Survival

Based on the analysis of 5 prospective cohort studies, Allison and coworkers estimated that between 275,000 and 325,000 Americans die each year from obesity-related diseases [35]. It has been estimated that approximately 400,000 Americans die each year from smoking-related diseases. With a significant decrease in cigarette smoking, it can be anticipated that, in the near future, obesity will achieve the distinction of being the most important single pathogen causing death in our communities [36].

Multiple studies have described the exponential relationship between increasing BMI and the relative risk of dying prematurely. As an example, Fig. 2 shows the relative risk reported in the Nurses’ Health Study in 1995 [37].

Figure. 2. Relationship of body mass index and adjusted* relative risk of mortality in the Nurses’ Health Study [37]. The risk of obesity is modified by a number of factors, including the location of body fat (central abdominal, or android, is worse than peripheral, or gynoid), age (the risk decreases with age), and sedentary lifestyle [3]. (Figure adapted from Manson et al. N Engl J Med 1995;333:677-685.)

*Adjusted for age in 5-year categories, smoking (never, former, or current [1 to 14,15 to 24,or ³ 25 cigarettes per day]), menopausal status, oral-contraceptiveand postmenopausal hormone use (never, past, or current), parental history of myocardial infarction before the age of 60 (yes or no), alcohol intake (in 5 categories), saturated-fat intake (in quintiles), and physical activity (in 5 categories).