By Katherine M. Flegal, PhD; Brian K. Kit, MD; Heather Orpana, PhD; Barry I. Graubard, PhD
JAMA, January 2, 2013
In this study, we used the National Heart, Lung, and Blood Institute’s terminology with categories of underweight (BMI of <18.5), normal weight (BMI of 18.5-<25), overweight (BMI of 25-<30), and obesity (BMI of ā„30). Grade 1 obesity was defined as a BMI of 30 to less than 35; grade 2 obesity, a BMI of 35 to less than 40; and grade 3 obesity, a BMI of 40 or greater.
The most recent data from the United States show that almost 40% of adult men and almost 30% of adult women fall into the overweight category with a BMI of 25 to less than 30.
In the United States and Canada, more than half of those who are obese fall into the grade 1 category (BMI of 30-<35).
According to the results presented herein, overweight (defined as a BMI of 25-<30) is associated with significantly lower mortality overall relative to the normal weight category with an overall summary HR (hazard ratio) of 0.94.
The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity.
http://jama.jamanetwork.com/article.aspx?articleid=1555137
And…
Obesity Update 2012
OECD
Obesity rates
16.9% – All OECD nations
33.8% – United States
http://www.oecd.org/health/49716427.pdf
And…
NIH Body Mass Index (BMI) calculator:
Comment
By Don McCanne, MD
If you are amongst the 30 to 40 percent of Americans who are overweight, you likely are resolving at the beginning of this year to finally do something about your weight. The good news is that you don’t have to. Being overweight (BMI 25->30) is associated with a mortality rate that is 6 percent lower than that for normal weight. Happy New Year.
In fact, even you fall into the category of grade 1 obesity (BMI 30->35), you still have no increase in mortality due to your weight alone. (You can use the BMI calculator at the NIH link above to determine where you fall.)
This, of course, does not mean that you are free to abandon healthy habits. Good nutrition and regular exercise are still important. To increase compliance, just be sure that the exercise program that you select is enjoyable and that it is easily integrated into your daily regimen. Same for selecting nutritious food.
Nevertheless, grade 2 and 3 obesity (BMI 35 or greater) are associated with increased mortality, so prevention and intervention are important. But is that primarily a responsibility of providers in the health care delivery system? Telling people to exercise and eat well is great advice, but it is not very effective, especially since everyone already knows that.
Prevention of obesity is more a function of society at large. Health education, school nutrition programs, responsible food product design by the industry, planning of communities to promote physical activity such as walking, biking or hiking, and including breaks for physical activity for those in sedentary occupations are types of measures that would take place out in the community rather than within the health care delivery system.
However, Grade 2 and 3 obesity do place a burden on the health care delivery system because of their association with chronic diseases. The policy community correctly emphasizes that the delivery system must provide chronic disease services. But that isn’t new. That is what primary care professionals have been doing all along.
What is a problem is that there has been a misplaced emphasis on chronic disease management as if that were a new solution to health care cost and quality issues. This has led to ineffectual tinkering by promoting nebulous models such as accountable care organizations. The efforts would be better directed toward reinforcing the primary care infrastructure.
If we really do want to improve the management of health care spending while improving quality we need to implement fundamental structural reform of our health care financing system by enacting a single payer, improved Medicare for all. It’s a system that would work great for all of us, even for those of us who are overweight.
Correction: “Overweight”
In today’s qotd message, “Overweight,” I wrote, “Being overweight (BMI 25->30) is associated with a mortality rate that is 6 percent lower than that for normal weight.”
The study demonstrated that the summary hazard ratio (HR) for overweight compared to normal weight was 0.94. Thus, “The researchers found that the summary HRs indicated a 6 percent lower risk of death for overweight.” (The JAMA Network, January 1, 2013).