OBESITY AS A RISK FACTOR
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OBESITY AS A RISK FACTOR
Tim Lobstein
IASO - International Obesity Task Force, London
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14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 440.00
0.05
0.10
Body Mass Index (kg/m2)
Probability density
Source: Rose, G. (1991) .
BMI distribution moves to the right as population mean risesBMI distribution moves to the right as population mean rises
UK women aged 30-40 1980: mean 24 2005: mean 27
Owt Ob21% 4%30% 25%
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Prevalence data
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Country
100 80 60 40 20 0 20 40 60 80
`
-100 -80 -60 -40 -20 0 20 40 60 80 100020406080100 20 40 60 80 100
WOMEN MEN
%
% obese % obese% overweight
* Urban** Self-reported
Albania *GreeceIsrael **CyprusCzech Rep.EnglandWales, N. **ScotlandGermanyFinlandSlovakiaLithuaniaLatviaCroatiaHungaryRussiaIrelandSpainAustriaTurkeySwedenFrance **BelgiumSwitzerland *DenmarkKyrgystanNetherlandsItaly **Norway
Country
100 80 60 40 20 0 20 40 60 80
`
-100 -80 -60 -40 -20 0 20 40 60 80 100020406080100 20 40 60 80 100
WOMEN MEN
%
% obese % obese% overweight
* Urban** Self-reported
Albania *GreeceIsrael **CyprusCzech Rep.EnglandWales, N. **ScotlandGermanyFinlandSlovakiaLithuaniaLatviaCroatiaHungaryRussiaIrelandSpainAustriaTurkeySwedenFrance **BelgiumSwitzerland *DenmarkKyrgystanNetherlandsItaly **Norway
European overweight and obesity adult prevalences (1992-2001)European overweight and obesity adult prevalences (1992-2001)
Age-ranges vary but most cover 20+ years. IOTF data for UK.Health Select Ctte. May 2004
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Excess weight by age
0
10
20
30
40
50
60
70
80
90
100
16-24 25-34 35-44 45-54 55-64 65-74 75+
men women
Health Survey of England 2001
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0 10 20 30 40
Netherlands
Denmark
Germany
Hungary
Czech Republic
Poland
Bulgaria
Switzerland
France
Greece
Sweden
Cyprus
Ireland (Republic)
England
Italy
Portugal
Crete
Gibraltar
Spain
Sicily
Malta
obese overweight
Overweight and obesity in children aged 7-11
%
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0 10 20 30 40
Slovakia
Netherlands
Germany
Czech Republic
Finland
Poland
Ireland (Northern)
Hungary
Denmark
Spain
Bulgaria
Greece
Ireland (Republic)
Cyprus
Italy
England
Crete
obese overweight
%
Overweight and obesity in adolescents aged 13-17
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Linking child to adult overweight prevalence
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Health risks
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Global burden of diseases – % attributable to BMI
ColonCancer
Heart Disease
DiabetesStroke Endometrialcancer
Hypertension
20
40
60
%
Source: IOTF/WHO Global Burden of Disease, World Health Report 2002
BreastCancer(Post Menopause)
Osteoarthritis
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0
0.5
1
1.5
2
2.5
3
15 20 25 30 35 40
BMI
rela
tiv
e r
isk
Mortality risk and BMI
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BMI in relation to morbidity over 18 yearsBMI in relation to morbidity over 18 years
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Endometrial cancer Women aged 50-74
4077 subjects (709 cases)
0
1
2
3
4
5
6
7
BMI <22.5 BMI 28-29.9 BMI 30-33.9 BMI ≥34
Odds ratio
E Weiderpass et al (2000) CCC, 11.
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Relative risk comparing obese (BMI 30+) with normal-weight adults
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male female
Disease 0-65 65+ 0-65 65+CHD BMI 25-30 1.35 1.00 1.40 1.00
BMI 30+ 1.80 1.20 2.00 1.25
Stroke BMI 25-30 1.35 1.00 1.25 1.00
BMI 30+ 1.50 1.15 1.60 1.20
Diabetes BMI <24 1.00 1.00 0.80 0.80
… BMI >35 90.00 90.00 42.10 42.10
C - colorectal BMI 25-30 1.15 1.15 1.15 1.15
BMI 30+ 1.33 1.33 1.33 1.33
C - breast BMI 25-30 1.00 1.00 1.00 1.12
BMI 30+ 1.00 1.00 1.00 1.25
C - endometrium BMI 25-30 1.00 1.00 1.59 2.52
Relative risks by obesity categoryCompared with normal-weight adults
UK Foresight 2007.
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Incremental risk x 1.08 per unit rise in BMI
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Risk of developing disease
Colorectal cancer 1.03 (1.01-1.05)
P-m breast cancer (f) 1.02 (1.02-1.03)
Endometrial cancer (f) 1.10 (1.07-1.14)
Renal cancer 1.06 (1.05-1.08)
Increased risk per unit of BMI
IARC/Karolinska 2001
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Risk of developing Type 2 diabetesmale female
age 15-29 na na
age 30-44 1.36 1.47
age 45-59 1.24 1.34
age 60-69 1.18 1.21
age 70 + 1.27 1.20
Increased risk per unit of BMI
GBD, 2005
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Need to update risk indices for full range of diseases of interest
Cancer – 6 sites
CHD, stroke, diabetes
COPD (chr. obstructive pulmonary dis)
Increased risk per unit of BMI
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Heart disease in adulthood according to BMI in childhoodIncreased risk according to 1 unit increase in BMI z score
Baker et al NEJM 2006
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Sources
Mean BMI, prevalence data• WHO global database• WHO- Murray and Lopez Global Burden analysis• IOTF adult and child databases
Relative risk• Cancer = IARC, Karolinska 2001, Renehan et al 2008• CHD = Vischer & Rissanen, GBD analyses • Diabetes = IDF, GBD, Danish Nutrition Council• COPD = ???