Original Communication

European Journal of Clinical Nutrition (2003) 57, 201–208. doi:10.1038/sj.ejcn.1601538

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

J R Banegas1,*,, E López-García1,, J L Gutiérrez-Fisac1,, P Guallar-Castillón1, and F Rodríguez-Artalejo1,

1Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

Correspondence: J R Banegas, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Avda Arzobispo Morcillo s/n, 28029 Madrid, Spain. E-mail: joseramon.banegas@uam.es

*Guarantor: JR Banegas.

Contributors: The authors have respectively made the following substantive contributions to the manuscript: JRB, EL-G, JLG-F, PG-C, FR-A, were involved with the conception of the study, data analysis and writing the manuscript.

Received 28 February 2002; Revised 9 May 2002; Accepted 27 May 2002.



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 greater than or equal to30 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.


obesity, body mass index, attributable deaths, Europe

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