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Obesity can cut 19 years of health, 8 years of life

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Declining mortality spurs need for better disease projections

As mortality from cardiovascular disease and diabetes decline, it may become more important to give overweight and obese patients a more accurate forecast of the effects of their excess weight. This is what Dr. Grover and his colleagues have done.

However, changing aspects of the epidemiology of obesity and diabetes might make healthy life-years a moving target. For example, the declining mortality from CVD and diabetes making the risk ratios for cardiovascular disease and related mortality associated with diabetes much lower than those used in the model by Dr. Grover and his colleagues.

Even so, efforts to refine estimation of the lifelong effect of obesity and diabetes are important for other reasons. Knowing more about the various clinical courses of these diseases will place a higher premium on decision-making methods that can simultaneously take a life-course perspective, incorporate interventions, and consider individual differences so that clinicians and public health leaders alike can effectively tackle the next phases of the obesity and diabetes epidemics.

Dr. Albert Gregg is a researcher at the National Center for Chronic Disease Prevention and Health Promotion unit of the Centers for Disease Control and Prevention. These comments were taken from an accompanying editorial (Lancet Diabetes Endocrinol. 2014 [doi: 10.1016/S2213-8587(14)70242-6]). He had no conflicts of interest to disclose.


 

FROM LANCET DIABETES AND ENDOCRINOLOGY

References

Excess body weight could lower “healthy life-years” by as much as 19 years, in addition to reducing life expectancy in certain demographics by as much as 8 years, new research published in Lancet Diabetes & Endocrinology suggests.

“The pattern is clear: The more an individual weighs and the younger their age, the greater the effect of excess weight on health,” wrote Dr. Steven A. Grover and his coinvestigators at the Research Institute of the McGill University Health Centre, Montreal.

They created a disease-simulation model, and by using data from 3,992 non-Hispanic white participants in the National Health and Nutrition and Examination Survey (NHANES) during 2003-2010, they estimated the annual risk of diabetes, cardiovascular disease, and mortality. They compared people with an ideal body mass index of 18.5 up to 25 kg/m² against overweight people with BMI of 25 up to 30 kg/m², obese participants with a BMI of 30 up to 35 kg/m², and very obese persons with a BMI of 35 kg/m² and higher. Health life-years lost was defined as years free of cardiovascular disease (CVD) and diabetes.

Younger adults with high body fat were hit harder with obesity-related health problems than their older peers. Courtesy Bill Branson/National Cancer Institute

Younger adults with high body fat were hit harder with obesity-related health problems than their older peers.

Depending on their age and sex, overweight individuals were estimated to lose 0-3 years of life expectancy, obese individuals could lose 1-6 years of life expectancy, and very obese individuals were estimated to lose 1-8 years. Younger adults with high body fat were generally at a greater risk for developing health problems than those who developed obesity later in life (Lancet Diabetes Endocrinol. 2014: [doi:10.1016/S2213-8587 (14)70229-3]) .The years of life lost for obese men ranged from 0.8 years in those aged 60-79 years to 5.9 years in those aged 20-39 years. Years lost for very obese men ranged from 0.9 years to 8.4 years, respectively. Years of life lost for very obese women females were similar, with 0.9 years lost for those aged 60-79 years and 6.1 years lost for those aged 20-39 years.

As expected, the negative health effects of excess body weight were greatest in patients with extreme obesity, with very obese males at the greatest risk for developing type 2 diabetes and obesity-associated CVD. The researchers further noted that morbidity (healthy life-years lost) can reduce quality of life nearly two to four times as much as the number of years of life lost.

These results might help health professionals to more actively encourage weight loss in their overweight and obese patients, and also provide such patients with additional motivation to adhere to healthier lifestyles, Dr. Grover said.

The study was funded by the Canadian Institutes of Health Research. Dr. Grover is a consultant to Merck, Roche, AstraZeneca, and Amgen. Several coinvestigators have ties to pharmaceutical companies.

mbock@frontlinemedcom.com

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