New
study provides strong evidence on dangers of excess weight.
Boston,
MA — Being overweight or obese is associated with a higher risk of dying
prematurely than being normal weight—and the risk increases with additional
pounds, according to a large international collaborative study led by
researchers at the Harvard T.H. Chan School of Public Health and the University
of Cambridge, UK. The findings contradict recent reports that suggest a
survival advantage to being overweight—the so-called “obesity paradox.”
The
study was published online on July 13, 2016 in The Lancet.
The
deleterious effects of excess body weight on chronic disease have been well
documented. Recent studies suggesting otherwise have resulted in confusion
among the public about what is a healthy weight. According to the authors of
the new study, those prior studies had serious methodological limitations. One
common problem is called reverse causation, in which a low body weight is the
result of underlying or preclinical illness rather than the cause. Another
problem is confounding by smoking because smokers tend to weigh less than
nonsmokers but have much higher mortality rates.
“To
obtain an unbiased relationship between BMI and mortality, it is essential to
analyze individuals who never smoked and had no existing chronic diseases at
the start of the study,” said Frank Hu, professor of nutrition and epidemiology
at Harvard Chan School and a co-leader of the collaboration. Hu stressed that
doctors should continue to counsel patients regarding the deleterious effects
of excess body weight, which include a higher risk of diabetes, cardiovascular
disease, and cancer.
In
order to provide more definitive evidence for the association of excess body
weight with premature mortality, researchers joined forces in 2013 to establish
the Global BMI Mortality Collaboration, which involves over 500 investigators
from over 300 global institutions.
“This
international collaboration represents the largest and most rigorous effort so
far to resolve the controversy regarding BMI and mortality,” said Shilpa
Bhupathiraju, research scientist in the Department of Nutrition at Harvard Chan
School and co-lead author of the study.
For
the new study, consortium researchers looked at data from more than 10.6
million participants from 239 large studies, conducted between 1970 and 2015,
in 32 countries. A combined 1.6 million deaths were recorded across these
studies, in which participants were followed for an average of 14 years. For
the primary analyses, to address potential biases caused by smoking and
preexisting diseases, the researchers excluded participants who were current or
former smokers, those who had chronic diseases at the beginning of the study,
and any who died in the first five years of follow-up, so that the group they
analyzed included 4 million adults. They looked at participants’ body mass
index (BMI)—an indicator of body fat calculated by dividing a person’s weight
in kilograms by their height in meters squared (kg/m2).
The
results showed that participants with BMI of 22.5-<25 kg/m2 (considered a
healthy weight range) had the lowest mortality risk during the time they were
followed. The risk of mortality increased significantly throughout the
overweight range: a BMI of 25-<27.5 kg/m2 was associated with a 7% higher
risk of mortality; a BMI of 27.5-<30 kg/m2 was associated with a 20% higher
risk; a BMI of 30.0-<35.0 kg/m2 was associated with a 45% higher risk; a BMI
of 35.0-<40.0 kg/m2 was associated with a 94% higher risk; and a BMI of
40.0-<60.0 kg/m2 was associated with a nearly three-fold risk. Every 5 units
higher BMI above 25 kg/m2 was associated with about 31% higher risk of
premature death. Participants who were underweight also had a higher mortality
risk.
Looking
at specific causes of death, the study found that, for each 5-unit increase in
BMI above 25 kg/m2, the corresponding increases in risk were 49% for
cardiovascular mortality, 38% for respiratory disease mortality, and 19% for
cancer mortality. Researchers also found that the hazards of excess body weight
were greater in younger than in older people and in men than in women.
Other
Harvard Chan School authors included Walter Willett, Fredrick John Stare
Professor of epidemiology and nutrition and chair of the Department of
Nutrition; and JoAnn Manson, professor of nutrition and epidemiology and chief
of the Division of Preventive Medicine at Brigham and Women’s Hospital.
.
The coordinating center at the University of Cambridge was funded by the UK
Medical Research Council (G0800270), British Heart Foundation (SP/09/002),
British Heart Foundation Cambridge Cardiovascular Centre of Excellence, and UK
National Institute for Health Research Cambridge Biomedical Research Centre.
Bottom Line: If your weight is
climbing, start getting it off NOW! Don’t wait,because time is running out.
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