OBESITY AS A RISK FACTOR

Tim Lobstein

IASO - International Obesity Task Force, London

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%

Prevalence data

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

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

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

%

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

Linking child to adult overweight prevalence

Health risks

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

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

BMI in relation to morbidity over 18 yearsBMI in relation to morbidity over 18 years

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.

Relative risk comparing obese (BMI 30+) with normal-weight adults

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.

Incremental risk x 1.08 per unit rise in BMI

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

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

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

Heart disease in adulthood according to BMI in childhoodIncreased risk according to 1 unit increase in BMI z score

Baker et al NEJM 2006

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 = ???