Overweight and obesity raise the risk of many serious diseases and health conditions.1-11 Obese adults have at least a 20% higher risk than normal weight adults of death from cardiovascular disease and all other causes.3 Disease and health conditions associated with overweight and obesity include:1-11
- Hypertension
- Cholesterol problems such as high LDL cholesterol, high triglycerides, and low HDL cholesterol
- Type 2 diabetes (T2DM)
- Cardiovascular disease (CVD) such as atherosclerosis, heart attack, stroke, and heart failure
- Nonalcoholic fatty liver disease
- Obstructive sleep apnea
- Acid reflux disease
- Asthma
- Osteoarthritis
- Some types of cancer such as breast, uterine, colon, kidney, gallbladder, and liver
- Polycystic ovary syndrome
- Female infertility
- Male hypogonadism (low testosterone)
- Alzheimer’s disease and dementia
- Mental health problems such as depression and anxiety
Definition of Overweight and Obese
Overweight and obesity were most recently defined in the 2013 guidelines for the management of overweight and obesity in adults by The Obesity Society and American College of Cardiology/American Heart Association (ACC/AHA).5 Overweight is defined as a body mass index (BMI) of 25.0 to 29.9 and obesity as a BMI of ≥30 [Strong Recommendation (Level B)). BMI is a measure that adjusts body weight for height.
In the US, about 70.7% of adults age 20 or older are overweight (BMI ≥25) (age-adjusted prevalence).12 Of these, 39.8% are obese (BMI ≥30). These estimates are based on an analysis of the 2015-2016 US National Health and Nutrition Examination Survey (NHANES).
Health Risks
Obese adults have at least a 20% higher risk of death than normal weight adults from CVD and all other causes.3 The rates in this 2014 study are based on the Third NHANES data (1988 – 1994) with follow-up linked to the 2006 National Death Index mortality file (n=16 868). The study found the rates of all-cause death were advanced by 3.7 years for adults with BMI ≥35. Obese adults may die earlier from CVD causes than people with normal weight, ranging from 1.6 years early (95% confidence interval [CI] [0.1 – 3.1]) for mildly obese to 5.0 years early (95% CI [1.7 – 8.4]) for severely obese (BMI ≥40). A 2009 analysis of United States nationally representative health surveys, such as NHANES 2003-2006, and US disease-specific mortality statistics found that about one in ten deaths in the US, or about 216 000 adults (95% CI [188 000 – 237 000]) could be attributed to overweight and obesity.4 In the same analysis, they found that hypertension (regardless of weight status) accounted for one in five to six deaths, or about 395 000 adults (95% CI [372 000 – 414 000]).
A systematic review and meta-analysis of 25 studies with a total of 2 274 961 participants found an increased risk of ischemic stroke for overweight (RR 1.22, 95% CI [1.05 – 1.41]) and obese (RR 1.64, 95% CI [1.36 – 1.99]) people versus normal weight participants.10
A 2009 meta-analysis of 89 studies found statistically significant associations between overweight (BMI ≥25 – 29.9) and obesity (BMI ≥30) and the incidence of T2DM, hypertension, stroke, coronary artery disease (CAD), osteoarthritis, gallbladder disease, asthma, pulmonary embolism, chronic back pain, and cancer of the breast, ovaries, endometrium, colon, and kidney.7 Risks details follow:
|
Disease (n=studies)
|
Gender
|
Overweight
Risk Est (95% CI)*
|
Obese
Risk Est (95% CI)
|
|
T2DM (n=9)
|
Men
Women
|
IRR 2.40 (2.12 – 2.72)
IRR 3.92 (3.10 – 4.97)
|
IRR 6.74 (5.55 – 8.19)
IRR 12.41 (9.03 – 17.06)
|
|
Hypertension (n=4)
|
Men
Women
|
IRR 1.28 (1.10 – 1.50)
IRR 1.65 (1.24 – 2.19)
|
IRR 1.84 (1.51 – 2.24)
IRR 2.42 (1.59 – 3.67)
|
|
Stroke (n=7)
|
Men
Women
|
RR-P 1.23 (1.13 – 1.34)
RR-P 1.15 (1.00 – 1.32)
|
RR-P 1.51 (1.33 – 1.72)
RR-P 1.49 (1.27 – 1.74)
|
|
CAD (n=11)
|
Men
Women
|
RR-P 1.29 (1.18 – 1.41)
IRR 1.80 (1.64 – 1.98)
|
RR-P 1.72 (1.51 – 1.96)
IRR 3.10 (2.81 – 3.43)
|
|
Pulmonary Embolism (n=1)
|
All
|
IRR 1.91 (1.39 – 2.64)
|
IRR 3.51 (2.61 – 4.73)
|
|
Osteoarthritis (n=3)
|
Men
Women
|
IRR 2.76 (2.05 – 3.70)
RR-P 1.80 (1.75 – 1.85)
|
IRR 4.20 (2.76 – 6.41)
RR-P 1.96 (1.88 – 2.04)
|
|
Chronic Back Pain (n=1)
|
All
|
RR-P 1.59 (1.34 – 1.89)
|
RR-P 2.81 (2.27 – 3.48)
|
|
Asthma (n=4)
|
Men
Women
|
RR-P 1.20 (1.08 – 1.33)
RR-P 1.25 (1.05 – 1.49)
|
RR-P 1.43 (1.14 – 1.79
RR-P 1.78 (1.36 – 2.32)
|
|
Gallbladder Disease (n=4)
|
Men
Women
|
IRR 1.09 (0.87 – 1.37)
IRR 1.44 (1.05 – 1.98)
|
IRR 1.43 (1.04 – 1.96)
IRR 2.32 (1.17 – 4.57)
|
|
Breast Cancer (n=14)
|
Womenꜜ
|
IRR 1.08 (1.03 – 1.14)
|
IRR 1.13 (1.05 – 1.22)
|
|
Endometrial Cancer (n-10)
|
Women
|
IRR 1.53 (1.45 – 1.61)
|
IRR 3.22 (2.91 – 3.56)
|
|
Ovarian Cancer (n=9)
|
Women
|
IRR 1.18 (1.12 – 1.23)
|
IRR 3.22 (2.91 – 3.56)
|
|
Colorectal Cancer (n=12)
|
Men
Women
|
IRR 1.51 (1.37 – 1.67
IRR 1.45 (1.30 – 1.62)
|
IRR 1.95 (1.59 – 2.39)
IRR 1.66 (1.52 – 1.81)
|
|
Kidney Cancer (n=5)
|
Men
Women
|
IRR 1.40 (1.31 – 1.49)
IRR 1.82 (1.68 – 1.98)
|
IRR 1.82 (1.61 – 2.05)
IRR 2.64 (2.39 – 2.90)
|
*IRR (incidence rate ratio); RR-P (relative risk calculated from the ratio of proportions)
ꜜPostmenopausal women
A cohort study of 5.24 million people age 16 years or older with no previous cancer diagnosis in the past 12 months looked at the incidence of 22 types of cancer in people who never smoked.6 The authors found that excess weight (BMI ≥25) could account for 41% of uterine cancer and at least 10% of colon, kidney, liver, and gallbladder cancers.
References
- Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 2016; 22 Suppl 3: 1-203.
- Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics - 2018 update: a report from the American Heart Association. Circulation 2018; 137 (12): e67-e492.
- Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health 2014; 104 (3): 512-519.
- Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009; 6 (4): e1000058.
- Expert panel report: guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring) 2014; 22 Suppl 2: S41-410.
- Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet 2014; 384 (9945): 755-765.
- Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88.
- Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67 (3): 220-229.
- Kodama S, Horikawa C, Fujihara K, et al. Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis. Obes Rev 2014; 15 (3): 202-214.
- Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke 2010; 41 (5): e418-426.
- Albanese E, Launer LJ, Egger M, et al. Body mass index in midlife and dementia: systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers Dement (Amst) 2017; 8: 165-178.
- Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017; (288): 1-8.
.png)
