Abstract
BackgroundStudies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown.ObjectiveThe aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities.MethodsUS adults aged 18-75 years who had ≥3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index.ResultsWe included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2).ConclusionsThe BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised.
Highlights
BackgroundObesity (BMI ≥30.0 kg/m2) is a global public health problem
We identified 11 common obesity-related comorbidities that were included in this study: anxiety, coronary artery disease (CAD), cerebrovascular disease, chronic pain, depression, gastroesophageal reflux disease, hyperlipidemia, hypertension, obstructive sleep apnea (OSA), osteoarthritis, and type 2 diabetes mellitus (T2DM) [8,9,16,17]
When comparing baseline demographics for the comorbidities with an identifiable cut point (CAD, hyperlipidemia, hypertension, OSA, osteoarthritis, and T2DM), we found that patients who developed each disease were older and more likely to be male than those who did not develop each disease for all six comorbidities (Multimedia Appendices 5-10 contain tables comparing baseline characteristics of patients who developed each comorbidity vs those who did not for all six comorbidities with a cut point)
Summary
BackgroundObesity (BMI ≥30.0 kg/m2) is a global public health problem. The highest rates of obesity occur in the United States, where over one-third of adults have obesity [1]. In 1998, the World Health Organization created international standardized BMI classifications for adults who are overweight and have obesity based on risks of obesity-related diseases for European adults [2]. Female Asian patients have been shown to develop comorbidities at lower BMIs, suggesting that BMI thresholds for overweight and obesity should be lower for these groups [2,4,5,6,7]. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective: The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Conclusions: The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised
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