The Impact of Obesity on Adult Mortality

Assessment of Estimates with Applications

  • Alberto Palloni
  • Hiram Beltran-Sanchez UCLA Community Health Sciences


In this paper we assess properties of commonly used estimates of total eects of obesity on mortality
and identify consequences of these properties for inferences. We argue that standard estimates
have important shortcomings that at best limit the reach of inferences and at worst lead to misleading
conclusions. Although some of these limitations are routinely acknowledged, rarely is their
use accompanied by careful scrutiny of their weaknesses, let alone by a quantitative assessment
of their sensitivity to violations of some stringent assumptions on which they are based. In this
paper we develop an integrated framework based on a multistate hazard model to describe properties
of the simpler standard estimates, identify conditions under which their performance is
best, and dene the nature of biases and interpretational ambiguities that emerge when empirical
conditions depart more than modestly from optimal ones. In particular, we show formally that
estimates from limited panel data and two-state hazard models with obesity as a covariate, the
workhorse in this area, produce estimates that are dicult to interpret and compare across studies
and, in some cases, biased. Finally, we propose a simple procedure that can be employed when
the use of conventional two-state models is risky and illustrate its application to an a empirical case.

How to Cite
PALLONI, Alberto; BELTRAN-SANCHEZ, Hiram. The Impact of Obesity on Adult Mortality. UCLA CCPR Population Working Papers, [S.l.], july 2017. Available at: <>. Date accessed: 23 aug. 2017.