Relationship of childhood obesity to adult obesity: a 20-year longitudinal study from birth in Ishikawa Prefecture, Japan

OBJECTIVE: Evidence regarding the relationship between childhood obesity and adult obesity in Japan is limited. This study was conducted to determine the relationship between childhood mass index (BMI) at 3 months, 12 months, 3 years and 20 years in a general population. METHODS: Data obtained from men and women aged 20 years (born between 1968-1974), who had received medical examinations in Ishikawa Prefecture, Japan, were linked to data of medical examinations of the same individuals as infants (3 months, 12 months, and 3 years). The relationship between childhood BMI (or Kaup index) and adult BMI was analyzed for a total of 2,314 participants (1,080 men and 1,234 women), whose data could be followed for 20 years. RESULTS: BMI at 20 years displayed significant positive correlations with BMI at 3 months, 12 months, and 3 years; this correlation was strongest with respect to BMI at 3 years (r = 0.33, p < 0.001 in men; r = 0.42, p < 0.001 in women). In terms of percentages of obese participants (BMI 25 kg/m2 or over) at 20 years in accordance with BMI categories at each age, the rates were 4.6% in men and 1.0% in women with a BMI less than 15 kg/m2 at 3 years, but 29.1% and 29.5%, respectively, with a BMI of 18 kg/m2 or over (6.3 and 29.5 times higher, respectively). Percentages of obese participants at 20 years were highest in those exhibiting an above average BMI at 3 years, regardless of the BMI at 3 months. CONCLUSIONS: Body mass in young adults is strongly related to body mass in childhood, especially with that at 3 years. About 30 percent of obese children at 3 years remain obese into adulthood. These results are of interest with respect to assessment of future risk of adulthood obesity at medical examinations for infants in Japan.     

Disability, arthritis, and body weight among adults 45 years and older

OBJECTIVE: To examine the association between body weight and disability among persons with and without self-reported arthritis. RESEARCH METHODS AND PROCEDURES: Data were analyzed for noninstitutionalized adults, 45 years or older, in states that participated in the Behavioral Risk Factor Surveillance System. Self-reported BMI (kilograms per meter squared) was used to categorize participants into six BMI-defined groups: underweight (<18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obese, class 1 (30 to < 35), obese, class 2 (35 to < 40), and obese, class 3 (> or = 40). RESULTS: Class 3 obesity (BMI > or = 40) was significantly associated with disability among participants both with and without self-reported arthritis. The adjusted odds ratio (AOR) for disability in participants with class 3 obesity was 2.75 [95% confidence interval (CI) = 2.22 to 3.40] among those with self-reported arthritis and 1.77 (95% CI = 1.20 to 2.62) among those without self-reported arthritis compared with those of normal weight (BMI 18.5 to < 25). Persons with self-reported arthritis who were obese, class 2 (BMI 35 to < 40) and obese, class 1 (BMI 30 to <35) and women with self-reported arthritis who were overweight (BMI 25 to < 30) also had higher odds of disability compared with those of normal weight [AOR = 1.72 (95% CI = 1.47 to 2.00), AOR = 1.30 (95% CI = 1.17 to 1.44), and AOR = 1.18 (95% CI = 1.06 to 1.32), respectively]. DISCUSSION: Our findings reveal that obesity is associated with disability. Preventing and controlling obesity may improve the quality of life for persons with and without self-reported arthritis.     

Stigmatized students: age, sex, and ethnicity effects in the stigmatization of obesity

OBJECTIVE: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. RESEARCH METHODS AND PROCEDURES: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m2; range, 14.4 to 45.0 kg/m2) who ranked six drawings of same-sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth- and sixth-grade children. RESULTS: Obesity was highly stigmatized relative to physical disabilities. African-American women liked obese peers more than did African-American men, white men, or white women [F(1,216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t(761) = 9.16, p < 0.001]. DISCUSSION: Although the stigmatization of obesity was high among participants overall, African-American women seemed to have more positive attitudes toward obesity than did white women, white men, or African-American men. Participants' weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non-overweight adults. Such internalized stigmatization could help to explain the low self-esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African-American women could help efforts to reduce stigma.     

Associations between combinations of body mass index plus non-alcoholic fatty liver disease and diabetes mellitus among Korean adults

The purpose of this study was to investigate associations between combinations of body mass index (BMI) categories plus non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) among Korean adults. We prepared the data of 5665 subjects aged 20 years and over who had visited a health promotion center. We excluded 582 subjects as they had a viral or alcoholic liver disease. According to BMI-NAFLD status, the subjects were categorized as non-obese (BMI<25 kg/m2) without NAFLD (n=2568), obese (BMI≥25 kg/m2) without NAFLD (n=572), non-obese with NAFLD (n=748), or obese with NAFLD (n=1195). The prevalence of NAFLD was highest in the obese subjects with DM (87.9%). In non-obese and non-DM subjects, the prevalence of NAFLD was lowest (18.4%). After adjustment of age, gender, waist circumference, smoking status, alcohol drinking, regular exercise, the odd ratios for DM or DM plus impaired fasting glucose (IFG) of subjects with mild NAFLD regardless of obesity were almost 2-fold compared to non-obese subjects without NAFLD. Moreover, those of subjects with moderate or severe NAFLD regardless of obesity were about 4- fold. Clinicians and investigators need to pay attention to non-obese patients with fatty liver.     

Four-week pedometer-determined activity patterns in normal-weight, overweight and obese adults

OBJECTIVE: To assess pedometer-determined ambulatory activity in normal-weight, overweight and obese UK adults. METHODS: Eighty-six normal-weight (BMI <25 kg/m(2)) (age=34+/-12.1 years), 91 overweight (BMI 25-29.9 kg/m(2)) (age=40.6+/-13.6 years) and 75 obese (BMI >or= 30 kg/m(2)) (age=41.2+/-12.4 years) participants, from the East Midlands, provided 4 weeks of continuous pedometer-determined activity data, during the winter in 2006. Activity levels and patterns were assessed for all three groups. RESULTS: The normal-weight group had a significantly higher mean step count (10247 steps/day) than the overweight (9095 steps/day) and obese (8102 steps/day) participants (p<0.05). No differences in step counts were observed between the overweight and obese groups. A consistent reduction in activity was observed on Sundays in all groups, with this reduction being two-fold greater in the overweight and obese groups (approximately 2000 steps/day) when compared with the normal-weight group (approximately 1000 steps/day). CONCLUSIONS: With the increasing prevalence of obesity in the UK, changes in the activity levels of those at risk are needed. The issuing of pedometers to overweight and obese individuals, with the instruction to increase their ambulatory activity on all days of the week, with particular emphasis on Sunday activity, could be a good starting point in tackling the problem of obesity in the UK.     

Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity

OBJECTIVE: To evaluate whether or not "uncomplicated" obesity (without associated comorbidities) is really associated with cardiac abnormalities. RESEARCH METHODS AND PROCEDURES: We evaluated cardiac parameters in obese subjects with long-term obesity, normal glucose tolerance, normal blood pressure, and regular plasma lipids. We selected 75 obese patients [body mass index (BMI) >30 kg/m(2)], who included 58 women and 17 men (mean age, 33.7 +/- 11.9 years; BMI, 37.8 +/- 5.5 kg/m(2)) with a > or =10-year history of excess fat, and 60 age-matched normal-weight controls, who included 47 women and 13 men (mean age, 32.7 +/- 10.4 years; BMI, 23.1 +/- 1.4 kg/m(2)). Each subject underwent an oral glucose tolerance test to exclude impaired glucose tolerance or diabetes mellitus, bioelectrical impedance analysis to calculate fat mass and fat-free mass, and echocardiography. RESULTS: Obese patients presented diastolic function impairment, hyperkinetic systole, and greater aortic root and left atrium compared with normal subjects. No statistically significant differences between obese subjects and normal subjects were found in indexed left ventricular mass (LVM/body surface area, LVM/height(2.7), and LVM/fat-free mass(kg)), and no changes in left ventricular geometry were observed. No statistically significant differences in cardiac parameters between extreme (BMI > 40 kg/m(2)) and mild obesity (BMI < 35 kg/m(2)) were observed. DISCUSSION: In conclusion, our data showed that obesity, in the absence of glucose intolerance, hypertension, and dyslipidemia, seems to be associated only with an impairment of diastolic function and hyperkinetic systole, and not with left ventricular hypertrophy.     

Body mass index and quality of well-being in a community of older adults

BACKGROUND: The impact of obesity and associated conditions on health has not been assessed in older adults using a generic, utility-based measure of health-related quality of life (HRQOL). This study evaluates the relationship between body mass index (BMI) and HRQOL scores and gives estimates of quality-adjusted life years (QALYs) lost to overweight, obesity, and associated conditions. METHODS: A total of 1326 adults from the Rancho Bernardo longitudinal cohort study, with a mean age of 72 years, completed the Quality of Well-Being Scale (QWB), a generic health-related quality of life measure. Height, weight, exercise, and smoking status were also assessed. Differences in QWB scores between obese adults and those with a normal BMI were used to estimate the QALYs lost due to obesity and associated conditions. RESULTS: Participants were divided into four groups based on BMI: <20 (underweight); 20 to 24.9 (normal); 25 to 29.9 (overweight); >30 kg/m(2) (obese). Analysis of covariance controlling for age, gender, smoking history, and exercise showed a significant difference between group means (F(7,1310)=30.79; p <0.001). The normal BMI group had the highest QWB score (0.709), followed by the underweight (0.698), overweight (0.695), and obese (0.663) groups. The QWB score for the obese group was significantly lower than that for the normal and overweight groups. An estimated 2.93 million QALYs are lost in this country each year from obesity and associated conditions. CONCLUSIONS: Obese older adults tend to have lower HRQOL than those who are overweight or of normal BMI. The lower QWB scores associated with obesity translate into millions of QALYs lost each year. Being overweight but not obese did not have a significant impact on HRQOL in this population.     

Obesity in South Africa: the South African demographic and health survey

OBJECTIVES: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, > or =15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m(2) and 27.1 kg/m(2), respectively. For men, 29.2% were overweight or obese (> or =25 kg/m(2)) and 9.2% had abdominal obesity (WHR > or =1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m(2)) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.     

Obesity affects nursing-care facility admission among whites but not blacks

OBJECTIVE: This study examines whether obese individuals have a greater rate of nursing care facility admission than normal weight individuals. RESEARCH METHODS AND PROCEDURES: Data from the National Health and Nutrition Examination Survey Epidemiological Follow-up Survey were analyzed. Cox proportional hazards models were used to examine the relationship between baseline weight status and subsequent time to first nursing home admission while adjusting for sex, age, race, marital status, height, presence of children, smoking status, education, region, urban residence, income, and physical activity. RESULTS: Of 5960 adults 45 to 74 years old, 989 individuals were admitted to a nursing care facility over the subsequent 20 years. Body mass index (BMI) was studied using five categories: < 18.5, 18.5 to <25, 25.0 to <30, 30.0 to <35, > or =35 kg/m(2). The effects of BMI differed by race: compared with those with a BMI of 18.5 to < 25 kg/m(2), adults with a BMI > or =30 kg/m(2) or a BMI <18.5 kg/m(2) had a greater rate of nursing home admission in whites, whereas no relationship was found in blacks. The inclusion of time to death with nursing home admission as a joint outcome yielded similar results. DISCUSSION: The large increase in the prevalence of obesity coupled with the rapid expansion of the number of older Americans will likely increase the demand for nursing facility use. More research is needed to understand differences in factors related to nursing home admission among ethnic groups.     

Prevalence of uncomplicated obesity in an Italian obese population

OBJECTIVE: The existence of healthy obese subjects has been suggested but not clearly reported. We sought to address the prevalence of uncomplicated obesity and adverse risk factors in a large Italian obese population. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional study of a population of consecutive Italian obese subjects. We studied 681 obese subjects (514 women and 167 men), with a mean age of 41.1+/-13.9 years (range, 16 to 77 years), mean BMI of 40.2+/-7.6 kg/m2 (range, 30 to 89.8 kg/m2), and a history of obesity for 20.5+/-7 years (range, 10.5 to 30 years). Anthropometric, metabolic, cardiac, and obesity-related risk factors were evaluated. RESULTS: The prevalence of uncomplicated subjects was 27.5%, independent of BMI and duration of obesity. The youngest group of obese subjects showed a higher, but not statistically significantly higher, prevalence of uncomplicated obesity. No statistical difference for the prevalence of impaired fasting glucose, glucose intolerance, high triglycerides, high total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol among BMI categories (from mild to extremely severe obesity degree) was found. Obese subjects with BMI>50 kg/m2 showed a higher prevalence of high blood pressure only when they were compared with the group with a BMI of 30 to 35 kg/m2 (p<0.01). Obese subjects with BMI>40 kg/m2 showed a higher prevalence of hyperinsulinemia than subjects with BMI 30 to 35 kg/m2 (p<0.01). DISCUSSION: This study shows that a substantial part of an Italian obese population has uncomplicated obesity, and the prevalence of adverse risk factors in this sample is unexpectedly low and partially independent of obesity degree. Uncomplicated obesity could represent a well-defined clinical entity.     

Association between obesity and medical care expenditure among Taiwanese adults

The aim of this study is to evaluate the relationships between obesity and medical care expenditure among Taiwanese adults and to assess the influence of sex, age and socioeconomic status. Our study sample consisted of 12,250 adults aged 18 years or older from the 2001 National Health Interview Survey (NHIS), who had consented to the linking of their survey responses with their NHI claims records. Obesity was defined by Body Mass Index based on the WHO-Asia Pacific categories. Adjusted expenditure for obese class II and class I men were, respectively, 44.6% (95%CI: 27.1%-68.7%) and 39.5% (95%CI: 39.4%-41.2%) greater than normal weight men. For obese class II and class I women, the adjusted expenditure were, respectively, 93.3% (95%CI: 69.9%-114.6%) and 56.1% (95%CI: 50.4%-61.4%) greater than normal weight women. After adjusting for other factors, higher medical care expenditure was associated with a higher BMI for each age group. The relative magnitude of the association became more apparent as age increased. Annual medical care expenditure increased as the BMI increased among women, which was particularly apparent among low socioeconomic status women. On the other hand, the relationship between BMI and medical care expenditure in men varied by household income. In conclusion, there is a strong positive relationship between higher BMI and increased medical care expenditure and this varies according to sex, age and socioeconomic status. Our findings suggest that projections of future health care costs attributable to obesity will need to take into consideration the demographic make-up of the obese population.     

Obesity predicts primary health care visits: a cohort study

The objective of this study was to explore the relationship between body mass index (BMI), its association with chronic disease, and its impact on health services utilization in the province of Newfoundland and Labrador, Canada, from 1998 to 2002. A data linkage study was conducted involving a provincial health survey linked to 2 health care use administrative databases. The study population comprised 2345 adults between the ages of 20 and 64 years. Self-reported height and weight measures and other covariates, including chronic diseases, were obtained from a provincial survey. BMI categories include: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese class I (BMI 30-34.9), obese class II (BMI ≥ 35), and obese class III (BMI ≥ 40). Survey responses were linked with objective physician and hospital health services utilization over a 5-year period. Weight classifications in the study sample were as follows: 37% normal, 39% overweight, 17% obese, and 6% morbidly obese. The obese and morbidly obese were more likely to report having serious chronic conditions after adjusting for age and sex. Only the morbidly obese group (BMI ≥ 35 kg/m(2)) had a significantly higher number of visits to a general practitioner (GP) over a 5-year period compared to the normal weight group (median 22.0 vs. 17.0, P<0.05). Using multivariate models and controlling for the number of chronic conditions and other relevant covariates, being morbidly obese remained a significant predictor of GP visits (P<0.001), but was not a predictor for visits to a specialist or any type of hospital use. The increase in the prevalence of obesity is placing a burden at the primary health care level. More resources are needed in order to support GPs in their efforts to manage and treat obese adults who have associated comorbidities.     

Obesity prevalence among veterans at Veterans Affairs medical facilities

BACKGROUND: Obesity is a significant public health problem in the United States. Comprehensive obesity prevalence data among veterans have not been previously reported. METHODS: This is a cross-sectional analysis of 1,803,323 veterans receiving outpatient care at 136 Veterans Affairs (VA) medical facilities in 2000. Measured weight, height, and demographic data were used to obtain age-adjusted prevalences of body mass index (BMI) categories, which were stratified by gender and examined by age and race/ethnicity. RESULTS: Of 93,290 women American veterans receiving care at VA medical facilities during 2000, 68.4% were at least overweight (body mass index [BMI]> or =25 kg/m(2)), with 37.4% classified as obese (BMI> or =30 kg/m(2)), and 6.0% as class-III obese (BMI> or =40 kg/m(2)). Of 1,710,032 men, 73.0% were at least overweight, 32.9% were obese, and 3.3% were class-III obese. Among women, obesity prevalence increased into the sixth and seventh decade of life before prevalence began to decline. Among men, prevalence was lowest for those aged <30 and >70. By race/ethnicity, Native American women (40.7%) and men (35.1%) had the highest prevalence of obesity, while Asian-American women (12.8%) and men (20.6%) had the lowest. CONCLUSIONS: There is a substantial burden of obesity among veterans using VA medical facilities. A comprehensive approach for weight management by the Veterans Health Administration is needed.     

Assessment of the nutritional status of children with special needs in Alexandria. Part II: Anthropometric measures

The present study was undertaken to evaluate the nutritional status of children with special needs in Alexandria city, on the basis of anthropometric measures. The following variables were determined in a sample of 278 disabled children (171 males, 107 females) aged 6 to 24 years, recruited from five specialized day care centers for retarded children in Alexandria: birth order, type of disability, socioeconomic status, body weight, height, body mass index (BMI) and hemoglobin level. Mentally retarded children represent the highest proportion of subjects followed by Down's syndrome and autism. There is an increase in the mean body weight of males with the increase in age among the three type of disability except at age from 14 to 18 years, while there is a fluctuation in the mean body weight between ages and disability among females. Down syndrome groups at all ages are shorter than the other groups, while disabled males are taller than females at all ages. Based on BMI for age, the incidence of obesity was higher among Down's syndrome and mentally retarded females and among autistic males (19.8%, 16.1% of males versus 15.8%, 6.7% of females with mental retardation and autism were underweight). Majority of subjects have mild degree anemia. Hemoglobin levels below the cut-off levels issued by WHO were found higher among autistic and mentally retarded females. The levels were comparable among males with autism and mental retardation and among Down's syndrome males and females. The results also revealed that underweight, overweight and obesity were more common in subjects who showed an evidence of anemia.     

Body weight,blood pressure,and mortality in a cohort of obese patients

The associations between body weight, raised blood pressure, and mortality remain controversial. The authors examined these relations by considering all degrees of obesity in the Düsseldorf Obesity Mortality Study (1961-1994). Among 6,193 obese German patients aged 18-75 years and having a body mass index (BMI) of > or =25 kg/m(2), 1,059 deaths were observed after a median follow-up of 14.8 years. The entire cohort was grouped into quartiles according to BMI (25-<32, 32-<36, 36-<40, > or =40 kg/m(2)) and systolic blood pressure (SBP) (<140, 140-<160, 160-<180, > or =180 mmHg). Cox proportional hazards analyses were performed to adjust for age. For women, the mortality risk curves for the four BMI groups in relation to SBP were flat without crossing, whereas the risk curve for moderately obese men (BMI 25-<32 kg/m(2)) crossed the risk curves for the higher BMI groups. In the group of patients with very high blood pressure (SBP > or = 180 mmHg), moderately obese subjects (BMI 25-<32 kg/m(2)) had a higher mortality risk for men when compared with the BMI group 32-<36 kg/m(2) (hazard ratio =1.62, 95% confidence interval: 1.0, 2.7) but not for women (hazard ratio = 0.71, 95% confidence interval: 0.4, 1.2). These findings support previous observations that the risk of death is lower for hypertensive men in high compared with low BMI groups.     

Serum levels of interleukin-6 and C-reactive protein correlate with body mass index across the broad range of obesity

BACKGROUND: It has been noted that elevated inflammatory markers, such as tumor necrosis factor-alpha (TNF), soluble TNF receptor II (sTNF-RII), interleukin 6 (IL-6) and C-reactive protein (CRP), are characteristically found in the serum in obese patients. In this study, we examined the correlation of these markers with BMI in nonobese, obese, and morbidly obese individuals to explore this relationship across the broad range of obesity. METHODS: A total of 9 nonobese, including normal and overweight (body mass index [BMI] <30 kg/m2) and 41 obese (BMI > or =30 kg/m2) adults were included in this study. Among obese subjects, 11 subjects were grade I or II obese (BMI > or =30 and <40 kg/m2), and 30 subjects were morbidly obese (grade III obese, BMI > or =40 kg/m2). Serum levels of glucose, insulin, TNF, sTNF-RII, IL-6, and CRP were measured. RESULTS: Obese subjects (BMI > or =30 kg/m2) had significantly higher serum levels of TNF, sTNF-RII, IL-6, and CRP compared with nonobese subjects. Serum levels of sTNF-RII, IL-6, and CRP, but not TNF, were positively correlated with BMI in obese subjects. However, in morbidly obese subjects, only the serum concentrations of IL-6 and CRP remained correlated with BMI, primarily because of this relationship in men. CONCLUSIONS: The present results support evidence that obesity represents an inflammatory state. In morbid obesity, the correlation of only IL-6 and CRP with BMI, particularly in males, suggests that IL-6 may be secreted in an endocrine manner in proportion to the expansion of fat mass particularly in the abdominal region, with a corresponding increase in hepatic production of CRP.     

Resting metabolic rate in severely obese diabetic and nondiabetic subjects

OBJECTIVES: To compare the resting metabolic rate (RMR) between diabetic and nondiabetic obese subjects and to develop a predictive equation of RMR for these subjects. RESEARCH METHODS AND PROCEDURES: Obese adults (1088; mean age = 44.9 +/- 12.7 years) with BMI > or = 35 kg/m2 (mean BMI = 46.4 +/- 8.4 kg/m2) were recruited. One hundred forty-two subjects (61 men, 81 women) were diagnosed with type 2 diabetes (DM), giving the prevalence of DM in this clinic population as 13.7%. RMR was measured by indirect calorimetry, and several multivariate linear regression models were performed using age, gender, weight, height, BMI, fat mass, fat mass percentage, and fat-free mass as independent variables. RESULTS: The severely obese patients with DM had consistently higher RMR after adjustment for all other variables. The best predictive equation for the severely obese was RMR = 71.767 - 2.337 x age + 257.293 x gender (women = 0 and men = 1) + 9.996 x weight (in kilograms) + 4.132 x height (in centimeters) + 145.959 x DM (nondiabetic = 0 and diabetic = 1). The age, weight, and height-adjusted least square means of RMR between diabetic and nondiabetic groups were significantly different in both genders. DISCUSSION: Severely obese patients with type 2 diabetes had higher RMR than those without diabetes. The RMR of severely obese subjects was best predicted by an equation using age, gender, weight, height, and DM as variables.     

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BackgroundAlthough recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission.ResultsA total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07?1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04?1.80; P = 0.026).ConclusionsObesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.     

Estimated economic costs of obesity to U.S. business.

OBJECTIVE: To estimate the economic costs of obesity to U.S. business. METHODS: Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as "nonobese" (BMI < 25 kg/m2), "mildly obese" (BMI = 25-28.9 kg/m2), or "moderately to severely obese" (BMI > or = 29 kg/m2). RESULTS: The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively. CONCLUSIONS: The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.     

Weight loss expectations in obese patients seeking treatment at medical centers

OBJECTIVE: To investigate weight loss expectations (expected 1-year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. RESEARCH METHODS AND PROCEDURES: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 +/- 11.0 years; BMI, 38.2 +/- 6.5 kg/m2) were evaluated. Diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale, and Body Uneasiness Test). RESULTS: In 1011 cases (53.4%), 1-year expected BMI loss was > or = 9 kg/m2, dream BMI was 26.0 +/- 3.4 kg/m2 (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 +/- 4.4 kg/m2 (-23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age. DISCUSSION: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients' perceptions and physicians' weight loss recommendations of desirable treatment outcome.