The distal driver formulation used for forecasting mortality in IFs contains a country’s average body mass index (HLBMI) for diabetes. HLBMI also affects mortality from cardiovascular disease in IFs via the mechanism that the model uses to modify cause-specific mortality from the distal driver formulation by actual risk level in a country.  The core of that approach is to compare the risk-specific population attributable fraction (PAF) of total morality as calculated from the distal drivers with the PAF calculated from the actual level of the risk in the country. 

The figure below shows the approach for body mass index.  The two key variables in the distal driver formulation at any point in time (ignoring the technology factor that adds dynamics over time) are GDP per capita at purchasing power parity and years of adult education.  They are used in a cross-sectionally estimated function to calculate an implicit body mass index that then produces the associated implicit PAF.  IFs uses an alternative and more risk-factor specific formulation to forecast values of body mass index over time.  The PAF associated with this explicit representation of HLBMI is compared with the PAF from the implicit calculation and the comparison alters the actual mortality pattern. 

To calculate HLBMI the explicit formulation uses calories per capita as the sole driving variable.  A multiplicative parameter ( hlbmim ) can be used to change HLBMI in scenario analysis.  A forecast of the obese population as a percent of the total population (HLOBESITY) is driven by the body mass index. A separate multiplicative parameter can modify it ( hlobesitym ).