The Impact of Obesity on Adult Mortality: Assessment of Estimates with Applications

26 Pages Posted: 14 Jun 2017

See all articles by Alberto Palloni

Alberto Palloni

RAND Corporation - Labor and Population

Hiram Beltran-Sanchez

University of California, Los Angeles (UCLA) - Department of Community Health Sciences

Date Written: May 18, 2017

Abstract

In this paper we assess properties of commonly used estimates of total effects 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 define 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 difficult 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.

Keywords: Obesity, T2D, Mortality, Multistate Hazard Model, Two-State Hazard Model

Suggested Citation

Palloni, Alberto and Beltran-Sanchez, Hiram, The Impact of Obesity on Adult Mortality: Assessment of Estimates with Applications (May 18, 2017). RAND Working Paper Series WR- 1193. Available at SSRN: https://ssrn.com/abstract=2985856 or http://dx.doi.org/10.2139/ssrn.2985856

Alberto Palloni (Contact Author)

RAND Corporation - Labor and Population ( email )

United States

Hiram Beltran-Sanchez

University of California, Los Angeles (UCLA) - Department of Community Health Sciences ( email )

650 Charles E. Young Drive South, 36-071 CHS
Box 951772
Los Angeles, CA 90095-1772
United States

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