The Disease Burden Associated with Overweight and Obesity
TL;DR: A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women.
Abstract: ContextOverweight and obesity are increasing dramatically in the United States
and most likely contribute substantially to the burden of chronic health conditions.ObjectiveTo describe the relationship between weight status and prevalence of
health conditions by severity of overweight and obesity in the US population.Design and SettingNationally representative cross-sectional survey using data from the
Third National Health and Nutrition Examination Survey (NHANES III), which
was conducted in 2 phases from 1988 to 1994.ParticipantsA total of 16,884 adults, 25 years and older, classified as overweight
and obese (body mass index [BMI] ≥25 kg/m2) based on National
Institutes of Health recommended guidelines.Main Outcome MeasuresPrevalence of type 2 diabetes mellitus, gallbladder disease, coronary
heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis.ResultsSixty-three percent of men and 55% of women had a body mass index of
25 kg/m2 or greater. A graded increase in the prevalence ratio
(PR) was observed with increasing severity of overweight and obesity for all
of the health outcomes except for coronary heart disease in men and high blood
cholesterol level in both men and women. With normal-weight individuals as
the reference, for individuals with BMIs of at least 40 kg/m2 and
who were younger than 55 years, PRs were highest for type 2 diabetes for men
(PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95%
CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2)
and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater
in younger than in older adults. The prevalence of having 2 or more health
conditions increased with weight status category across all racial and ethnic
subgroups.ConclusionsBased on these results, more than half of all US adults are considered
overweight or obese. The prevalence of obesity-related comorbidities emphasizes
the need for concerted efforts to prevent and treat obesity rather than just
its associated comorbidities.
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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
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
TL;DR: The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late.
Abstract: Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:
3,953 citations
TL;DR: It is shown that JNK activity is abnormally elevated in obesity and an absence of JNK1 results in decreased adiposity, significantly improved insulin sensitivity and enhanced insulin receptor signalling capacity in two different models of mouse obesity.
Abstract: Obesity is closely associated with insulin resistance and establishes the leading risk factor for type 2 diabetes mellitus, yet the molecular mechanisms of this association are poorly understood. The c-Jun amino-terminal kinases (JNKs) can interfere with insulin action in cultured cells and are activated by inflammatory cytokines and free fatty acids, molecules that have been implicated in the development of type 2 diabetes. Here we show that JNK activity is abnormally elevated in obesity. Furthermore, an absence of JNK1 results in decreased adiposity, significantly improved insulin sensitivity and enhanced insulin receptor signalling capacity in two different models of mouse obesity. Thus, JNK is a crucial mediator of obesity and insulin resistance and a potential target for therapeutics.
3,146 citations
Cites background from "The Disease Burden Associated with ..."
...Obesity and type 2 diabetes are the most prevalent and serious metabolic diseases; they affect more than 50% of adults in the US...
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TL;DR: From an analysis of the effect of obesity on longevity, it is concluded that the steady rise in life expectancy during the past two centuries may soon come to an end.
Abstract: Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its estimates of how long Americans are going to live in the 21st century, current trends in obesity in the United States suggest that these estimates may not be accurate. From our analysis of the effect of obesity on longevity, we conclude that the steady rise in life expectancy during the past two centuries may soon come to an end.
2,798 citations
References
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Journal Article•
8,507 citations
TL;DR: This work proposes a simple method to approximate a risk ratio from the adjusted odds ratio and derive an estimate of an association or treatment effect that better represents the true relative risk.
Abstract: Logistic regression is used frequently in cohort studies and clinical trials. When the incidence of an outcome of interest is common in the study population (>10%), the adjusted odds ratio derived from the logistic regression can no longer approximate the risk ratio. The more frequent the outcome, the more the odds ratio overestimates the risk ratio when it is more than 1 or underestimates it when it is less than 1. We propose a simple method to approximate a risk ratio from the adjusted odds ratio and derive an estimate of an association or treatment effect that better represents the true relative risk.
3,616 citations
"The Disease Burden Associated with ..." refers methods in this paper
...We corrected the PORs using the method of Zhang and Yu.24 Using our logistic regression models, we estimated the baseline prevalence of each condition for normal weight individuals, of modal race or ethnicity and modal smoking status....
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...We corrected the PORs using the method of Zhang and Yu.(24) Using our logistic regression models, we estimated the baseline prevalence of each condition for normal weight individuals, of modal race or ethnicity and modal smoking status....
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TL;DR: Between 1976–80 and 1988–94, the prevalence of obesity (BMI≥30.0) increased markedly in the US, in agreement with trends seen elsewhere in the world.
Abstract: OBJECTIVE: To describe the prevalence of, and trends in, overweight and obesity in the US population using standardized international definitions. DESIGN: Successive cross-sectional nationally representative surveys, including the National Health Examination Survey (NHES I; 1960–62) and the National Health and Nutrition Examination Surveys (NHANES I: 1971–1974; NHANES II: 1976–1980; NHANES III: 1988–94). Body mass index (BMI: kg/m2) was calculated from measured weight and height. Overweight and obesity were defined as follows: Overweight (BMI≥25.0); pre-obese (BMI 25.0–29.9), class I obesity (BMI 30.0–34.9), class II obesity (BMI 35.0–39.9), and class III obesity (BMI≥40.0). RESULTS: For men and women aged 20–74 y, the age-adjusted prevalence of BMI 25.0–29.9 showed little or no increase over time (NHES I: 30.5%, NHANES I: 32.0%, NHANES II: 31.5% and NHANES III: 32.0%) but the prevalence of obesity (BMI≥30.0) showed a large increase between NHANES II and NHANES III (NHES I: 12.8%; NHANES I, 14.1%; NHANES II, 14.5% and NHANES III, 22.5%). Trends were generally similar for all age, gender and race-ethnic groups. The crude prevalence of overweight and obesity (BMI>25.0) for age≥20 y was 59.4% for men, 50.7% for women and 54.9% overall. The prevalence of class III obesity (BMI≥40.0) exceeded 10% for non-Hispanic black women aged 40–59 y. CONCLUSIONS: Between 1976–80 and 1988–94, the prevalence of obesity (BMI≥30.0) increased markedly in the US. These findings are in agreement with trends seen elsewhere in the world. Use of standardized definitions facilitates international comparisons.
3,055 citations
"The Disease Burden Associated with ..." refers background or methods in this paper
...Recent estimates suggest that1 in2adults in the UnitedStates isoverweightorobese,defined by a body mass index (BMI) of higher than 25, an increase of more than 25% over the past 3 decades.(4) These dramatic increaseshaveoccurredamongthe 3 major racial and ethnic groups and include both sexes....
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...timates based on these definitions differ slightly from those published by Flegal and colleagues.(4) Their report was based on adults 20 years or older, whereas our report includes adults aged 25 years or older....
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...These dramatic increaseshaveoccurredamongthe 3 major racial and ethnic groups and include both sexes.(4)...
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TL;DR: The high rates of abnormal fasting and postchallenge glucose found in NHANES III, together with the increasing frequency of obesity and sedentary lifestyles in the population, make it likely that diabetes will continue to be a major health problem in the U.S.
Abstract: OBJECTIVE To evaluate the prevalence and time trends for diagnosed and undiagnosed diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults by age, sex, and race or ethnic group, based on data from the Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES 111) and prior Health and Nutrition Examination Surveys (HANESs). RESEARCH DESIGN AND METHODS NHANES III contained a probability sample of 18,825 U.S. adults ≥20 years of age who were interviewed to ascertain a medical history of diagnosed diabetes, a subsample of 6,587 adults for whom fasting plasma glucose values were obtained, and a subsample of 2,844 adults between 40 and 74 years of age who received an oral glucose tolerance test. The Second National Health and Nutrition Examination Survey, 1976–1980, and Hispanic HANES used similar procedures to ascertain diabetes. Prevalence was calculated using the 1997 American Diabetes Association fasting plasma glucose criteria and the 1980–1985 World Health Organization (WHO) oral glucose tolerance test criteria. RESULTS Prevalence of diagnosed diabetes in 1988–1994 was estimated to be 5.1% for U.S. adults ≥20 years of age (10.2 million people when extrapolated to the 1997 U.S. population). Using American Diabetes Association criteria, the prevalence of undiagnosed diabetes (fasting plasma glucose ≥126 mg/dl) was 2.7% (5.4 million), and the prevalence of impaired fasting glucose (110 to CONCLUSIONS The high rates of abnormal fasting and postchallenge glucose found in NHANES III, together with the increasing frequency of obesity and sedentary lifestyles in the population, make it likely that diabetes will continue to be a major health problem in the U.S
2,775 citations