Talk:Obesity

Bold text

Fetal origins of obesity

) There is a lot of evidence indicating that obesity might have a fetal background. Smoking in pregnancy leads to offspring obesity. This is not a genetic mechanism, which entitles it to have a separate section under "Causes and mechanisms". I would not call this "vandalism" Magfas (talk) 14:44, 30 May 2008 (UTC)

Cite the info, then im sure it would be considered. - FatM1ke (talk) 14:50, 30 May 2008 (UTC)

Here is a reviewMagfas (talk) 15:32, 30 May 2008 (UTC).

I didn't see anything on smoking in that. Did I miss something? -- Writtenonsand (talk) 20:17, 30 May 2008 (UTC)

Ok, that was more of a general review (were you able to access the entire review?) on fetal origins of obesity and fat distribution. Here is a more specific one on smoking. The point is that intrauterine processes influences the adaptation to life. It deserves a mention at least. Magfas (talk) 03:45, 31 May 2008 (UTC)

that photo of a love seat

How has that photo of a love seat stayed on here? Can someone ask the original poster to provide some evidence that that's indeed a special chair for large people, and if s/he can't, remove the picture? The whole thing screams "practical joke" to me. Triangular (talk) 22:07, 8 April 2008 (UTC)

exercise vs diet

The article currently says "exercise combined with diet resulted in a greater weight reduction than diet alone".

But that makes me wonder -- are there any studies comparing exercise alone vs. diet alone? Is "weight loss from exercise cod with diet" an additive effect of "weight loss due to exercise" plus "weight loss due to diet", or is there a synergetic effect? --68.0.124.33 (talk) 05:30, 19 February 2008 (UTC)

As well I think it's better to define what exactly is meant by exercise, diet and weight loss, as for myself, in the past 4 months I've changed my diet, started to exercise and as a result gained approximately 25 pounds, mainly of muscle. —Preceding unsigned comment added by 24.79.177.210 (talk) 00:09, 17 May 2008 (UTC)

Protection

Indefinite protection is not usually a good idea, but yesterday's unprotection of this page shows that it is a vandal magnet. I have yet to see a useful edit to this topic from an anon or newly-registered account. JFW | T@lk 07:35, 2 March 2008 (UTC)

Sounds like we're doing the right thing then. RFerreira (talk) 22:48, 4 March 2008 (UTC)

Keeping it off

mmmmmm: http://jama.ama-assn.org/cgi/content/abstract/299/10/1139?etoc JFW | T@lk 01:03, 17 March 2008 (UTC)

seen as a sign of lower socio-economic status

"Obesity is often seen as a sign of lower socio-economic status" sounds strange to me. Obesity correlates with low economic status. That is a fact and could be mentioned. But to see obese people as of lower socio-economic status is prejudice. Why mention the predjudice unless in a section on prejudice against the obsese?--Timtak (talk) 12:06, 23 March 2008 (UTC)

Anti-fat?

Fijagdh (talk · contribs) made some pretty sweeping changes to the introduction and opening sections. Edit summaries seem to indicate that the content was "anti-fat", but what came instead was a weasel-word laden attempt at NPOV. I don't think that there are many experts who disagree that prevalence of obesity is increasing or that it predisposes to many medical conditions. The news article that was inserted in the intro replaces peer-reviewed evidence already cited with "personal opinion" by "experts" with a sniff of conflict of interest. That may technically belong somewhere in the article, but is really not suitable for the intro. JFW | T@lk 07:26, 24 March 2008 (UTC)

For what it's worth, some of the additions lead to very interesting sources. I had heard of the UK twin study, but have now identified the actual reference and added it (in preferment over news articles that have the habit of dumbing down the data). The "10 alibis" news item led to a pretty high-profile review of additional explanations for the "obesity epidemic" that is highly quotable. JFW | T@lk 08:45, 24 March 2008 (UTC)

Units

Units in first paragraph The mg/kg2 should be kg/m2 —Preceding unsigned comment added by 67.169.27.178 (talk) 18:13, 25 March 2008 (UTC)

Usage of the term "healthy weight"

Given that there is conflicting evidence about the health effects of obesity, I propose that the term "healthy limits" in the first paragraph be changed to "established limits," or some other value-neutral term like that. Minerva9 (talk) 08:41, 29 March 2008 (UTC)

Disagree, your argument is clearly based on POV. —Preceding unsigned comment added by Ghyslyn (talk • contribs) 08:26, 14 April 2008 (UTC)

Here are some references --

http://query.nytimes.com/gst/fullpage.html?res=9F04E2D61F3EF934A35754C0A9649C8B63&sec=health&spon=&pagewanted=5

http://jama.ama-assn.org/cgi/content/abstract/298/17/2028

http://www.ncbi.nlm.nih.gov/pubmed/16339599?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I believe the issue deserves some discussion. Perhaps it's as simple as adding a section about crticisms of modern obesity research. Might provide useful information. Minerva9 (talk) 08:25, 25 April 2008 (UTC)

The following discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Merger proposal

I suggest that the Central obesity article be merged with this one. Central obesity contains NO references, and doesn't say much that is different from the Obesity article. -- JediLofty ^{User ¦ Talk} 09:06, 7 April 2008 (UTC)

I retract my proposal - the Central obesity article is much improved from the state it was in before and is now a well-rounded (ooh... poor choice of words there!), properly sourced article! -- JediLofty ^{User ¦ Talk} 16:08, 10 April 2008 (UTC)

• Support, but please spare us the slang terms ("muffin top" and "love handles") presently mentioned on that page. JFW | T@lk 10:31, 7 April 2008 (UTC)
• I believe we should keep the article on central obesity - because central obesity (belly fat) is a distinct topic in its own right, and has been covered a lot in the news lately, since much research has shown that there is a high correlation between belly fat and health risks such as stroke, and because users tend to look up specific things they'd like to know more about. Users who look this up will expect or hope there is an article explaining what this term is. Redirecting them to a huge article on obesity in general is inappropriate when it is central obesity specifically that they want clarified. Links to the general article can be provided in case users are interested in reading more (which is a core design philosophy of this and other encyclopedias - go from specific to general). Besides, the obesity article is already 74 kilobytes long, and we should start looking seriously at splitting it up. Also, more material is bound to be gathered on belly fat by our editors, and it makes sense that there is an article of its own for them to add more facts to - obesity is a wide enough topic (no pun intended) that we shouldn't expect to place everything about it on a single page. The Transhumanist    17:24, 7 April 2008 (UTC)
• Improvements to the article - I've copy-edited the whole central obesity article, have added references throughout, and have added two or three new sections as well. I think you will agree that the topic is well-worth covering in its own right. While I was researching additions to the article, I noticed a lot more material out there on this topic - for example, "central obesity" returns 111,000 hits on Google, while Google Scholar returned 14,400 hits. The Transhumanist    23:31, 7 April 2008 (UTC)
• Oppose merging. Central obesity is a distinct medical condition with a huge literature, which warrants its own page. The obesity page is sufficiently long to require splitting already. Espresso Addict (talk) 01:24, 9 April 2008 (UTC)
• Oppose merging. Per The Transhumanist and Espresso Addict. There's plenty of literature on central obesity, it has its own specific characteristics, and deserves to be treated in a separate article. --Eleassar ^{my talk} 15:17, 10 April 2008 (UTC)

---

The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made on the appropriate discussion page, such as the current discussion page. No further edits should be made to this discussion.

MC4R

http://www.mrc.ac.uk/NewsViewsAndEvents/News/MRC004564 - this has now been demonstrated to be relevant in a 90,000 people study. JFW | T@lk 06:32, 8 May 2008 (UTC)

Diets

OccamzRazor (talk · contribs) removed the entire section on dietary treatments, on the grounds that it because it discussed specific diets it was "not encylopedic information on obesity". A quick glance at the references will suggest that this is not just a list of diets. It is a list of diets that have actually been investigated in the treatment of obesity. It is therefore highly encyclopedic, because contrary to all the nonsense written in the ladies' magazines, these diets have been scientifically tested! I oppose removal of the section. If there are specific concerns, we ought to discuss them here. JFW | T@lk 09:59, 11 May 2008 (UTC)

Responsibility for World Ills

A recent letter by two members of the London School of Hygiene and Tropical Medicine, published in the Lancet, proposes that obese people are partially to blame for both global warming/climate change and the World food crisis (http://www.medicalnewstoday.com/articles/107629.php). It's been picked up by several reputable news outlets, and probably warrants inclusion in this article. I would reckon it should be put in the non-medical consequences section of the article, however, I would feel it warranted a little more exposition than just a bullet point and 2 or 3 sentences (as the section is currently comprised). Any thoughts on whether we should add a paragraph? Or just keep it to a bullet point? Malbolge (talk) 17:46, 16 May 2008 (UTC)

I'm not sure. This is a piece of opinion by two researchers who are not particularly notable in themselves. Obviously there is no direct evidence that obese people leave a larger carbon footprint (and it will be very hard to create that evidence). Furthermore, I submit that most obese people do not wilfully overeat/underexercise, so it would be rather unfair to place climate change squarely on their shoulders. JFW | T@lk 08:49, 23 May 2008 (UTC)

Semantics

For instance, reliance on energy-dense fast-food meals tripled between 1977 and 1995, and calorie intake quadrupled over the same period.[23]

Someone please clarify this, i.e. 'calorie intake of energy-dense foods quadrupled' —Preceding unsigned comment added by 198.166.47.72 (talk) 19:24, 16 May 2008 (UTC)

I think it makes perfect sense. Because more people have energy-dense meals, their overall calorie intake increased a lot. JFW | T@lk 08:49, 23 May 2008 (UTC)

Lardass redirects to Obesity?

I realize wikipedia is not censored, but the redirect to obesity from that word is offensive to those who are overweight.

I think Lardass belongs in the entry Insult on Wikipedia instead of redirecting to obesity. JasonHockeyGuy (talk) 00:46, 16 June 2008 (UTC)

Opening paragraph

The opening paragraph says that "Although obesity is an individual clinical condition, some authorities view it as a serious and growing public health problem". This should be changed to either "most authorities" or even "all". There is a debate about the effects of being overweight on mortality. There is however "No Serious" debate that obesity increases mortality and morbidity.

references include:

the CDC stats Canada The Joint Effects of Physical Activity and Body Mass Index on Coronary Heart Disease Risk in Women Arch Intern Med. 2008;168(8):884-890.

And listed below are a few more.

of 'Health hazards associated with obesity in adults' 6 TI The effect of age on the association between body-mass index and mortality. AU Stevens J; Cai J; Pamuk ER; Williamson DF; Thun MJ; Wood JL SO N Engl J Med 1998 Jan 1;338(1):1-7.

 	BACKGROUND: The effect of age on optimal body weight is controversial, and few studies have had adequate numbers of subjects to analyze mortality as a function of body-mass index across age groups. METHODS: We studied mortality over 12 years among white men and women who participated in the American Cancer Society's Cancer Prevention Study I (from 1960 through 1972). The 62,116 men and 262,019 women included in this analysis had never smoked cigarettes, had no history of heart disease, stroke, or cancer (other than skin cancer) at base line in 1959-1960, and had no history of recent unintentional weight loss. The date and cause of death for subjects who died were determined from death certificates. The associations between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and mortality were examined for six age groups in analyses in which we adjusted for age, educational level, physical activity, and alcohol consumption. RESULTS: Greater body-mass index was associated with higher mortality from all causes and from cardiovascular disease in men and women up to 75 years of age. However, the relative risk associated with greater body-mass index declined with age. For example, for mortality from cardiovascular disease, the relative risk associated with an increment of 1 in the body-mass index was 1.10 (95 percent confidence interval, 1.04 to 1.16) for 30-to-44-year-old men and 1.03 (95 percent confidence interval, 1.02 to 1.05) for 65-to-74-year-old men. For women, the corresponding relative risk estimates were 1.08 (95 percent confidence interval, 1.05 to 1.11) and 1.02 (95 percent confidence interval, 1.02 to 1.03). CONCLUSIONS: Excess body weight increases the risk of death from any cause and from cardiovascular disease in adults between 30 and 74 years of age. The relative risk associated with greater body weight is higher among younger subjects.

AD Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA. PMID 9414324 7 TI Body-mass index and mortality in a prospective cohort of U.S. adults. AU Calle EE; Thun MJ; Petrelli JM; Rodriguez C; Heath CW Jr SO N Engl J Med 1999 Oct 7;341(15):1097-105.

 	BACKGROUND: Body-mass index (the weight in kilograms divided by the square of the height in meters) is known to be associated with overall mortality. We investigated the effects of age, race, sex, smoking status, and history of disease on the relation between body-mass index and mortality. METHODS: In a prospective study of more than 1 million adults in the United States (457,785 men and 588,369 women), 201,622 deaths occurred during 14 years of follow-up. We examined the relation between body-mass index and the risk of death from all causes in four subgroups categorized according to smoking status and history of disease. In healthy people who had never smoked, we further examined whether the relation varied according to race, cause of death, or age. The relative risk was used to assess the relation between mortality and body-mass index. RESULTS: The association between body-mass index and the risk of death was substantially modified by smoking status and the presence of disease. In healthy people who had never smoked, the nadir of the curve for body-mass index and mortality was found at a body-mass index of 23.5 to 24.9 in men and 22.0 to 23.4 in women. Among subjects with the highest body-mass indexes, white men and women had a relative risk of death of 2.58 and 2.00, respectively, as compared with those with a body-mass index of 23.5 to 24.9. Black men and women with the highest body-mass indexes had much lower risks of death (1.35 and 1.21), which did not differ significantly from 1.00. A high body-mass index was most predictive of death from cardiovascular disease, especially in men (relative risk, 2.90; 95 percent confidence interval, 2.37 to 3.56). Heavier men and women in all age groups had an increased risk of death. CONCLUSIONS: The risk of death from all causes, cardiovascular disease, cancer, or other diseases increases throughout the range of moderate and severe overweight for both men and women in all age groups. The risk associated with a high body-mass index is greater for whites than for blacks.

AD Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329, USA. PMID 10511607 8 TI Body weight and mortality among women. AU Manson JE; Willett WC; Stampfer MJ; Colditz GA; Hunter DJ; Hankinson SE; Hennekens CH; Speizer FE SO N Engl J Med 1995 Sep 14;333(11):677-85.

 	BACKGROUND. The relation between body weight and overall mortality remains controversial despite considerable investigation. METHODS. We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes. RESULTS. In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood. CONCLUSIONS. Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.

AD Channing Laboratory, Harvard Medical School, Boston, MA, USA. PMID 7637744 9 TI Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. AU Wei M; Kampert JB; Barlow CE; Nichaman MZ; Gibbons LW; Paffenbarger RS Jr; Blair SN SO JAMA 1999 Oct 27;282(16):1547-53.

 	CONTEXT: Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations. OBJECTIVE: To quantify the influence of low cardiorespiratory fitness, an objective marker of physical inactivity, on CVD and all-cause mortality in normal-weight, overweight, and obese men and compare low fitness with other mortality predictors. DESIGN: Prospective observational data from the Aerobics Center Longitudinal Study. SETTING: Preventive medicine clinic in Dallas, Tex. PARTICIPANTS: A total of 25714 adult men (average age, 43.8 years [SD, 10.1 years]) who received a medical examination during 1970 to 1993, with mortality follow-up to December 31, 1994. MAIN OUTCOME MEASURES: Cardiovascular disease and all-cause mortality based on mortality predictors (baseline CVD, type 2 diabetes mellitus, high serum cholesterol level, hypertension, current cigarette smoking, and low cardiorespiratory fitness) stratified by body mass index. RESULTS: During the study period, there were 1025 deaths (439 due to CVD) during 258781 man-years of follow-up. Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD (age- and examination year-adjusted relative risk [RR], 14.0; 95% confidence interval [CI], 9.4-20.8); RRs for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 (95% CI, 2.7-7.1) for smoking to 5.0 (95% CI, 3.6-7.0) for low fitness. Relative risks for all-cause mortality in obese men ranged from 2.3 (95% CI, 1.7-2.9) for men with hypertension to 4.7 (95% CI, 3.6-6.1) for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 (95% CI, 2.5-3.8) and in obese men with diabetes mellitus 3.1 (95% CI, 2.3-4.2) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% (n = 1674) of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attributable risks of 51% and 27% for CVD and all-cause mortality, respectively. CONCLUSIONS: In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.

AD The Cooper Institute for Aerobics Research, Dallas, Tex 75230, USA. PMID 10546694 10 TI Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. AU Lee CD; Blair SN; Jackson AS SO Am J Clin Nutr 1999 Mar;69(3):373-80.

 	BACKGROUND: Cardiorespiratory fitness and body fatness are both related to health, but their interrelation to all-cause and cardiovascular disease (CVD) mortality is unknown. OBJECTIVE: We examined the health benefits of leanness and the hazards of obesity while simultaneously considering cardiorespiratory fitness. DESIGN: This was an observational cohort study. We followed 21925 men, aged 30-83 y, who had a body-composition assessment and a maximal treadmill exercise test. There were 428 deaths (144 from CVD, 143 from cancer, and 141 from other causes) in an average of 8 y of follow-up (176742 man-years). RESULTS: After adjustment for age, examination year, cigarette smoking, alcohol intake, and parental history of ischemic heart disease, unfit (low cardiorespiratory fitness as determined by maximal exercise testing), lean men had double the risk of all-cause mortality of fit, lean men (relative risk: 2.07; 95% CI: 1.16, 3.69; P = 0.01). Unfit, lean men also had a higher risk of all-cause and CVD mortality than did men who were fit and obese. We observed similar results for fat and fat-free mass in relation to mortality. Unfit men had a higher risk of all-cause and CVD mortality than did fit men in all fat and fat-free mass categories. Similarly, unfit men with low waist girths (<87 cm) had greater risk of all-cause mortality than did fit men with high waist girths (> or =99 cm). CONCLUSIONS: The health benefits of leanness are limited to fit men, and being fit may reduce the hazards of obesity.

AD Division of Epidemiology & Clinical Applications, Cooper Institute for Aerobics Research, Dallas, TX, USA. PMID 10075319 11 TI Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland. AU Jousilahti P; Tuomilehto J; Vartiainen E; Pekkanen J; Puska P SO Circulation 1996 Apr 1;93(7):1372-9.

 	BACKGROUND: Body weight is closely related to several known cardiovascular risk factors, but it may also have an independent effect on the risk of coronary heart disease (CHD). In this study, we analyzed the association between body mass index (BMI) and smoking, serum cholesterol, and blood pressure at baseline, as well as how BMI and the other risk factors are related to CHD mortality. METHODS AND RESULTS: A total of 16 113 men and women aged 30 to 59 years were examined in eastern Finland in either 1972 or 1977. Serum cholesterol and blood pressure had a positive association and smoking had a negative association with BMI. During the 15-year prospective follow-up, mortality from CHD was positively associated with BMI. The BMI-associated risk ratio of CHD mortality, adjusted for age and study year, estimated from the Cox proportional hazards model was 1.04 (per kg/m2) (P < .001) among men. Inclusion of smoking in the model increased the risk ratio for BMI, whereas inclusion of serum cholesterol and blood pressure decreased it. In the model that included age, study year, and all three major cardiovascular risk factors, the BMI-associated risk ratio was 1.03 (P = .027). Among women, the BMI-associated risk ratio of CHD mortality adjusted for age and study year was 1.05 (P = .023) and the multifactorial adjusted risk ratio was 1.03 (P = .151). CONCLUSIONS: Obesity is an independent risk factor for CHD mortality among men and also contributes to the risk of CHD among women. Part of the BMI-associated risk of CHD mortality is mediated through other known cardiovascular risk factors. By preventing overweight, a substantial part of CHD mortality may be prevented.

AD National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland. PMID 8641026 12 TI Midlife body mass index and hospitalization and mortality in older age. AU Yan LL; Daviglus ML; Liu K; Stamler J; Wang R; Pirzada A; Garside DB; Dyer AR; Van Horn L; Liao Y; Fries JF; Greenland P SO JAMA. 2006 Jan 11;295(2):190-8.

 	CONTEXT: Abundant evidence links overweight and obesity with impaired health. However, controversies persist as to whether overweight and obesity have additional impact on cardiovascular outcomes independent of their strong associations with established coronary risk factors, eg, high blood pressure and high cholesterol level. OBJECTIVE: To assess the relation of midlife body mass index with morbidity and mortality outcomes in older age among individuals without and with other major risk factors at baseline. DESIGN: Chicago Heart Association Detection Project in Industry study, a prospective study with baseline (1967-1973) cardiovascular risk classified as low risk (blood pressure < or =120/< or =80 mm Hg, serum total cholesterol level <200 mg/dL [5.2 mmol/L], and not currently smoking); moderate risk (nonsmoking and systolic blood pressure 121-139 mm Hg, diastolic blood pressure 81-89 mm Hg, and/or total cholesterol level 200-239 mg/dL [5.2-6.2 mmol/L]); or having any 1, any 2, or all 3 of the following risk factors: blood pressure > or =140/90 mm Hg, total cholesterol level > or =240 mg/dL (6.2 mmol/L), and current cigarette smoking. Body mass index was classified as normal weight (18.5-24.9), overweight (25.0-29.9), or obese (> or =30). Mean follow-up was 32 years. SETTING AND PARTICIPANTS: Participants were 17,643 men and women aged 31 through 64 years, recruited from Chicago-area companies or organizations and free of coronary heart disease (CHD), diabetes, or major electrocardiographic abnormalities at baseline. MAIN OUTCOME MEASURES: Hospitalization and mortality from CHD, cardiovascular disease, or diabetes, beginning at age 65 years. RESULTS: In multivariable analyses that included adjustment for systolic blood pressure and total cholesterol level, the odds ratio (95% confidence interval) for CHD death for obese participants compared with those of normal weight in the same risk category was 1.43 (0.33-6.25) for low risk and 2.07 (1.29-3.31) for moderate risk; for CHD hospitalization, the corresponding results were 4.25 (1.57-11.5) for low risk and 2.04 (1.29-3.24) for moderate risk. Results were similar for other risk groups and for cardiovascular disease, but stronger for diabetes (eg, low risk: 11.0 [2.21-54.5] for mortality and 7.84 [3.95-15.6] for hospitalization). CONCLUSION: For individuals with no cardiovascular risk factors as well as for those with 1 or more risk factors, those who are obese in middle age have a higher risk of hospitalization and mortality from CHD, cardiovascular disease, and diabetes in older age than those who are normal weight.

AD Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA. [email protected] PMID 16403931 13 TI Body weight and mortality among men and women in China. AU Gu D; He J; Duan X; Reynolds K; Wu X; Chen J; Huang G; Chen CS; Whelton PK SO JAMA. 2006 Feb 15;295(7):776-83.

 	CONTEXT: The effect of underweight and obesity on mortality has not been well characterized in Asian populations. OBJECTIVE: To examine the relationship between body mass index (BMI) and mortality in Chinese adults. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study in a nationally representative sample of 169,871 Chinese men and women aged 40 years or older. Data on body weight and covariables were obtained at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4% (n = 158,666). MAIN OUTCOME MEASURES: Body mass index and all-cause mortality. RESULTS: After excluding those participants with missing body weight or height values, 154,736 adults were included in the analysis. After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, education, geographic region (north vs south), and urbanization (urban vs rural), a U-shaped association between BMI and all-cause mortality was observed (P<.001). Using those participants with a BMI of 24.0 to 24.9 as the reference group, the relative risks of all-cause mortality across categories of BMI were 1.65 (95% confidence interval [CI], 1.54-1.77) for BMI less than 18.5, 1.31 (95% CI, 1.22-1.41) for BMI 18.5 to 19.9, 1.20 (95% CI, 1.11-1.29) for BMI 20.0 to 20.9, 1.12 (95% CI, 1.04-1.21) for BMI 21.0 to 21.9, 1.11 (95% CI, 1.03-1.20) for BMI 22.0 to 22.9, 1.09 (95% CI, 1.01-1.19) for BMI 23.0 to 23.9, 1.00 (95% CI, 0.92-1.08) for BMI 25.0 to 26.9, 1.15 (95% CI, 1.06-1.24) for BMI 27.0 to 29.9, and 1.29 (95% CI, 1.16-1.42) for BMI 30.0 or more. The U-shaped association existed even after excluding participants who were current or former smokers, heavy alcohol drinkers, or who had prevalent chronic illness at the baseline examination, or who died during the first 3 years of follow-up. A similar association was observed between BMI and mortality from cardiovascular disease, cancer, and other causes. CONCLUSIONS: Our results indicate that both underweight and obesity were associated with increased mortality in the Chinese adult population. Furthermore, our findings support the use of a single common recommendation for defining overweight and obesity among all racial and ethnic groups.

AD Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China. [email protected] PMID 16478900 14 TI Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. AU Adams KF; Schatzkin A; Harris TB; Kipnis V; Mouw T; Ballard-Barbash R; Hollenbeck A; Leitzmann MF SO N Engl J Med. 2006 Aug 24;355(8):763-78. Epub 2006 Aug 22.

 	BACKGROUND: Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. METHODS: We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. RESULTS: During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. CONCLUSIONS: Excess body weight during midlife, including overweight, is associated with an increased risk of death.

AD Nutritional Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md, USA. [email protected] PMID 16926275 15 TI Body-mass index and mortality in Korean men and women. AU Jee SH; Sull JW; Park J; Lee SY; Ohrr H; Guallar E; Samet JM SO N Engl J Med. 2006 Aug 24;355(8):779-87. Epub 2006 Aug 22.

 	BACKGROUND: Obesity is associated with diverse health risks, but the role of body weight as a risk factor for death remains controversial. METHODS: We examined the association between body weight and the risk of death in a 12-year prospective cohort study of 1,213,829 Koreans between the ages of 30 and 95 years. We examined 82,372 deaths from any cause and 48,731 deaths from specific diseases (including 29,123 from cancer, 16,426 from atherosclerotic cardiovascular disease, and 3362 from respiratory disease) in relation to the body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters). RESULTS: In both sexes, the average baseline BMI was 23.2, and the rate of death from any cause had a J-shaped association with the BMI, regardless of cigarette-smoking history. The risk of death from any cause was lowest among patients with a BMI of 23.0 to 24.9. In all groups, the risk of death from respiratory causes was higher among subjects with a lower BMI, and the risk of death from atherosclerotic cardiovascular disease or cancer was higher among subjects with a higher BMI. The relative risk of death associated with BMI declined with increasing age. CONCLUSIONS: Underweight, overweight, and obese men and women had higher rates of death than men and women of normal weight. The association of BMI with death varied according to the cause of death and was modified by age, sex, and smoking history.

AD Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea. [email protected] PMID 16926276 16 TI Mortality and cardiac and vascular outcomes in extremely obese women. AU McTigue K; Larson JC; Valoski A; Burke G; Kotchen J; Lewis CE; Stefanick ML; Van Horn L; Kuller L SO JAMA. 2006 Jul 5;296(1):79-86.

 	CONTEXT: Obesity, typically measured as body mass index of 30 or higher, has 3 subclasses: obesity 1 (30-34.9); obesity 2 (35-39.9); and extreme obesity (> or =40). Extreme obesity is increasing particularly rapidly in the United States, yet its health risks are not well characterized. OBJECTIVE: To determine how cardiovascular and mortality risks differ across clinical weight categories in women, with a focus on extreme obesity. DESIGN, SETTING, AND PARTICIPANTS: We examined incident mortality and cardiovascular outcomes by weight status in 90,185 women recruited from 40 US centers for the Women's Health Initiative Observational Study and followed up for an average of 7.0 years (October 1, 1993 to August 31, 2004). MAIN OUTCOME MEASURES: Incidence of mortality, coronary heart disease, diabetes, and hypertension. RESULTS: Extreme obesity prevalence differed with race/ethnicity, from 1% among Asian and Pacific Islanders to 10% among black women. All-cause mortality rates per 10,000 person-years were 68.39 (95% confidence interval [CI], 65.26-71.68) for normal body mass index, 71.16 (95% CI, 67.68-74.82) for overweight, 84.47 (95% CI, 78.90-90.42) for obesity 1, 102.85 (95% CI, 92.90-113.86) for obesity 2, and 116.85 (95% CI, 103.36-132.11) for extreme obesity. Analyses adjusted for age, smoking, educational achievement, US region, and physical activity levels showed that weight-related risk for all-cause mortality, coronary heart disease mortality, and coronary heart disease incidence did not differ by race/ethnicity. Adjusted analyses among white and black participants showed positive trends in all-cause mortality and coronary heart disease incidence with increasing weight category. Much of the obesity-related mortality and coronary heart disease risk was mediated by diabetes, hypertension, and hyperlipidemia. In white women, weight-related all-cause mortality risk was modified by age, with obesity conferring less risk among older women. CONCLUSIONS: Considering obesity as a body mass index of 30 or higher may lead to misinterpretation of individual and population risks. Escalating extreme obesity may exacerbate health effects and costs of the obesity epidemic.

AD Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa 15213, USA. [email protected] PMID 16820550 17 TI Body mass index and all-cause mortality in a nationwide US cohort. AU Freedman DM; Ron E; Ballard-Barbash R; Doody MM; Linet MS SO Int J Obes (Lond). 2006 May;30(5):822-9.

 	OBJECTIVE: To investigate whether the nature of the relationship between body mass index (BMI (kg/m2)) and all-cause mortality is direct, J- or U-shaped, and whether this relationship changes as people age. DESIGN: Prospective nationwide cohort study of US radiologic technologists (USRT). SUBJECTS: Sixty-four thousand seven hundred and thirty-three female and 19 011 male certified radiation technologists. METHODS: We prospectively followed participants from the USRT study who completed a mail survey in 1983-1989 through 2000. During an average of 14.7 years of follow-up or 1.23 million person-years, 2278 women and 1495 men died. Using Cox's proportional-hazards regression analyses, we analyzed the relationship between BMI and all-cause mortality by gender and by age group (<55 years; > or = 55 years). We also examined risk in never-smokers after the first 5 years of follow-up to limit bias owing to the confounding effects of smoking and illness-related weight loss on BMI and mortality. RESULTS: Risks were generally J-shaped for both genders and age groups. When we excluded smokers and the first 5 year of follow-up, risks were substantially reduced in those with low BMIs. In never-smoking women under the age of 55 years (excluding the initial 5-year follow-up period), risk rose as BMI increased above 21.0 kg/m2, whereas in older women, risk increased beginning at a higher BMI (> or = 25.0 kg/m2). Among younger men who never smoked (excluding the initial 5-year follow-up period), risk began to rise above a BMI of 23.0 kg/m2, whereas in older men, risk did not begin to increase until exceeding a BMI of 30.0 kg/m2. CONCLUSIONS: In younger/middle-aged, but not older, women and men, mortality risks appear directly related to BMI. The more complicated relationship between BMI and mortality in older subjects suggests the importance of assessing whether other markers of body composition better explain mortality risk in older adults.

AD Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, USA. [email protected] PMID 16404410 18 TI Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. AU Price GM; Uauy R; Breeze E; Bulpitt CJ; Fletcher AE SO Am J Clin Nutr. 2006 Aug;84(2):449-60.

 	BACKGROUND: Guidelines for optimal weight in older persons are limited by uncertainty about the ideal body mass index (BMI) or the usefulness of alternative anthropometric measures. OBJECTIVE: We investigated the association of BMI (in kg/m(2)), waist circumference, and waist-hip ratio (WHR) with mortality and cause-specific mortality. DESIGN: Subjects aged >/=75 y (n = 14 833) from 53 family practices in the United Kingdom underwent a health assessment that included measurement of BMI and waist and hip circumferences; they also were followed up for mortality. RESULTS: During a median follow-up of 5.9 y, 6649 subjects died (46% of circulatory causes). In nonsmoking men and women (90% of the cohort), compared with the lowest quintile of BMI (<23 in men and <22.3 in women), adjusted hazard ratios (HRs) for mortality were <1 for all other quintiles of BMI (P for trend = 0.0003 and 0.0001 in men and women, respectively). Increasing WHR was associated with increasing HRs in men and women (P for trend = 0.008 and 0.0002, respectively). BMI was not associated with circulatory mortality in men (P for trend = 0.667) and was negatively associated in women (P for trend = 0.004). WHR was positively related to circulatory mortality in both men and women (P for trend = 0.001 and 0.005, respectively). Waist circumference was not associated with all-cause or circulatory mortality. CONCLUSIONS: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged >/=75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.

AD Centre for Ageing and Public Health and the Nutrition and Public Health Interventions Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom. PMID 16895897 Jmh649 (talk) 17:38, 6 July 2008 (UTC) jmh649 Jmh649 (talk) 17:38, 6 July 2008 (UTC)

Genetics

The below segment does not follow from the reference. It implies that 7% of obese people have a single locus mutation. What the article says is that 7% of those with severe obesity [body mass index (BMI) SD score (SDS) > 3] of early onset (<10 yr) have a single locus mutation. Not 7% of the general population as is implied.

Various genetic conditions that feature obesity have been identified (such as Prader-Willi syndrome, Bardet-Biedl syndrome, MOMO syndrome, leptin receptor mutations and melanocortin receptor mutations), but known single-locus mutations have been found in only about 7% of obese individuals; these people tend to be very obese from a very young age.[26]