The disease burden associated with overweight and obesity

Context Overweight and obesity are increasing dramatically in the United St ates and most likely contribute substantially to the burden of chronic heal th conditions. Objective To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US popul ation. Design and Setting Nationally representative cross-sectional survey using d ata 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 ov erweight and obese (body mass index [BMI] greater than or equal to 25 kg/m( 2)) based on National Institutes of Health recommended guidelines. Main Outcome Measures Prevalence of type 2 diabetes mellitus, gallbladder d isease, coronary heart disease, high blood cholesterol level, high blood pr essure, or osteoarthritis, Results Sixty-three percent of men and 55% of women had a body mass index o f 25 kg/m(2) 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 ch olesterol level in both men and women. With normal-weight individuals as th e reference, for individuals with BMIs of at least 40 kg/m(2) 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 wo men (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 co nditions increased with weight status category across all racial and ethnic subgroups. Conclusions Based on these results, more than half of all US adults are con sidered overweight or obese. The prevalence of obesity-related comorbiditie s emphasizes the need for concerted efforts to prevent and treat obesity ra ther than just its associated comorbidities.