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Degree of Obesity Correlates With Mortality Risk

Posted: Friday, July 14, 2006

In women, the risk of all-cause and coronary heart disease mortality continues to increase as body mass index (BMI) rises above 30, according to the latest findings from the Women's Health Initiative (WHI) Observational Study.

Principal investigator Dr. Kathleen McTigue of the University of Pittsburgh, told Diabetes In Control that, "It's not good enough to consider obesity alone." "You need to look at degree of obesity."

In a study published in the July 5th Journal of the American Medical Association, Dr. McTigue and colleagues studied patterns of morbidity and mortality risk according to BMI in 90,185 women in the WHI study who were not in the diet or hormone treatment arms of the study. Average follow-up was 7 years.

Body mass index (BMI) was classified using NIH definitions of normal, overweight and obesity. Normal weight BMI ranged from 18.5 to 24.9 and overweight was defined as a BMI of 25-29.9. The investigators defined three categories of obesity: obesity 1 (BMI of 30-34.9), obesity 2 (BMI 35-39.9) and extreme obesity (BMI 40 and higher).

"The risks of extreme obesity have not been well-defined," Dr. McTigue noted. "This was a large enough sample to assess risk."

The prevalence of extreme obesity varied by ethnicity, occurring in 10% of black women and 1% of Asian and Pacific Islanders. However, all-cause mortality, coronary heart disease mortality and coronary heart disease incidence did not vary by ethnicity.
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There is an increasing risk of all-cause mortality with increasing weight, but it doesn't reach statistical significance until obesity exists," Dr. McTigue told Reuters Health. Compared with normal-weight women, she continued, "the risk of dying was increased 12% in all women in obesity category 1, while risk was increased 86% over seven years in women in obesity category 3."

Summing up, she said, "The coronary heart disease and all-cause mortality risk increases along a continuum."

In a University of Pittsburgh release, the researcher pointed out that "earlier studies, which tended to reflect lower degrees of obesity, may underestimate the risks of extremely obese individuals and overestimate the risk for mildly obese individuals in diverse groups."

She concluded, "More accurately assessing weight-related health risk may both improve policy decisions about obesity and assist women in making informed decisions about their health."

Source: Diabetes In Control: JAMA 2006;296:79-86