Underweight, overweight and obesity as risk factors for mortality and hospitalization
ABSTRACT The prevalence of overweight and obesity is increasing in many countries. We aimed to investigate differences in mortality and severe morbidity between underweight people (body mass index (BMI)<18.5), overweight people (BMI 25 to <30), obese people (BMI> or =30), and those with normal weights (BMI 18.5 to <25).
Random samples of the Swedish population aged 16-74 years in 1980-81 and 1988-89 were followed for 12 years with regard to all-cause mortality and mortality from circulatory diseases, all inpatient care, and inpatient care for circulatory and musculoskeletal diseases. Relative risks (RRs) for different levels of BMI were adjusted for age, longstanding illness, smoking, and educational level at baseline. In addition, analyses were made with delayed entry until the fourth-year after interview.
Obesity and underweight, but not overweight, was associated with higher all-cause mortality. Among underweight men, the adjusted RR for all-cause mortality was 2.4 (95% confidence interval 1.6-3.6), and among underweight women it was 2.0 (1.5-2.7), but population attributable risks (PARs) were small, at 1.2% and 2.7%, respectively. Overweight was associated with increased risks for inpatient care for circulatory diseases, with PARs being 13.4% among men and 8.1% among women, and musculoskeletal diseases (PARs were 12.7% and 12.9%, respectively). Obese men and women had about 50% higher risks of all-cause mortality than normal-weight people, PARs being 3.2% and 3.8% respectively.
This study supports the findings of other studies, in that overweight seems to be an exaggerated risk factor for all-cause mortality, but is related to other chronic disease. Underweight and obesity generally implies greater increases of RRs, but avoidance of overweight may have greater effect on the population level with regard to reduced cardiovascular and locomotor disease.
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ABSTRACT: The purpose of this study was to assess the perceptions in subgroups of the population on the counselling on lifestyle by health care professionals and the factors associated with this. The design was cross-sectional, based on a random sample of women and men aged 18-84 in south-central Sweden. The study was carried out in 2004 using a mail survey. Respondents who had reported at least one visit to a health care provider (and had also reported their weight and height) were eligible for this study. Multivariate logistic regression model was built to estimate odds ratios. In the area, approximately 49 percent of women and 62 percent of men who visited a health care provider were overweight or obese. Health care professionals asked those with raised BMI more often about their diet (normal-weight 14 percent, overweight 15 percent, obese 21 percent) and physical activity (PA) (normal-weight 17 percent, overweight 22 percent, obese 26 percent). Advising a change of habits showed a similar trend, although on lower levels than asking. An association with counselling about diet and PA was found for gender, age, country of birth, BMI, and weight-related comorbidities. The most notable was a strong association between health factors and reported counselling. Counselling about behaviour was strongly associated with smoking and risk-level drinking. The findings indicate that the majority of persons with lifestyle related risk factors did not receive lifestyle counselling. Obese persons, those with weight-related comorbidities, men, younger, and foreign-born people received diet and PA advice more often. The results show that further improvement of strategies for promoting a healthy lifestyle in health care settings is needed.
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ABSTRACT: Despite intense policy, media and research interest, childhood obesity rates continue to rise in most countries. Screening may seem a logical response to a situation in which obesity does not usually resolve spontaneously, yet most obese children do not present for treatment. This article explores recent evidence for and against monitoring and screening of children's BMI. Whether conducted in primary care or school settings, population screening of children's BMI can be feasible, acceptable and not intrinsically harmful. However, it incurs a substantial cost, and randomized controlled trials do not suggest that it improves BMI outcomes. Population trends in BMI are more complex than a simple rise in obesity; birth cohorts with higher rates of childhood overweight are not inevitably more overweight as young adults. The consequences of a concomitant increase in thinness are uncertain. Systematic monitoring of BMI is essential, but need not be continuous, and could involve representative samples rather than all individuals in a population. In contrast, BMI screening cannot be recommended until more effective management becomes available for overweight and mildly obese children. Research into prevention and intervention should, therefore, be prioritized over population screening at this point in time.Current opinion in pediatrics 09/2009; 21(6):811-6. DOI:10.1097/MOP.0b013e32833280e5 · 2.74 Impact Factor
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ABSTRACT: Surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) collect only self-reported data on height and weight to estimate obesity prevalence rates. Because of biased self-reporting of height and weight, obesity prevalence rates reported by these surveys are too low.Objective:To develop regression models that can predict corrected height, weight and obesity prevalence from self-reported data, as well as to compare obesity prevalence rates based on self-reported and modeled data and test for trends in obesity prevalence by gender, age and race/ethnicity. Data from the National Health and Nutrition Examination Survey (NHANES) for the period 1999-2006 were used to develop regression models to predict corrected height, weight and obesity prevalence. Regression coefficients estimated from these models were used to predict corrected height, weight and obesity prevalence for BRFSS data for 1999-2007. Self-reported weights for males were higher by 0.1-0.2 kg and lower by about 1.25 kg than corrected weights for females. Underreporting of weights was lowest for Hispanics when compared with other race/ethnicities. In addition, underreporting of weight increased with an increase in body mass index. Self-reported heights for males were higher than corrected heights by about 2 cm, and for females, by about 1 cm. Overreporting of height increased with an increase in age. Self-reported obesity prevalence was 4.5-5.8% lower than corrected rates for males and by 4.4-5.1% for females. Underreporting of obesity prevalence increased with an increase in age. Obesity prevalence rates increased over time for each gender, race/ethnicity and age group for BRFSS data. Obesity prevalence calculated from self-reported data is too low and should be used with caution for health-care planning purposes. When it is not possible to have measured data, corrected heights and weights may be predicted by using models such as those presented by us from a relatively large data set that has both measured and self-reported data.International journal of obesity (2005) 04/2010; 34(11):1655-64. DOI:10.1038/ijo.2010.80 · 5.39 Impact Factor