Impact Of Excess Body Weight Research Articles

No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome.

Background and PurposeThe impact of excess body weight on prognosis after stroke is controversial. Many studies report higher survival rates in obese patients (“obesity paradox”). Recently, obesity has been linked to worse outcomes after intravenous (IV) thrombolysis, but the number and sample size of these studies were small. Here, we aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study.MethodsIn a prospective observational multicenter study, we analyzed baseline and outcome data of 896 ischemic stroke patients who underwent IV thrombolysis. Patients were categorized according to body mass index (BMI) as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2) or severely obese (>35 kg/m2). Using uni- and multivariate modeling, we assessed the relationship of BMI with favorable outcome (defined as modified Rankin Scale 0 or 1) and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages (sICH). We also measured the incidence of patients that had an early neurological improvement of >40% on the National Institutes of Health Stroke Scale (NIHSS) after 24 hours.ResultsAmong 896 patients, 321 were normal weight (35.8%), 22 underweight (2.5%), 378 overweight (42.2%), 123 obese (13.7%) and 52 severely obese (5.8%). Three-month mortality was comparable in obese vs. non-obese patients (8.1% vs. 8.3%) and did not differ significantly among different BMI groups. This was also true for favorable clinical outcome, risk of sICH and early neurological improvement on NIHSS at 24 hours. These results remained unchanged after adjusting for potential confounding factors in the multivariate analyses.ConclusionBMI was not related to clinical outcomes in stroke patients treated with IVT. Our data suggest that the current weight-adapted dosage scheme of IV alteplase is appropriate for different body weight groups, and challenge the existence of the obesity paradox after stroke.

PS 02-85 Different Influences of Excessive Body Weight and Elevated Blood Pressure from Childhood on Left Ventricular Geometric Remodeling in Adulthood

Objective: Obesity and hypertension are two well established predictors for left ventricular hypertrophy (LVH) in adults. We aimed to examine the long-term impact of excessive body weight and elevated blood pressure (BP) from childhood on LVH and LV geometric remodeling in adulthood. Design and Method: Data were obtained from a school-based prospective study, which consisted of 1256 adults aged 27–42 years who had 2–10 measurements of body mass index (BMI) and blood pressure from childhood in 1987. The total area under the growth curve (AUC) and incremental AUC from childhood to adulthood were calculated to characterize the cumulative risk burden and long-term trends of BMI and BP during the follow-up duration. In the final survey, four LV geometric patterns were defined based on the values of left ventricular mass index and relative wall thickness: normal geometry, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH). Results: In adulthood, the prevalence rates of CR, EH, and CH were 26.4%, 2.0%, and 2.5%, respectively. In childhood, SBP but not BMI was associated with adult CR (Odds Ratio [OR] = 1.06,95% confidence interval [CI] = 0.93–1.18 for BMI;OR = 1.26,95% = 1.08–1.47 for SBP), whereas BMI but not SBP was associated with adult EH (OR = 3.53,95%CI = 2.09–5.98 for BMI;OR = 1.04,95% CI = 0.65–1.66 for SBP). Both BMI and SBP were significantly associated with adult CH, and BMI exhibited a stronger association (OR = 2.69,95% CI = 2.09–5.98 for BMI; OR = 1.64,95% CI = 1.07–2.51 for SBP). In addition, BMI and SBP in adulthood, as well as total AUC and incremental AUC, were all associated with risk of CR, EH, and CH, and BMI measures showed stronger associations with adult EH and CH compared to corresponding SBP measures. Conclusions: Excessive body weight and elevated BP from childhood have different influences on the development of LV geometric remodeling in adulthood.

Obesity and emotional well-being in adolescents: Roles of body dissatisfaction, loss of control eating, and self-rated health.

Weak or inconsistent association between obesity and impairment in emotional well-being in population-based samples has led to efforts to identify mediating variables. This study examined the relative importance of body dissatisfaction (BD), loss of control (LOC) eating, and self-rated health (SRH) in mediating the association between obesity and impairment in emotional well-being in a school-based sample of adolescents (boys, n = 437; girls, n = 950). Moderated mediation analysis was employed to assess the relative importance of the putative mediating variables and moderation of mediation effects by sex following the methods suggested by Hayes and coworkers. BD and SRH, but not LOC eating, were found to mediate the association between obesity and impairment in emotional well-being. Stronger mediation effects were observed for BD than for SRH. None of these results was moderated by sex. The findings suggest that it may be important to target BD in obesity prevention and treatment programs in order to reduce the adverse impact of excess body weight on young people's emotional well-being.

Impact of excess body weight on walking at the preferred speed.

The implications of a long-lasting mechanical load on the locomotor activity are poorly understood. The objective of the present studies was to determine an impact of excess body weight on basic spatiotemporal gait measures and to test the hypothesis that leg swing phase may account for a load-related adaptation of the stride characteristics. To this end the basic spatial and temporal stride measures were assessed in 100 obese and 36 lean women (age range between 18 and 67 years) walking with their self-selected pace on a 10-meter long and 1 meter wide instrumented pathway. Among the subjects there were: 44 with class I obesity, 27 with class II obesity, and 29 with class III. Subjects' stance and swing times as well as the stride lengths were recorded by means of contact copper-film electrodes attached to a sole of subject' footwear. The acquired gait measures were used then to compute: a mean velocity of walking, double support times and a mean velocity of a foot during swing phase. Data analysis showed that subjects from every experimental groups walked with a very similar speed (1.08 +/- 0.2 m/s) and cadence (106 +/- 10 steps/min). Their stance time was not affected by body weight and it remained at the mean level of 746 +/- 90 ms for all groups. The temporal stride characteristics and the stance-to-swing ratio were, however, substantially modified in obese individuals due to attenuation of the swing time. As a consequence, the remaining normalized (i.e., expressed as percentage of gait cycle time) phases of stride: the stance and the double support were relatively longer. While the swing time negatively correlated with the body mass index (BMI), the normalized stance and the double support exhibited strong positive correlation (r=0.46) with the BMI. The increase of leg swing velocity seems the main and unique adaptation mechanism that is utilized in the preferred walking gait in obese women.

Excess Body Weight and Coronary Artery Disease—Associated Risks, the Obesity Paradox, and Implications for Cardiac Rehabilitation

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Impact of Excess Body Weight on Arterial Structure, Function, and Blood Pressure in Firefighters

Cardiovascular disease is the leading cause of death among firefighters. The purpose of the present study was to examine the effect of excess body weight on arterial structure and function and blood pressure (BP) in relatively young, apparently healthy, firefighters. The body mass index, brachial BP, carotid BP, aortic BP, radial augmentation index, central pulse wave velocity, forearm blood flow, forearm vasodilatory capacity, carotid arterial compliance, carotid intima-media thickness, and brachial flow-mediated dilation were assessed in 110 firefighters (aged 29.7 +/- 8.0 years). The group was divided into equal tertiles according to the body mass index (<25.9, 25.9 to 29.4, and >or=29.5 kg/m(2)). Group differences in hemodynamics, anthropometrics, microvascular function, and macrovascular structure and function were tested using multivariate analysis of variance. The obese group was older, heavier, and had a larger waist circumference compared to the lean and overweight groups (p <0.05). The overweight group was also older, heavier, and had a larger waist circumference than the lean group (p <0.05). Compared to the lean group, the overweight and obese groups had a greater systolic BP (p <0.05). The obese group also had a significantly greater mean arterial BP and carotid systolic BP than the lean group (p <0.05). The obese group had greater beta stiffness and elastic modulus compared to the lean and overweight groups (p <0.05), but no group differences were found in endothelial function. In conclusion, in a population of relatively young firefighters, an increased body mass index was associated with elevated peripheral BP and arterial stiffness, with no apparent decrements in endothelial function.

Mortality, Health Outcomes, and Body Mass Index in the Overweight Range

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …

Effects of excessive body weight on postural control

Research that evaluated both static and dynamic stability was performed, to clarify the impact of excessive body weight on postural control. The spontaneous center of foot pressure (CP) motion during quiet stance and a range of forward voluntary CP displacements were studied in 100 obese, and 33 lean women. Characteristics of postural sway were acquired while the subjects were standing quiet on a force plate with eyes open (EO) and with eyes closed (EC). Their anterior range of CP voluntary displacements was assessed upon a range of maximal whole body leanings which were directed forward. A substantial reduction of postural sway was observed in all patients which had increased body weight. Main postural sway parameters i.e., the total path length as well as its directional components were negatively correlated with the body mass and body mass index (BMI). The range of a whole body voluntary forward leaning, did not exhibit any significant change in patients with an obesity grade of I and II. Such a deficit was, however, found in subjects with a body mass index above 40. In conclusion, the increased body weight imposed new biomechanical constraints, that resulted in functional adaptation of the control of the erect posture. This functional adaptation was characterized by a reduced postural sway associated with a substantial reduction of the dynamic stability range in subjects with BMI>40.

Overweight, Obesity, and the Risk of Recurrent Venous Thromboembolism

Excess body weight is a risk factor for a first venous thromboembolism. The impact of excess body weight on risk of recurrent venous thrombosis is uncertain. We studied 1107 patients for an average of 46 months after a first unprovoked venous thromboembolism and withdrawal of anticoagulant therapy. Excluded were pregnant patients, those requiring long-term antithrombotic treatment, and those who had a previous or secondary thrombosis, natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer. Our study end point was symptomatic recurrent venous thromboembolism. A total of 168 patients had recurrent venous thromboembolism. Mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was significantly higher among patients with recurrence than among those without recurrence: 28.5 (6.0) vs 26.9 (5.0) (P = .01). The relationship between excess body weight and recurrence was linear; the adjusted hazard ratio for each 1-point increase in BMI was 1.044 (95% confidence interval [CI], 1.013-1.076) (P < .001). Four years after discontinuation of anticoagulant therapy, the probability of recurrence was 9.3% (95% CI, 6.0%-12.7%) among patients of normal weight and 16.7% (95% CI, 11.0%-22.3%) and 17.5% (95% CI, 13.0%-22.0%) among overweight and obese patients, respectively. Compared with patients of normal weight, the hazard ratio of recurrence adjusted for age, sex, factor V Leiden, prothrombin G20210A mutation, high factor VIII levels, and type of initial venous thromboembolic event was 1.3 (95% CI, 0.9-1.9) (P = .20) among overweight patients and 1.6 (95% CI, 1.1-2.4) (P = .02) among obese individuals. The population attributable risk corresponding to excess body weight was 26.8% (95% CI, 5.3%-48.2%). Excess body weight is a risk factor of recurrent venous thromboembolism.

Estimating the burden of disease attributable to excess body weight in South Africa in 2000.

To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modeling techniques were used for the uncertainty analysis. South Africa. Adults >or= 30 years of age. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI >or= 21 kg/m2. Excess body weight is estimated to have caused 36,504 deaths (95% uncertainty interval 31,018 - 38,637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462,338 DALYs (95% uncertainty interval 396,512 - 478,847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. This study shows the importance of recognizing excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight.

Excess body weight, clinical profile, management practices, and hospital prognosis in men and women after acute myocardial infarction

Excess body weight is increasingly being recognized as a major health problem in American men and women. It is unclear, however, whether body weight is associated with the demographic and clinical profile, treatment of, and hospital prognosis after acute myocardial infarction (AMI). Nonconcurrent prospective epidemiologic investigation of Worcester (Massachusetts) metropolitan residents hospitalized at all 11 greater Worcester medical centers with validated AMI in 1997, 1999, 2001, and 2003. A total of 2008 men and 1505 women were hospitalized with confirmed AMI during the 4 study periods. Approximately 41% of men and 29% of women were classified as being overweight (body mass index [BMI] of 25-29.9), whereas 27% of men and 26% of women hospitalized with AMI were considered to be obese (BMI > or = 30). Obese men and women were significantly younger than individuals of normal weight. Effective cardiac treatment regimens were less often used in men and women of normal body weight, compared with patients who were overweight or obese. After controlling for several potentially confounding prognostic factors, there were no significant differences in the risk of dying during hospitalization for either overweight or obese men and women, compared with patients of normal body weight. Obese men and women were, however, at greater risk for developing heart failure during the acute hospitalization than men and women of normal weight. The results of this community study suggest an association between BMI and use of different treatment approaches in patients with AMI. Further examination of the impact of excess body weight on hospital outcomes associated with AMI remains warranted.

Leptin and cancer

The prevalence of obesity has markedly increased over the past two decades, especially in the industrialized countries. While the impact of excess body weight on the development of cardiac disease and diabetes has been well documented, the link between obesity and carcinogenesis is just being recognized. This review will focus on the link between leptin, a cytokine that is elevated in obese individuals, and cancer development. First, we briefly discuss the biological functions of leptin and its signaling pathways. Then, we summarize the effects of leptin on different cancer types in experimental cellular and animal models. Next, we analyze epidemiological data on the relationship between obesity and the presence of cancer or cancer risk in patients. Finally, leptin as a target for cancer treatment and prevention will be discussed.

Obesity and cancer risk among white and black United States veterans.

Obesity has been linked to excess risk for many cancers, but the evidence remains tenuous for some types. Although the prevalence of obesity varies by race, few studies of obesity-related cancer risk have included non-white subjects. In a large cohort of male US veterans (3,668,486 whites; 832,214 blacks) hospitalized with a diagnosis of obesity between 1969 and 1996, we examined risk for all major cancer sites and subsites. Person-years accrued from the date of first obesity diagnosis until the occurrence of a first cancer, death, or the end of the observation period (September 30, 1996). We calculated age- and calendar-year adjusted relative risks (RR) and 95% confidence intervals (CI) for cancer among white and black veterans, comparing obese men to men hospitalized for other reasons, with obesity status as time-dependent. For selected cancers, we performed additional analyses stratified by specific medical conditions related to both obesity and risk of those cancers. To determine whether obesity-related cancer risks differed significantly between white and black men, we evaluated heterogeneity of risk for each cancer site. Among white veterans, risk was significantly elevated for several cancers, including cancers of the lower esophagus, gastric cardia, small intestine, colon, rectum, gallbladder and ampulla of vater, male breast, prostate, bladder, thyroid, and connective tissue, and for malignant melanoma, multiple myeloma, chronic lymphocytic leukemia (CLL), and acute myeloid leukemia (AML). Excess risks initially observed for cancers of the liver and pancreas persisted among men without a history of diabetes or alcoholism. Among black veterans, risks were significantly elevated for cancers of the colon, extrahepatic bile ducts, prostate, thyroid, and for malignant melanoma, multiple myeloma, CLL and AML. Obese men are at increased risk for several major cancers as well as a number of uncommon malignancies, a pattern generally similar for white and black men. Due to the increasing prevalence of obesity and overweight worldwide, it is important to clarify the impact of excess body weight on cancer and to elucidate the mechanisms involved.

Costs of Excess Body Weight among Active Duty Personnel, U.S. Air Force, 1997

Although the increasing public health impact of excess body weight in the U.S. general population has received national attention, the impact of excess body weight among active duty military personnel is unknown. A study was conducted to determine the direct (increased medical care) and indirect (lost workdays) costs of excess body weight among active duty Air Force (ADAF) personnel in 1997. Based on measured height and weight values, in 1997, 20.4% of ADAF men and 20.5% of ADAF women had body weights that exceeded their official maximum allowable weight for height. Total excess body weight-attributable costs were estimated at $22.8 million per year, with annual direct and indirect costs estimated at $19.3 million (approximately 6% of total annual expenditures for ADAF medical care) and $3.5 million, respectively. Attributable lost workdays were estimated at 28,351 per year. Annual excess body weight-attributable costs among ADAF personnel are high, both in dollars and lost duty days.