Author
Kevin R. Fontaine
Other affiliations: Johns Hopkins Bayview Medical Center, Veterans Health Administration, University of Alabama ...read more
Bio: Kevin R. Fontaine is an academic researcher from University of Alabama at Birmingham. The author has contributed to research in topics: Body mass index & Population. The author has an hindex of 50, co-authored 157 publications receiving 13577 citations. Previous affiliations of Kevin R. Fontaine include Johns Hopkins Bayview Medical Center & Veterans Health Administration.
Papers published on a yearly basis
Papers
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TL;DR: Obesity appears to lessen life expectancy markedly, especially among younger adults, and Marked race and sex differences were observed in estimated YLL.
Abstract: ContextPublic health officials and organizations have disseminated health messages
regarding the dangers of obesity, but these have not produced the desired
effect.ObjectiveTo estimate the expected number of years of life lost (YLL) due to overweight
and obesity across the life span of an adult.Design, Setting, and SubjectsData from the (1) US Life Tables (1999); (2) Third National Health and
Nutrition Examination Survey (NHANES III; 1988-1994); and (3) First National
Health and Nutrition Epidemiologic Follow-up Study (NHANES I and II; 1971-1992)
and NHANES II Mortality Study (1976-1992) were used to derive YLL estimates
for adults aged 18 to 85 years. Body mass index (BMI) integer-defined categories
were used (ie, <17; 17 to <18; 18 to <19; 20 to <21; 21 to 45;
or ≥45). A BMI of 24 was used as the reference category.Main Outcome MeasureThe difference between the number of years of life expected if an individual
were obese vs not obese, which was designated YLL.ResultsMarked race and sex differences were observed in estimated YLL. Among
whites, a J- or U-shaped association was found between overweight or obesity
and YLL. The optimal BMI (associated with the least YLL or greatest longevity)
is approximately 23 to 25 for whites and 23 to 30 for blacks. For any given
degree of overweight, younger adults generally had greater YLL than did older
adults. The maximum YLL for white men aged 20 to 30 years with a severe level
of obesity (BMI >45) is 13 and is 8 for white women. For men, this could represent
a 22% reduction in expected remaining life span. Among black men and black
women older than 60 years, overweight and moderate obesity were generally
not associated with an increased YLL and only severe obesity resulted in YLL.
However, blacks at younger ages with severe levels of obesity had a maximum
YLL of 20 for men and 5 for women.ConclusionObesity appears to lessen life expectancy markedly, especially among
younger adults.
2,416 citations
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TL;DR: The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based onHRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.
Abstract: ContextObesity is a major health problem in the United States, but the number
of obesity-attributable deaths has not been rigorously estimated.ObjectiveTo estimate the number of deaths, annually, attributable to obesity
among US adults.DesignData from 5 prospective cohort studies (the Alameda Community Health
Study, the Framingham Heart Study, the Tecumseh Community Health Study, the
American Cancer Society Cancer Prevention Study I, and the National Health
and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published
study (the Nurses' Health Study) in conjunction with 1991 national statistics
on body mass index distributions, population size, and overall deaths.SubjectsAdults, 18 years or older in 1991, classified by body mass index (kg/m2) as overweight (25-30), obese (30-35), and severely obese (>35).Main Outcome MeasureRelative hazard ratio (HR) of death for obese or overweight persons.ResultsThe estimated number of annual deaths attributable to obesity varied
with the cohort used to calculate the HRs, but findings were consistent overall.
More than 80% of the estimated obesity-attributable deaths occurred among
individuals with a body mass index of more than 30 kg/m2. When
HRs were estimated for all eligible subjects from all 6 studies, the mean
estimate of deaths attributable to obesity in the United States was 280,184
(range, 236,111-341,153). Hazard ratios also were calculated from data for
nonsmokers or never-smokers only. When these HRs were applied to the entire
population (assuming the HR applied to all individuals), the mean estimate
for obesity-attributable death was 324,940 (range, 262,541-383,410).ConclusionsThe estimated number of annual deaths attributable to obesity among
US adults is approximately 280,000 based on HRs from all subjects and 325,000
based on HRs from only nonsmokers and never-smokers.
1,954 citations
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TL;DR: Additional research is needed to improve both the conceptualization and measurement of HRQL to incorporate the personal preferences and values of the patient, and develop ways to enhance and sustain positive changes in HRQL, even if weight maintenance is elusive.
Abstract: Although it is well documented that obesity is strongly associated with morbidity and mortality, less is known about the impact of obesity on functional status and health-related quality of life (HRQL). However, in recent years research has been conducted to estimate the impact of obesity on HRQL, and to determine the effects of weight reduction on HRQL. The majority of published studies indicate that obesity impairs HRQL, and that higher degrees of obesity are associated with greater impairment. Obesity-associated decrements on HRQL tend to be most pronounced on physical domains of functioning. Studies of the effect of obesity surgery among morbidly obese patients indicate that this procedure produces significant and sustained improvements in the majority of HRQL indices; among mild-to-moderately obese persons, modest weight reduction derived from lifestyle modification also appears to improve HRQL, at least in the short term. Additional research is needed to (1) further characterize the effect that obesity has on HRQL; (2) estimate the short- and long-term effects of various methods of weight reduction (e.g. surgery, lifestyle modification) on HRQL; (3) improve both the conceptualization and measurement of HRQL to incorporate the personal preferences and values of the patient; and (4) develop ways to enhance and sustain positive changes in HRQL, even if weight maintenance is elusive.
691 citations
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Pennington Biomedical Research Center1, Thomas Jefferson University2, Cornell University3, University of Wisconsin-Madison4, University of Alabama at Birmingham5, Michigan State University6, Johns Hopkins University7, University of Auckland8, Louisiana State University9, University of Verona10, Wayne State University11, University of Louisville12, Baylor College of Medicine13
TL;DR: Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects as contributing factors to the obesity epidemic are reviewed.
Abstract: The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines...
639 citations
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TL;DR: Investigation of plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices found supportive evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations.
Abstract: Putative contributors to the secular increase in obesity: exploring the roads less traveled
628 citations
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TL;DR: Current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women, and increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.
Abstract: background The influence of excess body weight on the risk of death from cancer has not been fully characterized. methods In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population. results The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin’s lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women. conclusions Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.
7,095 citations
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TL;DR: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery, and a substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.
Abstract: ContextAbout 5% of the US population is morbidly obese. This disease remains
largely refractory to diet and drug therapy, but generally responds well to
bariatric surgery.ObjectiveTo determine the impact of bariatric surgery on weight loss, operative
mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia,
hypertension, and obstructive sleep apnea).Data Sources and Study SelectionElectronic literature search of MEDLINE, Current Contents, and the Cochrane
Library databases plus manual reference checks of all articles on bariatric
surgery published in the English language between 1990 and 2003. Two levels
of screening were used on 2738 citations.Data ExtractionA total of 136 fully extracted studies, which included 91 overlapping
patient populations (kin studies), were included for a total of 22 094
patients. Nineteen percent of the patients were men and 72.6% were women,
with a mean age of 39 years (range, 16-64 years). Sex was not reported for
1537 patients (8%). The baseline mean body mass index for 16 944 patients
was 46.9 (range, 32.3-68.8).Data SynthesisA random effects model was used in the meta-analysis. The mean (95%
confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%)
for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding;
61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and
70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative
mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive
procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion
or duodenal switch. Diabetes was completely resolved in 76.8% of patients
and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more
of patients. Hypertension was resolved in 61.7% of patients and resolved or
improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients
and was resolved or improved in 83.6% of patients.ConclusionsEffective weight loss was achieved in morbidly obese patients after
undergoing bariatric surgery. A substantial majority of patients with diabetes,
hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete
resolution or improvement.
6,373 citations
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TL;DR: Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status, and increases in obesity and diabetes continue in both sexes, all ages, all races, all educational levels, and all smoking levels.
Abstract: Context Obesity and diabetes are increasing in the United States. Objective To estimate the prevalence of obesity and diabetes among US adults in 2001. Design, Setting, and Participants Random-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001. Main Outcome Measures Body mass index, based on self-reported weight and height and self-reported diabetes. Results In 2001 the prevalence of obesity (BMI ≥30) was 20.9% vs 19.8% in 2000, an increase of 5.6%. The prevalence of diabetes increased to 7.9% vs 7.3% in 2000, an increase of 8.2%. The prevalence of BMI of 40 or higher in 2001 was 2.3%. Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status. Compared with adults with normal weight, adults with a BMI of 40 or higher had an odds ratio (OR) of 7.37 (95% confidence interval [CI], 6.39-8.50) for diagnosed diabetes, 6.38 (95% CI, 5.67-7.17) for high blood pressure, 1.88 (95% CI,1.67-2.13) for high cholesterol levels, 2.72 (95% CI, 2.38-3.12) for asthma, 4.41 (95% CI, 3.91-4.97) for arthritis, and 4.19 (95% CI, 3.68-4.76) for fair or poor health. Conclusions Increases in obesity and diabetes among US adults continue in both sexes, all ages, all races, all educational levels, and all smoking levels. Obesity is strongly associated with several major health risk factors.
5,790 citations
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TL;DR: These analyses show that smoking remains the leading cause of mortality in the United States, however, poor diet and physical inactivity may soon overtake tobacco as the lead cause of death.
Abstract: ContextModifiable behavioral risk factors are leading causes of mortality in
the United States. Quantifying these will provide insight into the effects
of recent trends and the implications of missed prevention opportunities.ObjectivesTo identify and quantify the leading causes of mortality in the United
States.DesignComprehensive MEDLINE search of English-language articles that identified
epidemiological, clinical, and laboratory studies linking risk behaviors and
mortality. The search was initially restricted to articles published during
or after 1990, but we later included relevant articles published in 1980 to
December 31, 2002. Prevalence and relative risk were identified during the
literature search. We used 2000 mortality data reported to the Centers for
Disease Control and Prevention to identify the causes and number of deaths.
The estimates of cause of death were computed by multiplying estimates of
the cause-attributable fraction of preventable deaths with the total mortality
data.Main Outcome MeasuresActual causes of death.ResultsThe leading causes of death in 2000 were tobacco (435 000 deaths;
18.1% of total US deaths), poor diet and physical inactivity (400 000
deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other
actual causes of death were microbial agents (75 000), toxic agents (55 000),
motor vehicle crashes (43 000), incidents involving firearms (29 000),
sexual behaviors (20 000), and illicit use of drugs (17 000).ConclusionsThese analyses show that smoking remains the leading cause of mortality.
However, poor diet and physical inactivity may soon overtake tobacco as the
leading cause of death. These findings, along with escalating health care
costs and aging population, argue persuasively that the need to establish
a more preventive orientation in the US health care and public health systems
has become more urgent.
4,980 citations
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TL;DR: In this paper, the authors provided evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or transient ischemi-chemic attack, including the control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke.
Abstract: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
4,545 citations