Above-normal weight alone does not necessarily increase short-term risk of death, U.S. data suggest

ScienceDaily (July 6, 2012) — An evaluation of national data by UC Davis researchers has found that extra weight is not necessarily linked with a higher risk of death.

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When compared to those with normal weight, people who were overweight or obese had no increased risk of death during a follow-up period of six years. People who were severely obese did have a higher risk, but only if they also had diabetes or hypertension.

The findings, which appear in the July-August issue of The Journal of American Board of Family Medicine, call into question previous studies -- using data collected when obesity was less common -- linking higher short-term mortality with any amount of extra weight.

"There is currently a widespread belief that any degree of overweight or obesity increases the risk of death, however our findings suggest this may not be the case," said Anthony Jerant, professor of family and community medicine and lead author of the study. "In the six-year timeframe of our evaluation, we found that only severe obesity was associated with an increased risk of death, due to co-occurring diabetes and hypertension."

Based on the study, Jerant recommends that doctors' conversations with patients who are overweight or obese, but not severely obese, focus on the known negative effects of these conditions on mental and physical functioning, rather than on an increased short-term risk of death.

By contrast, Jerant added that it is important for doctors to talk with severely obese patients who also have diabetes or hypertension about their increased short-term mortality risk and treatment, including weight loss.

"Our results do not mean that being overweight or obese is not a threat to individual or public health," said Jerant. "These conditions can have a significant impact on quality of life, and for this reason alone weight loss may be advisable."

In conducting the study, Jerant used nationwide data from 2000 to 2005 of nearly 51,000 adults aged 18 to 90 years who participated in the Medical Expenditure Panel Surveys on health-care utilization and costs. The surveys include information on health conditions such as diabetes and hypertension.

Body mass index (BMI), or weight adjusted for height, was calculated for each respondent. The study categorized people as underweight (BMI < 20), normal weight (BMI 20 to < 25), overweight (BMI 25 to < 30), obese (BMI 30 to 35) or severely obese (BMI > 35).

Mortality was assessed using the National Death Index. Of the 50,994 people included in the UC Davis analysis, just over 3 percent (1,683) died during the six years of follow-up.

The investigators found that severely obese people were 1.26 times more likely to die during follow-up than people in the normal weight group. However, if people with diabetes or hypertension were eliminated from the data, those who were overweight, obese or even severely obese had similar or even lower death rates than people of normal weight. Consistent with a number of prior studies, underweight people were nearly twice as likely to die than people with normal weight, regardless of whether diabetes or hypertension was present.

The prevalence of overweight and obesity has increased dramatically in recent decades. An estimated one-third of all U.S. adults over age 20 are obese and another one-third are overweight. In addition to diabetes and hypertension, health problems associated with these conditions include heart disease, osteoarthritis and sleep apnea.

The relationship between weight and mortality is a controversial topic in public health. Although studies based on data collected 30 years ago showed that mortality risk rose as weight increased, analyses of more recently collected data, including the current one, call this assumption into question.

"Our findings indicate that the risk of having an above-normal BMI may be lower than in the past," said Jerant. "While this study cannot explain the reasons, it is possible that as overweight and obesity have become more common, physicians have become more aware of associated health issues like high blood pressure, cholesterol and blood sugar, and are more aggressive about early detection and treatment of these conditions."

Jerant said that the six-year period of his investigation limits the ability to make assumptions about the link between unhealthy weight and the risk of death over a longer timeframe.

"We hope our findings will trigger studies that re-examine the relationship of being overweight or obese with long-term mortality," said Jerant.

The study co-author was Peter Franks, professor in the UC Davis Department of Family and Community Medicine. Franks and Jerant used public access data in conducting the study, which involved no external funding.

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Loneliness, Living Alone Might Shorten Life

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- They say that one is the loneliest number, but it might also be the deadliest.

Two new studies suggest that living alone or being lonely can raise a person's risk of dying from heart disease or any cause.

In one study, people with heart disease who lived alone were more likely to die than their counterparts who did not. A second report showed that people aged 60 or older were at an increased risk of functional decline and/or death if they felt left out, isolated or reported a lack of companionship. Both studies were released online June 18 in the Archives of Internal Medicine.

"Living alone may be a risk factor for a bad outcome," said study author Dr. Deepak Bhatt, director of the integrated cardiovascular intervention program at Brigham and Women's Hospital in Boston. The study only looked at whether the individual lived alone. Researchers did not ask whether this was a choice or if they had lost a partner or had a pet.

But, he said, a person can be lonely and not live alone, and live alone and not be lonely. Still, living alone, regardless of the reason, should be a red flag for doctors to ask more questions.

There are many reasons that living alone or feeling lonely could increase risk for health problems and death. "If you had a heart attack and run out of medication and don't fill your prescription, you will run into trouble," he said. "Spouses and children can run out and get medications for you, and then you are less likely to get into trouble."

What's more, someone who is lonely may be more likely to be depressed, he said. This would make them less likely to take care of themselves, which could increase their risk of dying from any cause. Bottom line is that "doctors should get a good social history," Bhatt said.

In the second report, Dr. Carla Perissinotto, of the University of California, San Francisco, found that loneliness was associated with an increased risk of death during the study's six-year follow-up period. What's more, loneliness was also associated with functional decline.

Taken together, "the studies show that social isolation is associated with cardiovascular mortality in people with heart disease," said Dr. Nieca Goldberg, a clinical associate professor in the department of medicine at the Leon H. Carney Division of Cardiology at NYU Langone Medical Center and medical director at the Joan H. Tisch Center for Women's Health in New York City.

It's all about a patient's support system, she said. Health care providers need to try to identify a support system -- or lack thereof -- before a person with heart disease is released from the hospital. "A support system doesn't have to be an individual, it can be a place of worship or senior's group," Goldberg noted.

While the study uncovered an association between being lonely and an increased risk for health problems and death, it did not prove a cause-and-effect relationship.

More Information

Learn about other risks for heart disease at the American Heart Association.

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Living alone with Alzheimer's tough choice for all

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