction
Fontana and Klein
JAMA 2007;297:986-994.
ABSTRACT | FULL TEXT  

Gastric Bypass in Chronic Renal Failure and Renal Transplant
Alexander and Goodman
Nutr Clin Pract 2007;22:16-21.
ABSTRACT | FULL TEXT  

IGF-Binding Protein-2 Protects Against the Development of Obesity and Insulin Resistance
Wheatcroft et al.
Diabetes 2007;56:285-294.
ABSTRACT | FULL TEXT  

Metabolic syndrome: a fata morgana?
Bakker et al.
Nephrol Dial Transplant 2007;22:15-20.
FULL TEXT  

Autonomic Contribution to Blood Pressure and Metabolism in Obesity
Shibao et al.
Hypertension 2007;49:27-33.
ABSTRACT | FULL TEXT  

Life Expectancy Benefits of Gastric Bypass Surgery
Pope et al.
SURG INNOV 2006;13:265-273.
ABSTRACT  

Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status
Shah et al.
J. Clin. Endocrinol. Metab. 2006;91:4223-4231.
ABSTRACT | FULL TEXT  

The Effectiveness of Screening for Obesity in Primary Care: Weighing the Evidence
Wilson and McAlpine
Med Care Res Rev 2006;63:570-598.
ABSTRACT  

Extreme Obesity: A New Medical Crisis in the United States
Hensrud and Klein
Mayo Clin Proc. 2006;81:S5-S10.
ABSTRACT | FULL TEXT  

Gender and the Burden of Disease Attributable to Obesity
Muennig et al.
Am. J. Public Health 2006;96:1662-1668.
ABSTRACT | FULL TEXT  

Cannabinoid-1 Receptor Antagonist, Rimonabant, for Management of Obesity and Related Risks
Gadde and Allison
Circulation 2006;114:974-984.
FULL TEXT  

Cardiorespiratory Fitness and Short-term Complications After Bariatric Surgery.
McCullough et al.
Chest 2006;130:517-525.
ABSTRACT | FULL TEXT  

Mortality and cardiac and vascular outcomes in extremely obese women.
McTigue et al.
JAMA 2006;296:79-86.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Circulation 2006;113:e873-e923.
ABSTRACT | FULL TEXT  

Adolescent Gastric Bypass Surgery: Outcome at 1 Year
Cavett
AAP Grand Rounds 2006;15:66-67.
FULL TEXT  

Frequent Outpatient Contact and Decreasing Medication Affordability in Patients With Diabetes From 1997 to 2004.
Grant et al.
Diabetes Care 2006;29:1386-1388.
FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Stroke 2006;37:1583-1633.
ABSTRACT | FULL TEXT  

Re: Obesity and cardiovascular risk factors in rheumatoid arthritis
Hall and Dalbeth
Rheumatology (Oxford) 2006;45:782-783.
FULL TEXT  

Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss.
Poirier et al.
Arterioscler. Thromb. Vasc. Bio. 2006;26:968-976.
ABSTRACT | FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Circulation 2006;113:e409-e449.
ABSTRACT | FULL TEXT  

Effect of Obesity on Presentation of Breast Cancer
Porter et al.
Ann. Surg. Oncol. 2006;13:327-332.
ABSTRACT | FULL TEXT  

Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism
Poirier et al.
Circulation 2006;113:898-918.
ABSTRACT | FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Stroke 2006;37:577-617.
ABSTRACT | FULL TEXT  

Commentary: Obesity and mortality--light at the end but still a long tunnel
Caballero and Wang
Int J Epidemiol 2006;35:21-22.
FULL TEXT  

Central orexin sensitivity, physical activity, and obesity in diet-induced obese and diet-resistant rats
Novak et al.
Am. J. Physiol. Endocrinol. Metab. 2006;290:E396-E403.
ABSTRACT | FULL TEXT  

A Semiparametric Analysis of the Relationship of Body Mass Index to Mortality
Gronniger
Am. J. Public Health 2006;96:173-178.
ABSTRACT | FULL TEXT  

Men and Dieting: A Qualitative Analysis
de Souza and Ciclitira
J Health Psychol 2005;10:793-804.
ABSTRACT  

Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society
Villareal et al.
Am. J. Clin. Nutr. 2005;82:923-934.
ABSTRACT | FULL TEXT  

Obesity, courts, and the new politics of public health.
Kersh and Morone
Journal of Health Politics, Policy and Law 2005;30:839-868.
ABSTRACT  

Prevalence of and risk factors for childhood overweight and obesity
Veugelers and Fitzgerald
CMAJ 2005;173:607-613.
ABSTRACT | FULL TEXT  

Trends in Obesity and Arthritis Among Baby Boomers and Their Predecessors, 1971-2002
Leveille et al.
Am. J. Public Health 2005;95:1607-1613.
ABSTRACT | FULL TEXT  

The Impact of Obesity on Active Life Expectancy in Older American Men and Women
Reynolds et al.
Gerontologist 2005;45:438-444.
ABSTRACT | FULL TEXT  

Baseline Characteristics and Response to 2 Years of Growth Hormone (GH) Replacement of Hypopituitary Patients with GH Deficiency due to Adult-Onset Craniopharyngioma in Comparison with Patients with Nonfunctioning Pituitary Adenoma: Data from KIMS (Pfizer International Metabolic Database)
Verhelst et al.
J. Clin. Endocrinol. Metab. 2005;90:4636-4643.
ABSTRACT | FULL TEXT  

Paradoxical Effect of Body Mass Index on Survival in Rheumatoid Arthritis: Role of Comorbidity and Systemic Inflammation
Escalante et al.
Arch Intern Med 2005;165:1624-1629.
ABSTRACT | FULL TEXT  

Solutions to obesity: perspectives from the food industry
Verduin et al.
Am. J. Clin. Nutr. 2005;82:259S-261S.
ABSTRACT | FULL TEXT  

Myocardial Substrate Metabolism in the Normal and Failing Heart
Stanley et al.
Physiol. Rev. 2005;85:1093-1129.
ABSTRACT | FULL TEXT  

Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis
Habib et al.
Ann. Thorac. Surg. 2005;79:1976-1986.
ABSTRACT | FULL TEXT  

Comparative Impact of Morbid Obesity vs Heart Failure on Cardiorespiratory Fitness
Gallagher et al.
Chest 2005;127:2197-2203.
ABSTRACT | FULL TEXT  

Milk, Dairy Fat, Dietary Calcium, and Weight Gain: A Longitudinal Study of Adolescents
Berkey et al.
Arch Pediatr Adolesc Med 2005;159:543-550.
ABSTRACT | FULL TEXT  

Misdirection on the Road to Shangri-La
Olshansky et al.
Sci Aging Knowl Environ 2005;2005:pe15-pe15.
ABSTRACT | FULL TEXT  

Rise in Insulin Resistance Is Associated With Escalated Telomere Attrition
Gardner et al.
Circulation 2005;111:2171-2177.
ABSTRACT | FULL TEXT  

Obesity and the Neuroendocrine Control of Energy Homeostasis: The Role of Spontaneous Locomotor Activity
Castaneda et al.
J. Nutr. 2005;135:1314-1319.
ABSTRACT | FULL TEXT  

Excess Deaths Associated With Underweight, Overweight, and Obesity
Flegal et al.
JAMA 2005;293:1861-1867.
ABSTRACT | FULL TEXT  

Interaction of Body Mass Index and Framingham Risk Score in Predicting Incident Coronary Disease in Families
Mora et al.
Circulation 2005;111:1871-1876.
ABSTRACT | FULL TEXT  

Future Mortality: A Bumpy Road to Shangri-La?
Tuljapurkar
Sci Aging Knowl Environ 2005;2005:pe9-pe9.
ABSTRACT | FULL TEXT  

The exaggerated relations between diet, body weight and mortality: the case for a categorical data approach
Welch et al.
CMAJ 2005;172:891-895.
FULL TEXT  

A Potential Decline in Life Expectancy in the United States in the 21st Century
Olshansky et al.
NEJM 2005;352:1138-1145.
ABSTRACT | FULL TEXT  

Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison
Veugelers and Fitzgerald
Am. J. Public Health 2005;95:432-435.
ABSTRACT | FULL TEXT  

Impact of Obesity and the Metabolic Syndrome on Risk Factors in African American Stroke Survivors: A Report From the AAASPS
Ruland et al.
Arch Neurol 2005;62:386-390.
ABSTRACT | FULL TEXT  

Adolescent Bariatric Surgery: Treatment Delayed May Be Treatment Denied
Garcia
Pediatrics 2005;115:822-823.
FULL TEXT  

Quantification of Isoprostanes as Indices of Oxidant Stress and the Risk of Atherosclerosis in Humans
Morrow
Arterioscler. Thromb. Vasc. Bio. 2005;25:279-286.
ABSTRACT | FULL TEXT  

Health Care Expenditures Associated With Overweight and Obesity Among US Adults: Importance of Age and Race
Wee et al.
Am. J. Public Health 2005;95:159-165.
ABSTRACT | FULL TEXT  

Increased Utilization of Primary Care 5 Years Before Diagnosis of Type 2 Diabetes: A matched cohort study
Gulliford et al.
Diabetes Care 2005;28:47-52.
ABSTRACT | FULL TEXT  

Exercise Capacity in Adult African-Americans Referred for Exercise Stress Testing: Is Fitness Affected by Race?
Lavie et al.
Chest 2004;126:1962-1968.
ABSTRACT | FULL TEXT  

Enhanced metabolic efficiency contributes to weight regain after weight loss in obesity-prone rats
MacLean et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2004;287:R1306-R1315.
ABSTRACT | FULL TEXT  

Health Services Use and Health Care Costs of Obese and Nonobese Individuals
Raebel et al.
Arch Intern Med 2004;164:2135-2140.
ABSTRACT | FULL TEXT  

Bariatric Surgery: A Systematic Review and Meta-analysis
Buchwald et al.
JAMA 2004;292:1724-1737.
ABSTRACT | FULL TEXT  

Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health
Gordon-Larsen et al.
Am. J. Clin. Nutr. 2004;80:569-575.
ABSTRACT | FULL TEXT