Eligibility for obesity treatment and risk of mortality in men

OBJECTIVE: To evaluate the risk of all-cause and cardiovascular disease (CVD) mortality associated with each outcome of the NIH obesity treatment algorithm and to examine the effects of cardiorespiratory fitness on the risk of mortality associated with these outcomes. RESEARCH METHODS AND PROCEDURES: The NIH obesity treatment algorithm was applied to 18,666 men (20 to 64 years of age) from the Aerobics Center Longitudinal Study in Dallas, TX, examined between 1979 and 1995. Risk of all-cause and CVD mortality was assessed using Cox proportional hazards regression. RESULTS: A total of 7029 men (37.7%) met the criteria for needing weight loss treatment [overweight (BMI = 25 to 29.9 kg/m2 or WC > 102 cm) with > or =2 CVD risk factors or obese (BMI > or = 30 kg/m2)]. Mortality surveillance through 1996 identified 435 deaths (151 from CVD) during 191,364 man-years of follow-up. Compared with the normal weight reference group, the hazard ratios (95% confidence interval) for death from all causes were 0.63 (0.45 to 0.88), 1.23 (0.98 to 1.54), 1.05 (0.60 to 1.85), and 1.71 (1.64 to 2.31) for men who were overweight with <2 CVD risk factors, overweight with > or = 2 CVD risk factors, obese with <2 CVD risk factors, and obese with > or =2 CVD risk factors, respectively. Corresponding hazard ratios for CVD mortality were 0.72 (0.38 to 1.37), 1.67 (1.12 to 2.50), 1.69 (0.67 to 4.30), and 3.31 (2.07 to 5.30). Including physical fitness as a covariate significantly attenuated all risk estimates. DISCUSSION: The NIH obesity treatment algorithm is useful in identifying men at increased risk of premature mortality; however, including an assessment of fitness would help improve risk stratification among all groups of patients.     

The case for action on socioeconomic differences in overweight and obesity among Australian adults: modelling the disease burden and healthcare costs

Objective : We aimed to quantify the extent to which socioeconomic differences in body mass index (BMI) drive avoidable deaths, incident disease cases and healthcare costs. Methods : We used population attributable fractions to quantify the annual burden of disease attributable to socioeconomic differences in BMI for Australian adults aged 20 to <85 years in 2016, stratified by quintiles of an area‐level indicator of socioeconomic disadvantage (SocioEconomic Index For Areas Indicator of Relative Socioeconomic Disadvantage; SEIFA) and BMI (normal weight, overweight, obese). We estimated direct healthcare costs using annual estimates per person per BMI category. Results : We attributed $AU1.06 billion in direct healthcare costs to socioeconomic differences in BMI in 2016. The greatest number (proportion) of cases and deaths attributable to socioeconomic differences in BMI was observed for type 2 diabetes among women (8,602 total cases [16%], with 3,471 cases [22%] in the most disadvantaged quintile [SEIFA 1]) and all‐cause mortality among men (2027 total deaths [4%], with 815 deaths [6%] in SEIFA 1). Conclusions : Socioeconomic differences in BMI substantially contribute to avoidable deaths, disease cases and direct healthcare costs in Australia. Implications for public health : Population‐level policies to reduce socioeconomic differences in overweight and obesity must be identified and implemented.     

Exercise, body mass index, caloric intake, and cardiovascular mortality

BACKGROUND: The association of physical inactivity and elevated body mass index (BMI) with cardiovascular disease (CVD) risk is well established. The relationship of dietary caloric intake and CVD risk is less certain. METHODS: The epidemiologic follow-up of the First National Health and Nutrition Examination Survey (1971-1992) was examined to determine the relationship of caloric intake, BMI, and physical activity to CVD mortality. Of 14,407 participants, 9790 subjects aged 25 to 74 years met inclusion criteria. The CVD mortality rate was the outcome. RESULTS: During the 17 years of follow-up, there were 3183 deaths, 1531 of which were due to CVD (9.11/1000 person-years). People with relatively less physical activity, lower caloric intake, and who were overweight (BMI 25 to 29.9 kg/m(2)) and obese (BMI > or =30 kg/m(2)) had a less favorable baseline CVD risk profile than did those who were more active and of normal weight and had greater caloric intake. Age- and race/ethnicity-adjusted CVD mortality rates were highest among those with the least physical activity and lowest caloric intake, and who were overweight or obese. Moreover, subjects of normal weight who exercised most were more likely to have high caloric intake and lower CVD mortality (5.9 vs 14.7 per 1000 person-years, p =0.01) than subjects who were obese and exercised least. In Cox regression analysis, controlling for relevant CVD risk factors, least physical activity was independently associated with increased CVD mortality (hazard ratio=1.32, 95% confidence interval [CI]=1.13-1.53); and obesity was associated with increased CVD mortality (hazard ratio=1.24, 95% CI=1.06-1.44). Although highest dietary caloric intake was associated with reduced CVD mortality (hazard ratio=0.83, 95% CI=0.74-0.93), after adjusting for physical activity and BMI, there was no significant association of highest caloric intake with CVD mortality (hazard ratio=0.91, 95% CI=0.81-1.01). CONCLUSIONS: In this large general population sample, lower levels of physical activity and obesity were independently associated with decreased CVD survival. Moreover, when BMI, physical activity, and other relevant characteristics were taken into account, caloric intake was not related to CVD mortality.     

Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities

BACKGROUND: Overweight and obesity have reached epidemic proportions in Latin America. OBJECTIVE: The purpose of this study was to explore social and behavioral factors associated with obesity in Peruvian cities. DESIGN: Between 1998 and 2000 health examination surveys were conducted among adults in 1176 families identified in six cities. Stratified by social class, multistaged random sampling was used. Using body mass index (weight (kg)/height (m)(2)), men and women were classified into normal weight (BMI <25), overweight (BMI 25-29), or obese (BMI > or =30); abdominal circumference (> or =94 cm in men and > or =84 cm in women) further identified morbidity risk. Several demographic, social, and behavioral variables were collected following standardized procedures. RESULTS: Adjusting for age, 37% of women were categorized as normal weight, 40% overweight, and 23% obese; corresponding figures for men were 40, 44, and 16%. More developed cities, e.g., Lima, Arequipa, and Ica, had the largest prevalence of overweight and obesity for both men and women. Adjusted logistic models showed that BMI > or =25 was positively correlated with age; whereas, education was negatively associated, only among women. Other significant associated factors of overweight included city of residence, television viewing > or =4 h daily in women, and underestimation of body weight status. CONCLUSIONS: The study showed elevated rates of overweight across the income level spectrum. Factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight and must be considered in designing future public health interventions. Underestimation of body weight status and sedentary behavior may also constitute specific areas of intervention.     

Impact of Waist Circumference Difference on Health-Care Cost among Overweight and Obese Subjects: The PROCEED Cohort

ObjectiveTo estimate the incremental effect of waist circumference (WC) on health-care costs among overweight and obese subjects after adjusting for body mass index (BMI).MethodsA prospective study. The subjects were members of Internet panels in the United States (US) and Germany. 10,816 individuals (United States: n = 5410; Germany: n = 5406) aged 30–70 years with BMI scores between 20 and 35 kg/m² were recruited and grouped by category: healthy weight (BMI 20–24.9 kg/m²), overweight (BMI 25–29.9 kg/m²), and obese (BMI 30–35 kg/m²). Within the overweight and obese categories, the individuals were stratified by sex and within those subgroups, characterized as above or below the median WC. The subjects self-reported weight, WC, and health-care resource use at baseline, 3 months, and 6 months using online questionnaires. Over 65% of the recruited subjects completed all surveys. Resource utilization was translated into health-care costs by multiplying unit costs from national sources in each country. Annualized health costs were summarized for subjects with low and high WC within the overweight and obese categories. A two-part model generated predicted annual costs because of the WC difference controlling for BMI, demographic, and lifestyle variables among the overweight and obese subjects.ResultsWhen BMI and other characteristics are constant, annual health-care costs are 16% to 18% higher in Germany and 20% to 30% higher in the United States for the subjects with a high WC compared with subjects with a low WC.ConclusionsTargeting people with a high waist circumference for weight management whether they are overweight or obese may maximize cost-efficacy.     

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.     

Basal endothelial nitric oxide release is preserved in overweight and obese adults

OBJECTIVE: Impaired basal nitric oxide release is associated with a number of cardiovascular disorders including hypertension, arterial spasm, and myocardial infarction. We determined whether basal endothelial nitric oxide release is reduced in otherwise healthy overweight and obese adult humans. RESEARCH METHODS AND PROCEDURES: Seventy sedentary adults were studied: 32 normal weight (BMI <25 kg/m(2)), 24 overweight (BMI > or = 25 < 30 kg/m(2)), and 14 obese (BMI > or = 30 kg/m(2)). Forearm blood flow (FBF) responses to intra-arterial infusions of N(g)-monomethyl-L-arginine (5 mg/min), a nitric oxide synthase inhibitor, were used as an index of basal nitric oxide release. RESULTS: N(g)-monomethyl-L-arginine elicited significant reductions in FBF in the normal weight (from 4.1 +/- 0.2 to 2.7 +/- 0.2 mL/100 mL tissue/min), overweight (4.1 +/- 0.1 to 2.8 +/- 0.2 mL/100 mL tissue/min), and obese (3.9 +/- 0.3 to 2.7 +/- 0.2 mL/100 mL tissue/min) subjects. Importantly, the magnitude of reduction in FBF (approximately 30%) was similar among the groups. DISCUSSION: These results indicate that the capacity of the endothelium to release nitric oxide under basal conditions is not compromised in overweight and obese adults.     

Economic costs of obesity to self-insured employers

OBJECTIVE:: To quantify the direct and indirect costs of obesity within a cohort of commercially insured employees in the United States. METHOD:: Health plan claims, self-reported health risk assessment, and productivity data (Thomson MarketScan) from 2003 to 2005 were used to identify employees. Two-part regression models were used to compare body mass index (BMI) groups to estimate the incremental direct and indirect costs, conditional on expenditure, associated with elevated BMI. RESULTS:: Regression-adjusted incremental direct medical costs associated with being overweight, obese, and severely obese were estimated to be $147.11, $712.34, and $1977.43, respectively. Adjusted incremental indirect costs due to paid absence associated with being overweight, obese, and severely obese were estimated at $1403.81, $1511.24, and $1414.09, respectively. CONCLUSIONS:: Overall adjusted direct and indirect costs were higher for workers with elevated BMI relative to those of normal weight.     

Primary care of overweight children: the importance of parent weight and attitudes about overweight: a MetroNet study.

PURPOSE: The purpose of this study was to identify the association of parents' weight and attitude about their child's weight with the child's body mass index (BMI) status. DESIGN: Cross-sectional, clinic-based study in a practice-based research network. METHODS: One hundred seventy-one parents or adults accompanying children aged 5 to 17 years to a primary care visit in 4 family medicine centers completed a questionnaire. Parent/adult overweight status and attitudes were compared with child overweight status. RESULTS: Forty-eight percent of children were overweight or obese (BMI >or= the 85th percentile) as were 56% of mothers and 77% of fathers (BMI >or= 25 kg/m(2)). Child and parent overweight were significantly associated, as were mother overweight and beliefs about child overweight status. Children aged 5 to 13 years were more likely to be overweight than those aged >or=14 years. CONCLUSIONS: Parents of overweight children are often overweight and many do not recognize that their children are overweight. Suggestions are made for primary care physicians to engage parents of overweight children in family weight control efforts.     

Body fat percentages measured by dual-energy X-ray absorptiometry corresponding to recently recommended body mass index cutoffs for overweight and obesity in children and adolescents aged 3-18 y

BACKGROUND: Body mass index (BMI; in kg/m2) cutoffs for use with children and adolescents aged 2-18 y that correspond to the well-accepted BMI cutoffs for overweight (> or = 25 but < 30) and obesity (> or = 30) in adults were published recently. OBJECTIVE: The objective was to estimate the percentage body fat (%BF) values typically associated with these BMI cutoffs in children and adolescents. DESIGN: The %BF was measured by dual-energy X-ray absorptiometry in 661 subjects (49% male) aged 3-18 y. Regression equations using BMI, age, and sex were developed to predict the %BF associated with BMI cutoffs for overweight (age-specific BMI equivalent to a BMI of 25 in an 18-y-old) and obesity (age-specific BMI equivalent to a BMI of 30 in an 18-y-old) over this age range. RESULTS: Measurements classified 17.1% of males and 19.8% of females as overweight and 5.5% of males and 7.5% of females as obese. The %BF associated with an obese BMI tended to be higher in peripubertal males (34-36%) than in younger (24-30%) or older (27-30%) males. Although the predicted %BF of young females was similar to that of young males, values rose steadily with age, such that an 18-y-old female with a BMI of 30 had an estimated %BF of 42%, whereas that in males of similar age was 27%. CONCLUSION: The %BF values associated with BMI classifications of overweight and obesity vary considerably with age in growing children, particularly in girls.     

Additive interactions of maternal prepregnancy BMI and breast-feeding on childhood overweight

OBJECTIVE: To examine the interactions of maternal prepregnancy BMI and breast-feeding on the risk of overweight among children 2 to 14 years of age. RESEARCH METHODS AND PROCEDURES: The 1996 National Longitudinal Survey of Youth, Child and Young Adult data in the United States were analyzed (n = 2636). The weighted sample represented 51.3% boys, 78.0% whites, 15.0% blacks, and 7.0% Hispanics. Childhood overweight was defined as BMI >/=95th percentile for age and sex. Maternal prepregnancy obesity was determined as BMI >/=30 kg/m(2). The duration of breast-feeding was measured as the weeks of age from birth when breast-feeding ended. RESULTS: After adjusting for potential confounders, children whose mothers were obese before pregnancy were at a greater risk of becoming overweight [adjusted odds ratio (OR), 4.1; 95% confidence interval (CI), 2.6, 6.4] than children whose mothers had normal BMI (<25 kg/m(2); p < 0.001 for linear trend). Breast-feeding for >/=4 months was associated with a lower risk of childhood overweight (OR, 0.6; 95% CI, 0.4, 1.0; p = 0.06 for linear trend). The additive interaction between maternal prepregnancy obesity and lack of breast-feeding was detected (p < 0.05), such that children whose mothers were obese and who were never breast-fed had the greatest risk of becoming overweight (OR, 6.1; 95% CI, 2.9, 13.1). DISCUSSION: The combination of maternal prepregnancy obesity and lack of breast-feeding may be associated with a greater risk of childhood overweight. Special attention may be needed for children with obese mothers and lack of breast-feeding in developing childhood obesity intervention programs.     

The relationship between obesity and injuries among U.S. adults

PURPOSE: To quantify the relationship between body mass index (BMI) and rates of medically attended injuries by mechanism (overall, fall, motor vehicle, and sport-related) and by nature (strain/sprain, lower extremity fracture, and dislocations), and between BMI and injury treatment costs. DESIGN: Cross-sectional analysis. SETTING. The noninstitutionalized population of the United States. SUBJECTS: The 1999-2000, 2000-2001, and 2001-2002 waves of the Medical Expenditure Panel Survey, a large, nationally representative dataset, were combined to create the analysis sample. The final sample included 42,304 adults. MEASURES. Medically attended injury rates by mechanism and nature of injury and related treatment costs. ANALYSIS: Logistic regressions were used to separately estimate the odds of sustaining any injury by mechanism or by nature for overweight (25 < BMI : 29.9) and three categories of obese individuals compared with those who were normal weight. A second set of regressions tested whether, given that an injury occurred, obese individuals had greater injury treatment costs. RESULTS. Slightly more than one in five adults sustain an injury each year that requires medical treatment. The odds of sustaining an injury are 15% (overweight) to 48% (Class III obesity) greater among those with excess weight. Conditional on sustaining an injury, BMI did not have a significant impact on injury treatment costs. CONCLUSION: Our findings show a clear association between BMI and the probability of sustaining an injury. If increasing BMI is causing the rise in injury rates, then the incidence of injuries, including those related to falls, sprains/strains, lower extremity fractures, and joint dislocations, are likely to increase as the prevalence of obesity increases.     

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.     

Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery

BACKGROUND: The association between excessive gestational weight gain and preterm delivery is unclear, as is the association between low gestational weight gain and preterm delivery among overweight and obese women. METHODS: Using data from the Pregnancy Risk Assessment Monitoring System in 21 states, we estimated the risk of very (20-31 weeks) and moderately (32-36 weeks) preterm delivery associated with a combination of prepregnancy body mass index (BMI) and gestational weight gain among 113,019 women who delivered a singleton infant during 1996-2001. We categorized average weight gain (kilograms per week) as very low (<0.12), low (0.12-0.22), moderate (0.23-0.68), high (0.69-0.79), or very high (>0.79). We categorized prepregnancy BMI (kg/m) as underweight (<19.8), normal (19.8-26.0), overweight (26.1-28.9), obese (29.0-34.9), or very obese (>or=35.0). We examined associations for all women and for all women with no complications adjusting for covariates. RESULTS: There was a strong association between very low weight gain and very preterm delivery that varied by prepregnancy BMI, with the strongest association among underweight women (adjusted odds ratio = 9.8; 95% confidence interval = 7.0-13.8) and the weakest among very obese women (2.3; 1.8-3.1). Very low weight gain was not associated with moderately preterm delivery for overweight or obese women. Women with very high weight gain had approximately twice the odds of very preterm delivery, regardless of prepregnancy BMI. CONCLUSIONS: This study supports concerns about very low weight gain during pregnancy, even among overweight and obese women, and also suggests that high weight gain, regardless of prepregnancy BMI, deserves further investigation.     

Correlates of body mass index in hazardous materials firefighters.

We analyzed results from the medical examinations of 340 hazardous materials (HAZMAT) firefighters and observed the relationships between selected parameters and body mass index (BMI). Heights and weights were available for 98% of the subjects (333 of 340). The mean BMI was 28.9 +/- 4.1 kg/m2. Eighty-seven percent (290 of 333) of subjects were overweight (BMI > or = 25) and 34% (113 of 333) were obese (BMI > or = 30). Two percent (7 of 333) were morbidly obese (BMI > or = 39). For comparison purposes, we divided subjects into low (BMI < 27), medium (BMI 27 to < 30), and high (BMI > or = 30) BMI groups. The results demonstrated adverse associations between increasing BMI and resting blood pressures, forced vital capacity, alanine aminotransferase, aspartate aminotransferase, serum cholesterol, and overall morbidity scores. The high prevalence of overweight and obesity and the associated adverse health effects support the development and implementation of fitness-promotion programs for firefighters.     

A Preliminary analysis of medical expenditures among active and sedentary US adults with mental disorders

OBJECTIVE: To determine whether leisure-time physical activity is associated with lower direct annual medical expenditures among a sample of adults with mental disorders. METHODS: Using the 1995 National Health Interview Survey and 1996 Medical Expenditure Panel Survey, differences between medical expenditures for sedentary and active persons were analyzed using t-tests. RESULTS: The per capita annual direct medical expenditure was US 2785 dollars higher for sedentary than for active persons (P<0.05). The total expenditure associated with sedentary behavior was US 31.7 billion dollars (US 19.1 billion dollars in men; US 12.6 billion dollars in women). CONCLUSIONS: Physical activity is associated with a reduced economic burden among people with mental disorders.     

A comprehensive examination of health conditions associated with obesity in older adults

BACKGROUND: Over 70% of older adults in the United States are overweight or obese. To examine the overall health burden of obesity in older adults, the Vitamins and Lifestyle cohort study of western Washington State recruited 73,003 adults aged 50 to 76 who completed a self-administered questionnaire on current height and weight, medical history, and risk factors. METHODS: Cross-sectional analysis of body mass index (BMI) and health conditions was performed using data collected in 2000 to 2002. Participants were categorized as normal weight, overweight, obese I, or obese II/III using BMI cut-points. Health conditions included 7 serious diseases, 2 conditions associated with cardiovascular disease risk, 23 medical conditions, and 11 health complaints. Odds ratios (ORs) from logistic regression models were used to examine associations of the four BMI categories with each health condition. Analyses were gender stratified and adjusted for age, education, race/ethnicity, and smoking status. RESULTS: Among women, 34% were overweight, 16% in the obese I category, and 10% in obese categories II/III. Among men, 49% were overweight, 18% in the obese I category, and 6% in obese categories II/III. Overall, 37 of 41 conditions examined for women and 29 of 41 conditions examined for men were associated with increased levels of BMI (trend p <0.05 for all models). For women and men, respectively, the highest ORs comparing obese II/III to normal weight were diabetes (OR=12.5 and 8.3), knee replacement (OR=11.7 and 6.1), and hypertension (OR=5.4 and 5.6). Obesity also increased the odds of several rare diseases such as pancreatitis (OR=1.9 and 1.5) and health complaints such as chronic fatigue (OR=3.7 and 3.5) and insomnia (OR=3.5 and 3.1). CONCLUSIONS: A broad range of diseases and health complaints are associated with obesity. Clinicians should be aware of the diverse ways in which being overweight or obese may affect the health of their patients when counseling them about weight loss.     

BMI and health-related quality of life in adults 65 years and older

OBJECTIVE: To examine relationships of BMI with health-related quality of life in adults 65 years and older. RESEARCH METHODS AND PROCEDURES: In 1996, a health survey was mailed to all surviving participants > or = 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (> or = 30.0). Main outcome measures were Health Status Questionnaire-12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations-physical, bodily pain, energy/fatigue, social functioning, role limitations-mental, and mental health. The higher the score, the better the outcome. RESULTS: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well-being among women only. Both underweight men and women reported impairment in physical, social, and mental well-being. For example, multivariable-adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. DISCUSSION: Compared with normal-weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well-being. These results reinforce the importance of normal body weight in older age.     

Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies

PURPOSE: For this report, we examined the relationships between the conditions of being overweight and obese and mortality from all causes, heart disease, cardiovascular disease, and cancer. METHODS: We defined the categories of body weight according to level of body mass index, BMI=wt(kg)/ht(m)2, using classifications suggested by the National Institutes of Health and the World Health Organization. These classifications are as follows: "normal weight" is defined as BMI > or = 18.5, but less than 25; "overweight" equals BMI > or = 25, but less than 30; and "obese" individuals have BMIs > or = 30. Our investigation is based on person-level data from 26 observational studies that include both genders, several racial and ethnic groups, and samples from the US and other countries. The database consists of 74 analytic cohorts, arranged according to natural strata including gender, race, and area of residence. It includes 388,622 individuals, with 60,374 deaths during follow-up. We use proportional hazards models to examine the relationships between the BMI categories and mortality, controlling for age and smoking status. We use random-effects models to assess summary relative risks associated with the overweight and obesity conditions across cohorts. RESULTS: The relative risks among the heaviest individuals for overall death, death caused by coronary heart disease (CHD), and death caused by cardiovascular disease (CVD) are 1.22, 1.57, and 1.48, respectively, when compared with the those within the lowest BMI category. The summary relative risk among the heaviest participants for death from cancer is 1.07. CONCLUSIONS: We document once again, excess mortality associated with obesity. Our results do, however, question whether the current classification of individuals as "overweight" is optimal in the sense, since there is little evidence of increased risk of mortality in this group.     

Association of body mass index and weight change with all-cause mortality in the elderly

The authors explored the relation of body mass index (BMI; weight (kg)/height (m)(2)) and weight change to all-cause mortality in the elderly, using data from a large, population-based California cohort study, the Leisure World Cohort Study. They estimated relative risks of mortality associated with self-reported BMI at study entry, BMI at age 21 years, and weight change between age 21 and study entry. Participants were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), or obese (BMI >or=30). Of 13,451 participants aged 73 years (on average) at study entry (1981-1985), 11,203 died during 23 years of follow-up (1981-2004). Relative to normal weight, being underweight (relative risk (RR) = 1.51, 95% confidence interval (CI): 1.38, 1.65) or obese (RR = 1.25, 95% CI: 1.13, 1.38) at study entry was associated with increased mortality. People who were either overweight or obese at age 21 also had increased mortality (RR = 1.17, 95% CI: 1.09, 1.25). Participants who lost weight between age 21 and study entry had increased mortality regardless of their BMI category at age 21. Obesity was significantly associated with increased mortality only among persons under age 75 years and among never or past smokers. This study highlights the influence on older-age mortality risk of being overweight or obese in young adulthood and underweight or obese in later life.