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In men aged 40 years, multiadjusted life expectancy for those who were obese participants was 41.4 years (95% CI 38.28 to 44.70), which was 1.7 years non-significantly shorter than that for normal weight participants (p=0.3184).

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The present results indicate that (1) obese men and women have 14.7% non-significantly higher and 21.6% significantly higher multiadjusted lifetime medical expenditure than those of the normal weight participants (men, p=0.1141; women, p=0.0005), even though their life expectancy is non-significantly shorter by 1.7 and 3.1 years than those of the normal weight participants, respectively (men, p=0.3184; women, p=0.0724); (2) underweight men and women have 5.2% and 3.4% non-significantly lower lifetime medical expenditure than those of the normal weight participants (men, p=0.5174; women, p=0.3916) because men and women live 5.6 and 5.3 years significantly less than those of the normal weight participants, respectively (men, p<0.0001; women, p<0.0001).

Comparison with other studies

Obese participants had shorter life expectancy than normal weight participants, as has been observed in previous studies.6–10 Overweight participants had longer life expectancy than normal weight participants. Two of the four previous studies have reported that overweight participants had longer life expectancy than normal weight participants.7 9 These results support our finding of an association between being overweight and life expectancy. Additionally, an association between BMI and all-cause mortality in the Japanese population has been reported by other data sets.23–29 All seven previous studies showed that among the BMI categories, the lowest one had the highest mortality risk. These results are consistent with the fact that underweight participants have significantly the shortest life expectancy, as was observed in our study. Thus, the association between BMI and life expectancy showed same trend with the pooled analyses of the association between BMI and all-cause mortality in Asia and Japan.30 31 Our present results support three of the four previous studies of lifetime medical expenditure for obese participants.10 12 13 In comparison to previous studies, we calculated lifetime medical expenditure from individual medical expenditure and survival data covering longest follow-up period to date. Meanwhile, one study has shown that obese participants have lower lifetime medical expenditure than normal weight participants.11 However, that study limited the participants to non-smokers and calculated lifetime medical expenditure from the mortality of a hypothetical cohort and estimated medical expenditure from other cohort. In the present study, overweight participants were found to have higher lifetime medical expenditure than normal weight participants, as had been reported previously.10 12 13 We consider that this was attributable to the higher medical expenditure per month or per person from the 10-year or 9-year follow-up than for normal weight participants.1 3 4 On the other hand, with regard to underweight participants, our present findings were inconsistent with those of a previous study that examined the association between being underweight and lifetime medical expenditure.13 However, that study calculated lifetime medical expenditure for elderly participants aged over 70 years. Elderly underweight participants have high mortality,32 and medical expenditure increases in the 1 year prior to death.20 Thus, lifetime medical expenditure from 70 years for underweight participants becomes higher than for participants of normal weight. Our study results are thus inconsistent with those reported previously. We previously calculated life expectancy and lifetime medical expenditure for smokers and non-smokers from age 40 years by using the same data set as that for the present study.17 The results indicated that lifetime medical expenditure was non-significantly lower in smokers than in non-smokers, reflecting the 3.5 years shorter life expectancy of smokers. On the other hand, the present study indicated that lifetime medical expenditure was higher for obese participants in spite of their shorter life expectancy. This difference would result from the difference in which obesity and smoking affect one's health and longevity. Previous studies of healthy and disability free life expectancy have agreed that smoking shortens life expectancy without affecting the years of life spent with ill-health or disability, while obesity shortens life expectancy and extends the years of life with ill-health or disability.33 On the basis of these differences, Reuser et al summarised the situation as ‘smoking kills and obesity disables’.7 Extended years with ill-health and/or disability must result in increased lifetime medical expenditure. All these findings suggest that weight control would bring about longer life expectancy and long-term enhancement of the quality of life and a cost saving.

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