摘要：Objectives. We estimated the burden of disease in the United States attributable to obesity by gender, with life expectancy, quality-adjusted life expectancy, years of life lost annually, and quality-adjusted life years lost annually as outcome measures. Methods. We obtained burden of disease estimates for adults falling into the following body-mass index categories: normal weight (23 to <25), overweight (25 to <30), and obese (≥ 30). We analyzed the 2000 Medical Expenditure Panel Survey to obtain health-related quality-of-life scores and the 1990–1992 National Health Interview Survey linked to National Death Index data through the end of 1995 for mortality. Results. Overweight men and women lost 270 000 and 1.8 million quality-adjusted life years, respectively, relative to their normal-weight counterparts. Obese men and women lost 1.9 million and 3.4 million quality-adjusted life years, respectively, per year. Much of the burden of disease among overweight and obese women arose from lower health-related quality of life and late life mortality. Conclusions. Relative to men, women suffer a disproportionate burden of disease attributable to overweight and obesity, mostly because of differences in health-related quality of life. Between 1990 and 2000, the age-adjusted prevalence of obesity increased from 22.9% to 30.5% and the age-adjusted prevalence of overweight increased from 55.9% to 64.5%. 1 If similar trends continue, obesity may result in a decline in life expectancy in the United States. 2 This mortality risk arises from a higher risk of numerous comorbidities, including type 2 diabetes, hypertension, hypercholesterolemia, osteoarthritis, gallbladder disease, and some cancers. 3 However, obesity may also produce psychological morbidity, especially among women. 4 A number of studies have examined the burden of disease attributable to obesity and overweight with measures of mortality, such as annual years of life lost. 5 Although mortality data provide a common comparable endpoint for all diseases, they provide little information about the suffering caused by diseases while people are alive. Morbidity studies typically capture the association between obesity and a subset of conditions with which it is associated. 6 – 11 For instance, the burden of disease has been measured with the prevalence of high blood pressure, heart disease, and other conditions thought to be associated with obesity. 9 However, analyses based on attributable risk typically exclude diseases with a psychological dimension and those that are less prevalent. 4 To provide a more comprehensive assessment of morbidity, recent analyses have been conducted using preference-based health-related quality-of-life (HRQL) measures of overweight and obese people. 12 – 14 The advantage of preference-based measures over other quality-of-life measures is that they can be used to calculate quality-adjusted life years (QALYs). 15 The recent inclusion of an HRQL measure (the EuroQoL [EQ-5D]) into a large national survey makes it possible to capture the health states of people in the United States and convert them into QALYs. We examined the burden of disease in the US adult general population by body mass index (BMI). Specifically, we examined: (1) the distribution of sociodemographic variables and selected chronic conditions; (2) the distribution of average HRQL scores by sociodemographic variables and conditions; (3) the annual number of deaths, years of life lost to death, and QALYs in men and women; and (4) life expectancy and quality-adjusted life expectancy for men and women.
