Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Prevalence of overweight and obesity in a rural southern Italy population and relationships with total and cardiovascular mortality: the Ventimiglia di Sicilia project Obesity and Mortality in a Prospective Study of a Middle-Aged Industrial Population Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Weight change and risk of heart attack in middle-aged British men. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Does maternal body mass index influence treatment effect in women with mild gestational diabetes? The Natural History of the Development of Obesity in a Cohort of Young U.S. Adults between 1981 and 1998 Association of Obesity or Weight Change With Coronary Heart Disease Among Young Adults in South Korea International Day for the Evaluation of Abdominal Obesity (IDEA): A Study of Waist Circumference, Cardiovascular Disease, and Diabetes Mellitus in 168 000 Primary Care Patients in 63 Countries Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Reverse causality and confounding and the associations of overweight and obesity with mortality. The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Cold-activated brown adipose tissue in healthy men. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox.
BACKGROUND To our knowledge , no single investigation concerning the long-term effects of overweight status on the risk for hypertension , hypercholesterolemia , diabetes mellitus , and cardiovascular sequelae has been reported . METHODS Relations between categories of body mass index ( BMI ) , cardiovascular disease risk factors , and vascular disease end points were examined prospect ively in Framingham Heart Study participants aged 35 to 75 years , who were followed up to 44 years . The primary outcome was new cardiovascular disease , which included angina pectoris , myocardial infa rct ion , coronary heart disease , or stroke . Analyses compared  overweight ( BMI [ calculated as weight in kilograms divided by the square of height in meters ] , 25.0 - 29.9 ) and obese persons ( BMI > or = 30 )  to a  referent group of normal-weight persons ( BMI , 18.5 - 24.9 ) . RESULTS The age-adjusted relative risk ( RR ) for new hypertension was highly associated with overweight status ( men : RR , 1.46 ; women : RR , 1.75 ) . New hypercholesterolemia and diabetes mellitus were less highly associated with excess adiposity . The age-adjusted RR ( confidence interval [ CI ] ) for cardiovascular disease was increased among those who were overweight ( men : 1.21 [ 1.05 - 1.40 ] ; women : 1.20 [ 1.03 - 1.41 ] ) and the obese ( men : 1.46 [ 1.20 - 1.77 ] ; women : 1.64 [ 1.37 - 1.98 ] ) . High population attributable risks were related to excess weight ( BMI > or = 25 ) for the outcomes hypertension ( 26 % men ; 28 % women ) , angina pectoris ( 26 % men ; 22 % women ) , and coronary heart disease ( 23 % men ; 15 % women ) . CONCLUSIONS The overweight category is associated with increased relative and population attributable risk for hypertension and cardiovascular sequelae . Interventions to reduce adiposity and avoid excess weight may have large effects on the development of risk factors and cardiovascular disease at an individual and population level OBJECTIVE : We investigated the prevalence of overweight and obesity and their relationships with the main cardiovascular risk factors in the population of Ventimiglia di Sicilia , a rural village in Southern Italy characterized by low cholesterol levels and by a low incidence of early coronary heart disease mortality . We related all deaths to body weight and fat distribution during an 8 y follow-up . DESIGN : Cross-sectional and prospect i ve observational study .SUBJECTS : A total of 835 free-living individuals , 363 males and 472 females , of age between 20 and 69 y. MEASUREMENTS : In all participants body weight , waist-to-hip ratio ( WHR ) , cardiovascular risk factors and plasma lipids were measured . During the follow-up , total and cardiovascular deaths were registered . RESULTS : We found a high overall prevalence of subjects with overweight or obesity ( respectively 45.0 % and 27.7 % ) , with great differences among classes of age . As expected , body weight and fat distribution were associated with diabetes , hypertension , dyslipidemia and with a worsening of lipid profile . During the follow-up we registered 37 total and 11 cardiovascular deaths . All-cause and cardiovascular mortality risks were , respectively , 1.64 ( 95 % CI 0.65–4.15 ) and 2.71 ( 95 % CI 0.29–25.26 ) in subjects with a body mass index ( BMI ) of 27–29.99 kg/m2 and 2.45 ( 95 % CI 1.03–5.87 ) and 5.36 ( 95 % CI 1.41–62.01 ) in subjects with a BMI of≥30 kg/m2 in comparison with participants with a BMI of < 27 kg/m2 , and 3.48 ( 95 % CI 1.46–8.30 ) and 4.55 ( 95 % CI 1.12–18.40 ) in subjects with a WHR higher than the median in comparison with individuals with a WHR lower than the median . CONCLUSION : The Ventimiglia di Sicilia Study highlights the great importance of overweight and obesity as a public health issue in a rural population and indicates that it is necessary to consider the impact of body weight and fat distribution on both total and CHD mortality Background : Although obesity is an established risk factor for coronary heart disease and stroke mortality , its role as a risk factor for other causes of death has not been extensively investigated , particularly in an industrial population . Methods : This prospect i ve mortality study included 20 years of follow up of middle-aged industrial workers ( n = 7139 ) at Shell Oil Company 's manufacturing and research facilities . Baseline health risk factor data as of December 31 , 1983 , and mortality data as of December 31 , 2003 , were extracted from the company 's Health Surveillance System . Relative risks ( RRs ) for selected causes of death by body mass index ( BMI ) category were calculated using the Cox proportional hazards model adjusted for age , sex , and smoking status as well as other potential risk factors , ie , cholesterol , hypertension , and fasting blood glucose . Results : Compared with employees with BMI between 18.5 and 24.9 kg/m2 , those with BMI of 30 kg/m2 or greater had a statistically increased RR ( adjusted for age , sex , and smoking status ) for all causes ( RR , 1.25 ; 95 % confidence interval [ CI ] = 1.03–1.51 ) , coronary heart diseases ( RR , 2.29 ; 95 % CI = 1.50–3.50 ) , cardiovascular diseases ( RR , 2.22 ; 95 % CI = 1.51–3.27 ) , diabetes ( RR , 16.97 ; 95 % CI = 2.11–136.44 ) , and accidental deaths ( RR , 2.64 ; 95 % CI = 1.23–5.66 ) . After adjusting for additional covariates , coronary heart diseases and cardiovascular diseases remained statistically significant . Conclusions : Obesity was associated with increased death rates for all causes , cardiovascular diseases , diabetes , and all accidents . Overweight individuals had a statistically lower cancer rate . Death rates for lung cancer and respiratory disease were lower among overweight/obese employees but did not reach statistical significance . Reductions of employee obesity can be an effective means of reducing these causes of death Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases , such as diabetes , cancer , hypertension , and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades , questions regarding factors driving overweight and obesity remain , particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and /or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological , social , and emotional issues that continue into adulthood , including depression and anxiety , social withdrawal , feeling worthless , lower self-esteem , and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite , obesogenic behaviors ( eg , overeating ) to cope with negative mood , sedentary behavior , and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other h and , increased body mass index ( BMI ) could result in adverse emotional outcomes over time due to weight-based stigma , bullying , or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms ( e.g. , only examining depression)10 or behavioral concerns ( e.g. , conduct).11 Physical outcomes , including BMI , were often collected by self-report12 and /or retrospectively.13 Furthermore , they have been limited to predominantly White sample s of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts . Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity , such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied . Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies .17 Longitudinal , prospect i ve design s are critical to explicate the association between emotional health and BMI among Black and Latino youth . The primary objective of this study is to examine whether negative emotional symptoms prospect ively predict increases in BMI z-scores ( BMI -z ) across 2 years among a sample of predominantly Black and Latino , urban youth . We hypothesize that more negative emotional symptoms measured at baseline ( grade s 5 and 6 ) would predict increases in BMI -z scores 2 years later . Results can inform programs and interventions aim ed at reducing obesity in youth of color CONTEXT Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease ( CVD ) risk factors , but the role of physical inactivity is not prominent in these recommendations . OBJECTIVE To quantify the influence of low cardiorespiratory fitness , an objective marker of physical inactivity , on CVD and all-cause mortality in normal-weight , overweight , and obese men and compare low fitness with other mortality predictors . DESIGN Prospect i ve observational data from the Aerobics Center Longitudinal Study . SETTING Preventive medicine clinic in Dallas , Tex . PARTICIPANTS A total of 25714 adult men ( average age , 43.8 years [ SD , 10.1 years ] ) who received a medical examination during 1970 to 1993 , with mortality follow-up to December 31 , 1994 . MAIN OUTCOME MEASURES Cardiovascular disease and all-cause mortality based on mortality predictors ( baseline CVD , type 2 diabetes mellitus , high serum cholesterol level , hypertension , current cigarette smoking , and low cardiorespiratory fitness ) stratified by body mass index . RESULTS During the study period , there were 1025 deaths ( 439 due to CVD ) during 258781 man-years of follow-up . Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors . Using normal-weight men without CVD as the referent , the strongest predictor of CVD death in obese men was baseline CVD ( age- and examination year-adjusted relative risk [ RR ] , 14.0 ; 95 % confidence interval [ CI ] , 9.4 - 20.8 ) ; RRs for obese men with diabetes mellitus , high cholesterol , hypertension , smoking , and low fitness were similar and ranged from 4.4 ( 95 % CI , 2.7 - 7.1 ) for smoking to 5.0 ( 95 % CI , 3.6 - 7.0 ) for low fitness . Relative risks for all-cause mortality in obese men ranged from 2.3 ( 95 % CI , 1.7 - 2.9 ) for men with hypertension to 4.7 ( 95 % CI , 3.6 - 6.1 ) for those with CVD at baseline . Relative risk for all-cause mortality in obese men with low fitness was 3.1 ( 95 % CI , 2.5 - 3.8 ) and in obese men with diabetes mellitus 3.1 ( 95 % CI , 2.3 - 4.2 ) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels . Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors . Approximately 50 % ( n = 1674 ) of obese men had low fitness , which led to a population -attributable risk of 39 % for CVD mortality and 44 % for all-cause mortality . Baseline CVD had population attributable risks of 51 % and 27 % for CVD and all-cause mortality , respectively . CONCLUSIONS In this analysis , low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors BACKGROUND The obesity epidemic is a major health problem in the United States . Alcohol consumption is a source of energy intake that may contribute to body weight gain and development of obesity . However , previous studies of this relationship have been limited , with inconsistent results . METHODS We conducted a prospect i ve cohort study among 19 220 US women aged 38.9 years or older who were free of cardiovascular disease , cancer , and diabetes mellitus and had a baseline body mass index ( BMI ; calculated as weight in kilograms divided by height in meters squared ) within the normal range of 18.5 to less than 25 .  Alcoholic beverage consumption was reported on a baseline question naire . Body weight was self-reported on baseline and 8 annual follow-up question naires . RESULTS There was an inverse association between amount of alcohol consumed at baseline and weight gained during 12.9 years of follow-up . A total of 7942 ( 41.3 % ) initially normal-weight women became overweight or obese ( BMI > or = 25 ) and 732 ( 3.8 % ) became obese ( BMI > or = 30 ) . After adjusting for age , baseline BMI , smoking status , nonalcohol energy intake , physical activity level , and other lifestyle and dietary factors , the relative risks of becoming overweight or obese across total alcohol intake of 0 , more than 0 to less than 5 , 5 to less than 15 , 15 to less than 30 , and 30 g/d or more were 1.00 , 0.96 , 0.86 , 0.70 , and 0.73 , respectively ( P ( ) for trend ( ) < .001 ) . The corresponding relative risks of becoming obese were 1.00 , 0.75 , 0.43 , 0.39 , and 0.29 ( P ( ) for trend ( ) < .001 ) . The associations were similar by subgroups of age , smoking status , physical activity level , and baseline BMI . CONCLUSION Compared with nondrinkers , initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and /or obese during 12.9 years of follow-up BACKGROUND Prior research yielded conflicting results about the magnitude of the association between body mass index ( BMI ) and chronic kidney disease ( CKD ) . STUDY DESIGN Prospect i ve cohort study . SETTING S & PARTICIPANTS Framingham Offspring participants ( n = 2,676 ; 52 % women ; mean age , 43 years ) free of stage 3 CKD at baseline who participated in examination cycles 2 ( 1978 - 1981 ) and 7 ( 1998 - 2001 ) . PREDICTOR BMI . OUTCOME Stage 3 CKD ( estimated glomerular filtration rate < 59 mL/min/1.73 m(2 ) for women and < 64 mL/min/1.73 m(2 ) for men ) . MEASUREMENTS Age- , sex- , and multivariable-adjusted ( diabetes , systolic blood pressure , hypertension treatment , current smoking status , and high-density lipoprotein cholesterol level ) logistic regression models were used to examine the relationship between BMI at baseline and incident stage 3 CKD and incident dipstick proteinuria ( trace or greater ) . RESULTS At baseline , 36 % of the sample was overweight and 12 % was obese ; 7.9 % ( n = 212 ) developed stage 3 CKD during 18.5 years of follow-up . Relative to participants with normal BMI , there was no association between overweight individuals and stage 3 CKD incidence in age- and sex-adjusted models ( odds ratio [ OR ] , 1.29 ; 95 % confidence interval [ CI ] , 0.93 to 1.81 ; P = 0.1 ) or multivariable models ( OR , 1.06 ; 95 % CI , 0.75 to 1.50 ; P = 0.8 ) . Obese individuals had a 68 % increased odds of developing stage 3 CKD ( OR , 1.68 ; 95 % CI , 1.10 to 2.57 ; P = 0.02 ) , which became nonsignificant in multivariable models ( OR , 1.09 ; 95 % CI , 0.69 to 1.73 ; P = 0.7 ) . Similar findings were observed when BMI was modeled as a continuous variable or quartiles . Incident proteinuria occurred in 14.4 % ; overweight and obese individuals were at increased odds of proteinuria in multivariable models ( OR , 1.43 ; 95 % CI , 1.09 to 1.88 ; OR , 1.56 ; 95 % CI , 1.08 to 2.26 , respectively ) . LIMITATIONS BMI is measure of generalized obesity and not abdominal obesity . Participants are predominantly white , and these findings may not apply to different ethnic groups . CONCLUSIONS Obesity is associated with increased risk of developing stage 3 CKD , which was no longer significant after adjustment for known cardiovascular disease risk factors . The relationship between obesity and stage 3 CKD may be mediated through cardiovascular disease risk factors BACKGROUND Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US . This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects . METHODS In a prospect i ve study of cardiovascular disease , the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men . RESULTS Over half of the men remained stable ( < 4 % change in bodyweight ) and served as the reference group ; 31 % gained weight and 13 % lost weight . The 6445 men free from a history of coronary heart disease experienced 318 heart attacks , fatal and non-fatal , during the 6.5 years . Men who gained 4 - 10 % bodyweight had the lowest rate of heart attack , although this was not significantly different from the stable group . The men who lost weight had an increased risk of heart attack , which after adjustment ( for age , recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol , blood pressure , social class , initial body mass index ( BMI ) and lung function ( FEV1 ) , and smoking status at screening and 5 years later ) , was of a similar level of risk to the stable group . The men who gained > 10 % bodyweight had a significantly increased risk of a heart attack after the above adjustment ( P < 0.05 ) . When the effect of weight change was examined according to initial BMI , those men with a BMI < 25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment ( P = 0.06 ) , while men who were overweight ( BMI 25 - 27.9 kg/m2 ) or obese ( BMI > or = 28 kg/m2 ) showed no benefit from weight loss . A small amount of weight gain ( 4 - 10 % ) in the overweight or obese men was associated with decreased risk , whereas considerable weight gain ( > 10 % ) was associated with increased risk , both findings reaching statistical significance in the overweight men ( P < 0.05 and P < 0.001 respectively ) . CONCLUSIONS Considerable weight gain ( > 10 % ) in middle-aged men is associated with increased risk of a heart attack , but weight loss does not appear to reduce risk even in the overweight or obese The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified OBJECTIVE The aim of the article is to determine whether maternal body mass index ( BMI ) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus ( GDM ) . STUDY DESIGN Secondary analysis of a multicenter r and omized treatment trial of women with GDM . Outcomes of interest were elevated umbilical cord c-peptide levels ( > 90th percentile 1.77 ng/mL ) , large for gestational age ( LGA ) birth weight ( > 90th percentile ) , and neonatal fat mass ( g ) . Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal , overweight , and obese adults . Outcomes were analyzed according to treatment group assignment . RESULTS A total of 958 women were enrolled ( 485 treated and 473 controls ) .  Maternal BMI at enrollment was not related to umbilical cord c-peptide levels . However , treatment of women in the overweight , Class I , and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass . Neither measure of excess fetal growth was reduced with treatment in normal weight ( BMI < 25 kg/m(2 ) ) or Class III ( BMI ≥ 40 kg/m(2 ) ) obese women . CONCLUSION There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese . These effects were not apparent for normal weight and very obese women Context Studies of the natural history of obesity have had limitations , such as cross-sectional design , short follow-up , or narrowly defined population s. Contribution Using data from a national study of Americans born between 1957 and 1964 and followed for nearly two decades , these investigators found that more than 25 % were obese by age 35 years . Obesity developed most quickly in black women , with moderate rapidity in Hispanic women , and most slowly in white women . Hispanic men developed obesity more quickly than other men . More recent birth cohorts became obese faster than earlier cohorts . Implication s Underst and ing ethnic differences in the age of onset and rate of progression of obesity may help efforts to prevent obesity . The Editors The proportion of Americans who are overweight or obese is increasing at an alarming rate . From 1960 to 1999 , the prevalence of excess weight ( body mass index [ BMI ] 25 kg/m2 ) increased from 44 % to 61 % of the adult population ( persons aged 20 to 74 years ) and the prevalence of obesity ( BMI 30 kg/m2 ) doubled from 13 % to 27 % ( 1 , 2 ) . Obesity has been linked to increased mortality and chronic morbidity from such diverse causes as hypertension , diabetes , sleep apnea , certain types of cancer , and depression . In the context of this rising prevalence , obesity is increasingly being recognized as an important medical and public health problem ( 3 - 6 ) . Treatment options are available for obesity . However , they can be expensive , often involve difficult lifestyle modifications , and pose adherence problems for many patients . In addition , weight loss , once achieved , is difficult to sustain . Because the health consequences are often long term , the costbenefit ratio of treatment may be more favorable if people who have recently become obese are targeted . Similarly , prevention should focus on those at immediate risk for becoming obese or overweight . Such approaches require a clear underst and ing of who is at highest risk for obesity , when this risk is greatest , and how excess weight develops over time . Although inactivity and high caloric intake are the primary risk factors for obesity , other risk factors have been established . Three of the most influential are age , sex , and race or ethnicity ( 1 , 7 - 9 ) . To better identify people at risk for obesity and those who might benefit from early intervention , we assessed the relationship between weight development and these influential factors . Despite the morbidity and mortality burden of obesity , its natural history has not been well characterized . Current knowledge is based largely on cross-sectional data . Although several large studies have examined weight development in adults , they have important limitations . Only a few tracked weight long enough to detect age-based trends . The first National Health and Nutrition Examination Survey ( NHANES I ) Epidemiologic Follow-up Study examined a representative group of U.S. residents but sample d only two time points , spaced 10 years apart , and had insufficient follow-up to track weight patterns in most minority groups ( 10 ) . The Coronary Artery Risk Development in Young Adults study followed weight development in a large cohort of young black and white Americans but did not provide data for other population s and was geographically restricted ( 8) . Other studies have been performed outside of the United States , but the results may not apply here ( 10 , 11 ) . We design ed our study to address the limitations described earlier . We examined data from the National Longitudinal Survey of Youth 1979 ( NLSY79 ) . This large , prospect i ve cohort study allowed longitudinal examination of weight trends over a time frame sufficient to capture the dynamics of such a slowly changing problem and of an age range during which obesity becomes prevalent . Because not all weight gain has been documented to be harmful , our analysis focused on obesity onset ( defined as the time at which a person reaches obesity ) rather than weight gain . We used the clinical definition of obesity ( BMI 30 kg/m2 ) as our end point because it reflects a point at which mortality risk increases substantially ( 12 ) . Underst and ing how obesity develops over time , who is at greatest risk , and when that risk is highest may be essential in reversing the population trend toward excess weight . Methods Study Group and Obesity Measurement We analyzed data from the NLSY79 , which was initiated by the U.S. Department of Labor , Bureau of Labor Statistics . This survey was design ed to gather information about the labor market activities and other life events of young U.S. citizens . It has been used extensively in economic and sociologic analyses , and the sample design is described elsewhere ( 13 - 16 ) . The cohort of men and women , born between 1957 and 1964 , has been followed for more than two decades . It consists of a nationally representative group , with supplemental sample s overrepresenting minority racial and ethnic groups and poor persons . We excluded a sample of military personnel because this population was removed from the study in 1985 and because physical activity requirements for these individuals could lead to atypical weight patterns . We included only persons who reported that the ethnicity with which they most closely identified was Hispanic , black , or white ( or European origin ) . Height and weight data were self-reported ; height was reported in 1981 and 1985 , and weight was reported 12 times between 1981 and 1998 . Examination of Age-Specific Body Mass Index Patterns Age-specific BMI was calculated for all participants . Height was assumed to remain constant after age 21 years . St and ard clinical definitions were used for overweight ( BMI 25 to 29.9 kg/m2 ) and obesity ( BMI 30 kg/m2 ) . Trends in age-specific BMI were examined by race or ethnicity and birth year . Cohort Differences We examined whether rates of obesity onset differed for people maturing at different times in our sample . Birth cohorts were grouped by 2-year increments . To st and ardize relative rates to age rather than calendar year , time was expressed as the number of years until a person reached obesity , starting from a st and ard age . In the cohort analysis , obesity onset was evaluated from age 24 years ( the baseline age of the oldest participants ) . The outcome of interest was obesity , and the time variable was years from age 24 years to obesity . People who were already obese at age 24 years were excluded . KaplanMeier plots visually demonstrated differences in rates of obesity onset . Cox proportional-hazards modeling estimated the ratio of rates ( hazard ratio ) between groups . For this method to be correct , the ratio of rates must be constant over time ( proportional ) . To assess this assumption , we used two methods : a statistical test of the scaled Schoenfeld residuals , with a P value greater than 0.05 implying that the rates were proportional and a visual method with parallel lines implying proportional rates . In all our analyses , results of proportional hazards testing were reported whenever the assumption was violated . Timing of Obesity Onset by Race or Ethnicity and Sex We evaluated relative rates of obesity onset in 17- and 18-year-old persons of different race or ethnicity who were not obese at the start of the study ; different models were used for men and women . Time was expressed as the number of years from age 17 years until reaching obesity . To control for birth cohort differences , models were adjusted for birth year . As before , KaplanMeier plots were examined and hazard ratios were estimated by using Cox proportional-hazards modeling . To determine relative importance of weight gain during childhood compared with adulthood in terms of the timing of obesity onset , we adjusted the models for baseline BMI at 17 or 18 years of age and examined the effect on hazard ratio estimation . Prevalence and Incidence of Obesity in Early Adulthood For this analysis , we defined early adulthood as the period from 20 to 22 years of age to 35 to 37 years of age . Persons born between 1959 and 1963 were queried about their weight one to two times during each of these age intervals . We calculated the prevalence and incidence of obesity across the early adulthood range . Logistic regression modeling predicted obesity status at age 35 to 37 years from an individual 's race or ethnicity , sex , and BMI at age 20 to 22 years . The model was adjusted in 2-year increments for year of birth . Its predictive ability was quantified by using receiver-operating characteristic ( ROC ) curves . This study was evaluated and exempted from review by the Institutional Review Board of the University of North Carolina at Chapel Hill . Role of the Funding Sources Primary funding was through the Robert Wood Johnson Clinical Scholars Program , with additional support from the National Institute of Child Health and Human Development . Neither entity had a role in the design , conduct , or reporting of this study . Results Description of the Study Sample The total sample included 9179 people : 19 % Hispanic , 31 % black , and 50 % white ( Table ) . People who did not report ethnicity ( n = 106 ) were not included . Age ( sample year minus birth year ) ranged from 17 to 24 years in 1981 to 34 to 41 years in 1998 , and participants were equally distributed across 8 years of birth . Baseline weight was 31.7 to 136.1 kg , and baseline BMI was 11.3 to 51.5 kg/m2 . Table . Sample Characteristics in 1981 Relationship of Body Mass Index to Time Mean age-specific BMI increased with time . This relationship between weight and time has two components , illustrated with data from the oldest and youngest birth cohorts of our sample ( Figure 1 ) . The first is the natural history of body weight : Average BMI increased with age throughout early adulthood . The second is a secular weight trend : Persons born in later calendar years tended to have larger age-specific BMI values . In every case in which the same age was sample d for both birth cohorts , the group born in 1957 had a lower mean BMI than the group born Importance Previous studies have shown a U- or J-shaped association of body mass index ( BMI ) or change in BMI with coronary heart disease ( CHD ) among middle-aged and elderly adults . However , whether a similar association exists among young adults is unclear . Objective To determine whether an association exists between BMI or BMI change with CHD among young adults . Design , Setting , and Participants This population -based longitudinal study used data obtained by the Korean National Health Insurance Service from 2002 to 2015 . The study population comprised 2 611 450 men and women aged between 20 and 39 years who underwent 2 health examinations , the first between 2002 and 2003 and the second between 2004 and 2005 . Exposures World Health Organization Western Pacific Region guideline BMI categories of underweight , normal weight , overweight , obese grade 1 , and obese grade 2 derived during the first health examination and change in BMI calculated during the second health examination . Main Outcomes and Measures Body mass index ( calculated as weight in kilograms divided by height in meters squared ) . Absolute risks ( ARs ) , adjusted hazard ratios ( aHRs ) , and 95 % CIs for acute myocardial infa rct ion or CHD during follow-up from 2006 to 2015 . Results Data from 1 802 408 men with a mean ( SD ) age of 35.1 ( 4.8 ) years and 809 042 women with a mean ( SD ) age of 32.5 ( 6.3 ) years were included . The  mean ( SD ) BMI was 23.2 ( 3.2 ) for the total population , 24.0 ( 3.0 ) for men , and 21.4 ( 2.9 ) for women . Compared with normal weight men , overweight ( AR , 1.38 % ; aHR , 1.18 [ 95 % CI , 1.14 - 1.22 ] ) , obese grade 1 ( AR , 1.86 % ; aHR , 1.45 [ 95 % CI , 1.41 - 1.50 ] ) , and obese grade 2 ( AR , 2.69 % ; aHR , 1.97 [ 95 % CI , 1.86 - 2.08 ] ) men had an increased risk of CHD ( P < .001 for trend ) . Similarly , compared with normal weight women , overweight ( AR , 0.77 % ; aHR , 1.34 [ 95 % CI , 1.24 - 1.46 ] ) , obese grade 1 ( AR , 0.95 % ; aHR , 1.52 [ 95 % CI , 1.39 - 1.66 ] ) , and obese grade 2 ( AR , 1.01 % ; aHR , 1.64 [ 95 % CI , 1.34 - 2.01 ] ) women had an increased risk of CHD ( P < .001 for trend ) . Compared with participants who maintained their weight at normal levels , those who became obese had elevated CHD risk among men ( 0.35 % increase in AR ; aHR , 1.35 [ 95 % CI , 1.17 - 1.55 ] ) and women ( 0.13 % increase in AR ; aHR , 1.31 [ 95 % CI , 0.95 - 1.82 ] ) . Weight loss to normal levels among obese participants was associated with reduced CHD risk for men ( 0.58 % decrease in AR ; aHR , 0.77 [ 95 % CI , 0.64 - 0.94 ] ) and women ( 0.57 % decrease in AR ; aHR , 0.66 [ 95 % CI , 0.45 - 0.98 ] ) . Conclusions and Relevance Obesity and weight gain were associated with elevated risk of CHD among young adults in this study . Studies that prospect ively determine the association between weight change and CHD risk are needed to vali date these findings Background — Abdominal adiposity is a growing clinical and public health problem . It is not known whether it is similarly associated with cardiovascular disease ( CVD ) and diabetes mellitus in different regions around the world , and thus whether measurement of  waist circumference ( WC ) in addition to body mass index ( BMI ) is useful in primary care practice . Methods and Results — R and omly chosen primary care physicians in 63 countries recruited consecutive patients aged 18 to 80 years on 2 prespecified half days .  WC and BMI  were measured and the presence of CVD and diabetes mellitus recorded . Of the patients who consulted the primary care physicians , 97 % agreed to participate in the present study . Overall , 24 % of 69 409 men and 27 % of 98 750 women were obese ( BMI ≥30 kg/m2 ) . A further 40 % and 30 % of men and women , respectively , were overweight ( BMI 25 to 30 kg/m2 ) . Increased WC ( > 102 for men and > 88 cm for women ) was recorded in 29 % and 48 % , CVD in 16 % and 13 % , and diabetes mellitus in 13 % and 11 % of men and women , respectively . A statistically significant grade d increase existed in the frequency of CVD and diabetes mellitus with both BMI and WC , with a stronger relationship for WC than for BMI across regions for both genders . This relationship between WC , CVD , and particularly diabetes mellitus was seen even in lean patients ( BMI < 25 kg/m2 ) . Conclusions — Among men and women who consulted primary care physicians  , BMI and particularly WC were both strongly linked to CVD and especially to diabetes mellitus . Strategies to address this global problem are required to prevent an epidemic of these major causes of morbidity and mortality Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control OBJECTIVE To examine the effect of reverse causality and confounding on the association of BMI with all-cause and cause-specific mortality . RESEARCH METHODS AND PROCEDURES Data from two large prospect i ve studies were used . One ( a community-based cohort ) included 8327 women and 7017 men who resided in two Scottish towns at the time of the baseline assessment in 1972 - 1976 ; the other ( an occupational cohort ) included 4016 men working in the central belt of Scotl and at the time of the baseline assessment in 1970 - 1973 . Participants in both cohorts were ages 45 to 64 years at baseline ; the follow-up period was 28 to 34 years . RESULTS In age-adjusted analyses that did not take account of reverse causality or smoking , there was no association between being overweight ( BMI 25 to < 30 kg/m(2 ) ) and mortality , and weak to modest associations between obesity ( BMI > or = 30 kg/m(2 ) ) and mortality . There was a strong association between smoking and lower BMI in women and men in both cohorts ( all p < 0.0001 ) . Among never-smokers and with the first 5 years of deaths removed , overweight was associated with an increase in all-cause mortality ( relative risk ranging from 1.12 to 1.38 ) , and obesity was associated with a doubling of risk in men in both cohorts ( relative risk , 2.10 and 1.96 , respectively ) and a 60 % increase in women ( relative risk , 1.56 ) . In both never-smokers and current smokers , being overweight or obese was associated with important increases in the risk of cardiovascular disease . DISCUSSION These findings demonstrate that with appropriate control for smoking and reverse causality , both overweight and obesity are associated with important increases in all-cause and cause-specific mortality , and in particular with cardiovascular disease mortality OBJECTIVE : To examine the association of physical activity and body mass index ( BMI ) , and their combined effect , with the risk of total , cardiovascular disease ( CVD ) and cancer mortality .  DESIGN : Prospect i ve follow-up study .SUBJECTS : In all , 22 528 men and 24 684 women aged 25–64 y at baseline having 7394 deaths during a mean follow-up of 17.7 y . MEASUREMENT : A self-administered question naire data on smoking , socioeconomic factors , physical activity and medical history , together with measured height , weight , blood pressure and serum cholesterol using st and ardized protocol . RESULT : Physically active subjects had significantly lower age-adjusted mortality from cardiovascular , cancer and all causes compared with sedentary ones . Further adjustment for smoking , systolic blood pressure , cholesterol , BMI , diabetes and education affected the results only slightly . Obese subjects ( BMI ≥30 kg/m2 ) had significantly higher cardiovascular and total mortality than the normal weight ( 18.5≤ BMI < 25 kg/m2 ) subjects . Part of increased mortality among obese subjects was mediated through obesity-related cardiovascular risk factors . BMI had an inverse association with cancer mortality among men and almost significant direct association among women . Total mortality was also increased among the lean ( BMI < 18.5 kg/m2 ) subjects . However , less than 0.3 % of deaths were attributed to low body weight , whereas in men 5.5 % and in women 17.7 % of deaths were attributed to obesity . CONCLUSION : Regular physical activity and normal weight are both important indicators for a decreased risk of mortality from all causes , CVD and cancer . Physical activity had a strong independent effect on mortality , whereas the effect of BMI was partly mediated through other obesity-related risk factors OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) CONTEXT Individual contributions of obesity and physical fitness ( physical activity and functional capacity ) to risk of coronary heart disease in women remain unclear . OBJECTIVE To investigate the relationships of measures of obesity ( body mass index [ BMI ] , waist circumference , waist-hip ratio , and waist-height ratio ) and physical fitness ( self-reported Duke Activity Status Index [ DASI ] and Postmenopausal Estrogen-Progestin Intervention question naire [ PEPI-Q ] scores ) with coronary artery disease ( CAD ) risk factors , angiographic CAD , and adverse cardiovascular ( CV ) events in women evaluated for suspected myocardial ischemia . DESIGN , SETTING , AND PARTICIPANTS The National Heart , Lung , and Blood Institute-sponsored Women 's Ischemia Syndrome Evaluation ( WISE ) is a multicenter prospect i ve cohort study . From 1996 - 2000 , 936 women were enrolled at 4 US academic medical centers at the time of clinical ly indicated coronary angiography and then assessed ( mean follow-up , 3.9 [ SD , 1.8 ] years ) for adverse outcomes . MAIN OUTCOME MEASURES Prevalence of obstructive CAD ( any angiographic stenosis > or=50 % ) and incidence of adverse CV events ( all-cause death or hospitalization for nonfatal myocardial infa rct ion , stroke , congestive heart failure , unstable angina , or other vascular events ) during follow-up . RESULTS Of 906 women ( mean age , 58 [ SD , 12 ] years ) with complete data , 19 % were of nonwhite race , 76 % were overweight ( BMI > or=25 ) , 70 % had low functional capacity ( DASI scores < 25 , equivalent to < or=7 metabolic equivalents [ METs ] ) , and 39 % had obstructive CAD . During follow-up , 337 ( 38 % ) women had a first adverse event , 118 ( 13 % ) had a major adverse event , and 68 ( 8 % ) died . Overweight women were more likely than normal weight women to have CAD risk factors , but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors ( P = .05 to.88 ) . Conversely , women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD ( 44 % vs 26 % , P<.001 ) at baseline , and each 1-MET increase in DASI score was independently associated with an 8 % ( hazard ratio , 0.92 ; 95 % confidence interval , 0.85 - 0.99 ; P = .02 ) decrease in risk of major adverse CV events during follow-up . CONCLUSIONS Among women undergoing coronary angiography for suspected ischemia , higher self-reported physical fitness scores were independently associated with fewer CAD risk factors , less angiographic CAD , and lower risk for adverse CV events . Measures of obesity were not independently associated with these outcomes OBJECTIVE Severe obesity ( body mass index [ BMI ] ≥40 kg/m(2 ) ) is a serious public health concern . Although bariatric surgery is an efficacious treatment approach , it is limited in reach ; thus , nonsurgical treatment alternatives are needed . We examined the 4-year effects of an intensive lifestyle intervention  on body weight and cardiovascular disease risk factors among severely obese , compared with overweight ( 25 ≤ BMI < 30 ) , class I ( 30 ≤ BMI < 35 ) , and class II obese ( 35 ≤ BMI < 40 ) participants . METHODS There were 5145 individuals with type 2 diabetes ( 45 - 76 years , BMI ≥25 kg/m(2 ) ) r and omized to an intensive lifestyle intervention or diabetes support and education .  The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings , a ≥10 % weight loss goal , calorie restriction , and increased physical activity . Diabetes support and education received a less intense educational intervention . Four-year changes in body weight and cardiovascular disease risk factors were assessed . RESULTS Across BMI categories , 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( Ps < .05 ) . At year 4 , severely obese lifestyle participants lost 4.9%±8.5 % , which was similar to class I ( 4.8%±7.2 % ) and class II obese participants ( 4.4%±7.6 % ) , and significantly greater than overweight participants ( 3.4%±7.0 % ; P < .05 ) . Four-year changes in low-density-lipoprotein cholesterol , triglycerides , diastolic blood pressure , HbA(1c ) , and blood glucose were similar across BMI categories in lifestyle participants ; however , the severely obese had less favorable improvements in high-density-lipoprotein cholesterol ( 3.1±0.4 mg/dL ) and systolic blood pressure ( -1.4±0.7 mm Hg ) compared with the less obese ( Ps < .05 ) . CONCLUSION Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals BACKGROUND Studies in animals indicate that brown adipose tissue is important in the regulation of body weight , and it is possible that individual variation in adaptive thermogenesis can be attributed to variations in the amount or activity of brown adipose tissue . Until recently , the presence of brown adipose tissue was thought to be relevant only in small mammals and infants , with negligible physiologic relevance in adult humans . We performed a systematic examination of the presence , distribution , and activity of brown adipose tissue in lean and obese men during exposure to cold temperature .  Brown-adipose-tissue activity was studied in relation to body composition and energy metabolism . METHODS We studied 24 healthy men--10 who were lean ( body-mass index [ BMI ] [ the weight in kilograms divided by the square of the height in meters ] , < 25 ) and 14 who were overweight or obese ( BMI , > or = 25)--under thermoneutral conditions ( 22 degrees C ) and during mild cold exposure ( 16 degrees C ) . Putative brown-adipose-tissue activity was determined with the use of integrated (18)F-fluorodeoxyglucose positron-emission tomography and computed tomography .  Body composition and energy expenditure were measured with the use of dual-energy x-ray absorptiometry and indirect calorimetry . RESULTS Brown-adipose-tissue activity was observed in 23 of the 24 subjects ( 96 % ) during cold exposure but not under thermoneutral conditions . The activity was significantly lower in the overweight or obese subjects than in the lean subjects ( P=0.007 ) . BMI and percentage of body fat both had significant negative correlations with brown adipose tissue , whereas resting metabolic rate had a significant positive correlation . CONCLUSIONS The percentage of young men with brown adipose tissue is high , but its activity is reduced in men who are overweight or obese . Brown adipose tissue may be metabolically important in men , and the fact that it is reduced yet present in most overweight or obese subjects may make it a target for the treatment of obesity BACKGROUND Obesity , defined by a body-mass index ( BMI ) ( the weight in kilograms divided by the square of the height in meters ) of 30.0 or more , is associated with an increased risk of death , but the relation between overweight ( a BMI of 25.0 to 29.9 ) and the risk of death has been question ed . METHODS We prospect ively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995 - 1996 .  BMI was calculated from self-reported weight and height . Relative risks and 95 percent confidence intervals were adjusted for age , race or ethnic group , level of education , smoking status , physical activity , and alcohol intake . We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status . RESULTS During a maximum follow-up of 10 years through 2005 , 61,317 participants ( 42,173 men and 19,144 women ) died  . Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women , in all racial or ethnic groups , and at all ages . When the analysis was restricted to healthy people who had never smoked , the risk of death was associated with both overweight and obesity among men and women . In analyses of BMI during midlife ( age of 50 years ) among those who had never smoked , the associations became stronger , with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons ; the risk of death among underweight persons was attenuated . CONCLUSIONS Excess body weight during midlife , including overweight , is associated with an increased risk of death BACKGROUND Questions remain as to whether higher levels of cardiorespiratory fitness , a measure of regular physical activity , are associated with lower risk of cardiovascular disease ( CVD ) mortality in overweight and obese individuals with diabetes . Our objective was to quantify the independent and joint relations of cardiorespiratory fitness ( hereafter , fitness ) and body mass index ( BMI ; calculated as weight in kilograms divided by the square of height in meters ) with  CVD mortality in men with diabetes . METHODS This study was conducted using prospect i ve observational data from the Aerobics Center Longitudinal Study . Study participants comprised 2316 men with no history of stroke or myocardial infa rct ion and who were diagnosed as having diabetes ( mean [ SD ] age , 50 [ 10 ] years ) ; had a medical examination , including a maximal exercise test during 1970 to 1997 with mortality surveillance to December 31 , 1998 ; and had a BMI of 18.5 or greater and less than 35.0 . The main outcome measure was CVD mortality across levels of fitness with stratification by BMI . RESULTS We identified 179  CVD deaths during a mean ( SD ) follow-up of 15.9 ( 7.9 ) years and 36,710 man-years of exposure . In a model containing age , examination year , fasting glucose level , systolic blood pressure , parental history of premature CVD , total cholesterol level , cigarette smoking , abnormal resting , and exercise electrocardiograms , a significantly higher adjusted risk of mortality was observed in men with a low fitness level who were normal weight ( hazard ratio , 2.7 [ 95 % confidence interval , 1.3 - 5.7 ] ) , overweight ( hazard ratio , 2.7 [ 95 % confidence interval , 1.4 - 5.1 ] ) , and class 1 obese ( hazard ratio , 2.8 [ 95 % confidence interval , 1.4 - 5.1 ] ) compared with normal weight men with a high fitness level . CONCLUSION In this cohort of men with diabetes , low fitness level was associated with increased risk of CVD mortality within normal weight , overweight , and class 1 obese weight categories BACKGROUND Obese patients have favorable outcomes in congestive heart failure , hypertension , peripheral vascular disease , and coronary artery disease . Obesity also has been linked with increased incidence of atrial fibrillation , but its influence on outcomes in atrial fibrillation patients has not been investigated . The objective of this research is to investigate the effect of obesity on outcomes in atrial fibrillation . METHODS The Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study was one of the largest multicenter trials of atrial fibrillation , with 4060 patients . Subjects were r and omized to rate versus rhythm-control strategy . We performed a post hoc analysis of the National Heart , Lung and Blood Institute limited access data set of atrial fibrillation patients who had body mass index ( BMI ) data available in the AFFIRM study . BMI data were not available on 1542 patients . Patients with BMI > or=18.5 were split into normal ( 18.5 - 25 ) , overweight ( 25 - 30 ) , and obese ( > 30 ) categories as per BMI ( kg/m(2 ) ) . Multivariate Cox proportional hazards regression was used on the eligible 2492 patients . End points were all-cause mortality and cardiovascular mortality . RESULTS Over three fourths of all patients in our cohort were overweight or obese . There were 304 deaths ( 103 among normal weight , 108 among overweight , and 93 among obese ) and 148 cardiovascular deaths ( 54 among normal weight , 41 among overweight , and 53 among obese ) over a mean period of 3 years of patient follow-up . On multivariate analysis , overweight ( hazard ratio [ HR ] 0.64 ; 95 % confidence interval [ CI ] , 0.48 - 0.84 ; P=.001 ) and obese ( HR 0.80 ; 95 % CI , 0.68 - 0.93 ; P=.005 ) categories were associated with lower all-cause mortality as compared with normal weight . Overweight ( HR 0.40 ; 95 % CI , 0.26 - 0.60 ; P < .001 ) and obese patients ( HR 0.77 ; 95 % CI , 0.62 - 0.95 ; P=.01 ) also had lower cardiovascular mortality as compared with the normal weight patients . CONCLUSIONS Although in prior studies , obesity has been associated with increased risk of atrial fibrillation , an obesity paradox exists for outcomes in atrial fibrillation . Obese patients with atrial fibrillation appear to have better long-term outcomes than nonobese patients
This indicates that even in the absence of metabolic abnormalities , overweight and obesity are not innocuous , perhaps because the traditional cardiovascular risk factors are either not present early or remain undetected using routine clinical assessment .
This raises the concept that early or sub clinical organ damage assessment s may be better at identifying subjects who are more likely to progress to develop cardiovascular disease .
Obesity and Consequences The prevalence of overweight and obesity has reached epidemic proportion , with the recent figures from the World Health Organization indicating that in 2016 39 % of adults aged ≥18 years ( 39 % of men and 40 % of women ) were overweight and 13 % ( 11 % of men and 15 % of women ) obese .
The World Health Organization states that raised body mass index ( BMI ) is a major risk factor for noncommunicable diseases such as cardiovascular diseases ( mainly heart disease and stroke ) , which were the leading causes of death in 2012 , diabetes mellitus , musculoskeletal disorders , and some cancers .
The Framingham Heart Study data have indicated that overweight and obesity are associated with significantly decreased life expectancy .
Nevertheless , and against these strong evidence s , the relationship between BMI and mortality has been challenged by several studies , indicating a survival advantages for those who are overweight and class I obese .
However , the determinants of these observations are poorly understood and continue to be debated because BMI may not be the ideal index of adiposity and fat distribution and fitness and disease prevention may obscure the link between BMI and mortality .
Overweight or obesity is not always accompanied by traditional risk factors .
In fact , a systematic review and meta analysis revealed that about 35 % of obese individuals are metabolically healthy .
There is evidence that an important factor driving at least some of the obesity-associated end-organ damage is overactivity of the sympathetic nervous system ( SNS ) , an observation that suggests that targeting SNS in obesity may help reduce the cardiovascular risk associated with obesity .
In this review , we highlight the current knowledge of the potential role of SNS function in obesity-induced organ damage and examine whether interventions aim ed at reducing cardiovascular risk in obesity may be mediated via alterations in SNS activity .