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Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals
Abstract and Figures
Though the benefits of healthy lifestyle choices are well-established among the general population, less is known about how developing and adhering to healthy lifestyle habits benefits obese versus normal weight or overweight individuals. The purpose of this study was to determine the association between healthy lifestyle habits (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking) and mortality in a large, population-based sample stratified by body mass index (BMI).
We examined the association between healthy lifestyle habits and mortality in a sample of 11,761 men and women from the National Health and Nutrition Examination Survey III; subjects were ages 21 and older and fell at various points along the BMI scale, from normal weight to obese. Subjects were enrolled between October 1988 and October 1994 and were followed for an average of 170 months.
After multivariable adjustment for age, sex, race, education, and marital status, the hazard ratios (95% CIs) for all-cause mortality for individuals who adhered to 0, 1, 2, or 3 healthy habits were 3.27 (2.36-4.54), 2.59 (2.06-3.25), 1.74 (1.51-2.02), and 1.29 (1.09-1.53), respectively, relative to individuals who adhered to all 4 healthy habits. When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group.
Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.
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... This reconceptualization will require scientific and ethical examination of the evidence, narratives, 148 and assumptions influencing how medicine understands and deems desirable goals of health. 149 Weight-neutral and weight-inclusive approaches 1,87,88,150,151,152,153 provide insight into actualizing a clinical practice in which weight status-rather than being the definitive standard-is just one factor informing our understanding and pursuit of health. ...
Ethically evaluating prescription of weight loss pharmaceuticals for adolescents classified by body mass index (BMI) as obese requires reconsideration of how medicine's overreliance on BMI as a diagnostic criterion supports a weight normative approach to health. This commentary on a case suggests that weight loss is not a safe, effective, or permanent method of health promotion. The unknown extent of pharmacotherapeutics' risks to adolescents in addition to the controvertible benefits of weight loss ethically preclude their prescription, despite scientific consensus to fight obesity by prescribing weight reduction.
... Healthcare professionals should support and encourage patients to sustainably improve their eating habits, improve the quality of their food intake, and boot physical activity. Such lifestyle changes are likely to improve patients' long-term health, even in the absence of significant weight loss (Matheson et al., 2012). ...
... Several lines of evidence suggest that individuals with an elevated BMI might still be at lower ASCVD risk if they are metabolically healthy (insulin sensitive, normal blood pressure and lipid levels) and if they have healthy lifestyle habits (are physically active, do not smoke, and eat a healthy diet). 4,5 However, recent prospective studies Paulin et al Impact of Body Weight on Cardiovascular Disease have shown that individuals with an elevated BMI might be at higher ASCVD risk, even if they are metabolically healthy 6 or if they have healthy lifestyle habits. 7 This has led many investigators to conclude that regardless of their metabolic health and lifestyle habits, individuals with an elevated body weight should lose weight to reduce ASCVD risk, even in the absence of conclusive trial evidence showing that intentional weight loss is linked with a lower risk of cardiovascular outcomes and despite the fact that BMI is not included in ASCVD risk prediction algorithms such as the Pooled Cohort Equations. ...
Background
The impact of an elevated body mass index (BMI) on atherosclerotic cardiovascular disease (ASCVD) risk in individuals who are metabolically healthy is debated. We investigated the respective contributions of BMI as well as lifestyle and cardiometabolic risk factors combined to ASCVD incidence in 319 866 UK Biobank participants.
Methods and Results
We developed a cardiovascular health score (CVHS) based on 4 lifestyle and 6 cardiometabolic parameters. The impact of the CVHS on incident ASCVD (15 699 events) alone and in BMI and waist‐to‐hip ratio categories was assessed using Cox proportional hazards in women and men separately. In participants with a high CVHS (8–10), those with a BMI ≥35.0 kg/m ² had a nonsignificantly higher ASCVD risk (hazard ratio [HR], 1.20 [95% CI, 0.84–1.70]; P =0.32) compared with those with a BMI of 18.5 to 24.9 kg/m ² . In participants with a BMI of 18.5 to 24.9 kg/m ² , those with a lower CVHS (0–2) had a higher ASCVD risk (HR, 4.06 [95% CI, 3.23–5.10]; P <0.001) compared with those with a higher CVHS (8–10). When we used the waist‐to‐hip ratio instead of the BMI, a dose–response relationship between the waist‐to‐hip ratio and ASCVD risk was obtained in healthier participants. Results were similar in women compared with men.
Conclusions
In women and men in the UK Biobank, the relationship between the BMI and ASCVD incidence in healthy individuals was inconsistent, whereas cardiovascular risk factors strongly predicted ASCVD incidence in all BMI categories. Assessing lifestyle and cardiometabolic risk factors as well as body fat distribution indices may help identify individuals at high ASCVD risk, regardless of body weight.
... In fact, healthy eating can positively affect psychological well-being 6 and overall health 7 regardless of weight status. 8,9 Therefore, interventions to improve population nutrition will have a substantive public benefit. Given that what people choose to eat is largely socially determined [10][11][12] -that is, based on what they can afford, what is available and what they know-effective public health interventions must consider food environments, because research has shown that dietary interventions targeted only at the individual level generally produce only small and temporary changes in health outcomes. ...
Context:
Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces.
Objective:
The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces.
Data sources:
Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists.
Data extraction:
All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language.
Data analysis:
Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers' acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy.
Conclusions:
Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation.
Systematic review registration:
PROSPERO registration no. CRD42021246340.
... The IPG method measures the action of the heart and lungs with a change in the electromagnetic (EM) field. [22][23][24][25][26][27] In the IPG method in which the sensor's metal must contact the skin directly, the possibility of electric shock cannot be excluded, and users may also feel unpleasant. The fact that two to four sensors are required also makes the IPG method challenging to be applied to wearable devices. ...
Despite coronavirus disease 2019, cardiovascular disease, the leading cause of global death, requires timely detection and treatment for a high survival rate, underscoring the 24 h monitoring of vital signs. Therefore, telehealth using wearable devices with vital sign sensors is not only a fundamental response against the pandemic but a solution to provide prompt healthcare for the patients in remote sites. Former technologies which measured a couple of vital signs had features that disturbed practical applications to wearable devices, such as heavy power consumption. Here, we suggest an ultralow power (100 μW) sensor that collects all cardiopulmonary vital signs, including blood pressure, heart rate, and the respiration signal. The small and lightweight (2 g) sensor designed to be easily embedded in the flexible wristband generates an electromagnetically reactive near field to monitor the contraction and relaxation of the radial artery. The proposed ultralow power sensor measuring noninvasively continuous and accurate cardiopulmonary vital signs at once will be one of the most promising sensors for wearable devices to bring telehealth to our lives.
... BMI is not useful in cardiovascular risk prediction when actual measurements of health, such as blood pressure, lipids, or history of diabetes are available [46]. Moreover, if people participate in healthy lifestyle habits, such as eating fruits and vegetables, exercising, consuming alcohol in moderation, and not smoking, BMI no longer is associated with increased mortality [47], demonstrating that BMI is simply one way of measuring a body and not an actual health indicator. Investigations in nonpregnant patients have found that adjustment for actual markers of metabolic dysfunction, such as CRP and fasting insulin, obviates the role of BMI in mortality prediction [48]. ...
Purpose of Review
Our goal is to describe the prevalence and harms of weight stigma and bias in obstetric care in order to challenge the current weight-centric model of care.
Recent Findings
Weight stigma and bias are commonly experienced by pregnant people when seeking medical care. Weight stigma has the potential to cause adverse pregnancy outcomes through allostatic load, avoidance of care to avoid stigma, and inequities in provision of care to people of higher weight. The BMI was not established as a measure of health and is not a strong predictor of adverse pregnancy outcomes, despite existing associations. Although there are many associations between higher BMI and adverse pregnancy outcomes, those associations have not accounted for the possible concurrent harms of weight stigma and weight cycling. Both weight loss recommendations and routine weighing in pregnancy care are not supported by evidence and warrant reconsideration.
Summary
We encourage people to take simple steps to decrease weight bias in their care of pregnant people and to reconsider the associations between BMI and adverse pregnancy outcomes.
Importance:
A healthy lifestyle is associated with a reduced risk of cardiovascular disease in adults with obesity. Little is known about the associations between a healthy lifestyle and the risk of other obesity-attributable diseases in this population.
Objective:
To examine the association between healthy lifestyle factors and the incidence of major obesity-related diseases in adults with obesity compared with those with normal weight.
Design, setting, and participants:
This cohort study evaluated UK Biobank participants aged 40 to 73 years and free of major obesity-attributable disease at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis.
Exposures:
A healthy lifestyle score was constructed using information on not smoking, exercising regularly, no or moderate alcohol consumption, and eating a healthy diet. For each lifestyle factor, participants scored 1 if they met the criterion for a healthy lifestyle and 0 otherwise.
Main outcomes and measures:
The risk of outcomes according to the healthy lifestyle score in adults with obesity compared with those with normal weight were examined using multivariable Cox proportional hazards models with Bonferroni correction for multiple testing. The data analysis was performed between December 1, 2021, and October 31, 2022.
Results:
A total of 438 583 adult participants in the UK Biobank were evaluated (female, 55.1%; male, 44.9%; mean [SD] age, 56.5 [8.1] years), of whom 107 041 (24.4%) had obesity. During a mean (SD) follow-up of 12.8 (1.7) years, 150 454 participants (34.3%) developed at least 1 of the studied diseases. Compared with adults with obesity and 0 healthy lifestyle factors, individuals with obesity who met all 4 healthy lifestyle factors were at lower risk of hypertension (HR, 0.84; 95% CI, 0.78-0.90), ischemic heart disease (HR, 0.72; 95% CI, 0.65-0.80), arrhythmias (HR, 0.71; 95% 0.61-0.81), heart failure (HR, 0.65; 95% CI, 0.53-0.80), arteriosclerosis (HR, 0.19; 95% CI, 0.07-0.56), kidney failure (HR, 0.73; 95% CI, 0.63-0.85), gout (HR, 0.51; 95% CI, 0.38-0.69), sleep disorders (HR, 0.68; 95% CI, 0.56-0.83), and mood disorders (HR, 0.66; 95% CI, 0.56-0.78). The lifestyle profiles associated with the lowest risks included a healthy diet and at least 1 of the 2 healthy behaviors of physical activity and never smoking. Compared with adults with normal weight, those with obesity were at higher risk of several outcomes, irrespective of the lifestyle score (adjusted HRs ranged from 1.41 [95% CI, 1.27-1.56] for arrhythmias to 7.16 [95% CI, 6.36-8.05] for diabetes for adults with obesity and 4 healthy lifestyle factors).
Conclusion and relevance:
In this large cohort study, adherence to a healthy lifestyle was associated with reduced risk of a wide range of obesity-related diseases, but this association was modest in adults with obesity. The findings suggest that although a healthy lifestyle seems to be beneficial, it does not entirely offset the health risks associated with obesity.
Obesity is a chronic metabolic disease that is prevalent worldwide, causing complications that affect the quality of life and longevity of humans. Currently, the low bioavailability upon subcutaneous injection of an appetite suppressant, liraglutide, and health problems in the locally injected region remain to be overcome. In this study, we developed a novel hyaluronic acid-based liraglutide-encapsulated triple-layer microneedle (TLM) as a painless and patient-friendly long-term drug delivery system. In contrast to previous anti-obesity microneedle approaches, this TLM is composed of three layers for complete skin insertion, protecting the encapsulated liraglutide from environmental stresses. Daily topical application of the liraglutide-loaded TLM significantly reduced body weight and improved body composition in a mouse model of high-fat diet-induced obesity. Additionally, it ameliorated diet-induced hepatic steatosis in obese mice. This novel TLM could promote a glucagon-like peptide-1 drug release system for long-term daily administration with relatively higher patient compliance compared to subcutaneous injection.
A systematic review and meta-analysis was conducted to evaluate evidence-based strategies for increasing the delivery of smoking cessation treatments in primary care clinics.
The review included studies published before January 1, 2009. The pooled odds-ratio (OR) was calculated for intervention group versus control group for practitioner performance for "5As" (Ask, Advise, Assess, Assist and Arrange) delivery and smoking abstinence. Multi-component interventions were defined as interventions which combined two or more intervention strategies.
Thirty-seven trials met eligibility criteria. Evidence from multiple large-scale trials was found to support the efficacy of multi-component interventions in increasing "5As" delivery. The pooled OR for multi-component interventions compared to control was 1.79 [95% CI 1.6-2.1] for "ask", 1.6 [95% CI 1.4-1.8] for "advice", 9.3 [95% CI 6.8-12.8] for "assist" (quit date) and 3.5 [95% CI 2.8-4.2] for "assist" (prescribe medications). Evidence was also found to support the value of practice-level interventions in increasing 5As delivery. Adjunct counseling [OR 1.7; 95% CI 1.5-2.0] and multi-component interventions [OR 2.2; 95% CI 1.7-2.8] were found to significantly increase smoking abstinence.
Multi-component interventions improve smoking outcomes in primary care settings. Future trials should attempt to isolate which components of multi-component interventions are required to optimize cost-effectiveness.
Background: Exercise is widely promoted as a method of weight management, while the other health benefits are often ignored. The purpose of this study was to examine whether exercise-induced improvements in health are influenced by changes in body weight.
Methods: Fifty-eight sedentary overweight/obese men and women (BMI 31.8 (SD 4.5) kg/m2) participated in a 12-week supervised aerobic exercise intervention (70% heart rate max, five times a week, 500 kcal per session). Body composition, anthropometric parameters, aerobic capacity, blood pressure and acute psychological response to exercise were measured at weeks 0 and 12.
Results: The mean reduction in body weight was −3.3 (3.63) kg (p<0.01). However, 26 of the 58 participants failed to attain the predicted weight loss estimated from individuals’ exercise-induced energy expenditure. Their mean weight loss was only −0.9 (1.8) kg (p<0.01). Despite attaining a lower-than-predicted weight reduction, these individuals experienced significant increases in aerobic capacity (6.3 (6.0) ml/kg/min; p<0.01), and a decreased systolic (−6.00 (11.5) mm Hg; p<0.05) and diastolic blood pressure (−3.9 (5.8) mm Hg; p<0.01), waist circumference (−3.7 (2.7) cm; p<0.01) and resting heart rate (−4.8 (8.9) bpm, p<0.001). In addition, these individuals experienced an acute exercise-induced increase in positive mood.
Conclusions: These data demonstrate that significant and meaningful health benefits can be achieved even in the presence of lower-than-expected exercise-induced weight loss. A less successful reduction in body weight does not undermine the beneficial effects of aerobic exercise. From a public health perspective, exercise should be encouraged and the emphasis on weight loss reduced.
There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
Context The increase in sedentary lifestyle may contribute to the rise in obesity
nationally. Although guidelines suggest that physicians counsel all patients
about exercise, physicians counsel only a minority of their patients. Whether
patient factors influence physician counseling is not well established.Objectives To examine and to identify factors associated with exercise counseling
by US physicians.Design and Setting National population-based supplemental (Year 2000) survey to the 1995
National Health Interview Survey.Participants Of the 17,317 respondents to the Year 2000 supplemental survey, 9711
adults had seen a physician in the previous year, and 9299 responded when
asked about physician counseling on exercise.Main Outcome Measure Physician counseling to begin or to continue to exercise.Results Of 9299 respondents, 34% reported being counseled about exercise at
their last visit. After adjustment for other sociodemographic and clinical
factors, women were slightly more likely to be counseled, with an adjusted
odds ratio (AOR) of 1.15 (95% confidence interval [CI], 1.02-1.29). Physicians
counseled older patients (>30 years) more often than younger patients; those
aged 40 to 49 years were counseled most often (AOR, 1.71 [95% CI, 1.34-2.20]).
Patients with incomes above $50,000, those with higher levels of physical
activity, college graduates, and patients who were overweight to obese (body
mass index: 25 to ≥30 kg/m2) were more likely to be counseled,
as were patients with cardiac disease (AOR, 1.81 [95% CI, 1.52-2.14]) and
diabetes (AOR, 1.87 [95% CI, 1.46-2.38]). Counseling did not vary by physician
specialty or patient race.Conclusion The rate of physician counseling about exercise is low nationally. Physicians
appear to counsel as secondary prevention and are less likely to counsel patients
at risk for obesity. The failure to counsel younger, disease-free adults and
those from lower socioeconomic groups may represent important missed opportunities
for primary prevention.
About 97 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. The aim of this guideline is to provide useful advice on how to achieve weight reduction and maintenance of a lower body weight. It is also important to note that prevention of further weight gain can be a goal for some patients. Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort. Assessment of Weight and Body Fat Two measures important for assessing overweight and total body fat content are; determining body mass index (BMI) and measuring waist circumference. 1. Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in body weight. Measurements of body weight alone can be used to determine efficacy of weight loss therapy. BMI is calculated as weight (kg)/height squared (m 2). To estimate BMI using pounds and inches, use: [weight (pounds)/height (inches) 2 ] x 703. Weight classifications by BMI, selected for use in this report, are shown in the table below. • Pregnant women who, on the basis of their pre-pregnant weight, would be classified as obese may encounter certain obstetrical risks. However, the inappropriateness of weight reduction during pregnancy is well recognized (Thomas, 1995). Hence, this guideline specifically excludes pregnant women. Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997.
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