First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults

Objective: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. Research Methods and Procedures: A nationwide cross‐sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal‐weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and ≥40 (kg/m²), respectively. Abdominal obesity was defined as WC ≥102 cm in men and ≥88 cm in women. Results: The age‐adjusted means for BMI and WC were 24.6 kg/m² in men and 26.5 kg/m² in women and 86.6 cm in men and 89.6 cm in women, respectively. The age‐adjusted prevalence of overweight or obesity (BMI ≥25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI ≥30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. Discussion: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.     

Increasing trends in waist circumference and abdominal obesity among US adults

Objective: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all‐cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States. Research Methods and Procedures: Data from the National Health and Nutrition Examination Survey during 1988–1994, 1999–2000, 2001–2002, and 2003–2004 were analyzed to estimate the trends in the mean WC and the prevalence of abdominal obesity. Pooled t tests were used to test the differences in estimates between two time periods. Results: Between the periods of 1988–1994 and 2003–2004, the age‐adjusted mean WC increased from 96.0 cm to 100.4 cm among men (p < 0.001) and from 89.0 cm to 94.0 cm among women (p < 0.001); the age‐adjusted prevalence of abdominal obesity increased from 29.5% to 42.4% among men (p < 0.001) and from 47.0% to 61.3% among women (p < 0.001). Between the periods of 1999–2000 and 2003–2004, a significant increase occurred in mean WC only among men (from 99.0 cm to 100.4 cm; p = 0.03) and in the prevalence of abdominal obesity among both men (from 37.0% to 42.2%; p = 0.03) and women (from 55.3% to 61.3%; p = 0.04). People with a BMI of 25 to 29 kg/m² had a greater relative increase in abdominal obesity. Discussion: The mean WC and the prevalence of abdominal obesity among U.S. adults have increased continuously during the past 15 years. Over one‐half of U.S. adults had abdominal obesity in the period of 2003–2004.     

Fitness Alters the Associations of BMI and Waist Circumference with Total and Abdominal Fat

Objective: We tested the following hypotheses in black and white men and women: 1) for a given BMI or waist circumference (WC), individuals with moderate cardiorespiratory fitness (CRF) have lower amounts of total fat mass and abdominal subcutaneous and visceral fat compared with individuals with low CRF; and 2) exercise training is associated with significant reductions in total adiposity and abdominal fat independent of changes in BMI or WC. Research Methods and Procedures: The sample included 366 sedentary male (111 blacks and 255 whites) and 462 sedentary female (203 blacks and 259 whites) participants in the HERITAGE Family Study. The relationships between BMI and WC with total fat mass (determined by underwater weighing) and abdominal subcutaneous and visceral fat (determined by computed tomography) were compared in subjects with low (lower 50%) and moderate (upper 50%) CRF. The effects of a 20‐week aerobic exercise training program on changes in these adiposity variables were examined in 86% of the subjects. Results: Individuals with moderate CRF had lower levels of total fat mass and abdominal subcutaneous and visceral fat than individuals with low CRF for a given BMI or WC value. The 20‐week aerobic exercise program was associated with significant reductions in total adiposity and abdominal fat, even after controlling for reductions in BMI and WC. With few exceptions, these observations were true for both men and women and blacks and whites. Discussion: These findings suggest that a reduction in total adiposity and abdominal fat may be a means by which CRF attenuates the health risk attributable to obesity as determined by BMI and WC.     

Migration Surrogates and Their Association With Obesity Among Within‐Country Migrants

Limited studies have evaluated the link between acculturation and health outcomes of within‐country migrants. The objective of this study was to evaluate whether well‐known acculturation surrogates were associated with obesity among Peruvian rural‐to‐urban migrants. We performed a cross‐sectional survey, the PERU MIGRANT study, using single‐stage random sampling. Evaluation included weight, height, and waist circumference (WC) as well as acculturation surrogates. Obesity was assessed using BMI and WC. Length of residence, age at migration, language proficiency, and language preferences (Spanish or Quechua) were assessed in logistic regression models to calculate odd ratios and 95% confidence intervals adjusting for potential confounders. A total of 589 rural‐to‐urban migrants were enrolled. The mean age was 47.8 (s.d.: 11.7, range: 30–92), and 280 (47.5%) were men. Obesity prevalence assessed using BMI was 30.4% among women and 10.7% among men (P < 0.001), whereas abdominal obesity assessed using WC was 29.1% among women and 19.1% among men (P < 0.01). Obesity was associated with older age at first migration, language speaking proficiency, and language preferences. The association between obesity and acculturation surrogates is variable in this population. Thus, acculturation per se can explore positive channels associated with better health outcomes. The patterns shown in this report suggest a more complex association for these factors.     

Relationship of BMI,Waist Circumference,and Weight Change with Use of Health Services by Older Adults

Objective: To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults. Research Methods and Procedures: This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non‐institutionalized Spanish population ≥60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease. Results: Obesity (BMI ≥ 30 kg/m²) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001–2003. Compared with women with WC ≤ 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06–1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03–1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non‐obese subjects of both sexes. In comparison with those who reported no important weight change, non‐obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02–2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06–2.45), be hospitalized (OR: 1.88; 95% CL: 1.29–2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19–4.47). Discussion: Obesity and weight loss are associated with greater health service use among the elderly.     

Total and Central Obesity among Elderly Hispanics and the Association with Type 2 Diabetes

Objective: To report the prevalence of total and central obesity in a representative sample of Puerto Rican and Dominican elders in Massachusetts, to compare them with a neighborhood‐based group of non‐Hispanic white elders, and to examine associations of obesity indices with the presence of type 2 diabetes. Research Methods and Procedures: We examined the prevalence of overweight, obesity, and central obesity in 596 Hispanics of Caribbean origin, ages 60 to 92 years, and 239 non‐Hispanic whites, and tested linear and logistic regression models to determine associations among body mass index (BMI), waist circumference (WC), and diabetes. Results: Obesity (BMI ≥ 30 kg/m²) was prevalent among all ethnic groups, ranging from 17% to 29% for Dominican and Puerto Rican men, respectively, and from 29% to 40% for non‐Hispanic white and Dominican women, respectively. These differences were not statistically significant. Among Hispanic men and women, diabetes was prevalent across all BMI and WC categories but tended to be greatest among those with BMI of 25 to 29 kg/m² (41% to 43%). In contrast, diabetes was most prevalent in the obese group (36% to 45%) of non‐Hispanic whites. Both BMI and WC were associated with the presence of diabetes, but the coefficients were greater for non‐Hispanic whites than for Hispanics. Discussion: Caribbean Hispanics and non‐Hispanic whites living in the same Massachusetts localities had high prevalences of overweight and obesity. Total and central obesity exerted a differential effect on the presence of diabetes among ethnic groups; for Hispanics, diabetes was prevalent even among non‐obese individuals, whereas for non‐Hispanic white women, the prevalence of diabetes was strongly associated with total and central obesity. Additional research is needed to investigate the factors associated with the differential effect of obesity on the prevalence of type 2 diabetes among Hispanic and non‐Hispanic white elders.     

Waist circumference and BMI cut-off based on 10-year cardiovascular risk: evidence for "central pre-obesity"

Objective: The objective was to assess the waist circumference (WC) cut‐off point that best identifies a level of 10‐year cardiovascular disease (CVD) risk with optimal balance of sensitivity and specificity in Chinese subjects according to their predicted 10‐year CVD risk. Research Methods and Procedures: A community‐based cross‐sectional observational study involving 14,919 Hong Kong Chinese subjects. The 10‐year CVD risk based on various prediction models was calculated. The projected WC cut‐off points were then determined. Results: There were 4837 (32.4%) men and 10,082 (67.6%) women (mean age ± standard deviation, 47.3 ± 13.5 years; age range, 18 to 93 years; median age, 45.0 years). The mean optimal WC or BMI predicting a 15% to 30% 10‐year CVD risk were 83 to 88 cm and 25 kg/m² for men, and 76 cm and 23 kg/m² for women, respectively. With WC ≥90 cm in men and ≥80 cm in women, the likelihood ratio at various WC cut‐off points to develop a ≥20% 10‐year CVD risk is 1.5 to 2.0 in men and 3.0 in women. The likelihood ratio was 1.5 in men with WC at 84 cm and in women at 70 cm. Discussion: Our results agree with the present guidelines on the definition of general and central obesity in Asia‐Pacific regions. We propose the creation of an intermediate state of high WC, the “central pre‐obesity” for Chinese men with WC ≥84 to 90 cm (≥33 to 36 inches) and women with WC ≥74 to 80 cm (≥29 to 32 inches). People with central pre‐obesity, similar to those with overweight (BMI ≥23 to 25 kg/m²), already have an increased risk of co‐morbidities.     

Development of Health‐Related Waist Circumference Thresholds Within BMI Categories

Objective: To develop and cross‐validate waist circumference (WC) thresholds within BMI categories. The utility of the derived values was compared with the single WC thresholds (women, 88 cm; men, 102 cm) recommended by NIH and Health Canada. Research Methods and Procedures: The sample included adults classified as normal weight (BMI = 18.5 to 24.9), overweight (BMI = 25 to 29.9), obese I (BMI = 30 to 34.9), and obese II+ (BMI ≥ 35) from the Third U.S. National Health and Nutrition Examination Survey (NHANES III; n = 11, 968) and the Canadian Heart Health Surveys (CHHS; n = 6286). Receiver operating characteristic curves were used to determine the optimal WC thresholds that predicted high risk of coronary events (top quintile of Framingham scores) within BMI categories using the NHANES III. The BMI‐specific WC thresholds were cross‐validated using the CHHS. Results: The optimal WC thresholds increased across BMI categories from 87 to 124 cm in men and from 79 to 115 cm in women. The validation study indicated improved sensitivity and specificity with the BMI‐specific WC thresholds compared with the single thresholds. Discussion: Compared with the recommended WC thresholds, the BMI‐specific values improved the identification of health risk. In normal weight, overweight, obese I, and obese II+ patients, WC cut‐offs of 90, 100, 110, and 125 cm in men and 80, 90, 105, and 115 cm in women, respectively, can be used to identify those at increased risk.     

Discrimination of Health Risk by Combined Body Mass Index and Waist Circumference

Objective: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. Research Methods and Procedures: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high‐density lipoprotein‐cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m²) and obese I (30 to 34.9 kg/m²) BMI categories. Results: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. Discussion: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.     

Genetic and Environmental Influences on Body‐Fat Measures among African‐American Twins

Objective: To investigate the genetic and environmental influences on body‐fat measures including waist circumference (WC), waist‐to‐hip ratio (WHR), and body mass index (BMI) among African‐American men and women. Research Methods and Procedures: Measurements were taken as part of the Carolina African American Twin Study of Aging. This sample currently comprises 146 same‐sex African‐American twins with an average age of 50 years (range, 22 to 88 years). This analysis included 26 monozygotic and 29 dizygotic men and 45 monozygotic and 46 dizygotic women. Maximum likelihood quantitative genetic analysis was used. Results: In men, additive genetic effects accounted for 77% of the variance in WC, 59% in WHR, and 89% in BMI. In women, additive genetic effects accounted for 76% of the variance in WC, 56% in WHR, and 73% in BMI. The remaining variance in both men and women was attributed to unique environmental effects (WC, 21%; WHR, 36%; BMI, 11% in men and WC, 22%; WHR, 38%; BMI, 27% in women) and age (WC, 2%; WHR, 5% in men and WC, 2%; WHR, 6% in women). When BMI was controlled in the analysis of WC and WHR, it accounted for a portion of the genetic and environmental variance in WHR and over one‐half of the genetic and environmental variance in WC. Discussion: There are both genetic and environmental influences on WC, WHR, and BMI, and independent of BMI, there are genetic and environmental effects on WC and WHR among both genders. The results from this African‐American twin sample are similar to findings among white twin samples.     

BMI vs. waist circumference for identifying vascular risk

Objective: Current guidelines recommend measurement of both BMI and waist circumference (WC) in individuals with BMI between 25.0 and 34.9 kg/m². We investigated the relative contributions of BMI and WC toward identifying risk of adverse vascular events in a community‐based sample. Methods and Procedures: We evaluated Framingham Study participants (n = 4,195 person‐examinations, 53% women) using pooled logistic regression to assess the incremental prognostic utility of WC in predicting risk of a first cardiovascular disease (CVD) event in the three BMI categories (normal, <25 kg/m²; overweight, 25 to <30 kg/m²; obese, ≥ 30 kg/m²) and to assess the incremental prognostic utility of BMI and WC separately for predicting risk of a first cardiovascular event. Results: On follow‐up (16 years), 430 participants (158 women) had experienced a first CVD event. In overweight women, but not in overweight men, larger WC was found to be an independent predictor of CVD incidence, longitudinally (in women, multivariable‐adjusted odds ratio (OR) per s.d. increment in WC 1.86, 95% confidence interval (CI) = 1.03–3.36, P = 0.04; in men adjusted OR per s.d. increment in WC 0.91, 95% CI 0.60–1.38, P = 0.66). In obese individuals and in those with normal BMI, WC was not associated independently with incident CVD. When BMI and WC were analyzed separately for predicting risk of a first cardiovascular event, the c statistics associated with the multivariable CVD models incorporating BMI vs. WC were nearly identical in men and women. Discussion: Knowledge of WC aids identification of vascular risk among overweight women. Among normal weight or obese women and men (regardless of BMI category) WC did not appear to substantially add to prediction of risk of vascular events.     

Alcohol intake, insulin resistance, and abdominal obesity in elderly men

Objective: Moderate and high alcohol intake have been associated with decreased and increased risk of type 2 diabetes, respectively. Insulin resistance, insulin secretion, and abdominal obesity are major predictors of diabetes, but the links with alcohol intake remain contradictory because of limited data. Research Methods and Procedures: In a population‐based cohort of 807 men (age, 70 years), we studied whether alcohol intake was related to insulin sensitivity, measured with the gold standard technique (euglycemic clamp), insulin secretion (early insulin response), or adiposity [BMI, waist circumference (WC), waist‐to‐hip ratio]. Alcohol intake was self‐reported (questionnaire) and was assessed from a validated 7‐day dietary record. The cross‐sectional associations were evaluated using multivariable linear regression, adjusting for smoking, education level, physical activity, dietary total energy intake, hypertension, diabetes, triglycerides, and cholesterol. Results: In multivariable models, self‐estimated alcohol intake was not related to insulin sensitivity, early insulin response, or BMI, but was positively related to WC (β‐coefficient, 0.77; 95% confidence interval, 0.15 to 1.39; p = 0.02) and waist‐to‐hip ratio (0.006 [0.002–0.009], p = 0.003). The association with WC and waist‐to‐hip ratio was most pronounced in men in the lowest tertile of BMI. The results using dietary records were similar. Discussion: Evaluated in a large sample in elderly men, neither insulin sensitivity measured by clamp technique nor insulin secretion was significantly associated with alcohol intake. However, high alcohol intake was associated with abdominal obesity, which might explain the higher diabetes risk previously observed in high alcohol consumers.     

Waist circumference as a predictor of disability among older adults

Objective: Few studies have addressed the association between abdominal obesity, as measured by waist circumference (WC), and disability in the elderly. Moreover, those studies were cross‐sectional and yielded inconsistent results. The objective of this study was to examine longitudinally the association between WC and self‐reported disability among older adults. Research Methods and Procedures: A prospective cohort study was conducted from 2001 to 2003 in 3235 persons (1411 men and 1824 women) representative of the non‐institutionalized Spanish population ages 60 years and older. Baseline information was collected by home‐based personal interviews and measurement of WC, weight, and height. Two years later, information on disability was obtained by telephone interview. The association of interest was summarized with odds ratios obtained by logistic regression. Results: Among persons reporting no disability at baseline, WC predicted disability 2 years later. After adjustment for age, education, tobacco use, alcohol consumption, and physical activity, men in the highest WC quintile had 2.17 (95% confidence interval, 1.15 to 4.09) times more risk of mobility disability and 4.77 (95% confidence interval, 2.50 to 9.13) times more risk of agility disability than those in the lowest quintile. Additional adjustment for BMI, chronic diseases, and cognitive function led to only a slight reduction in this association. Results were similar for women. No statistically significant association was observed between WC and restriction of daily activities, limitation in instrumental activities of daily living, and limitation in bathing or dressing, in either men or women. Discussion: WC predicts mobility and agility disability in old age. Avoidance of the highest values of WC might decrease the risk of disability in older adults.     

Obesity in the Elderly and Its Relationship with Cardiovascular Risk Factors in Taiwan**

Objectives: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly. Research Methods and Procedures: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non‐institutionalized subjects (age, 72.8 ± 9.4 years; BMI, 23.6 ± 6.4 kg/m²) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist‐to‐hip ratio (WHR). Results: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI ≥ 25 kg/m²) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI ≥ 27 kg/m²). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut‐off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2–88.0 cm in men and 82.0–84.0 cm in women, respectively. Discussion: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.     

Comparison of Overall Obesity and Body Fat Distribution in Predicting Risk of Mortality

Results of studies comparing overall obesity and abdominal adiposity or body fat distribution with risk of mortality have varied considerably. We compared the relative importance and joint association of overall obesity and body fat distribution in predicting risk of mortality. Participants included 5,799 men and 6,429 women aged 30–102 years enrolled in the third National Health and Nutrition Examination Survey who completed a baseline health examination during 1988–1994. During a 12‐year follow‐up (102,172 person‐years), 1,188 men and 925 women died. In multivariable‐adjusted analyses, waist‐to‐thigh ratio (WTR) in both sexes (P_trend <0.01 for both) and waist‐to‐hip ratio (WHR) in women (P_trend 0.001) were positively associated with mortality in middle‐aged adults (30–64 years), while BMI and waist circumference (WC) exhibited U‐ or J‐shaped associations. Risk of mortality increased with a higher WHR and WTR among normal weight (BMI 18.5–24.9 kg/m²) and obese (BMI ≥30.0 kg/m²) adults. In older adults (65–102 years), a higher BMI in both sexes (P_trend <0.05) and WC in men (P_trend 0.001) were associated with increased survival, while remaining measures of body fat distribution exhibited either no association or an inverse relation with mortality. In conclusion, ratio measures of body fat distribution are strongly and positively associated with mortality and offer additional prognostic information beyond BMI and WC in middle‐aged adults. A higher BMI in both sexes and WC in men were associated with increased survival in older adults, while a higher WHR or WTR either decreased or did not influence risk of death.     

Impact of Obesity and Body Fat Distribution on Cardiovascular Risk Factors in Hong Kong Chinese

Objective: Body fat distribution has been reported to differentially contribute to the development of cardiovascular risk. We report the relative associations between general and central obesity and risk factors in 2893 Chinese subjects recruited from the Hong Kong population. Research Methods and Procedures: Anthropometric parameters [waist circumference (WC) and BMI], surrogate measures of insulin resistance (fasting plasma glucose and insulin, oral glucose tolerance test, 2 hours glucose and insulin), fasting lipids (total, low‐density lipoprotein‐cholesterol, high‐density lipoprotein‐cholesterol, and triglycerides) and systolic and diastolic blood pressure were measured. General obesity was classified as BMI ≥25.0 kg/m² and central obesity as a WC ≥80 or ≥90 cm in women and men, respectively. Results: A total of 39.2% of the population was found to be obese. Obesity per se increased the levels of the risk factors, but central adiposity contributed to a greater extent to adverse high‐density lipoprotein‐cholesterol, triglyceride, and insulin resistance levels. There was a continuous relationship between increasing obesity, both general and central, and cardiovascular risk, with lowest risk associated with the lowest indices of obesity. In the 1759 nonobese subjects divided into quartiles of BMI or WC, the levels of the cardiovascular risk factors still significantly increased with increasing quartiles of adiposity. Discussion: Central adiposity appears to contribute to a greater extent than general adiposity to the development of cardiovascular risk in this population. The relationship between obesity parameters and risk is a continuum, with risk factors significantly increasing even at levels usually considered nonobese. These observations support the proposed redefinition of overweight and obesity in Asian populations using lower cut‐off points.     

Prevalence of Pre‐obesity and Obesity in Urban Adult Mexicans in Comparison with Other Large Surveys

Objective: 1. To estimate the prevalence of pre‐obesity and obesity in a 1992 to 1993 national survey of the Mexican urban adult population. 2. To compare our findings with other national surveys and with data for Mexican Americans. Research Methods and Procedures: The national representative sample of the Mexican urban adult population included 8462 women and 5929 men aged 20 to 69 years from 417 towns of >2500 people. Body mass index (BMI), calculated from measured weight and height, was classified using the World Health Organization categories of underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5 to 24.9 kg/m²), pre‐obesity (PreOB = BMI 25 to 29.9 kg/m²) and obesity (OB = BMI 30+ kg/m²). Estimates for Mexican Americans were calculated from U.S. survey data. Results: Overall, 38% of the Mexican urban adult population were classified as pre‐obese and 21% as obese. Men had a higher prevalence of pre‐obesity than women did at all ages, but women had higher values of obesity. Both pre‐obesity and obesity increased with age up to the age range brackets of 40 to 49 or 50 to 59 years for both men and women. Both pre‐obesity and obesity prevalence estimates were remarkably similar to data for Mexican Americans from 1982 through 1984. Comparison with other large surveys showed that countries differed more in the prevalence of obesity than of pre‐obesity, leading to differences in the PreOB/OB ratio, and that countries also differed in the gender ratio (female/male) for both pre‐obesity and obesity. Discussion: Pre‐obesity and obesity were high in our population and increased with age. Our approach of characterizing large surveys by PreOB/OB and gender ratios appeared promising.     

Clinical Utility of Waist Circumference in Predicting All‐cause Mortality in a Preventive Cardiology Clinic Population: A PreCIS Database Study

Although obesity is a risk factor for mortality, it is unclear whether waist circumference (WC) is a better predictor of mortality than BMI in a clinical setting of patients at high risk for coronary artery disease (CAD). Thus, we compared the association between WC and BMI with all‐cause mortality in relation to traditional CAD risk factors in a high‐risk cohort. Study population included 5,453 consecutive new patients seen between 1996 and 2005 for management of CAD risk factors in a preventive cardiology clinic. Mortality was determined from the Social Security Death Index. There were 359 deaths over a median follow‐up of 5.2 years. Mortality was greater in high (>102 cm in men and >88 cm in women) vs. normal WC in both genders (P < 0.01). The unadjusted Cox proportional hazard ratio (HR) for continuous WC (per cm) was 1.02 (P < 0.001) in both genders and remained significant after adjustment for CAD risk factors (HR = 1.01 in men, HR = 1.03 in women, both P < 0.05). BMI did not associate statistically with mortality. WC associated with diabetes mellitus (DM) and CAD prevalence (P < 0.001). BMI associated only with DM (P < 0.001) and this association disappeared when WC was added to the model. We conclude that WC is an independent predictor of all‐cause mortality in a preventive cardiology population. These data affirm the clinical importance of WC measurements for mortality, DM, and CAD risk prediction and suggest that obesity‐specific interventions targeting WC in addition to traditional risk factor management may favorably impact these outcomes.     

Trends in obesity and its distribution: data from the Northern Sweden MONICA Survey, 1986-2004

Objective: Obesity, especially abdominal, is a risk factor for many diseases. This study explored trends in the prevalence of general and abdominal obesity, 1986–2004, in northern Sweden. Methods and Procedures: Cross‐sectional population surveys were performed in 1986, 1990, 1994, 1999, and 2004; 250 men and 250 women aged 25–34, 35–44, 45–54, and 55–64 years (from 1994, also 65–74 years) were randomly selected; the overall participation rate was 77%. Anthropometric data were used. Results: Weight and BMI increased in all men, most significantly in men aged 25–64 years (P < 0.0005). Weight increased in women aged 25–64 years (P < 0.005) and BMI in women aged 25–44 years (P < 0.005). Prevalence of obesity (BMI ≥ 30) increased significantly in men aged 25–44 and 55–74 years (P < 0.005; for men 65–74 years old, P < 0.05) and in women aged 25–44 years (P < 0.005). Waist circumference decreased significantly between 1986 and 1990 in all women (P < 0.005) and in men aged 55–64 years (P < 0.05). After 1990 waist circumference increased, most markedly so in women; by 2004 circumference measurements for women, and for men aged 55–64 years, were equal to those of 1986, while for men aged 25–54 years they were higher. Prevalence of abdominal obesity has increased since 1990, most markedly so in women aged 45–64 years (P < 0.0005). Discussion: The rapid increase in both general and central obesity raises concern for the future; increasing abdominal obesity in women is particularly alarming.     

Obesity in South Africa: The South African Demographic and Health Survey

Objectives: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. Research Methods and Procedures: A sample of 13,089 men and women (age, ≥15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. Results: Mean BMI values for men and women were 22.9 kg/m² and 27.1 kg/m², respectively. For men, 29.2% were overweight or obese (≥25 kg/m²) and 9.2% had abdominal obesity (WHR ≥1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m²) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. Discussion: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.