Objective:​ The automotive safety community is questioning the impact of obesity on the performance and assessment of occupant protection systems. This study investigates fatality and serious injury risks for front-seat occupants by body mass index (BMI) using a matched-pair analysis. It also develops a simple model for the change in injury risk with obesity.

Methods:​ A simple model was developed for the change in injury risk with obesity. It included the normal mass (m) and stiffness (k) of the body resisting compression during a blunt impact. Stiffness is assumed constant as weight is gained (Δ m). For a given impact severity, the risk of injury was assumed proportional to compression. Energy balance was used to determine injury risks with increasing mass. NASS-CDS field data were analyzed for calendar years 1993–2004. Occupant injury was divided into normal (18.5 kg/m²≤ BMI < 25.0 kg/m²) and obese (BMI ≥ 30 kg/m²) categories. A matched-pair analysis was carried out. Driver and front-right passenger fatalities or serious injuries (MAIS 3+) were analyzed in the same crash to determine the effect of obesity. This also allowed the determination of the relative risk of younger (age ≤ 55 years), older (age >55years), male, and female drivers that were obese compared to normal BMI. The family of Hybrid III crash test dummies was evaluated for BMI and the amount of ballast was determined so they could represent an obese or morbidly obese occupant.

Results:​ Based on the simple model, the relative injury risk (r) for an increase in body mass is given by:​ r = (1 + Δ m / m) 0.5 . For a given stature, an obese occupant (BMI = 30–35 kg/m²) has 54–61% higher risk of injury than a normal BMI occupant (22 kg/m²). Matched pairs showed that obese drivers have a 97% higher risk of fatality and 17% higher risk of serious injury (MAIS 3+) than normal BMI drivers. Obese passengers have a 32% higher fatality risk and a 40% higher MAIS 3+ risk than normal passengers. Obese female drivers have a 119% higher MAIS 3+ risk than normal BMI female drivers and young obese drivers have a 20% higher serious injury risk than young normal drivers. This range of increased risk is consistent but broader than predicted by the simple injury model. The smallest crash test dummies need proportionately more ballast to represent an obese or morbidly obese occupant in the evaluation of safety systems. The 5% female Hybrid III has a BMI = 20.4 kg/m²and needs 22 kg of ballast to represent an obese and 44.8 kg to represent a morbidly obese female, while the 95% male needs only 1.7 and 36.5 kg, respectively.

Conclusions:​ Obesity influences the risk of serious and fatal injury in motor vehicle crashes. The effect is greatest on obese female drivers and young drivers. Since some of the risk difference is related to lower seatbelt wearing rates, the comfort and use of seatbelt extenders should be examined to improve wearing rates. Also, crash testing with ballasted dummies to represent obese and morbidly obese occupants may lead to refined safety systems for this growing segment of the population.