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Date of release: 25 April, 2011

Overweight and health outcomes


There has been a continuous interest in the consequences of excessive weight on health outcomes, mainly because of the fact that the world’s population is becoming heavier. The World Health Organization estimates that more than 1 billion people are overweight, with 300 million meeting the criteria for obesity. A recent review on this issue [1] was based on a PubMed search using the key words "obesity", "overweight", "body mass index" (BMI), "gender", "women’s health". This review analyzes in separate chapters the associations between common diseases and obesity. The main topics discussed were summarized in the article as follows: 


 


1. Obesity and type 2 diabetes mellitus (DM): ‘The risk of DM increases with the degree and duration of being overweight or obese and with a more central or visceral distribution of body fat.’


 


2. Obesity and coronary artery disease (CAD): ‘Obesity is an independent risk factor for the development of CAD in women and is an important modifiable risk factor for prevention of CAD.’


 


3. Obesity and musculo-skeletal pain: ‘Obesity has been implicated in the development or progression of low back pain and knee osteoarthritis in women.’

Comment

A recent, relevant study investigated the relations of obesity and biomarkers for health risks: C-reactive protein for inflammation, HbA1C for metabolic function, and high density lipoprotein cholesterol for cardiovascular function [2]. The study group consisted of a nationally representative sample of US adults aged 20–80 years (n = 9255) from the National Health and Nutrition Examination Survey (2005–2008). It was found that the association between BMI and each biomarker was monotonic, with higher BMI being consistently associated with worse health risk profiles at all ages.
 
The intriguing aspect of these results lies in previous well-established data that overweight adults (defined as BMI 25–30 kg/m2) experience lower overall mortality than those who are underweight, normal-weight, or obese. Many studies have demonstrated a U-shaped relation between BMI and mortality, the lowest mortality being at BMI 25–27 kg/m2 in women [3]. Thus, whether moderate elevations in BMI truly increase the risk of death is controversial, and many argue whether the disparity of results in various studies merely reflects statistical, methodological issues, and different approaches toward adjustments for co-variables, or whether it is truly biologically plausible. That being too lean or too obese does carry substantial health risks is well-accepted and not debated. However, whether being a little overweight, according to current definitions (the ‘chubby’ type), is OK in this respect seems an exciting question that is constantly debated but far from being resolved at the moment. My personal view has always been that we should not be too aggressive in our strategies to achieve ‘optimal’ targets of weight, blood pressure, lipid levels and glucose control. What are your views? Please write to Jean, and we will publish it in the coming issue of Our Menopause World.

Comentario

Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel

    References

  1. Kulie T, Slattengren A, Redmer J, et al. Obesity and womens health: An evidence-based review. J Am Board Fam Med 2011;24:75-85 (free for downloading in PubMed).
    http://www.ncbi.nlm.nih.gov/pubmed/21209347

  2. Zajacova A, Dowd JB, Burgard SA. Overweight adults may have the lowest mortality do they have the best health? Am J Epidemiol 2011;173:430-7.
    http://www.ncbi.nlm.nih.gov/pubmed/21228416

  3. 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;355:763-78 (free for downloading in PubMed).
    http://www.ncbi.nlm.nih.gov/pubmed/16926275