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Senior Citizen Health & Medicine
Health and Death Risks Underestimated for Extremely
Obese Women
Study finds obesity conferring less risk among
older white women
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Extreme Obesity in Women Increasing, Linked to
Greater Risk of Death -
7/04/06
»1 min 58
sec |
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July 5, 2006 - The health risks for women who are
extremely obese may be underestimated as a new study indicates they have
a higher prevalence of hypertension, diabetes, and high cholesterol than
women at lower levels of obesity, which increases the risk of death.
Interestingly, however, they found obesity creating less risk among
older white women, according to a study in the July 5 issue of JAMA.
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Obesity diagnosis and treatment are typically based
on body mass index (BMI) of at least 30. BMI is calculated as weight in
kilograms divided by height in meters squared.
However, three categories of obesity are defined:
obesity 1 (30-34.9); obesity 2 (35-39.9); and extreme obesity (40 and
greater). (A 54 person would have a BMI of 40 if they weighed 233
lbs).
Editor's Note: To easily check your BMI use
our handy table - click here.
The latter 2 categories, sometimes termed severe
obesity, are reported to be increasing especially rapidly in the United
States, according to background information in the article. From 1986 to
2000, prevalence of BMI of 30 or higher approximately doubled, while
that of BMI of 40 or higher quadrupled and that of BMI of 50 or higher
increased 5-fold. In 2000, 2.8 percent of all U.S. women, and 6 percent
of black women reported measurements consistent with extreme obesity.
Estimates of obesity-related risks in women have
generally been based on weight data that preceded the increase in
extreme obesity. It has been unclear whether health risk increases or
plateaus as body weight increases throughout the obese range.
Kathleen McTigue, M.D., M.S., M.P.H., of the
University of Pittsburgh, and colleagues conducted a study to examine
the relationship between weight category and risk of death and coronary
heart disease (CHD) in a large population-based sample of U.S. women,
focusing on risk across degree of obesity.
The researchers analyzed data on incident death and
cardiovascular outcomes by weight status in 90,185 women recruited from
40 U.S. centers for the Womens Health Initiative-Observational Study
who were followed-up for an average of 7.0 years (Oct. 1993 to Aug.
2004).
The researchers found that extreme obesity
prevalence differed with race/ethnicity, from 1 percent among Asian and
Pacific Islanders to 10 percent among black women.
In this diverse population-based sample of older
women, we found that obesity was linked with considerable health risk
and that accounting for degree of excess weight is important in
understanding weight-related health risk.
"Overall, extremely obese women
were more likely to die over the average 7.0 years of follow-up than
were women in other examined weight categories. Modeling analyses
adjusted for age, smoking status, educational achievement, U.S. region,
and physical activity level showed that weight-related risk for
all-cause mortality, CHD mortality, and CHD incidence did not differ by
race/ethnicity.
There was a positive trend in all-cause mortality
risk and CHD incidence with increasing weight category. This trend had
borderline significance for CHD mortality among black women, likely
reflecting sample size limitations. Much of the obesity-related
mortality and CHD risk was mediated by diabetes, hypertension, and
hyperlipidemia [high cholesterol levels].
"In white women, as other studies have found,
weight-related all-cause mortality risk was modified by age, with
obesity conferring less risk among older women. (At
each decade of baseline age, rates of all-cause mortality
were higher in the obese vs normal BMI weight categories. However,
the relative increase in mortality rates with weight category
decreased with age.)
"Smoking may modify weight-related risk in black
women, but further study is needed to understand the nature of this
relationship, the authors write.
Our findings have important clinical and policy
implications. The escalating prevalence of extreme obesity may
exacerbate the health effects and health-related expenditures resulting
from the U.S. obesity epidemic. Calculating the weight-related risks of
morbidity and mortality based on findings in earlier population samples,
which tended to reflect lower degrees of obesity, may underestimate the
risks for extremely obese individuals and overestimate the risks for
mildly obese individuals in diverse groups, the researchers write.
More accurately assessing weight-related health
risk may both improve policy decisions about obesity and assist women in
making informed decisions about their health.
Editor's Note: The Womens Health Initiative
program is funded by the National Heart, Lung, and Blood Institute, U.S.
Department of Health and Human Services. Dr. McTigue was supported by a
grant from the National Institute of Diabetes and Digestive and Kidney
Diseases.
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