Mortality attributable to overweight and obesity: methodological aspects and estimations
1
Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
2
Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
3
Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
4
Epidemiology and Preventive Medicine, National & Kapodistrian University of Athens, Athens, Greece
Popul. Med. 2026;8(Supplement Supplement 1):A3025
ABSTRACT
INTRODUCTION:
Attributable mortality (AM) is a well-established measure to quantify the population-level burden, providing a clear indicator that raises public awareness and helps policymakers and healthcare professionals to prioritize prevention and intervention strategies for risk factors. The aim of this study is to critically reflect on the methodology and describe the estimations of AM to overweight and obesity (excess weight) among adults.
METHODS:
A systematic review was conducted in MEDLINE(Ovid), Embase, and Web of Science, following PRISMA 2020 guidelines. Studies estimating AM to excess weight published up to December 2024 were included. Data were extracted using an ad-hoc table based on the STREAMS-P tool, and a descriptive analysis was performed.
RESULTS:
Twenty-three studies estimating AM in Asia, Europe, America, and Oceania were included. Most estimated AM for all-cause mortality (n=9) and cardiovascular diseases (n=9), followed by cancer (n=7). There was variation in the BMI cut-off points used across studies. Most relative risks (RR) were from meta-analyses (n=14), while fewer studies (n=6) used RR derived from national studies of the analyzed populations. In Asia, all-cause AM ranged from 9851 in Taiwan to 1414670 in Indonesia. Cancer-related AM estimates were largest in Europe, ranging from 6398 in Italy to 40870 in England and Wales. In the Americas, most estimates were from the United States (US) (5 of 9 studies), primarily for all-cause mortality. The AM varied between 4321 (Canada) and 324940 (US). In New Zealand, the AM was 3150.
CONCLUSIONS:
Important methodological variations—such as the selection of causes of death, BMI cut-off points, and sources of risks—were observed. These differences likely influenced AM estimates, often making them not comparable within countries or overtime, hindering conclusions about the actual AM to excess weight. Notwithstanding these concerns, the estimation of AM constitutes a relevant measure for highlighting the health impact of overweight and obesity
Attributable mortality (AM) is a well-established measure to quantify the population-level burden, providing a clear indicator that raises public awareness and helps policymakers and healthcare professionals to prioritize prevention and intervention strategies for risk factors. The aim of this study is to critically reflect on the methodology and describe the estimations of AM to overweight and obesity (excess weight) among adults.
METHODS:
A systematic review was conducted in MEDLINE(Ovid), Embase, and Web of Science, following PRISMA 2020 guidelines. Studies estimating AM to excess weight published up to December 2024 were included. Data were extracted using an ad-hoc table based on the STREAMS-P tool, and a descriptive analysis was performed.
RESULTS:
Twenty-three studies estimating AM in Asia, Europe, America, and Oceania were included. Most estimated AM for all-cause mortality (n=9) and cardiovascular diseases (n=9), followed by cancer (n=7). There was variation in the BMI cut-off points used across studies. Most relative risks (RR) were from meta-analyses (n=14), while fewer studies (n=6) used RR derived from national studies of the analyzed populations. In Asia, all-cause AM ranged from 9851 in Taiwan to 1414670 in Indonesia. Cancer-related AM estimates were largest in Europe, ranging from 6398 in Italy to 40870 in England and Wales. In the Americas, most estimates were from the United States (US) (5 of 9 studies), primarily for all-cause mortality. The AM varied between 4321 (Canada) and 324940 (US). In New Zealand, the AM was 3150.
CONCLUSIONS:
Important methodological variations—such as the selection of causes of death, BMI cut-off points, and sources of risks—were observed. These differences likely influenced AM estimates, often making them not comparable within countries or overtime, hindering conclusions about the actual AM to excess weight. Notwithstanding these concerns, the estimation of AM constitutes a relevant measure for highlighting the health impact of overweight and obesity
| eISSN: | 2654-1459 |
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