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Jerome Timothy Gronniger, MPP, MHSA

The author is with the Congressional Budget Office, Washington, DC.

Correspondence: Requests for reprints should be sent to Jerome Timothy Gronniger, MPP, MHSA, Ford House Office Building, 2nd and D Sts, SW, Washington, DC 20515 (e-mail: tim. gronniger{at}cbo.gov).

Objectives. I used a semi-parametric analysis of the relationship between body mass index (BMI) and mortality to assess the adequacy of conventional BMI categories for planning public health programs to reduce mortality.

Methods. I linked supplements from the 1987 and 1989 versions of the National Health Interview Survey to the 1995 Multiple Cause of Death File to obtain mortality information. I constructed nonlinear estimates of the association between BMI and mortality using a semiparametric regression technique.

Results. The mortality risk among "normal" weight men (i.e., those in the BMI range of 20 to 25 kg/m²) was as high as that among men in the mild obesity category (BMIs of 30–35 kg/m²), with a minimum risk observed at a BMI of approximately 26 kg/m². Among women, the mortality risk was smallest at approximately 23 to 24 kg/m², with the risk increasing steadily with BMIs above 27 kg/m². In each specification, the slope of the line was small and volatile through the BMI range of 20 to 35 kg/m², suggesting negligible risk differences with minor differences in weight for much of the population.

Conclusions. Traditional BMI categories do not conform well to the complexities of the BMI–mortality relationship. In concurrence with conclusions from previous literature, I found that the current definitions of obesity and overweight are imprecise predictors of mortality risk.

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