Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years

BackgroundOverweight has increased in many countries over the past 20 years and excessive body weight is an established risk factor for adverse health outcomes and chronic diseases. This study aimed to determine comorbidity associated with overweight and obesity in a nationally representative sample of German adults.MethodsIn the German National Health Interview and Examination Survey 1998 standardized measures of body weight, height and waist circumference (WC) were obtained for 7,124 men and women 18 to 79 years of age. Information on pre-existing health conditions, health-related behaviors, and sociodemographic characteristics was collected using physician-administered computer-assisted interviews and self-administered questionnaires. World Health Organization (WHO) cut-off criteria were applied to define overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥30.0 kg/m2) and abdominal obesity (men: WC ≥102 cm; women: WC ≥88 cm).ResultsThe crude prevalence of persons with cardiometabolic risk factors, diabetes mellitus, cardiovascular disease (CVD), gall bladder disease, and osteoarthritis showed a significant stepwise increase from the lowest to the highest BMI category in both sexes. In multiple logistic regression models adjusting for age, social status, and smoking, significant associations with overweight and obesity persisted for cardiometabolic risk factors and osteoarthritis. For example, obese persons had a three- to fourfold higher chance of having any cardiometabolic risk factor compared to normal weight persons (odds ratio (OR) = 4.07, 95% CI: 3.16-5.25 for men; OR = 3.40 (2.60-4.46) for women). Only in women, overweight and obesity as well as abdominal obesity, independent of BMI category, were significantly and consistently associated with diabetes (overweight: OR = 1.85 (1.03-3.30); obesity: OR = 2.94 (1.63-5.31); abdominal obesity: OR = 1.44 (1.08-1.92) and gall bladder disease (overweight: OR = 1.65 (1.22-2.25); obesity: OR = 3.06 (2.26-4.14); abdominal obesity: OR = 1.73 (1.25-2.39)).ConclusionCurrent estimates of disease burden underline the public health importance and clinical relevance related to overweight and obesity and needs to take into account comorbidity aspects.

[1]  S. Middeldorp,et al.  Association between weight or body mass index and hand osteoarthritis: a systematic review , 2009, Annals of the rheumatic diseases.

[2]  J. Danesh,et al.  Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies , 2011, The Lancet.

[3]  C. Lange,et al.  Prevalence and patterns of morbidity among adults in Germany , 2012, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz.

[4]  T. Pischon,et al.  Body mass index, waist circumference, and the risk of type 2 diabetes mellitus: implications for routine clinical practice. , 2010, Deutsches Arzteblatt international.

[5]  M. Koskenvuo,et al.  Body mass index and physical activity in relation to asthma and atopic diseases in young adults. , 2006, Respiratory medicine.

[6]  Ralph B D'Agostino,et al.  Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. , 2002, Archives of internal medicine.

[7]  M. Zwahlen,et al.  Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies , 2008, The Lancet.

[8]  Hyon K. Choi,et al.  Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. , 2005, Archives of internal medicine.

[9]  W. Willett,et al.  Prospective study of abdominal adiposity and gallstone disease in US men. , 2004, The American journal of clinical nutrition.

[10]  Arya M. Sharma,et al.  A proposed clinical staging system for obesity , 2009, International Journal of Obesity.

[11]  HELEN B. HUBERT,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[12]  F. Hu,et al.  Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. , 2007, Archives of internal medicine.

[13]  A. Mokdad,et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. , 2003, JAMA.

[14]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[15]  G A Colditz,et al.  Impact of overweight on the risk of developing common chronic diseases during a 10-year period. , 2001, Archives of internal medicine.

[16]  Mark Woodward,et al.  Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. , 2011, Lancet.

[17]  S. Jebb,et al.  Prevalence of obesity in Great Britain , 2005, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[18]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[19]  J. Manson,et al.  Risk of symptomatic gallstones in women with severe obesity. , 1992, The American journal of clinical nutrition.

[20]  Diederick E Grobbee,et al.  Comparison of routine care self-reported and biometrical data on hypertension and diabetes: results of the Utrecht Health Project. , 2007, European journal of public health.

[21]  W. Rathmann,et al.  Prevalence of undiagnosed diabetes and impaired glucose regulation in 35–59‐year‐old individuals in Southern Germany: the KORA F4 Study , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[22]  Luca Scalfi,et al.  Excess Body Weight and Incidence of Stroke: Meta-Analysis of Prospective Studies With 2 Million Participants , 2010, Stroke.

[23]  T. Reinehr.  Obesity and thyroid function , 2010, Molecular and Cellular Endocrinology.

[24]  A. Folsom,et al.  Hyperinsulinemia, dyslipidemia, and obesity as risk factors for hospitalized gallbladder disease. A prospective study. , 2002, Annals of epidemiology.

[25]  Yue Chen,et al.  Association between Obesity and Atopy in Adults , 2010, International Archives of Allergy and Immunology.

[26]  Katherine M Flegal,et al.  Mean body weight, height, and body mass index, United States 1960-2002. , 2004, Advance data.

[27]  N. Yoshiike,et al.  Twenty‐year changes in the prevalence of overweight in Japanese adults: The National Nutrition Survey 1976–95 , 2002, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[28]  M. Höfler,et al.  Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey , 2002, International journal of methods in psychiatric research.

[29]  Gert B. M. Mensink,et al.  Food and nutrient intake in East and West Germany, 8 years after the reunification—The German Nutrition Survey 1998 , 2004, European Journal of Clinical Nutrition.

[30]  F. Speizer,et al.  The Nurses' Health Study , 1978, The American journal of nursing.

[31]  D. Jarvis,et al.  Association of body mass index with respiratory symptoms and atopy: results from the European Community Respiratory Health Survey , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[32]  M. Grotle,et al.  Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow-up , 2008, BMC musculoskeletal disorders.

[33]  H. Stolzenberg,et al.  [The Federal Health Survey: response, composition of participants and non-responder analysis]. , 1999, Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)).

[34]  A. Dirksen,et al.  Factors related to allergic sensitization to aeroallergens in a cross‐sectional study in adults: The Copenhagen Allergy Study , 2001, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[35]  Stefan N. Willich,et al.  Health-economic burden of obesity in Europe , 2008, European Journal of Epidemiology.

[36]  J Michael Gaziano,et al.  A prospective study of body mass index and the risk of developing hypertension in men. , 2007, American journal of hypertension.

[37]  S. Larsson,et al.  Obesity and the risk of gallbladder cancer: a meta-analysis , 2007, British Journal of Cancer.

[38]  H. Löwel,et al.  High prevalence of undiagnosed diabetes mellitus in Southern Germany: Target populations for efficient screening. The KORA survey 2000 , 2003, Diabetologia.

[39]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[40]  H. Stolzenberg,et al.  [Social class index in the Federal Health Survey]. , 1999, Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)).

[41]  L. Fratiglioni,et al.  Aging with multimorbidity: A systematic review of the literature , 2011, Ageing Research Reviews.

[42]  M. Dören,et al.  Differences in Menopausal Hormone Therapy Use among Women in Germany between 1998 and 2003 , 2007, BMC women's health.

[43]  Wei Zhang,et al.  The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis , 2009, BMC public health.

[44]  B Rosner,et al.  A prospective study of obesity and risk of coronary heart disease in women. , 1990, The New England journal of medicine.

[45]  M. Jarvelin,et al.  Body build and atopy. , 2000, The Journal of allergy and clinical immunology.

[46]  A. Linneberg,et al.  The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance? , 2007, Allergy.

[47]  F. Speizer,et al.  Body Weight, Weight Change, and Risk for Hypertension in Women , 1998, Annals of Internal Medicine.

[48]  S. Knowles,et al.  Obesity, insulin resistance and the prevalence of atopy and asthma in US adults , 2010, Allergy.

[49]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2008. , 2010, JAMA.

[50]  Hyon K. Choi,et al.  Epidemiology of gout in women: Fifty-two-year followup of a prospective cohort. , 2010, Arthritis and rheumatism.

[51]  E. Ponce,et al.  World Cancer Research Fund, American Institute for Cancer Research. Second Expert Report, Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. United Kingdom: WCRF/AICR, 2001 , 2009 .

[52]  G A Colditz,et al.  Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. , 1997, American journal of epidemiology.

[53]  D. Lawlor,et al.  Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study , 2009, BMJ : British Medical Journal.