Overview

• Body mass index (BMI) determines the classification of obesity for clinical use.

• Waist circumference reflects the distribution of adipose tissue and helps determine obesity risk.

• Central obesity, reflected by a high waist measurement, is associated with more complications.

Obesity has been a rapidly developing health concern in the United States. The ongoing Behavioral Risk Factor Surveillance System (BRFSS) and National Health and Nutrition Examination Survey (NHANES) provide a longitudinal view of changes in the obesity problem. BRFSS data are from a state-based telephone survey, and NHANES data are based on measurements of a representative sample of the U.S. population. The self-reporting design of BRFSS tends to underestimate weight, but ongoing studies can be examined for trends. NHANES reported that the prevalence of U.S. adults in the overweight category (BMI >25 kg/m2) increased from 46% to 61% between the late 1970s and 1990s

(Zimmerman, 2002). As of 1999-2000, 64.5% of adults were overweight and 30.5% were obese (BMI >30 kg/m2) (Flegal et al., 2002). Prevalence estimates from the Centers for Disease Control and Prevention (CDC) for 2007-2008 found that 32.2% of men and 35.5% of women were obese. In addition, surveys from 1976-1980 and 2003-2006 found that obesity increased from 5.0% to 12.4% among children age 2 to 5 years; from 6.5% to 17.0% for ages 6 to 11 years; and 5.0% to 17.6% for ages 12 to 19 years. Changes in obesity prevalence have affected all U.S. regions (Fig. 36-1).

The problem of obesity is not limited to the United States. Globally, overnutrition has now surpassed undernutrition as a public health concern. An estimated 8.5% of the world population is overweight versus 5.8% underweight (Zimmerman, 2002). Although obesity prevalence estimates vary among countries, the World Health Organization (WHO) has projected that 2.3 billion adults will be overweight and 700,000 million obese by 2015.

Improved treatment of comorbidities has made assessing obesity's impact on mortality more difficult, but estimates of the excess mortality associated with obesity in the United States range from 100,000 to 300,000 deaths each year. Persons in the overweight category have 20% to 40% increased mortality, and obese persons have a twofold to threefold increase in mortality (Adams et al., 2006).

Key Points

OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 1999 (*BMI = 30, or ~30 lbs. overweight for 5' 4" person)

□ No data □ <10% □ 10%-14% □ 15%-19% □ = 20%

□ No data □ <10% □ 10%-14% □ 15%-19% □ = 20%

OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2003 *BMI = 30, or ~30 lbs. overweight for 5' 4" person)

OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2003 *BMI = 30, or ~30 lbs. overweight for 5' 4" person)

□ No data □ <10% □ 10%-14% □ 15%-19% □ 20%-24% □ = 25%

OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2008 *BMI = 30, or ~30 lbs. overweight for 5' 4" person)

OBESITY TRENDS* AMONG U.S. ADULTS BRFSS, 2008 *BMI = 30, or ~30 lbs. overweight for 5' 4" person)

□ No data □ <10% □ 10%-14% □ 15%-19% □ 20%-24% □ 25%-29% □ = 30%

Figure 36-1 U.S. maps reflecting changes in obesity prevalence estimates over time. (Courtesy Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance

Table 36-1 Obesity and Body Mass Index (BMI): Height and Weight

Healthy

Overweight

Obese

BMI (kg/m2)

18.5

24.9

25

27

29.9

30

35

40

45

Height

Weight (lb)

4'10'

89

119

120

129

143

144

167

191

215

4' 11"

92

123

124

134

147

148

173

198

223

5'0"

95

127

128

138

153

154

179

205

230

5'1"

98

131

132

143

158

159

185

211

238

5'2"

101

136

137

148

163

164

191

218

246

5'3"

104

140

141

152

168

169

197

226

254

5'4"

108

145

146

157

174

175

204

233

262

5 5"

111

149

150

162

179

180

210

240

270

5'6"

115

154

155

167

185

186

217

247

278

5'7"

118

158

159

172

190

191

223

255

287

5'8"

122

163

164

177

196

197

230

263

296

5'9"

125

168

169

183

202

203

237

270

304

5'10"

129

173

174

188

208

209

244

278

313

5' 11"

133

178

179

193

214

215

251

286

322

6 0"

136

183

184

199

220

221

258

294

331

6 1"

140

188

189

204

226

227

265

303

340

6'2"

144

193

194

210

232

233

272

311

350

6 3"

148

199

200

216

239

240

280

319

359

6 4"

152

204

205

221

245

246

287

328

369

The increased prevalence of obesity has many other health ramifications. An increase in body mass index (BMI) is a risk factor for short-term disability in the workplace. Overweight and obese individuals have odds ratios of 1.26 and 1.76, respectively, compared to normal-weight workers (Arena et al., 2006). Obesity increases "presenteeism," or the reduced productivity in workers still on the job. Workers with BMI over 35 kg/m2 experienced a 4.2% health-related drop in productivity (Gates et al., 2008). Evidence indicates that the 37% increase in obesity rates (BRFSS) between 1998 and 2006 is a significant factor driving health care costs. The medical consequences of obesity have been estimated to account for 9.1% of annual medical spending (Finkelstein et al., 2009).

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