Impact of polymorphisms of the human beta2-adrenoceptor gene on obesity in a French population

OBJECTIVE: To investigate the impact of two common polymorphisms in the human beta2-adrenoceptor gene (Gly16Arg and Gln27Glu substitutions) on obesity and anthropometric measurements as well as blood variables in a large sample of a French population. DESIGN AND SUBJECTS: Within the framework of the WHO-MONICA project, a population study composed of 1195 subjects aged 35-64 y was randomly sampled from the electoral rolls of the Urban Community of Lille, in northern France. Subjects without any medical treatment (for hypercholesterolaemia, hypertension or diabetes mellitus) susceptible to interfere with body weight and biological variables were selected (n = 836, 419 men/417 women, age = 49.5+/-8.1 y, body mass index (BMI) = 25.7+/-4.4 kg/m2). Subjects with a body mass index > or = 30 kg/m2 were considered as obese (n = 119, age = 49.5+/-8.2 y, BMI = 33.9+/-3.3 kg/m2 range 30-44). MEASUREMENTS: Genotyping was carried out with allele-specific oligonucleotides hybridization. Association between genotypes and various obesity markers (body weight, body mass index, waist and waist-to-hip ratio), lipid, glucose and insulin variables were studied. RESULTS: The Gly16Arg and Gln27Glu polymorphisms were in complete linkage disequilibrium. Gln27Gln subjects had an increased risk of obesity (odds ratio (OR) = 1.77, 95% CI 1.19-2.62, P = 0.005). This effect was mainly detected in men (OR = 2.40, 95% CI 1.34-4.27, P = 0.003). Men bearing the Gln27Gln genotype had higher body weight, BMI, waist and hip circumferences and waist-to-hip ratio than others. Moreover, if Gln27Gln men carried in addition the Arg16 allele, the increase in body weight, BMI and waist-to-hip ratio was more important. CONCLUSION: Our results suggest that genetic variability of the beta2-adrenoceptor gene is implicated in body weight regulation and in the onset of obesity in French men.     

Obesity in Austria: body mass index of 15 000 euthyroid men and women referred to a thyroid outpatient service between 1992 and 2000.

A mean body mass index (BMI) of 25.4 +/- 5.0 kg/m(2) was calculated in 15439 euthyroid patients newly referred to our thyroid outpatient department from January 1, 1992 until December 31, 1999. This patient population included 2916 men aged 50 +/- 16 years (BMI: 26.2 +/- 4.3 kg/m(2)) and 12563 women aged 47 +/- 17 years (BMI 25.3 +/- 5.1 kg/m(2) ). Mean BMI appeared to rise (p < 0.01) from 25.0 +/- 4.7 kg/m(2) (1992) to 25.6 +/- 5.0 kg/m(2) (1999) and the share of obese patients (BMI > 30 kg/m(2)) increased from 13.8% in 1992 to 17.2% in 1999. However these changes were parallelled by a rise (p < 0.01) in the mean age of newly referred patients from 45 +/- 16 years (1992) to 49 +/- 17 years (1999). When the whole population was subdivided into groups of different age no time-related trend was apparent in mean BMI or in the prevalence of obesity in any of these subgroups. Only in men and women beyond 60 years of age BMI of those referred in 1998 and 1999 was higher (p < 0.05) than in those individuals referred in 1992-1994. These data indicate that close to half of all euthyroid patients referred to a thyroid outpatient service in eastern Austria is overweight. From 1992 to the end of 1999 there was, however, no marked increase in the prevalence of obesity in this population.     

Factors associated with overweight and obesity in Quebec adults

OBJECTIVE: To measure the independent correlates of excess body weight and obesity in Quebec in 1993 and 1997. DESIGN: A population-based, cross-sectional survey in three settings in the province of Quebec. SUBJECTS: A total of 10014 individuals aged 18-64 y. MEASUREMENTS: Excess body weight was defined as a body mass index (BMI) (self-reported weight and height) greater than or equal to 25 kg/m(2) and obesity as BMI greater than or equal to 30 kg/m(2). Data were collected by a questionnaire completed at home by the participants. Diet was assessed by a food frequency questionnaire. RESULTS: The correlates varied according to gender. While university achievement, smoking habit and physical activity level reduced the risk of excess body weight in both genders, increased dietary fat intake was positively associated with overweight and obesity in men only. In women, greater family income lowered the risk of having a BMI over 25. Increasing age, speaking a language other than French and living in a rural environment elevated the risk. CONCLUSION: Future interventions for the control of obesity should be gender-specific. Target groups should include individuals with low education, those living in rural environments and non-caucasian women. Dietary interventions should target men in particular.     

Obesity and high blood pressure in French West Indies women, some difference according to definition of obesity; BMI or abdominal obesity

OBJECTIVES: To compare prevalence of abdominal obesity with obesity defined as BMI >or=30 kg/m2 in a West Indies population, and to define the relation between obesity and hypertension. METHODS: A cross-sectional study of 2420 consecutive unemployed subjects referred for check-up in the two health centres of Guadeloupe, a French Caribbean island. Height and weight were measured and the body mass index (BMI) was calculated as weight/height2 (kg/m2). Obesity was defined as BMI >or=30 kg/m2 and excess weight as BMI >or=25 kg/m2 and<30 kg/m2. Abdominal obesity was defined as waist measurement more than 88 cm for women and more than 102 cm for men. RESULTS: [table: see text] CONCLUSION: A high prevalence of obesity was observed in this Caribbean population suggesting the interest of primary prevention in The Caribbean. In women, abdominal obesity (waist measurement>88 cm) was more frequent than obesity defined as BMI>30 kg/m2). In a multivariate analysis, obesity is an independent risk factor of hypertension (Odds-ratio=3), however the definition of obesity.     

Medical care expenditure associated with body mass index in Japan: the Ohsaki Study

OBJECTIVE: To examine the impact of body mass index (BMI) upon medical care use and its costs in Japan. DESIGN: A population-based prospective cohort study from 1995 to 1998. SUBJECTS: A cohort of 41 967 Japanese adults aged 40-79 y. Subjects who died during the first year of follow-up, or who at baseline reported having had cancer, myocardial infarction, stroke or kidney disease were excluded. MEASUREMENTS: Medical care use and its costs, actual charges, by linkage with the National Health Insurance claim history files after adjustment of smoking, drinking and physical functioning status. RESULTS: There was a U-shaped association between BMI and total medical costs. The nadir of the curve was found at a BMI of 21.0-22.9 kg/m(2). Relative to the nadir, total costs were 9.8% greater among those with BMIs of 25.0-29.9 (rate ratio, 1.10; 95% confidence interval (CI), 1.03-1.17), and 22.3% greater among those with BMIs of 30.0 or higher (rate ratio, 1.22; 95% CI, 1.08-1.37). Estimated excess direct costs attributable to overweight (BMI of 25.0-29.9 kg/m(2)) and obesity (BMI of 30.0 kg/m(2) or higher) represent 3.2% of total health expenditure in the present study, which is within the range reported in Western countries (0.7-6.8%). CONCLUSION: Our prospective data demonstrate that the impact of overweight and obesity upon medical care costs in Japan is as large as in Western countries, despite the much lower mean BMI in Japanese populations.     

Independent impact of body mass index and metabolic syndrome on the risk of type 2 diabetes in koreans

Abstract Background: Although obesity and metabolic syndrome have been associated with the risk of type 2 diabetes mellitus (T2DM), it is unclear whether obese or overweight people without metabolic syndrome are at increased risk for T2DM. Methods: Clinical and laboratory data were assessed in 8,748 subjects without diabetes (5,707 men, 3,041 women; age 20-79 years) who underwent voluntary medical check-ups at a 5-year interval. The subjects were categorized by body mass index (BMI) and metabolic syndrome status at baseline, and the incidence of diabetes over 5 years was assessed. Results: Of the 8,748 subjects, 308 (3.5%) developed T2DM over 5 years. Compared with normal weight (BMI <25.0?kg/m(2)) individuals without metabolic syndrome, the adjusted odds ratios (ORs) were 1.61 (1.13-2.29) and 4.93 (1.90-12.79) for overweight (BMI 25.0-29.9?kg/m(2)) and obese (BMI ≥30.0?kg/m(2)) individuals without metabolic syndrome, respectively, and 6.94 (5.08-9.47) and 10.61 (5.59-20.14) for overweight and obese individuals with metabolic syndrome, respectively. Using the lower BMI cutoff points for Asian populations, compared with subjects with BMI <23?kg/m(2) without metabolic syndrome, the adjusted ORs for subjects with BMI 23-27.4?kg/m(2) and BMI ≥27.5?kg/m(2) without metabolic syndrome were 2.64 (1.74-4.00) and 4.31 (2.36-7.86), respectively, and 10.11 (6.53-15.67) and 16.69 (10.40-26.77), respectively, for those with metabolic syndrome. Conclusions: Overweight/obesity and metabolic syndrome both are significant risk factors for development of T2DM in Koreans, and overweight or obesity without metabolic syndrome should not be considered a harmless condition. The lower BMI cutoffs for Asian populations can be useful in predicting risk of T2DM in Koreans.     

G protein beta3 subunit 825T allele and its potential association with obesity in hypertensive individuals.

OBJECTIVE: The 825T allele of the G protein beta3 subunit is associated with hypertension in Caucasians. To generate a novel hypothesis regarding the underlying mechanisms, we examined for a potential association of the 825T allele with obesity in hypertension. PATIENTS AND METHODS: We genotyped 197 hypertensive individuals (104 men, 93 women; mean age 54 years) recruited from the general population in the Heidelberg (Germany) area. Data acquisition included age at first diagnosis of hypertension, body weight and height, actual treated blood pressure values, and history of stroke and/or myocardial infarction (cardiovascular events). RESULTS: The 825T allele was significantly (P = 0.02) associated with body mass index (BMI), mean values being 28.6+/-4.1, 27.0+/-3.1, and 26.1+/-3.8 kg/m2 for TT, TC, and CC respectively, which persisted after correction for sex and age. The 825T allele frequency was 23.8, 31.4 and 40.0% in individuals with normal weight (BMI <24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI >29.9 kg/m2), respectively. Odds ratio for obesity versus normal weight was 3.9 [95% confidence interval (CI) 1.1-14.3; P = 0.03] for TT/CC and 1.8 (95% CI 0.7-4.6; P = 0.18) for TC/CC. BMI and age, but not genotype were significantly correlated with cardiovascular events as determined by logistic regression analysis. CONCLUSIONS: The findings suggest an association between obesity and the 825T allele, a genetic marker for enhanced G protein reactivity, in hypertensive individuals.     

Change in height, weight and body mass index: Longitudinal data from the HUNT Study in Norway

OBJECTIVE: The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity. DESIGN: Prospective population based study with 11-year follow-up. SUBJECTS: Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984-1986 and the other in 1995-1997. MEASUREMENTS: Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters. RESULTS: Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20-29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0-29.9 kg/m(2)) and obesity (BMI>/=30 kg/m(2)) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups. CONCLUSION: During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.     

Association between different measurements of obesity and the incidence of hypertension

BACKGROUND: Obesity is a risk factor for the incidence of hypertension, but it is still unclear whether this risk can be better estimated by body mass index (BMI) or waist circumference (WC). METHODS: In the baseline evaluation of a population-based cohort, 1089 adults answered a pretested questionnaire and had their baseline blood pressure (BP) and anthropometric measurements assessed according to standardized recommendations. Excluding the individuals with hypertension at baseline, and those deceased or lost during the follow-up, 592 individuals (80.5% of those eligible) were visited again. Obesity was defined as BMI >/=30 kg/m(2) for both genders, and WC >/=102 cm for men and WC >/=88 cm for women. Incident cases of hypertension were characterized by BP >/=140/90 mm Hg or use of BP medication in the follow-up visit. RESULTS: After a mean follow-up of 5.6 +/- 1.1 years, 127 incident cases of hypertension were identified. The hazard ratios (Cox model), adjusted for age and baseline systolic BP (95% CI and P), for BMI higher than 30 kg/m(2) were 1.08 (0.52-2.24, P =.82) in men and 1.74 (0.93-3.26, P =.08) in women. The corresponding figures were 1.78 (0.76-4.09, P =.18) for men with WC >/=102, and 1.72 (1.09-2.73, P =.02) for women with WC >/=88 cm. CONCLUSIONS: We conclude that the risk for hypertension may be better identified by obesity defined by higher WC than higher BMI.     

Variants of uncoupling protein-2 gene and obesity: interaction with peroxisome proliferator-activated receptorgamma2

OBJECTIVE: To analyse the association of the UCP2 gene, alone or in combination with the PPARgamma2 gene, with obesity. DESIGN: Cross-sectional, case-control study. STUDY POPULATION: From a working population of 4500 Italian Caucasian employees of the Italian telephone company participating in a firm-sponsored health screening programme, we selected all those with obesity [n = 122; body mass index (BMI) > or = 30 kg/m2]. For each case, three nonobese age- and sex-matched individuals were selected as controls from the same population (n = 374). Included in the study were also 76 severely obese (BMI > or = 40 kg/m2) patients consecutively admitted to the obesity clinic of the department. Diabetic individuals were excluded. MEASUREMENTS: The -866G/A UCP2 and the Pro12Ala PPARgamma2 polymorphisms were determined on genomic DNA of the studied individuals. Several metabolic and anthropometric measures were also obtained, like plasma glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol and BMI. RESULTS: BMI, plasma glucose, insulin, triglycerides, total and HDL cholesterol were not significantly different in carriers and noncarriers of the -866G/A variant. No significant association was observed between the -866G/A UCP2 gene polymorphism and moderate or severe obesity. This was also observed when the UCP2 polymorphism was analysed in combination with the PPARgamma2 polymorphisms. CONCLUSIONS: The -866G/A variants of the UCP2 gene are not associated with either obesity or other features of the metabolic syndrome in the studied groups of the Italian population. This negative finding is not modified after a combined analysis of the UCP2 polymorphism and the Pro12Ala polymorphism of PPARgamma2.     

Lack of association between polymorphism of the human cyclic GMP-dependent protein kinase gene and obesity

OBJECTIVE: To investigate whether genetic variation in the cyclic GMP-dependent protein kinase gene (PRKG1) is associated with obesity. METHODS: The study included 143 individuals from New York City area, NY, USA. The subjects were sampled on the basis of body mass index (BMI): obese (BMI ranging from 33.8 to 89.5 kg/m(2)), and nonobese (BMI ranging from 16.0 to 29.4 kg/m(2)). The association between C2276T polymorphism in PRKG1 gene and obesity was tested using linear regression analysis. RESULTS: BMI levels were predicted by linear regression models adjusted for demographic factors. An analysis was performed twice: in individuals of all ethnic backgrounds and in European-Americans only. In both cases, genotype did not have a significant effect. CONCLUSION: We found no evidence that the C2276T polymorphism in the PKRG1 gene is associated with obesity.     

Relationship of obesity to depression: a family-based study

OBJECTIVE: To examine the relationship between obesity and depression in a sample of extremely obese individuals and their siblings and parents. SUBJECTS: A total of 1730 European Americans (558 men, 1172 women, aged 49.29+/-15.42 y, body mass index (BMI) of 35.57+/-11.53 kg/m(2)) and 373 African Americans (103 men, 270 women, aged 44.85+/-15.08 years, BMI of 36.83+/-11.31 kg/m(2)) in a sample of 482 nuclear families segregating extreme obesity and normal weight. MEASUREMENTS: Individual BMI, history of depression treatment and covariates (age, sex, race, education, marital status, socioeconomic status, chronic medical conditions and exercise program). RESULTS: Greater odds for depression were found for the obese, European American, women, the unmarried, the more educated, those with chronic physical disorder(s) and the offspring of depressed parents. A trend test found that the odds ratios for depression increased with BMI and number of chronic medical conditions (P<0.0001). Multivariate logistic regression analyses indicated that BMI, race, marital status, chronic medical conditions and family history were the predicators of depression for both the genders. Hierarchical analyses revealed that BMI significantly increased the risk above that predicated by the combined effects of all other variables. CONCLUSIONS: Extreme obesity was associated with the increased risk for depression across gender and racial groups, even after controlling for chronic physical disease, familial depression and demographic risk factors. More detailed research is needed to determine the underlying mechanisms.     

Past, present and future of obesity pharmacotherapy

Obese (BMI > or = 30 kg/m2) and overweight (BMI > or = 25 and < 30 kg/m2) individuals are at high risk of developing serious chronic health problems, including type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease. Caloric restriction, increased physical activity and behavioral therapy remain the primary treatment options for the management of body weight in these individuals. When a weight loss of 5-10% cannot be achieved in 3-6 months by lifestyle changes drug therapy might be indicated. This review will provide a brief history of obesity pharmacotherapy, discuss the status of currently available obesity drugs and outline the future drug development. A medical need exists for the development of novel weight loss therapies or combinations of known therapies.     

The prediction of body composition in Chinese Australian females.

OBJECTIVE: To determine the efficacy of applying specific body composition techniques to, and assess the relationship between body mass index (BMI) and body fat levels for Chinese Australian females. DESIGN: Statistical comparative analysis of body composition techniques. SUBJECTS: Australian resident females of Chinese extraction (n=40) (aged 18-45 y, mean 32.5+/-8.0; BMI range 15.7-30.9 kg/m2, mean 21.7+/-3.1 kg/m2, median 20.8 kg/m2). MEASUREMENTS: Body composition determined using bio-electrical impedance analysis (BIA), the skin-fold equations of Durnin and Womersley (D&W) and a deuterium dilution technique. Body size was calculated as the body mass index (BMI) weight/height(2) (kg/m2). RESULTS: With a median BMI of 20.8, range 15.7-30.9, an acceptable BMI existed for 87.5% of the subjects (mean (s.d.) 21.7+/-3.1 kg/m2). Percentage fat mass (%FM) from the deuterium dilution technique (mean (s.d.) 35.6+/-6.4) suggested 75% were overweight or obese. %FM from the D&W equation (mean (s.d.) 28.0+/-3.9) and BIA (mean (s.d.) 29.4+/-5.1) also indicated a tendency towards overweight or obese. The deuterium technique was significantly correlated and significantly different to the D&W eqn, r=0.71 P=0.001; and BIA, r=0.77, P=0.001. Bland and Altman analysis indicated that bias existed between the techniques (BIA mean (s.d.)-6.7+/-4.1) and D&W equation mean (s.d.)-6+/-4.5) when compared to the deuterium method. CONCLUSIONS: Despite a low mean BMI, body fat levels determined by the three methods suggested that, overall, an unsatisfactory body composition existed. The levels of overweight and obesity (%FM>30) were higher than reported in previous research despite a mean BMI lower than the Australian national average. Comparative analysis suggested that the body fat prediction techniques used may be precise but not accurate. Comparative results obtained for the BIA and D&W equation techniques suggest an overestimation of body fat levels for leaner individuals and under estimation for overfat individuals. The results support the notion that accurate determination of body composition and the determination of appropriate body size may require equations developed for specific ethnic populations.     

Effect of combined cardiovascular risk factors on individual and population medical expenditures: a 10-year cohort study of national health insurance in a Japanese population.

BACKGROUND: Although obesity is required for some criteria defining metabolic syndrome, clustering of other risk factors also indicates an increased risk of cardiovascular disease. Whether the relationship between cardiovascular risk factor clustering and medical expenditures differs with body mass index (BMI) requires investigation, especially in a population with a low prevalence of obesity such as that in Japan. METHODS AND RESULTS: A 10-year cohort study of 4,478 Japanese National Health Insurance beneficiaries aged 40-69 years in a community between 1990 and 2001 was carried out in the present study. The clustering of cardiovascular risk factors showed a positive and graded relationship to personal medical expenditures in participants who are overweight (BMI > or =25.0) and normal weight (BMI <25.0). The individual medical expenditures per month were 1.7-fold higher for participants with 2 or 3 risk factors and overweight than for those without these factors (26,782 vs 15,377 Japanese yen). Differences in the geometric means were similarly significant after adjustment for other confounding factors. However, the excess medical expenditures by risk clustering of normal weight categories within the total medical expenditures were higher than those of overweight categories because more participants were of normal weight. CONCLUSIONS: Cardiovascular risk factor clustering and being overweight can be a useful predictor of medical expenditures in a Japanese population.     

Prevalence of overweight and obesity in a rural southern Italy population and relationships with total and cardiovascular mortality: the Ventimiglia di Sicilia project.

OBJECTIVE: We investigated the prevalence of overweight and obesity and their relationships with the main cardiovascular risk factors in the population of Ventimiglia di Sicilia, a rural village in Southern Italy characterized by low cholesterol levels and by a low incidence of early coronary heart disease mortality. We related all deaths to body weight and fat distribution during an 8 y follow-up. DESIGN: Cross-sectional and prospective observational study. SUBJECTS: A total of 835 free-living individuals, 363 males and 472 females, of age between 20 and 69 y. MEASUREMENTS: In all participants body weight, waist-to-hip ratio (WHR), cardiovascular risk factors and plasma lipids were measured. During the follow-up, total and cardiovascular deaths were registered. RESULTS: We found a high overall prevalence of subjects with overweight or obesity (respectively 45.0% and 27.7%), with great differences among classes of age. As expected, body weight and fat distribution were associated with diabetes, hypertension, dyslipidemia and with a worsening of lipid profile. During the follow-up we registered 37 total and 11 cardiovascular deaths. All-cause and cardiovascular mortality risks were, respectively, 1.64 (95% CI 0.65-4.15) and 2.71 (95% CI 0.29-25.26) in subjects with a body mass index (BMI) of 27-29.99 kg/m2 and 2.45 (95% CI 1.03-5.87) and 5.36 (95% CI 1.41-62.01) in subjects with a BMI of > or =30 kg/m2 in comparison with participants with a BMI of <27 kg/m2, and 3.48 (95% CI 1.46-8.30) and 4.55 (95% CI 1.12-18.40) in subjects with a WHR higher than the median in comparison with individuals with a WHR lower than the median. CONCLUSION: The Ventimiglia di Sicilia Study highlights the great importance of overweight and obesity as a public health issue in a rural population and indicates that it is necessary to consider the impact of body weight and fat distribution on both total and CHD mortality.     

Perceptions of healthy and desirable body size in urban Senegalese women

OBJECTIVE: To examine the cultural ideals for body size held by urban Senegalese women; to determine the body size that women associate with health; and to estimate the change in prevalence of female obesity in an urban neighbourhood of Dakar. DESIGN: Cross-sectional, population-based study in the subject's home, using a structured interviewer-administered questionnaire, conducted in the same Dakar neighbourhood as that of a previous survey conducted in 1996. SUBJECTS: A total of 301 randomly selected women, aged 20-50 y, living in a specific Dakar neighbourhood, Senegal. MEASUREMENTS: A total of 32 items concerning body satisfaction, social status, health and individual attributes to associate with one of six photographic silhouettes; body mass index (BMI), waist circumference, waist-to-hip ratio by anthropometry; and measures of economic status. RESULTS: In all, 26.6% of women were overweight (BMI 25-29.9 kg/m2) and 18.6% were obese (BMI > or =30 kg/m2) compared with 22.4 and 8.0% respectively in 1996. Overweight was the most socially desirable body size, although obesity itself was seen as undesirable, associated with greediness and the development of diabetes and heart disease. Lay definitions of overweight and normal weight differed substantially from health definitions, as one-third of the sample saw the 'overweight' category as normal. Over a third of women with BMI > or =25 kg/m2 wanted to gain more weight. CONCLUSION: There has been a sharp rise in the prevalence of obesity in Senegalese women living in a Dakar neighbourhood over the last 7 y. In general, overweight body sizes (but not obese) were seen in a positive light. The finding that the term 'overweight' made little sense to these Senegalese women could have important implications for developing public health policies.     

Impact of obesity on health-related quality of life in patients with chronic illness

OBJECTIVE:To determine the association between overweight and obesity and health-related quality of life (HRQOL) in patients with chronic conditions typical of those seen in general medical practice, after accounting for the effects of depression and medical comorbidities. DESIGN: Cross-sectional analysis of data from the Medical Outcomes Study. SETTING: Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in three U.S. cities. PATIENTS: We surveyed 2,931 patients with chronic medical and psychiatric conditions. The patients completed a self-administered questionnaire at enrollment and had complete data on height and weight. MEASUREMENTS AND MAIN RESULTS: Body mass index (BMI), chronic medical conditions, and depression were obtained by structured interview. Health-related quality of life was measured by the SF-36 Health Survey. Patients who were overweight (BMI 25.0-29.9 kg/m2), patients with class I obesity (BMI 30.0-34.9 kg/m2), and patients with class II-III obesity (BMI > or = 35 kg/m2) had significantly lower adjusted physical function scores (by 3.4, 7.8, and 13.8 points, respectively) compared with nonoverweight patients. Patients with class I and class II-III obesity also had significantly lower adjusted general health perceptions scores (by 2.8 and 4.4 points, respectively) and lower adjusted vitality scores (by 4.0 and 7.1 points, respectively), compared with nonoverweight patients. No significant differences between nonoverweight, overweight, and obese patients were observed for the mental health scale. Women with elevated BMI had significantly lower HRQOL scores compared with the scores of obese men in several domains. Additionally, blacks with elevated BMI had significantly lower scores than whites in several domains of HRQOL. CONCLUSIONS: Overweight and obesity have the largest association with physical function measures. Recent national standards, which have lowered the threshold for defining overweight, identify patients who are more likely to have clinically significant reductions in HRQOL and functional impairment.     

Overweight and obesity and the burden of disease and disability in elderly men

OBJECTIVE: To examine the prevalence of disease burden and disability associated with overweight and obesity in men aged 60-79 y and to assess whether the current WHO weight guidelines are appropriate in the elderly. DESIGN: Cross-sectional survey 20 y after enrollment. SETTING: General practices in 24 British towns. PARTICIPANTS: In total, 4232 men aged 60-79 y (77% of survivors) with measured weight and height. MAIN OUTCOME MEASURES: Cardiovascular (CV) risk factors, prevalence of diabetes, cardiovascular disease, cancer, disability and regular medication. RESULTS: In total, 17% of the men were obese (body mass index (BMI) >/=30 kg/m(2)) and a further 52% were overweight (BMI 25-29.9 kg/m(2)). Prevalence of hypertension, low HDL-cholesterol, high triglycerides and insulin resistance and the prevalence of most disease outcomes increased with increasing degrees of overweight/obesity. Men in the normal weight range (18.5-24.9 kg/m(2)) had the lowest prevalence of ill health. Compared with normal weight men, obese men showed a two-fold risk of major CVD (odds ratio (OR)=1.96, 95% CI 1.44-2.67) and locomotor disability (OR=2.26, 95% CI 1.66, 3.09) and were nearly three times as likely to have diabetes, CV interventions or to be on CV medication. Over 60% of the prevalence of high insulin resistance was attributable to overweight and obesity as was over a third of diabetes and hypertension, a quarter of locomotor disability and a fifth of major CVD. CONCLUSION: In elderly men, overweight and obesity are associated with a significantly increased burden of disease, in particular CV-related disorders and disability. The current guidelines for overweight and obesity appear to be appropriate in elderly men.