Obesity May Be Killing More People Than Smoking In England And Scotland

Smoking kills. That idea is universally and scientifically accepted. Millions have died from smoking-related illnesses and many more continue to die. But obesity and excess body fat may be giving smoking a run for it’s money, according to new research. They may even be the new biggest killer.

According to a new study, published in the journal BMC Public Health, obesity and excess body fat may well have contributed to more deaths in Scotland and England in 2014 than smoking did. The percentage of deaths attributed to smoking fell from 23.1% to 19.4% between 2003 ans 2017. Deaths attributable to excess body fat and obesity, as a percentage of total deaths, climbed from 17.9% to 23.1%.


The researchers estimate that obesity and excess body fat became the death contribution leader in 2014. Through 2017, the lead continued to widen.

Jill Pell, at the University of Glasgow, United Kingdom, the corresponding author said: “For several decades smoking has been a major target of public health interventions as it is a leading cause of avoidable deaths. As a result, the prevalence of smoking has fallen in the United Kingdom. At the same time the prevalence of obesity has increased. Our research indicates that, since 2014, obesity and excess body fat may have contributed to more deaths in England and Scotland than smoking.”

The study authors did acknowledge that the number of deaths attributable to any of the listed causes are estimates only. Factors influencing the deaths analyzed would require further investigation to confirm.


That being said, the team used an extensive amount of information to create seemingly very reliable estimates. In order to look at changes in how many adults smoked or had excess body fat or were obese, they analyzed data from the Health Surveys for England and the Scottish Health Surveys. The data came from 192,239 adults across England and Scotland and was collected between 2003 and 2017.

The participants had their height and weight measured and provided information as to whether they had ever smoked regularly. The average age of participants was 50 years old. The researchers used this data, along with estimates of the risk of dying from obesity or excess body fat (from 198 studies) or from smoking (17 studies.) From this information, they calculated the number of deaths which could be attributed to obesity and excess body fat and smoking.


There was a split in the findings along age lines, to a degree. Obesity and excess body fat probably accounted for more deaths than smoking since 2006 among older adults. For younger adults, however, smoking is still more likely to be a contributor to the cause of death.

Obesity and excess body fat contributed to 3.5% more deaths than smoking among adults aged 65 or over in 2017. For adults aged 45-64, obesity and excess body fat contributed to 3.4% more deaths. Among those aged 16-44, smoking led the way by 2.4% more estimated deaths.

The analysis also suggests that gender plays a role in the contribution to estimated deaths of smoking, obesity and excess body fat. For men, obesity and excess body fat may have accounted for 5.2% more deaths than smoking in 2017. This compares to a 2.2% higher rate in women. Between 2003 and 2017, it appears that deaths due to obesity and excess body fat increased by 31.5% for men and 25.9% for women. Deaths due to smoking during that period are believed to have declined by 14.9% for men and 18.1% for women.


Jill Pell said: “The increase in estimated deaths due to obesity and excess body fat is likely to be due to their contributions to cancer and cardiovascular disease. Our findings suggest that the public health and policy interventions aimed at reducing the prevalence of smoking have been successful and that national strategies to address obesity and excess body fat, particularly focusing on middle-aged and older age groups and men, should be a public health priority.”

Research into the potential contributions of passive smoking, e-cigarette use and vaping, among other habits may help shed more light on these changes. It could also explore whether the proportion of deaths due to obesity and excess body fat differs by ethnicity, race or other factors.

We undertook a massive education effort to help people understand the dangers of smoking. With the rise in obesity-related disease, distress and death, one has to wonder what it will take for people to recognize the dangers and take action. Action that, in very real terms, might just save their lives.

Keep the faith and keep after it!

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Journal Reference – Frederick K. Ho, Carlos Celis-Morales, Fanny Petermann-Rocha, Solange Liliana Parra-Soto, James Lewsey, Daniel Mackay, Jill P. Pell. Changes over 15 years in the contribution of adiposity and smoking to deaths in England and Scotland. BMC Public Health, 2021; 21 (1) DOI: 10.1186/s12889-021-10167-3

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