ReviewThe effect of obesity on health outcomes
Section snippets
Background
There has been a steady increase in the prevalence of obesity over the last 30 years with developed countries leading the way. Unfortunately, developing countries are following suit as they urbanize and modernize. More than 300 million people worldwide now exceed the body mass index (BMI) obesity threshold of 30 kg/m (Kelly et al., 2008). Almost one-third of the US adult population are obese, and this proportion is expected to continue to increase (Ogden et al., 2006, Wang et al., 2008). In
Mortality
It is estimated that there are more than 300,000 annual deaths attributed to overweight and obesity in the USA and 80% of these are in subjects with a BMI greater than 30 (Allison et al., 1999). The relationship between BMI and mortality is generally a U-shaped curve with increased mortality at both lower and higher levels (Calle et al., 1999, Gu et al., 2006, Jee et al., 2006). The nadir appears to vary with ethnicity and age, and may be close to 25 kg/m2 for an adult Caucasian population (
Cardiovascular disease
There are many components of the obesity related metabolic and inflammatory state that predispose to atherosclerosis and these include the more traditional elements of hypertension, type-2 diabetes and impaired glucose tolerance, and dyslipidemia characterized by raised triglycerides, low HDL-cholesterol and a small LDL particle phenotype (Tchernof et al., 1996, Lamarche et al., 1999). Other components include markers of systemic inflammation and oxidative stress including raised C-reactive
Cancer
There is a clear association between increasing BMI and the incident risk of many common and rarer cancers. There is a graded increased mortality from cancer with increasing BMI. On the basis of associations observed in 2003 it was estimated that overweight and obesity in the United States could account for 14% of all deaths from cancer in men and 20% of those in women (Calle et al., 2003). A recent thorough systematic review found that in men BMI was strongly associated with oesophageal
Diabetes
Obesity and type-2 diabetes are likely to be the two greatest public health problems of the coming decades (Zimmet et al., 2001). The WHO estimates in 2000 that worldwide there were 171 million people with diabetes and this will more than double to 366 million by 2030. In 2000 the greatest burden of diabetes was in India (40 million), followed by China (21 million), and USA (18 million), with disproportionately higher future increases expected in developing countries (WHO, 2008, King et al.,
Physical impairment
There is a positive association between musculoskeletal disorders, physical disability and osteoarthritis, and the level of obesity. The prevalence of doctor diagnosed arthritis is 31% for obese adults and 16% for the non-obese (Arthritis related statistics, 2006). Obesity is associated with major mobility problems and pain reducing quality of life (Han et al., 1998, Barofsky et al., 1998). Obesity is related strongly to limitations in activities of daily living and to activities related to
Psychological issues
Obesity of increasing severity is associated with a broad range of psychological and social burden most notable in younger women. Poor body image and self-esteem, binge eating disorder, depression, anxiety and psychological disturbance are common, and as with obesity related metabolic disorders, tend to cluster in those most susceptible individuals (Colles et al., 2008, Dixon et al., 2003, Wadden et al., 2006).
There is also a positive relationship between increasing obesity and depression in
Quality of life
Increasing the level of obesity has a major impact on patients’ physical, mental, psychosocial and economic health. These understandably have an impact on the patient's health related quality of life and from the patients’ perspective quality of life is arguably the most important reason for seeking any medical intervention (Katz et al., 2000, Doll et al., 2000, Dixon et al., 2001). It has been estimated that obesity has a greater negative impact on quality of life than 20 years of aging (
The economic burden
The economic burden of obesity is considerable and rising. In 1995 it was estimated that overweight, obesity and inactivity generated 9.4% of direct health costs in the US (Colditz, 1999). Healthcare expenditure for obesity in the US is an estimated additional $395 per person per year, and estimated total direct medical costs are $75 billion (2003 values), corresponding to approximately 4% of all adult healthcare expenditure (Sturm, 2002b, Finkelstein et al., 2005). In the (UK 2003–2004)
Conclusion
The evolving obesity pandemic is exacting a considerable toll on those affected, the treating health services, and on our communities. It has a clearly measurable impact on physical and mental health, quality of life, and generated considerable direct an indirect cost. Weight loss appears to be the most effective therapy for obesity and obesity related comorbidity. Unfortunately health care providers are likely to play a peripheral role in the prevention of obesity, but a central role
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