Defining obesity: an adventure in cardiovascular disease epidemiology
1998
Garrison, R.J.
While the association of overweight and health, as well as longevity, has been scrutinized in volumes of research the association of overweight with cardiovascular disease is a dominant theme in the medical literature. This report will detail the arguments and present selected summaries of published reports that support the emerging consensus that overweight and obesity have the major causal role in the ongoing epidemic of cardiovascular disease in the United States. Examples will include relative risk and attributable risk estimates for several metabolic perturbations caused by overweight, including type 2 diabetes mellitus and hypertension. Results of the Nurses Health Study, which found a fivefold increased risk of type 2 diabetes among women with body mass index between 24.0 and 24.9 compared to the referent group with body mass index less than or equal to 22, will be highlighted. The presentation will also explicitly identify the position of excess adiposity in the causal chain that leads from overnutrition to the majority of cardiovascular disease. Based on the position in the causal sequence, a strategy for defining the threshold of "overweight" will be described. From the foregoing, it is concluded that the overweight thresh hold should be no higher than body mass index = 25. Finally, it is concluded that the majority of men and women with a body mass index between 22 and 25 are overweight and should be identified and appropriately counseled to improve nutrition and increase physical activity.
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