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Lifestyle Management of Adult Obesity

Health Risks of Obesity

Overweight and obesity are risk factors for numerous chronic diseases. After statistically accounting for tobacco use, an estimated 325,000 deaths each year are attributable to obesity (body mass index [BMI] > 30.0). [16] Several studies confirm a strong relationship between BMI and mortality in US adult men and women. [17] [18] [19] [20]

Calle et al. reported that the lowest risk for mortality in a 14 year follow-up of a large cohort of 457,785 men and 588,369 women was at a BMI of 23.5 to 24.9 in men and 22.0 to 23.4 in women. [17] The relative risk for mortality in the heaviest BMI group ( > 40) was 2.58 in men and 2.0 for women compared to those in the group between 23.5 and 24.9 in men and 22.0 and 23.4 in women. A high body mass index was most predictive of death from coronary vascular disease (CVD), especially in men (relative risk = 2.90). The CVD risk of overweight and obesity was greater in Caucasians than African-Americans.

Similar findings in large cohorts were reported previously by Manson et al. (women) and Stevens et al. (men and women) although the nadir of their curves was somewhat lower at between 19 and 22 BMI. [18] [19] In the study by Manson et al., the lowest mortality over 16 years was observed among women who weighed at least 15% less than the U.S. average for women of similar age and among those whose weight had remained stable since early adulthood. [18]

In a 26-year study of 26,000 white Seventh Day Adventist women who never smoked and were healthy at baseline, the relative risk of death was lowest for 30-54 year old women at a BMI between 21.3 to 22.9. [15] [20] For women between 55 and 74 years of age, the lowest relative risk was found at a BMI between 23.0 to 24.8.

A recent ten-year follow-up report of middle aged women (Harvard Nurses' Health Study) and men (Health Professionals Follow-up Study) looked at the impact of overweight on the risk of developing common chronic diseases during a 10-year period. [21] The most significant and startling finding from this study was that men and women with a BMI over 35 were approximately 20 times more likely to develop diabetes mellitus (DM) than their same-sex peers with a BMI between 18.5 and 24.9. Additionally, women and men who were not obese, but were overweight (BMI's between 25 and 29.9) were at 1.5 to 2.0 fold greater risk of developing gallstones, hypertension, high cholesterol, colon cancer, heart disease, or stroke. The results of another study also found that persons with coronary artery disease (CAD) and a BMI greater than 35 had a seven-fold increased risk for mortality compared to persons with CAD and a BMI less than 25. [22]

Chronic diseases are the leading causes of mortality and morbidity in the United States and they pose a tremendous public health challenge. Clearly, one of the most well-established risk factors for chronic diseases is overweight and obesity. In fact, a recent report from the RAND Corporation found that after controlling for demographics, obesity was associated with more chronic conditions and worse physical health-related quality of life than tobacco use or poverty. [23]

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Last Update: March 6 2013