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Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: A modelling study

A CHOICES study estimates excess mortality associated with elevated body weight nationally and by US state and subgroup.

Ward ZJ, Willett WC, Hu FB, Pacheco LS, Long MW, Gortmaker SL. Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: A modelling study. eClinicalMedicine. 2022 Apr;48. doi:10.1016/j.eclinm.2022.101429

The obesity epidemic in the U.S. continues to grow. Excess weight-related mortality has been estimated for the general population, however, less is known about how it varies by state and demographic subgroup within the U.S. Estimating the health consequences of obesity can improve understanding of the implications of the obesity epidemic, as excess weight is associated with increased incidence and mortality of many health conditions.

Although no comprehensive data on this topic exist in any one study or dataset, mathematical modelling is an approach that can analyze information from multiple sources and make estimates for relevant outcomes of interest. This study estimated state-level trends in excess deaths and life expectancy loss due to excess weight between 1999 and 2016 by population subgroup using a microsimulation model.

The researchers developed a computational approach to stimulate a nationally representative virtual population of U.S. adults, estimating annual all-cause mortality rates for each person according to their demographic characteristics, body mass index (BMI), and smoking history.

Using this microsimulation model, the team found that excess weight was responsible for more than:

  • 1,300 excess deaths per day (nearly 500,000 per year)
  • Loss in life expectancy of nearly 2.4 years in 2016

Relative excess mortality rates were nearly twice as high for women compared to men in 2016 and were higher for Black non-Hispanic adults. By state, overall excess weight-related life expectancy loss ranged from 1.75 years in Colorado to 3.18 years in Mississippi.

Excess weight has significant impacts on mortality in the U.S. with large disparities by state and subgroup. As the obesity epidemic continues to grow, premature mortality due to excess weight is likely to rise. This highlights the need for cost-effective interventions to promote healthy weight across the life course.

“Overall, we found that excess weight contributed to more than 1,300 excess deaths per day (nearly 500,000 per year) in the USA in 2016, increasing the total mortality rate by nearly 18% and resulting in nearly 2.4 years of life expectancy loss. On the basis of these findings, it is vital to invest in cost-effective policies and programs that can make a difference.” – Zach Ward, lead author.


The JPB Foundation, NIH, CDC