Obesity and Death

recent study followed more than 320,000 men and women for 12 years and found that excessive body weight increases the risk of death from all causes and from cardiovascular disease in particular.1 Drawing on data supplied by the American Cancer Society (collected from 1962-1974), the researchers found that obesity increased the probability of a shortened life span in adults ranging from the age of 34 to 72.

The subjects of the study had never smoked, nor did they have any history of heart disease, stroke, or cancer at baseline in 1959-1960 when the study began. By comparing death certificates, which included the cause and date of death, against the body-mass index (BMI), the study found associations between excessive body weight and mortality. BMI is defined as a person's weight in kilograms divided by their height in meters (see Waist Size Reduction: Three Easy Ways). The risk of dying was doubled for younger and mid-life individuals (ages 30 to 54) in the moderate obesity category (BMI>32), compared to those who were not obese (BMI of 21).

In an accompanying editorial in the New England Journal of Medicine (NEJM) titled "Losing Weight - An Ill-Fated New Year's Resolution," two top editors went on to downplay the findings on the presumption that obesity is not as dangerous as was once thought (!) and because the remedy is dire or ultimately ineffective. In vociferous support for the seriousness of obesity, Dr. C. Everett Koop - the former U.S. Surgeon General - spoke out against the NEJM editorial.2 In Dr. Koop's view, the debilitation and costly hardship of obesity, which he characterized as the second leading cause of preventable death in the United States, were trivialized by the editorial. "The editorial is at odds with the totality of scientific evidence concerning the health risks of obesity ..." wrote Dr. Koop in a letter responding to the NEJM editorial.

PREVENTABLE DEATHS
Estimating that a minimum of 20 percent of all deaths in the US due to "natural causes" (excluding deaths from accidents, suicides, infectious diseases, and those related to cigarette smoking) are attributable to excess weight, Koop went on to cite several large-scale prospective epidemiologic studies that document an increased risk of death from excess weight. As support, Dr. Koop used statistics from the Center for Disease Control, indicating that more than 300,000 preventable deaths occur each year from obesity.

Diseases associated with obesity include hypertension, dyslipidemia, adult-onset diabetes, heart disease, stroke, sleep apnea, osteoarthritis and deep-vein thrombosis. Moreover, research such as that reported in the NEJM shows that weight loss often completely resolves many of these conditions, and when an individual loses weight and keeps it off, these diseases abate.

Long-time obesity researcher George Blackburn, M.D., Ph.D., President of the American Society of Clinical Nutrition, especially challenges NEJM's contention that mortality among obese people may be "misleadingly high." "Adult weight gain carries the same attributable risk as smoking with regard to preventable death," writes Blackburn.

WORLD RECORD FOR HEAVINESS?
Perhaps most galling about the NEJM editorial is that it ignores the findings of the lead study in the same issue. This study is very clear in its conclusion that excess body weight increases the risk of death from any cause and from cardiovascular disease in adults between 30 and 74 years of age. Moreover, the study points out that the subjects who had the longest life had a BMI between 19 and 22 and that anything less than 25 is generally recognized as desirable and healthy unless the person has specific health problems, like hypertension or adult-onset diabetes where a lower BMI is the cut point.

According to the principal author of the NEJM study, Dr. June Stephens, "Obesity is an extremely important public health problem." She went on to say that more than one-third of all Americans are overweight (BMI>27).3 According to Brigham and Women's Hospital's chief of preventive medicine, Dr. Charles Hennekens, "the United States is not just the heaviest society in the world but probably the heaviest society in the history of the world."

References

  1. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. N Engl J Med. 1998;338:1-7.
  2. Anon. Dr. Koop and Leading Public Health Experts Challenge an Editorial in the New England Journal of Medicine Which "Trivializes" Obesity. 1998; http://nytsyn.com/ . . . [use search facility for Ckoop].
  3. Kolata G. Obesity's link to early death is found less than thought. New York Times. January 1, 1998;1,14.

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