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Health hazards associated with obesity in adults

INTRODUCTION

The morbidity and mortality associated with being overweight or obese have been known to the medical profession for more than 2000 years [1]. Overweight refers to a weight above the "normal" range. This is determined by calculating the body mass index (BMI, defined as the weight in kilograms divided by height in meters squared). Overweight is defined as a BMI of 25 to 29.9 kg/m2, obesity as a BMI of >30 kg/m2. Severe obesity is defined as a BMI >40 kg/m2 (or ≥35 kg/m2 in the presence of comorbidities).

The health hazards associated with obesity are reviewed here. The prevalence of and therapy for obesity, and the evaluation of the overweight patient are discussed elsewhere. (See "Overview of therapy for obesity in adults" and "Screening for and clinical evaluation of obesity in adults".)

MORTALITY

A number of large epidemiologic studies have evaluated the relationship between obesity and mortality [2-12]. In general, greater body mass index (BMI) is associated with increased rate of death from all causes and from cardiovascular disease (CVD) (figure 1). This is particularly true for those with severe obesity [6]. Estimates for the annual number of excess deaths attributable to obesity in the United States are variable and range from 111,909 to 365,000 [13,14].

Being overweight also appears to be associated with decreased survival in some [4,10,15], but not all [12,16], studies. As an example, a prospective study from the United States evaluated the relationship between BMI and risk of death over a maximum follow-up period of 10 years among over 500,000 men and women aged 50 to 71 years [4]. Among the subset of individuals 50 years of age (when prevalence of chronic disease is low) who had never smoked, an increased risk of death was associated with being either overweight (20 to 50 percent increase in those between 26.5 to 29.9 kg/m2) or obese (two- to over threefold increase in those ≥30 kg/m2). The risk of all-cause mortality with increasing BMI of 25 kg/m2 or higher appears to be independent of gender and ethnicity [4,17].

Similar findings were noted in the Prospective Studies Collaboration analysis of 57 prospective studies (894,000 European and North American adults followed for a mean of eight years), in a pooled analysis of 19 prospective studies (1.4 million Caucasian adults with median follow-up of 10 years) from the National Cancer Institute Cohort Consortium (NCICC), and in a pooled analysis of 19 prospective cohort studies (1.1 million Asian adults with mean follow-up of nine years) from the Asia Cohort Consortium [10,15,18].

                                   

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Literature review current through: Mar 2014. | This topic last updated: Jan 23, 2014.
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References
Top
  1. Bray GA. The Battle of the Bulge: A History of Obesity Research, Dorrance, Pittsburgh 2007.
  2. Yan LL, Daviglus ML, Liu K, et al. Midlife body mass index and hospitalization and mortality in older age. JAMA 2006; 295:190.
  3. Gu D, He J, Duan X, et al. Body weight and mortality among men and women in China. JAMA 2006; 295:776.
  4. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006; 355:763.
  5. Jee SH, Sull JW, Park J, et al. Body-mass index and mortality in Korean men and women. N Engl J Med 2006; 355:779.
  6. McTigue K, Larson JC, Valoski A, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA 2006; 296:79.
  7. Freedman DM, Ron E, Ballard-Barbash R, et al. Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond) 2006; 30:822.
  8. Price GM, Uauy R, Breeze E, et al. Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 2006; 84:449.
  9. Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359:2105.
  10. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373:1083.
  11. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298:2028.
  12. Tobias DK, Pan A, Jackson CL, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med 2014; 370:233.
  13. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States, 2000. JAMA 2005; 293:293.
  14. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293:1861.
  15. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010; 363:2211.
  16. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309:71.
  17. Boggs DA, Rosenberg L, Cozier YC, et al. General and abdominal obesity and risk of death among black women. N Engl J Med 2011; 365:901.
  18. Zheng W, McLerran DF, Rolland B, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011; 364:719.
  19. Tsai AG, Wadden TA. In the clinic: obesity. Ann Intern Med 2013; 159:ITC3.
  20. Mark DH. Deaths attributable to obesity. JAMA 2005; 293:1918.
  21. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995; 333:677.
  22. Chen Y, Copeland WK, Vedanthan R, et al. Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium. BMJ 2013; 347:f5446.
  23. van Dam RM, Willett WC, Manson JE, Hu FB. The relationship between overweight in adolescence and premature death in women. Ann Intern Med 2006; 145:91.
  24. Gregg EW, Cheng YJ, Cadwell BL, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005; 293:1868.
  25. Alley DE, Chang VW. The changing relationship of obesity and disability, 1988-2004. JAMA 2007; 298:2020.
  26. Calle EE, Teras LR, Thun MJ. Obesity and mortality. N Engl J Med 2005; 353:2197.
  27. Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr 1999; 69:373.
  28. Stevens J, Cai J, Evenson KR, Thomas R. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 2002; 156:832.
  29. Hu FB, Willett WC, Li T, et al. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004; 351:2694.
  30. Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138:24.
  31. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003; 289:187.
  32. Stewart ST, Cutler DM, Rosen AB. Forecasting the effects of obesity and smoking on U.S. life expectancy. N Engl J Med 2009; 361:2252.
  33. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352:1138.
  34. Haslam DW, James WP. Obesity. Lancet 2005; 366:1197.
  35. Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 2011; 378:815.
  36. Nguyen NT, Magno CP, Lane KT, et al. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg 2008; 207:928.
  37. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351:2683.
  38. Field AE, Coakley EH, Must A, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161:1581.
  39. Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med 1999; 341:427.
  40. Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 122:481.
  41. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS Jr. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991; 325:147.
  42. Neeland IJ, Turer AT, Ayers CR, et al. Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults. JAMA 2012; 308:1150.
  43. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002; 162:2074.
  44. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17:961.
  45. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393.
  46. Kahn CR. Banting Lecture. Insulin action, diabetogenes, and the cause of type II diabetes. Diabetes 1994; 43:1066.
  47. Wilson PW, D'Agostino RB, Sullivan L, et al. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162:1867.
  48. Huang Z, Willett WC, Manson JE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998; 128:81.
  49. Neter JE, Stam BE, Kok FJ, et al. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003; 42:878.
  50. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol 2006; 26:968.
  51. Rosito GA, D'Agostino RB, Massaro J, et al. Association between obesity and a prothrombotic state: the Framingham Offspring Study. Thromb Haemost 2004; 91:683.
  52. Davì G, Guagnano MT, Ciabattoni G, et al. Platelet activation in obese women: role of inflammation and oxidant stress. JAMA 2002; 288:2008.
  53. Klein S, Burke LE, Bray GA, et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110:2952.
  54. McGill HC Jr, McMahan CA, Herderick EE, et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 2002; 105:2712.
  55. Iribarren C, Darbinian JA, Lo JC, et al. Value of the sagittal abdominal diameter in coronary heart disease risk assessment: cohort study in a large, multiethnic population. Am J Epidemiol 2006; 164:1150.
  56. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937.
  57. Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet 2005; 366:1640.
  58. Björntorp P. Regional patterns of fat distribution. Ann Intern Med 1985; 103:994.
  59. Rexrode KM, Carey VJ, Hennekens CH, et al. Abdominal adiposity and coronary heart disease in women. JAMA 1998; 280:1843.
  60. Madala MC, Franklin BA, Chen AY, et al. Obesity and age of first non-ST-segment elevation myocardial infarction. J Am Coll Cardiol 2008; 52:979.
  61. Arita Y, Kihara S, Ouchi N, et al. Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 1999; 257:79.
  62. Diercks DB, Roe MT, Mulgund J, et al. The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J 2006; 152:140.
  63. Buettner HJ, Mueller C, Gick M, et al. The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction. Eur Heart J 2007; 28:1694.
  64. Zeller M, Steg PG, Ravisy J, et al. Relation between body mass index, waist circumference, and death after acute myocardial infarction. Circulation 2008; 118:482.
  65. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med 2007; 167:1720.
  66. Emerging Risk Factors Collaboration, Wormser D, Kaptoge S, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011; 377:1085.
  67. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347:305.
  68. Alpert MA, Hashimi MW. Obesity and the heart. Am J Med Sci 1993; 306:117.
  69. Ingelsson E, Sundström J, Arnlöv J, et al. Insulin resistance and risk of congestive heart failure. JAMA 2005; 294:334.
  70. Wong CY, O'Moore-Sullivan T, Leano R, et al. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 2006; 47:611.
  71. McGavock JM, Victor RG, Unger RH, et al. Adiposity of the heart, revisited. Ann Intern Med 2006; 144:517.
  72. Alpert MA, Terry BE, Cohen MV, et al. The electrocardiogram in morbid obesity. Am J Cardiol 2000; 85:908.
  73. Pontiroli AE, Pizzocri P, Saibene A, et al. Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes Relat Metab Disord 2004; 28:1118.
  74. Papaioannou A, Michaloudis D, Fraidakis O, et al. Effects of weight loss on QT interval in morbidly obese patients. Obes Surg 2003; 13:869.
  75. Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004; 292:2471.
  76. Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med 2005; 118:489.
  77. Dublin S, French B, Glazer NL, et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med 2006; 166:2322.
  78. Tedrow UB, Conen D, Ridker PM, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). J Am Coll Cardiol 2010; 55:2319.
  79. Rexrode KM, Hennekens CH, Willett WC, et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997; 277:1539.
  80. Kurth T, Gaziano JM, Rexrode KM, et al. Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation 2005; 111:1992.
  81. Kurth T, Gaziano JM, Berger K, et al. Body mass index and the risk of stroke in men. Arch Intern Med 2002; 162:2557.
  82. Hu G, Tuomilehto J, Silventoinen K, et al. Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med 2007; 167:1420.
  83. Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr 1992; 55:652.
  84. Grotle M, Hagen KB, Natvig B, et al. Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord 2008; 9:132.
  85. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol 1993; 20:331.
  86. Cicuttini FM, Baker JR, Spector TD. The association of obesity with osteoarthritis of the hand and knee in women: a twin study. J Rheumatol 1996; 23:1221.
  87. Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992; 116:535.
  88. Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis 2006; 6:438.
  89. Farmakiotis D. Obesity and serious infections. Ann Intern Med 2013; 159:859.
  90. Power K, Davies MM, Hargest R, et al. A case-control study of risk factors for wound infection in a colorectal unit. Ann R Coll Surg Engl 2014; 96:37.
  91. Kwong JC, Campitelli MA, Rosella LC. Obesity and respiratory hospitalizations during influenza seasons in Ontario, Canada: a cohort study. Clin Infect Dis 2011; 53:413.
  92. Almond MH, Edwards MR, Barclay WS, Johnston SL. Obesity and susceptibility to severe outcomes following respiratory viral infection. Thorax 2013; 68:684.
  93. Rogers DL. Acanthosis nigricans. Semin Dermatol 1991; 10:160.
  94. Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 2009; 32:1017.
  95. Kress JP, Pohlman AS, Alverdy J, Hall JB. The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest. Am J Respir Crit Care Med 1999; 160:883.
  96. Ray CS, Sue DY, Bray G, et al. Effects of obesity on respiratory function. Am Rev Respir Dis 1983; 128:501.
  97. Camargo CA Jr, Weiss ST, Zhang S, et al. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med 1999; 159:2582.
  98. Young SY, Gunzenhauser JD, Malone KE, McTiernan A. Body mass index and asthma in the military population of the northwestern United States. Arch Intern Med 2001; 161:1605.
  99. Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med 2002; 162:1477.
  100. Pan SY, Johnson KC, Ugnat AM, et al. Association of obesity and cancer risk in Canada. Am J Epidemiol 2004; 159:259.
  101. Rapp K, Schroeder J, Klenk J, et al. Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. Br J Cancer 2005; 93:1062.
  102. Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 2009; 301:2553.
  103. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348:1625.
  104. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371:569.
  105. Esposito K, Giugliano F, Ciotola M, et al. Obesity and sexual dysfunction, male and female. Int J Impot Res 2008; 20:358.
  106. Kramer H, Luke A, Bidani A, et al. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 2005; 46:587.
  107. Fox CS, Larson MG, Leip EP, et al. Predictors of new-onset kidney disease in a community-based population. JAMA 2004; 291:844.
  108. Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144:21.
  109. Ferris M, Hogan SL, Chin H, et al. Obesity, albuminuria, and urinalysis findings in US young adults from the Add Health Wave III study. Clin J Am Soc Nephrol 2007; 2:1207.
  110. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005; 293:455.
  111. Gortmaker SL, Must A, Perrin JM, et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329:1008.
  112. Dixon JB, Dixon ME, O'Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003; 163:2058.
  113. Narbro K, Agren G, Jonsson E, et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Intern Med 2002; 162:2061.
  114. Daviglus ML, Liu K, Yan LL, et al. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA 2004; 292:2743.
  115. Quesenberry CP Jr, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med 1998; 158:466.
  116. International Obesity Task Force: Managing the global epidemic of obesity: a report of the International Obesity Task Force (Unpublished document).
  117. Finkelstein EA, Trogdon JG, Brown DS, et al. The lifetime medical cost burden of overweight and obesity: implications for obesity prevention. Obesity (Silver Spring) 2008; 16:1843.