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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.

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