Overweight and Obesity in Young and Middle Age and Early Retirement: The ARIC Study

The objective of this study was to examine associations between weight status in young and middle age and early retirement in African‐American and white men and women. Data were from the Atherosclerosis Risk in Communities (ARIC) study. Analyses were restricted to participants aged 45–55 years at baseline (n = 6,483). Associations between weight status at age 25 and ages 45–55 and age at early retirement (prior to age 65) over 9 years of follow‐up were examined using proportional hazard regression analyses in models stratified by race and gender. Models were adjusted for education, household income, health insurance status, occupation, occupational physical activity, marital status, smoking, and field center. Between 18.7 and 21.6% of African‐American and white men and women reported retiring prior to age 65. Although not always statistically significant, overweight and obesity were associated with early retirement in all but white women. Overweight (BMI ≥ 25 kg/m²) at age 25 was significantly associated with early retirement in African‐American women (hazard ratio (95% confidence interval): 1.62 (1.17–2.23)) and white men (1.32 (1.12–1.57)). There was also a trend between overweight at age 25 and early retirement in African‐American men (1.43 (0.99–2.07)). Obesity (BMI ≥ 30 kg/m²) in middle age was significantly associated with early retirement in white men only (1.32 (1.03–1.69)). Furthermore, overweight at age 25 and obesity at ages 45–55 were associated with early retirement for health reasons among African‐American and white men and women. In conclusion, analyses of the economic impact of obesity may need to consider its effects on early retirement.     

Self‐Reported Body Mass Index and Health‐Related Quality of Life: Findings from the Behavioral Risk Factor Surveillance System

Objective: To examine the relationship between self‐reported body mass index (BMI) and health‐related quality of life in the general adult population in the United States. Research Methods and Procedures: Using data from 109,076 respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined how self‐reported BMI is associated with five health‐related quality of life measures developed by the Centers for Disease Control and Prevention for population health surveillance. Results: After adjusting for age, gender, race or ethnicity, educational attainment, employment status, smoking status, and physical activity status, participants with a self‐reported BMI of <18.5 kg/m² and participants with a self‐reported BMI of ≥30 kg/m² reported impaired quality of life. Compared with persons with a self‐reported BMI of 18.5 to <25 kg/m², odds ratios (ORs) of poor or fair self‐rated health increased among persons with self‐reported BMIs of <18.5 (1.57, 95% confidence interval [CI]: 1.31 to 1.89), 25 to <30 kg/m² (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m² (1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m² (2.58, 95% CI: 2.21 to 3.00), and ≥40 kg/m² (3.23, 95% CI: 2.63 to 3.95); ORs for reporting ≥14 days of poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to 1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI: 1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having ≥14 days of poor mental health during the previous 30 days were 1.18 (95% CI: 0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68 (95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively. Discussion: In the largest study to date, low and increased self‐reported BMI significantly impaired health‐related quality of life. Particularly, deviations from normal BMI affected physical functioning more strongly than mental functioning.     

Health perceptions and demographic characteristics associated with underassessment of body weight

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self‐reported general health, and perceived health risk in relation to one's body weight. Methods and Procedures: In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self‐reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest. Results: Among persons with a BMI ≥25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self‐rated health among obese women; and self‐rated health among obese men (P < 0.05). Discussion: While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.     

Disability,Arthritis, and Body Weight among Adults 45 Years and Older

Objectives : To examine the association between body weight and disability among persons with and without self‐reported arthritis. Research Methods and Procedures : Data were analyzed for noninstitutionalized adults, 45 years or older, in states that participated in the Behavioral Risk Factor Surveillance System. Self‐reported BMI (kilograms per meter squared) was used to categorize participants into six BMI‐defined groups: underweight (<18.5), normal weight (18.5 to <25), overweight (25 to <30), obese, class 1 (30 to <35), obese, class 2 (35 to <40), and obese, class 3 (≥40). Results : Class 3 obesity (BMI ≥ 40) was significantly associated with disability among participants both with and without self‐reported arthritis. The adjusted odds ratio (AOR) for disability in participants with class 3 obesity was 2.75 [95% confidence interval (CI) = 2.22 to 3.40] among those with self‐reported arthritis and 1.77 (95% CI = 1.20 to 2.62) among those without self‐reported arthritis compared with those of normal weight (BMI 18.5 to <25). Persons with self‐reported arthritis who were obese, class 2 (BMI 35 to <40) and obese, class 1 (BMI 30 to <35) and women with self‐reported arthritis who were overweight (BMI 25 to <30) also had higher odds of disability compared with those of normal weight [AOR = 1.72 (95% CI = 1.47 to 2.00), AOR = 1.30 (95% CI = 1.17 to 1.44), and AOR = 1.18 (95% CI = 1.06 to 1.32), respectively]. Discussion : Our findings reveal that obesity is associated with disability. Preventing and controlling obesity may improve the quality of life for persons with and without self‐reported arthritis.     

Obesity and Self‐reported General Health,Hawaii BRFSS: Are Polynesians at Higher Risk?

Objective: This study compared the relationship between fair/poor general health status among overweight and obese Polynesians with that among other overweight and obese persons in Hawaii. Methods and Procedures: Data were pooled from the 1998–2003 Hawaii Behavioral Risk Factor Surveillance System (BRFSS) and logistic regression used to examine the predictors of fair/poor health status. Results: Polynesians were significantly more likely to be obese than non‐Polynesians; overweight Polynesians were more likely than other overweight individuals to report fair/poor health status. After adjusting for confounders, among Polynesians, being obese was no longer associated with fair/poor health. Non‐Polynesians who were obese (odds ratio 1.9; 95% confidence interval: 1.4–2.6), older, less educated, smokers, diabetic, hypertensive, and physically inactive were more likely to report fair/poor health. Discussion: Although Polynesians were significantly more obese than the rest of the Hawaii population, their weight was not independently associated with their odds for fair/poor health as it was with non‐Polynesians. The difference may be that, for Polynesians, hypertension and diabetes overrode the effect of obesity on general health status or this group maintains different cultural perceptions of body size. Regardless, these findings show a major health risk among Polynesians and suggest the need for culturally specific health interventions.     

Parental perceptions of overweight counseling in primary care: the roles of race/ethnicity and parent overweight

Objective: To examine parental perceptions of primary care efforts aimed at childhood obesity prevention Methods and Procedures: We interviewed 446 parents of children, aged 2–12 years, with an age‐ and sex‐specific BMI ≥85th percentile; interviews occurred within 2 weeks of their child's primary care visit. We assessed parental ratings of the nutrition and physical activity advice received. Using children's clinical heights and weights and parents' self‐reported heights and weights, we classified children into three categories: BMI 85th–94th percentile without an overweight parent, BMI 85th–94th percentile with an overweight parent (adult BMI ≥25 kg/m²), and BMI ≥95th percentile. Results: In multivariate analyses, compared to parents of children with BMI ≥95th percentile, overweight parents with children whose BMI was 85th–94th percentile were more likely to report receiving too little advice on nutrition and physical activity (odds ratio (OR) 3.05; 95% confidence interval (CI) 1.49, 6.25) and to rate as poor or fair the quality of advice they received (OR 2.23; 95% CI 1.18, 4.24). Independently, African‐American (OR 2.55; 95% CI 1.18, 5.51) and Hispanic/Latino (OR 2.78; 95% CI 1.27, 6.10) parents were more likely than white parents to rate as poor or fair the quality of advice they received. Discussion: Parental overweight is associated with low subjective ratings of overweight counseling in pediatric primary care. Our findings of poorer perceived quality among racial/ethnic minority parents need further investigation.     

Self-reported comorbidities among self-described overweight African-American and Hispanic adults in the United States: results of a national survey

Objective: To examine the concordance between self‐described weight status and BMI, the prevalence of self‐reported comorbidities, and the association between comorbidities and self‐rated health among overweight African‐American and Hispanic US adults. Methods and Procedures: A nationally representative sample of 537 African‐American and 526 Hispanic adults who were identified using a combination of random digit dialing and listed household sampling and self‐described as being slightly or very overweight participated in a telephone interview. Self‐reported height and weight were used to calculate BMI. Results: More than half of African Americans (56%) and one‐third of Hispanics (34%) who self‐described as “slightly” overweight would be classified as obese based on BMI. One‐third (33%) of African Americans reported high blood pressure, followed by arthritis (20%), high cholesterol (18%), and diabetes (15%). Among Hispanics, high cholesterol was the most frequently reported comorbidity (17%), followed by high blood pressure (15%), and difficulty sleeping (12%). Almost three‐quarters of African Americans surveyed (72%) reported that their overall health was good to excellent compared to 62% for Hispanics. Discussion: Self‐reported rates of obesity‐related comorbidities fall below what would be expected based on prevalence data derived from physiologic measures, suggesting a lack of awareness of actual risk. Despite the greater self‐reported prevalence of certain risk factors for poor health, African Americans have a more optimistic view of their overall health and weight status compared to Hispanics. Physicians have an important opportunity to communicate to their minority patients the serious health consequences associated with excess weight.     

Obesity and Quality of Life: Mediating Effects of Pain and Comorbidities

Objective: To estimate the association between body mass index (BMI) and health‐related quality of life (HRQL) and examine whether joint pain and obesity‐related comorbidities mediate the BMI‐HRQL association. Research Methods and Procedures: Population‐based survey data from the 1999 Behavioral Risk Factor Surveillance Survey. Adults (N = 155, 989) were classified according to BMI as underweight (<18.5 kg/m²), desirable weight (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), obese class I (30 to 34.9 kg/m²), obese class II (35 to 39.9 kg/m²), and obese class III (≥40 kg/m²). Data including general health status, unhealthy days in the past 30 caused by physical problems and mental problems, and total unhealthy days in the past 30 were collected. Results: After adjusting for age, sex, race, smoking, education, and income, we observed J‐shaped associations between BMI and HRQL. Compared with desirable weight adults, underweight, overweight, and obesity classes I, II, and III adults [odds ratio (OR) = 1.57, 1.19, 1.95, 2.72, and 4.36, respectively] were significantly (p < 0.001) more likely to report fair/poor general health status. For unhealthy days caused by physical problems, the corresponding ORs were 1.51, 1.15, 1.66, 2.27, and 3.61 (p < 0.001). For unhealthy days caused by mental problems, the ORs were 1.35, 1.14 1.43, 1.57, and 2.25 (p < 0.001). For total unhealthy days, the corresponding ORs were 1.27, 1.09, 1.37, 1.73, and 2.46 (p < 0.01). Adding joint pain and obesity‐related comorbidities into models attenuated BMI‐HRQL associations. Discussion: Associations between BMI and HRQL indices were J‐shaped. Joint pain and comorbidities may mediate BMI‐HRQL associations.     

Smoking Kills,Obesity Disables: A Multistate Approach of the US Health and Retirement Survey

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity‐related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age‐, risk‐, and state‐dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self‐reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23–24.9), nonsmoking and high education. Mild obesity (BMI: 30–34.9) did not change total life expectancy (LE) but exchanged disabled for disability‐free years. Mild obesity decreased disability‐free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability‐free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25–29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability‐free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.     

The Association Between Sleep Duration and General and Abdominal Obesity in Koreans: Data From the Korean National Health and Nutrition Examination Survey, 2001 and 2005

This study aimed to investigate the association between self‐reported sleep duration and general and abdominal obesity in Korean adults. A total of 8,717 adults aged 20–65 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 2001 and 2005 were included. General obesity was defined as BMI ≥25 kg/m² and abdominal obesity as waist circumference ≥90 cm in men and ≥85 cm in women. To control for sociodemographic and lifestyle factors and comorbidities, multivariable logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of general and abdominal obesity across the following sleep duration categories: ≤5, 6, 7, 8, and ≥9 h/day. Mean sleep duration (±s.d.) was 6.9 ± 1.3 h. Those sleeping ≤5 h/day had the highest BMI and waist circumference compared with those sleeping 7, 8, or ≥9 h/day (P < 0.05 for all comparisons). After controlling for sociodemographic and lifestyle factors, the adjusted ORs (95% CIs) associated with sleeping ≤5 h/day (vs. 7 h/day) were 1.25 (1.06–1.48) for general obesity and 1.24 (1.03–1.48) for abdominal obesity. Further adjustment for hypertension and diabetes mellitus did not significantly affect the associations. These data suggest that short sleep duration is significantly associated with a modest increase in general and abdominal obesity in Korean adults.     

From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms

In this article, we describe differences in the self‐perception of weight status in the United States between the two most recent National Health and Nutrition Examination Survey (NHANES) periods (1988–1994 and 1999–2004), and test the hypothesis that secular increases in adult mean BMI, adult obesity, and childhood obesity contributed to changes over time in weight perceptions. We find that the probability of self‐classifying as overweight is significantly lower on average in the more recent survey, for both women and men, controlling for objective weight status and other factors. Among women, the decline in the tendency to self‐classify as overweight is concentrated in the 17–35 age range, and is more pronounced among women with normal BMI than those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups. Overweight men exhibit a sharper decline in feeling overweight than normal weight men. Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. We interpret the findings as evidence of a generational shift in social norms related to body weight. As a result, people may be less likely to desire weight loss than previously, limiting the effectiveness of public health campaigns aimed at weight reduction. On the other hand, there may be health benefits associated with improved body image.     

Physical Activity,TV Viewing,and Weight in U.S. Youth: 1999 Youth Risk Behavior Survey

Objective: To examine the relationship between physical activity, TV watching, and weight in U.S. youth ages 14 to 18 years. Research Methods and Procedures: Data from a nationally representative sample of 15,143 U.S. high‐school students participating in the 1999 Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey were examined. Prevalence rates of participation in moderate physical activity (MPA), vigorous physical activity (VPA), and television watching (TV) were determined. The association between MPA, VPA, TV and the body mass index (BMI) and overweight status (BMI ≥85th percentile of age‐ and sex‐specific CDC/National Center for Health Statistics reference values) were examined by analysis of covariance and logistic regression. Results: Overall, 45% reported participating in MPA ≥3 d/wk, 65% reported participating in VPA ≥3 d/wk, and 25% reported watching TV ≥4 h/school day. Boys reporting six to seven bouts of MPA had a significantly lower BMI compared with boys reporting three to five or less than two. The mean BMI differed significantly between the lowest and highest levels of MPA groups in girls. The mean BMI was significantly lower in the highest VPA group compared with the other two groups in both sexes. There was a significant graded response for BMI across all levels of TV. Decreased levels of MPA and 3 to 4 days of VPA were significantly associated with an increased risk of overweight in boys when compared with those engaging in 6 to 7 d/wk (odds ratio = 1.26 to 1.37). A graded response existed between TV and overweight in both sexes. Boys and girls were ～20% to 25% less likely to be classified as overweight if they reported 2 to 3 hours of TV per day and ～40% less likely to be classified as overweight if they reported ≤1 hour of TV per day compared with those who watched ≥4 hours of TV. In general, youth who engaged in less physical activity watched more TV per week. Discussion: Increased levels of physical activity are associated with a lower BMI and less TV watching. However, the relationship between TV watching and weight status is more pronounced.     

BMI and health status among adults with asthma

Background: A convincing body of literature links obesity with a higher risk for developing adult‐onset asthma. The impact of obesity on asthma severity among adults with pre‐existing asthma, however, is less clear. Methods and Procedures: In a prospective cohort study of 843 adults with severe asthma, we studied the impact of BMI on asthma health status. Results: The prevalence of obesity and overweight were 44% (95% confidence interval (CI) 41–47%) and 28% (95% CI 25–32%). The obese BMI group was associated with a higher risk for daily or near daily asthma symptoms than was the normal BMI group (odds ratio (OR) 1.81; 95% CI 1.10–2.96). Compared to the normal BMI group, generic physical health status was worse in the overweight (mean score decrement ?2.42 points; 95% CI ?4.39 to ?0.45) and the obese groups (?6.31 points; 95% CI ?8.14 to ?4.49). Asthma‐specific quality of life was worse in the underweight (mean score increment 8.66 points; 95% CI 2.53–14.8) and obese groups (4.51 points; 95% CI 2.21–6.81), compared to those with normal BMI. Obese persons also had a higher number of restricted activity days that past month (5.05 days; 95% CI 2.90–7.19 days). Discussion: It appears that obesity has a substantive negative effect on health status among adults with asthma. Further work is needed to clarify the precise mechanisms. Clinicians should counsel dietary modification and weight loss for their overweight and obese patients with asthma.     

Long-term effects of obesity on employment and work limitations among U.S. Adults, 1986 to 1999

Objective: To determine the relationships between BMI and workforce participation and the presence of work limitations in a U.S. working‐age population. Research Methods and Procedures: We used data from the Panel Study of Income Dynamics, a nationwide prospective cohort, to estimate the effect of obesity in 1986 on employment and work limitations in 1999. Individuals were classified into the following weight categories: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Using multivariable probit models, we estimated the relationships between obesity and both employment and work disability. All analyses were stratified by sex. Results: After adjusting for baseline sociodemographic characteristics, smoking status, exercise, and self‐reported health, obesity was associated with reduced employment at follow‐up [men: marginal effect (ME) ?4.8 percentage points (pp); p < 0.05; women: ME ?5.8 pp; p < 0.10]. Among employed women, being either overweight or obese was associated with an increase in self‐reported work limitations when compared with normal‐weight individuals (overweight: ME +3.9 pp; p < 0.01; obese: ME +12.6 pp; p < 0.01). Among men, the relationship between obesity and work limitations was not statistically significant. Discussion: Obesity appears to result in future productivity losses through reduced workforce participation and increased work limitations. These findings have important implications in the U.S., which is currently experiencing a rise in the prevalence of obesity.     

Racial/Ethnic Differences in Weight Perception

The objective of this research was to estimate the prevalence of weight misperception among adults using the most recent nationally representative data, according to measured weight category and to assess the relationship between weight misperception and race/ethnicity. Height and weight were measured as part of the 1999–2006 National Health and Nutrition Examination Survey. The study sample consisted of 17,270 adults aged ≥20 years. BMI was categorized as underweight (BMI < 18.5), healthy weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Subjects reported self‐perception of weight status. Among study subjects, 31.7% of healthy weight adults, 38.1% of overweight adults, and 8.1% of obese adults incorrectly perceived their weight category. Among obese men, the odds of weight misperception were higher for non‐Hispanic blacks (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 2.0–4.5) compared to non‐Hispanic whites and for persons with less than a high school education (OR = 2.1; 95% CI = 1.3–2.1), compared to those with some college education. Among obese women, the odds of weight misperception were higher for non‐Hispanic blacks (OR = 3.4; 95% CI = 1.4, 3.1) and Mexican Americans (OR = 1.9; 95% CI = 1.2, 3.2) compared to non‐Hispanic whites and for persons with less than high school education compared to those with some college education (OR = 5.5; 95% CI = 3.3–9.3). Weight misperception is highly prevalent in the US population, and more frequent in racial/ethnic minorities, males, and in persons with lower educational levels. Addressing the issue of weight misperception may help address the problem of obesity in the United States by increasing awareness of healthy weight levels, which may subsequently have an impact on weight‐related behavior change.     

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

A representative sample of 365 low‐income African‐American preschool children aged 3–5 years was studied to determine the association between sugar‐sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002–2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age‐sex specific BMI: those with an age‐sex specific BMI ≥85th, but <95th percentile as overweight and those with BMI ≥95th age‐sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar‐sweetened beverages were positively associated with baseline BMI z‐scores. After adjusting for covariates, additional intake of fruit drinks and all sugar‐sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African‐American preschool children, high consumption of sugar‐sweetened beverages was significantly associated with an increased risk for obesity.     

Disability prevalence among healthy weight,overweight, and obese adults

Objective:

Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese.

Design and Methods:

Pooled data from the 2003‐2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5‐<25.0), overweight (BMI 25.0‐<30.0), and obese (BMI ≥ 30.0).

Results:

In this pooled sample, among the 25.4% of US adults who were obese, 41.7% reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%).

Conclusions:

This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs.     

Reverse causality and confounding and the associations of overweight and obesity with mortality

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 prospective 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 Scotland 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/m²) and mortality, and weak to modest associations between obesity (BMI ≥30 kg/m²) 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.     

Increase in the Prevalence of Obesity in Switzerland 1982–2007: Birth Cohort Analysis Puts Recent Slowdown into Perspective

Although the prevalence of obesity continues to increase in Switzerland, the latest figures suggest a slowdown in the rate of increase. In order to elucidate whether this could be the onset of a trend reversal, we analyzed cross‐sectional data by birth cohort. We assessed the prevalence of overweight+ (BMI ≥25 kg/m²) and obesity (BMI ≥30 kg/m²) in six population surveys with self‐reported height and weight values (Switzerland, N = 68,829, 1982–2007, men (45%) and women (55%), aged 20–84 years) by 10‐year birth cohorts (from the decade 1910–1919 through to 1970–1979). We found that increases in the prevalence of overweight+ and obesity occurred mainly in the cohort born 1930 to 1939, and again in the cohorts born 1960 to 1979. The accelerated increase in the prevalence of overweight+ in the youngest birth cohort and the lower prevalence in the oldest birth cohorts suggest that the current slowdown seen in Switzerland may not herald the onset of a trend reversal. As this example shows, simple comparisons of prevalence rates over time could provide a misleading picture of actual trends. Birth cohort analysis may offer a valuable alternative.     

Adolescents' perceived weight associated with depression in young adulthood: a longitudinal study

Objective: The objective of this study is to examine whether adolescents’ measured BMI and self‐ or mother's perception of weight status at age 14 are associated with depression at age 21. Research Methods and Procedures: The study participants were a subsample of 2017 participants of the Mater–University of Queensland Study of Pregnancy and Its Outcomes, a population‐based birth cohort study, which commenced in 1981 in Brisbane, Australia, for whom measured BMI at ages 14 and 21 and information on self‐reported mental health problems were available at the age 21 follow‐up. A total of 1802 individuals had measured BMI and reported weight perception in a supplementary questionnaire at 14 years, and their self‐reported mental health problems were reported at 21 years. Mental health was measured using Center for Epidemiology Studies Depression Scale and Young Adults Self‐Reported depression/anxiety at 21 years of age. Results: We found that both young adult males and females who perceived themselves as overweight at age 14 had more mental health problems compared with those who perceived themselves as the right weight. When we combined adolescents’ weight perception with their measured BMI categories, weight perception but not measured overweight was associated with mental health problems for males and females at age 21. This association remained after adjusting for potential confounders, including adolescents’ behavioral problems, family meals, diet, physical activity, and television watching. Conclusions: This study suggests that the perception of being overweight during adolescence is a significant risk factor for depression in young adult men and women. The perception of being overweight during adolescence should be considered a possible target for a prevention intervention.