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. 2018 Jan 30;115(5):957-961.
doi: 10.1073/pnas.1716802115. Epub 2018 Jan 16.

The role of obesity in exceptionally slow US mortality improvement

Samuel H Preston  1 , Yana C Vierboom  2 , Andrew Stokes  3
Affiliations

The role of obesity in exceptionally slow US mortality improvement

Samuel H Preston et al. Proc Natl Acad Sci U S A. .

Abstract

Recent studies have described a reduction in the rate of improvement in American mortality. The pace of improvement is also slow by international standards. This paper attempts to identify the extent to which rising body mass index (BMI) is responsible for reductions in the rate of mortality improvement in the United States. The data for this study were obtained from subsequent cohorts of the National Health and Nutrition Examination Survey (NHANES III, 1988-1994; NHANES continuous, 1999-2010) and from the NHANES linked mortality files, which include follow-up into death records through December 2011. The role of BMI was estimated using Cox models comparing mortality trends in the presence and absence of adjustment for maximum lifetime BMI (Max BMI). Introducing Max BMI into a Cox model controlling for age and sex raised the annual rate of mortality decline by 0.54% (95% confidence interval 0.45-0.64%). Results were robust to the inclusion of other variables in the model, to differences in how Max BMI was measured, and to how trends were evaluated. The effect of rising Max BMI is large relative to international mortality trends and to alternative mortality futures simulated by the Social Security Administration. The increase in Max BMI over the period 1988-2011 is estimated to have reduced life expectancy at age 40 by 0.9 years in 2011 (95% confidence interval 0.7-1.1 years) and accounted for 186,000 excess deaths that year. Rising levels of BMI have prevented the United States from enjoying the full benefits of factors working to improve mortality.

Keywords: life expectancy; mortality; obesity; population health.

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Conflict of interest statement

Conflict of interest statement: A.S. has received research funding from Johnson & Johnson, Inc.

Figures

Fig. 1.
Fig. 1.
Annual rates of mortality decline among adults ages 40–84 in 16 OECD countries, 1988–2011. Mortality decline is shown for adults ages 40–85 in the United States and 15 comparable OECD countries between 1988 and 2011, if all countries had the same age distribution of 40–84 y olds as in the 2000 US Census. Data from the Human Mortality Database.
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