The obesity epidemic in Europe:Assessing the past and current mortality burden and the future of obesity

Obesity is considered a global epidemic in terms of both its prevalence and associated health burden. Although Europe has the second-highest obesity prevalence levels in the world, few studies have focused on the obesity epidemic in Europe, or on its mortality burden. This thesis examined for Europe how obesity affects mortality levels and trends, and how obesity is likely to develop in the future, using a combination of demographic and epidemiological data and methods. In 2012, the share of mortality due to obesity (obesity-attributable mortality fraction) was, on average, 10% in the 26 European countries studied. If obesity was eliminated, life expectancy would, on average, increase 1.22 and 0.98 years among men and women, respectively. The mortality burden of obesity was slightly lower in Western than in Eastern Europe. Within Western Europe, the UK had the largest mortality burden. The mortality burden of obesity has been increasing over time, with important cohort effects. The obesity epidemic in Europe is expected to reach its peak between 2026 and 2054, with prevalence levels of at least 25%. The mortality burden of obesity in Europe is significant, with clear variations between countries. The UK seems to be the forerunner in obesity levels in Western Europe, and to be following US trends. The variations observed between European countries can be linked to both contextual factors (e.g., obesogenic environment) and individual factors (e.g., dietary and physical activity patterns). Obesity and its associated mortality burden in Europe are problems that clearly warrant further attention from society and health policy-makers

The obesity epidemic in Europe:Assessing the past and current mortality burden and the future of obesity

Obesity is considered a global epidemic in terms of both its prevalence and associated health burden. Although Europe has the second-highest obesity prevalence levels in the world, few studies have focused on the obesity epidemic in Europe, or on its mortality burden. This thesis examined for Europe how obesity affects mortality levels and trends, and how obesity is likely to develop in the future, using a combination of demographic and epidemiological data and methods. In 2012, the share of mortality due to obesity (obesity-attributable mortality fraction) was, on average, 10% in the 26 European countries studied. If obesity was eliminated, life expectancy would, on average, increase 1.22 and 0.98 years among men and women, respectively. The mortality burden of obesity was slightly lower in Western than in Eastern Europe. Within Western Europe, the UK had the largest mortality burden. The mortality burden of obesity has been increasing over time, with important cohort effects. The obesity epidemic in Europe is expected to reach its peak between 2026 and 2054, with prevalence levels of at least 25%. The mortality burden of obesity in Europe is significant, with clear variations between countries. The UK seems to be the forerunner in obesity levels in Western Europe, and to be following US trends. The variations observed between European countries can be linked to both contextual factors (e.g., obesogenic environment) and individual factors (e.g., dietary and physical activity patterns). Obesity and its associated mortality burden in Europe are problems that clearly warrant further attention from society and health policy-makers

The obesity epidemic in Europe:Assessing the past and current mortality burden and the future of obesity

Obesity is considered a global epidemic in terms of both its prevalence and associated health burden. Although Europe has the second-highest obesity prevalence levels in the world, few studies have focused on the obesity epidemic in Europe, or on its mortality burden. This thesis examined for Europe how obesity affects mortality levels and trends, and how obesity is likely to develop in the future, using a combination of demographic and epidemiological data and methods. In 2012, the share of mortality due to obesity (obesity-attributable mortality fraction) was, on average, 10% in the 26 European countries studied. If obesity was eliminated, life expectancy would, on average, increase 1.22 and 0.98 years among men and women, respectively. The mortality burden of obesity was slightly lower in Western than in Eastern Europe. Within Western Europe, the UK had the largest mortality burden. The mortality burden of obesity has been increasing over time, with important cohort effects. The obesity epidemic in Europe is expected to reach its peak between 2026 and 2054, with prevalence levels of at least 25%. The mortality burden of obesity in Europe is significant, with clear variations between countries. The UK seems to be the forerunner in obesity levels in Western Europe, and to be following US trends. The variations observed between European countries can be linked to both contextual factors (e.g., obesogenic environment) and individual factors (e.g., dietary and physical activity patterns). Obesity and its associated mortality burden in Europe are problems that clearly warrant further attention from society and health policy-makers

Impact of obesity on life expectancy among different European countries: secondary analysis of population-level data over the 1975-2012 period.

OBJECTIVE: This study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975-2012 period. DESIGN: Secondary analysis of population-level obesity and mortality data. SETTING: European countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA. PARTICIPANTS: National populations aged 18-100 years, by sex. MEASUREMENTS: Using data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables. RESULTS: In the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women. CONCLUSIONS: Obesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people's ability and capacity to adopt healthier lifestyles

Impact of Different Estimation Methods on Obesity-Attributable Mortality Levels and Trends:The Case of The Netherlands

The available methodologies to estimate the obesity-attributable mortality fraction (OAMF) affect the levels found and hamper the construction of time series. Our aim was to assess the impact of using different techniques to estimate the levels and the trends in obesity-attributable mortality for The Netherlands between 1981 to 2013. Using Body Mass Index (BMI), all-cause and cause-specific mortality data, and worldwide and European relative risks (RRs), we estimated OAMFs using three all-cause approaches (partially adjusted, weighted sum, and the two combined) and one cause-of-death approach (Comparative Risk Assessment; CRA). We adjusted the CRA approach to purely capture obesity (BMI ≥ 30 kg/m²). The different approaches led to a range of estimates. The weighted sum method using worldwide RRs generated the lowest (0.9%) while the adjusted CRA approach using 2013 RRs generated the highest estimate (1.5%). Using European-specific RRs instead of worldwide RRs resulted in higher estimates. Most of the approaches revealed an increasing OAMF over the period 1981 to 2013 especially from 1993 onwards except for the adjusted CRA approach among women. Estimates of OAMF levels and trends differed depending on the method applied. Given the limited available data, we recommend using the weighted-sum method to compare obesity-attributable mortality across European countries over time

Past trends in obesity-attributable mortality in eight European countries: an application of age-period-cohort analysis.

OBJECTIVES: To assess age, period, and birth cohort effects and patterns of obesity-attributable mortality in Czech Republic, Finland, France, Germany, Hungary, Italy, Poland, and the UK (UK). METHODS: We obtained obesity prevalence and all-cause mortality data by age (20-79), sex and country for 1990-2012. We applied Clayton and Schifflers' age-period-cohort approach to obesity-attributable mortality rates (OAMRs). RESULTS: Between 1990 and 2012, obesity prevalence increased and age-standardised OAMRs declined, although not uniformly. The nonlinear birth cohort effects contributed significantly (p < 0.01) to obesity-attributable mortality trends in all populations, except in Czech Republic, Finland, and among German women, and Polish men. Their contribution was greater than 25% in UK and among French women, and larger than that of the nonlinear period effects. In the UK, mortality rate ratios (MRRs) increased among the cohorts born after 1950. In other populations with significant birth cohort effects, MRRs increased among the 1935-1960 cohorts and decreased thereafter. CONCLUSIONS: Given its potential effects on obesity-attributable mortality, the cohort dimension should not be ignored and calls for interventions early in life next to actions targeting broader societal changes