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Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The Disease Burden Associated With Overweight and Obesity. JAMA. 1999;282(16):1523–1529. doi:https://doi.org/10.1001/jama.282.16.1523
Author Affiliations: Department of Family Medicine and Community Health, Tufts University School of Medicine (Dr Must); US Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University (Dr Must and Ms Spadano); Departments of Nutrition (Ms Coakley) and Epidemiology (Ms Coakley and Dr Colditz), Harvard School of Public Health; Channing Laboratory (Drs Field and Colditz), Brigham and Women's Hospital and Harvard Medical School; and Department of Pediatric Gastroenterology and Nutrition, New England Medical Center (Dr Dietz), Boston, Mass; and Division of Nutrition and Physical Activity, Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Dietz).
Context Overweight and obesity are increasing dramatically in the United States
and most likely contribute substantially to the burden of chronic health conditions.
Objective To describe the relationship between weight status and prevalence of
health conditions by severity of overweight and obesity in the US population.
Design and Setting Nationally representative cross-sectional survey using data from the
Third National Health and Nutrition Examination Survey (NHANES III), which
was conducted in 2 phases from 1988 to 1994.
Participants A total of 16,884 adults, 25 years and older, classified as overweight
and obese (body mass index [BMI] ≥25 kg/m2) based on National
Institutes of Health recommended guidelines.
Main Outcome Measures Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary
heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis.
Results Sixty-three percent of men and 55% of women had a body mass index of
25 kg/m2 or greater. A graded increase in the prevalence ratio
(PR) was observed with increasing severity of overweight and obesity for all
of the health outcomes except for coronary heart disease in men and high blood
cholesterol level in both men and women. With normal-weight individuals as
the reference, for individuals with BMIs of at least 40 kg/m2 and
who were younger than 55 years, PRs were highest for type 2 diabetes for men
(PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95%
CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2)
and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater
in younger than in older adults. The prevalence of having 2 or more health
conditions increased with weight status category across all racial and ethnic
Conclusions Based on these results, more than half of all US adults are considered
overweight or obese. The prevalence of obesity-related comorbidities emphasizes
the need for concerted efforts to prevent and treat obesity rather than just
its associated comorbidities.
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