Obesity More Deadly than Previously Believed
Research has consistently shown that obesity is correlated with many health risks, including diabetes and other chronic conditions. New findings call into question current beliefs about being overweight, specifically that only extreme obesity and underweight increase mortality risk. A new study suggests that obesity is a greater health threat than previously thought.
Obesity Risks and Diabetes
Obesity is one of the most prevalent public health threats in the U.S. According to 2021 findings of the National Health and Nutrition Examination Survey (NHANES), the prevalence of obesity in this country rose from 30.5% to 41.9% from 1999-2000 through 2017-2020. During this period, severe obesity rates increased from 4.7% to 9.2%.
Obesity places a significant economic burden on the U.S. In 2019, the cost of treating obesity and related conditions was almost $173 billion. Adults with obesity paid an average of $1,861 more in medical expenses than those with a healthy weight.
Being overweight or obese often comes with coexisting health conditions or comorbidities. One prevalent comorbidity is diabetes, which afflicts 37.3 million (11.3%) of the U.S. population. Experts estimate that 8.5 million individuals remain undiagnosed.
Diabetes rates experienced continual increases for several years. But from 2009 to 2019, prevalence decreased from 9.3 to 5.9 per 1,000 adults. However, prediabetes rates are rising, with diagnoses increasing from 6.5% to 17.4%.
Being overweight is the leading factor that raises the risk of developing type 2 diabetes. This disease was the eighth most common cause of death in 2020. The combination of obesity and diabetes can also increase a person’s cardiovascular disease risk.
The U.S. is experiencing a growing obesity epidemic. Four in 10 adults have obesity, and these rates are increasing. Behavioral choices like poor diet and low activity factor into some health outcomes. However, socioeconomic and environmental conditions like the lack of access to nutritious food, health inequities, and working conditions with increased sedentary behavior also contribute to the problem. The failure to address this epidemic from various angles will only add to the nation’s economic and medical burdens.
Problems with Body Mass Index (BMI) When Estimating Obesity-Related Mortality
As a risk factor for diabetes and other chronic conditions, obesity increases mortality by 22% to 91%. According to research conducted at the University of Colorado at Boulder, these rates are more significant than previously thought. The study also asserts that estimated mortality risks from being underweight have been exaggerated.
Body mass index (BMI) has been a standard metric for measuring body fatness and weight categories to estimate risk factors. BMI is based on height and weight. Based on this metric, experts have previously asserted that people in the “obese” and “overweight” categories tend to have lower mortality risks. Also, people at the extreme ends of “underweight” and “extremely obese” were thought to have the highest risks.
According to Ryan Masters, author of the new study, BMI is a biased measure because it does not consider how long someone has been overweight or their body composition. Due to this bias, previous studies using BMI could yield findings that overestimate the mortality risks for individuals in the “underweight” category and underestimate them for people classified as “overweight” or “obese.”
To investigate this obesity paradox, the Masters analyzed data from almost 18,000 individuals in the NHANES. He found that 20% of individuals with “healthy” weights were overweight or obese in the previous decade. Moreover, these patients experienced worse health than those with more stable weights. The implication is that being overweight for several years can increase the risk of the kinds of illnesses that cause sudden weight loss.
Masters also found that 37% of people in the “overweight” group and 60% in the “obese” group had lower BMIs in the previous decade. These individuals who put on weight relatively recently exhibited better health. Their current inclusion in the higher categories likely contributed to assumptions that higher BMI categories were less risky than they are.
After factoring out these biases, Masters found that people with lower BMIs also had a reduced mortality risk. Whereas previous research claimed that 2-3% of adult deaths were attributed to high BMIs, the current findings put those estimates at eight times higher. Masters concludes that previous research “likely underestimated the mortality consequences of living in a country where cheap, unhealthy food has grown increasingly accessible, and sedentary lifestyles have become the norm.”
Addressing the Obesity Crisis
It is essential to have an accurate picture of the obesity epidemic in the U.S. and to understand its medical and economic impacts. Many researchers, physicians, and health educators are rethinking the use of BMI and finding more accurate ways to assess obesity risk factors. Using caution when drawing conclusions based on BMI categorizations would be wise.
The availability of processed foods, increased sedentary lifestyles, and limited access to nutritious food in some areas have contributed to the growing obesity problem in the U.S. Being mindful of the behavioral, economic, and environmental conditions contributing to the increasing obesity epidemic can help us understand and arrest this problem.
If you are overweight and are ready to drop the extra pounds, there are several steps you can take to improve your health. Even losing 10-15 pounds can significantly impact your well-being. The American Diabetes Association recommends the following:
- Being physically active for most days of the week
- Eating a breakfast rich in protein to stay fuller longer
- Limit TV viewing to 10 hours per week
- Reducing fat, sugar, and caloric intake
- Weighing yourself once per week
If you have young children or adolescents, consider getting them screened for obesity. Your physician can recommend counseling and behavioral interventions for any child who is overweight or at risk.
Research and materials for this article were compiled, written, and distributed on behalf of the National Public Health Information Coalition. The views and opinions expressed in this blog are those of the various authors and do not necessarily reflect the official policy or position of the National Public Health Information Coalition or its members.
References
https://stacks.cdc.gov/view/cdc/106273
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247307
https://www.healthline.com/health/comorbidity#definition
https://www.cdc.gov/diabetes/data/statistics-report/index.html
https://diabetes.org/healthy-living/weight-loss/extra-weight-extra-risk
https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm
https://www.tfah.org/wp-content/uploads/2022/09/2022ObesityReport_FINAL3923.pdf
https://www.colorado.edu/today/2023/02/23/excess-weight-obesity-more-deadly-previously-believed
https://www.cdc.gov/healthyweight/assessing/bmi/index.html
https://www.colorado.edu/today/2023/02/23/excess-weight-obesity-more-deadly-previously-believed
https://www.commonwealthfund.org/blog/2018/rising-obesity-united-states-public-health-crisis