Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

A simple estimate of mortality attributable to excess weight in the European Union

Abstract

Objective: To estimate the current burden of mortality attributable to excess weight in the European Union (EU).

Methods: Prevalence of overweight (body mass index, BMI 25–29.9 kg/m2) and obesity (BMI ≥30 kg/m2) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries.

Results: Annual deaths attributable to overweight and obesity totalled approximately 279 000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304 000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337 000 based on European data and at about 401 000 based on US data. In the EU, therefore, a minimum of 279 000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175 000) than among the overweight (104 000). Around 70% were cardiovascular disease deaths (195 000) and 20% cancer deaths (53 000).

Conclusion: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.

Sponsorship: This study has been partially funded by Madrid Regional Authority (Comunidad de Madrid) grant no. 08.4/0011/2000.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  • Allison, DB, Fontaine, KR, Manson, JE, Stevens, J & VanItallie, TB (1999). Annual deaths attributable to obesity in the United States. JAMA, 282, 1530–1538.

    Article  CAS  Google Scholar 

  • Anonymous (1996). World Health Statistics Annual, 1995, Geneva: WHO

  • Anonymous (1998). World Health Statistics Annual, 1996, Geneva: WHO

  • Bergström, A, Pisani, P, Tenet, V, Wolk, A & Adami, HO (2001). Overweight as an avoidable cause of cancer in Europe. Int. J. Cancer, 91, 421–430.

    Article  Google Scholar 

  • Brownson, RC, Remington, PL & Davis, JR (1993). Chronic Disease Epidemiology and Control, Washington, DC: American Public Health Association

    Google Scholar 

  • Calle, EE, Thun, MJ, Petrelli, JM, Rodriguez, C & Heath, CW (1999). Body-mass index and mortality in a prospective cohort of U.S. adults. New Engl. J. Med., 341, 1097–1105.

    Article  CAS  Google Scholar 

  • Grundy, SM (1998). Multifactorial causation of obesity: implications for prevention. Am. J. Clin. Nutr., 67, (Suppl) 563S–572S.

    Article  CAS  Google Scholar 

  • Gunning Schepers, L (1989). The health benefits of prevention. Health Policy, 12, 1–256.

    CAS  PubMed  Google Scholar 

  • Institute of European Food Studies, Trinity College, Dublin (1999). A Pan-EU Survey on Consumer Attitudes to Physical Activity, Body-weight and Health, Luxembourg: Office for Official Publications of the European Communities

  • James, WPT (1995). A public health approach to the problem of obesity. Int. J. Obes. Relat. Metab. Disord., 19, (Suppl 3) S37–S45.

    PubMed  Google Scholar 

  • Kearny, M, Kearney, JM & Gibney, MJ (1997). Methods used to conduct the survey on consumer attitudes to food, nutrition and health on nationally representative samples of adults from each member state of the European Union. Eur. J. Clin. Nutr., 51, (Suppl 2) S3–S7.

    Google Scholar 

  • Keys, A (1980). Seven Countries. A Multivariate Analysis of Death and Coronary Heart Disease, Cambridge, MA: Harvard University Press

    Book  Google Scholar 

  • Keys, A, Menotti, A, Aravanis, C, Blackburn, H, Djordevic, BS, Buzina, R, Dontas, AS, Fidanza, F, Karvonen, MJ, Kimura, N, Mohacek, I, Nedeljkovic, S, Puddu, V, Punsar, S, Taylor, HL, Conti, S, Kromhout, D & Toshima, H (1984). The Seven Countries Study: 2289 deaths in 15 y. Prev. Med., 13, 141–154.

    Article  CAS  Google Scholar 

  • Kleinbaum, DG, Kupper, LL & Morgenstern, H (1982). Epidemiologic Research. Principles and Quantitative Methods, New York: Van Nostrand Reinhold

    Google Scholar 

  • Lew, EA & Garfinkel, L (1979). Variations in mortality by weight among 750 000 men and women. J. Chron. Dis., 32, 563–576.

    Article  CAS  Google Scholar 

  • Manson, JE, Stampfer, MJ, Hennekens, CH & Willett, WC (1987). Body weight and longevity. A reassessment. JAMA, 257, 353–358.

    Article  CAS  Google Scholar 

  • Mikkelsen, KL, Heitmann, BL, Keiding, N & Sørensen, TIA (1999). Independent effects of stable and changing body weight on total mortality. Epidemiology, 10, 671–678.

    Article  CAS  Google Scholar 

  • Morgenstern, W, Tsechkovski, MS, Nüssel, E & Schettler, G (eds) (1991). CINDI, Countrywide Integrated Noncommunicable Disease Intervention Programme. Baseline Evaluation, WHO Regional Office for Europe, and CINDI 2000 Berlin: Springer

    Google Scholar 

  • Murray, CJL & Lopez, AD (1996). Quantifying the burden of disease and injury attributable to ten major risk factors. In:The Global Burden of Disease, ed. CJL Murray & AD Lopez VolI, pp295–324, Cambridge, MA: Harvard University Press

    Google Scholar 

  • National Institutes of Health (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes. Res., 6, (Suppl 2) 51S–209S.

  • National Institute of Public Health, Stockholm (1997). Determinants of the Burden of Disease in the European Union, Stockholm: NIPH

  • Nieto-García, FJ, Bush, TL & Kely, PM (1990). Body mass definition of obesity, sensitivity and specificity using self-reported weight and height. Epidemiology, 1, 146–152.

    Article  Google Scholar 

  • Peto, R, Lopez, AD, Boreham, J, Thun, M & Heath, C (1994). Mortality from Smoking in Developed Countries 1950–2000, Oxford: Oxford University Press

    Google Scholar 

  • Seidell, JC (1995a). Obesity in Europe: scaling an epidemic. Int. J. Obes. Metab. Disord., 19, (Suppl 3) S1–S4.

    Google Scholar 

  • Seidell, JC (1995b). The impact of obesity on health status: Some implications for health care costs. Int. J. Obes. Relat. Metab. Disord., 19, (Suppl 6) S13–S16.

    PubMed  Google Scholar 

  • Seidell, JC & Flegal, KM (1997). Assessing obesity: classification and epidemiology. Br. Med. Bull., 53, 238–252.

    Article  CAS  Google Scholar 

  • Sempos, CT, Durazo-Arvizu, R, McGee, DL, Cooper, RS & Prewitt, TE (1998). The influence of cigarette smoking on the association between body weight and mortality. The Framingham Heart Study revisited. Ann. Epidemiol., 8, 289–300.

    Article  CAS  Google Scholar 

  • Stevens, J, Keil, JE, Waid, LR & Gazes, PC (1990). Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am. J. Epidemiol., 132, 1156–1163.

    Article  CAS  Google Scholar 

  • Stevens, J, Cai, J, Pamuk, AR, Williamson, DF, Thun, MJ & Wood, JL (1998). The effect of age on the association between body-mass index and mortality. New Engl. J. Med., 338, 1–7.

    Article  CAS  Google Scholar 

  • Troiano, RP, Frongillo, EA, Sobal, J & Levitsky, DA (1996). The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies. Int. J. Obes. Relat. Metab. Disord., 20, 63–75.

    CAS  PubMed  Google Scholar 

  • Visscher, TLS & Seidell, JC (2001). The public health impact of obesity. A. Rev. Public Health, 22, 355–375.

    Article  CAS  Google Scholar 

  • Visscher, TLS, Seidell, JC, Menotti, A, Blackburn, H, Nissinen, A, Feskens, EJM & Kromhout, D for the Seven Countries Study Research Group (2000). Underweight and overweight in relation to mortality among men 40–59 and 50–69 years. The Seven Countries Study. Am. J. Epidemiol., 151, 660–666.

    Article  CAS  Google Scholar 

  • Walter, SD (1978). Calculations of attributable risks from epidemiological data. Int. J. Epidemiol., 7, 175–182.

    Article  CAS  Google Scholar 

  • World Health Organization (2000). Obesity: Preventing and Managing the Global Epidemic, WHO Technical Report Series no. 894 Geneva: WHO

  • World Health Organization MONICA Project (1989). A worldwide monitoring system for cardiovascular diseases: cardiovascular mortality and risk factors in selected communities. In:World Health Statistics Annual 1987, pp27–59, Geneva: WHO

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J R Banegas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Banegas, J., López-García, E., Gutiérrez-Fisac, J. et al. A simple estimate of mortality attributable to excess weight in the European Union. Eur J Clin Nutr 57, 201–208 (2003). https://doi.org/10.1038/sj.ejcn.1601538

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601538

Keywords

This article is cited by

Search

Quick links