Adult Obesity and the Burden of Disability throughout Life

Objective: To analyze the prevalence of disability throughout life and life expectancy free of disability, associated with obesity at ages 30 to 49 years. Research Methods and Procedures: We used 46 and 20 years of mortality follow‐up, respectively, for 3521 Original and 3013 Offspring Framingham Heart Study participants 30 to 49 years and classified as normal weight, overweight, or obese at baseline. Disability measures were available between 36 and 46 years of follow‐up for 1352 Original participants and at 20 years of follow‐up for 2268 Offspring participants. We measured the odds of disability in the Original cohort after 46 years follow‐up, and we estimated life expectancy with and without disability from age 50. Two disability measures were used, one representing limitations with mobility only and the second representing limitations with activities of daily living (ADL). Results: Obesity at ages 30 to 49 years was associated with a 2.01‐fold increase in the odds of ADL limitations 46 years later. Nonsmoking adults who were obese between 30 and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and 5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of ADL limitations from age 50 than their normal‐weight counterparts. There was no significant difference in the total number of years lived with disability throughout life between those obese or normal weight, due to both higher disability prevalence and higher mortality in the obese population. Discussion: Obesity in adulthood is associated with an increased risk of disability throughout life and a reduction in the length of time spent free of disability, but no substantial change in the length of time spent with disability.     

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.     

Are Sexual Dissatisfaction and Sexual Abuse Associated with Obesity? A Population‐Based Study

Objective: To investigate whether there is any association between obesity and sexual satisfaction and sexual abuse in a normal population. Research Methods and Procedures: A representative sample of 2810 subjects from a population study was interviewed about sexual satisfaction, sexual abuse, and life satisfaction. The answers from normal weight, overweight, and obese participants were compared. Univariate and multivariate analyses were performed. Results: Data were presented separately for two age groups, 18 to 49 and 50 to 74 years, and gender. The older group of obese men reported a greater decrease of sexual desire compared with 5 years prior than normal weight men [odds ratios (OR), 2.44; 95% confidence interval (CI), 1.4 to 4.3]. The older group of overweight men reported involuntary participation in sexual activities more often than normal weight men (OR, 2.06; 95% CI, 1.1 to 3.8). Although older overweight and obese women were diagnosed with a lingering disease (defined as >1 month) more often than normal weight women (overweight: OR, 2.41; 95% CI, 1.3 to 4.4; obese: OR, 4.45; 95% CI, 1.7 to 11.5), there was no difference between BMI groups in satisfaction with physical health. Discussion: Overweight and obese groups seem to be heterogeneous with respect to sexual satisfaction and experiences of sexual abuse. No significant differences were detected between BMI groups, which does not exclude the possibility of significant differences between BMI groups among patients seeking medical attention.     

Eligibility for Obesity Treatment and Risk of Mortality in Men

Objective: To evaluate the risk of all‐cause and cardiovascular disease (CVD) mortality associated with each outcome of the NIH obesity treatment algorithm and to examine the effects of cardiorespiratory fitness on the risk of mortality associated with these outcomes. Research Methods and Procedures: The NIH obesity treatment algorithm was applied to 18, 666 men (20 to 64 years of age) from the Aerobics Center Longitudinal Study in Dallas, TX, examined between 1979 and 1995. Risk of all‐cause and CVD mortality was assessed using Cox proportional hazards regression. Results: A total of 7029 men (37.7%) met the criteria for needing weight loss treatment [overweight (BMI = 25 to 29.9 kg/m² or WC > 102 cm) with ≥2 CVD risk factors or obese (BMI ≥ 30 kg/m²)]. Mortality surveillance through 1996 identified 435 deaths (151 from CVD) during 191, 364 man‐years of follow‐up. Compared with the normal weight reference group, the hazard ratios (95% confidence interval) for death from all causes were 0.63 (0.45 to 0.88), 1.23 (0.98 to 1.54), 1.05 (0.60 to 1.85), and 1.71 (1.64 to 2.31) for men who were overweight with <2 CVD risk factors, overweight with ≥2 CVD risk factors, obese with <2 CVD risk factors, and obese with ≥2 CVD risk factors, respectively. Corresponding hazard ratios for CVD mortality were 0.72 (0.38 to 1.37), 1.67 (1.12 to 2.50), 1.69 (0.67 to 4.30), and 3.31 (2.07 to 5.30). Including physical fitness as a covariate significantly attenuated all risk estimates. Discussion: The NIH obesity treatment algorithm is useful in identifying men at increased risk of premature mortality; however, including an assessment of fitness would help improve risk stratification among all groups of patients.     

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.     

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.     

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.     

Familial Risk of Overweight and Obesity in the Canadian Population using the WHO/NIH Criteria

Objective: To determine the familial risk of overweight and obesity in Canada. Research Methods and Procedures: The sample was comprised of 15,245 participants from 6377 families of the Canada Fitness Survey. The risk of overweight and obesity among spouses and first‐degree relatives of individuals classified as underweight, normal weight, pre‐obese, or obese (Class I and II) according to the WHO/NIH guidelines for body mass index (BMI) was determined using standardized risk ratios. Results: Spouses and first‐degree relatives of underweight individuals have a lower risk of overweight and obesity than the general population. On the other hand, the risk of Class I and Class II obesity (BMI 35 to 39.9 kg/m²) in relatives of Class I obese (BMI 30 to 34.9 kg/m²) individuals was 1.84 (95% CI: 1.27, 2.37) and 1.97 (95% CI: 0.67, 3.25), respectively, in spouses, and 1.44 (95% CI:1.10, 1.78) and 2.05 (95% CI: 1.37, 2.73), respectively in first‐degree relatives. Further, the risk of Class II obesity in spouses and first‐degree relatives of Class II obese individuals was 2.59 (95% CI: ?0.91, 6.09) and 7.07 (95% CI: 1.48, 12.66) times the general population risk, respectively. Discussion: There is significant familial risk of overweight and obesity in the Canadian population using the BMI as an indicator. Comparison of risks among spouses and first‐degree relatives suggests that genetic factors may play a role in obesity at more extreme levels (Class II obese) more so than in moderate obesity.     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

Lifestyle factors and incident mobility limitation in obese and non-obese older adults

Objective: This study examines the association between incident mobility limitation and 4 lifestyle factors: smoking, alcohol intake, physical activity, and diet in well‐functioning obese (n = 667) and non‐obese (n = 2027) older adults. Research Methods and Procedures: Data were from men and women, 70 to 79 years of age from Pittsburgh, PA and Memphis, TN, participating in the Health, Aging and Body Composition (Health ABC) study. In addition to individual lifestyle practices, a high‐risk lifestyle score (0 to 4) was calculated indicating the total number of unhealthy lifestyle practices per person. Mobility limitation was defined as reported difficulty walking 1/4 mile or climbing 10 steps during two consecutive semiannual assessments over 6.5 years. Results: In non‐obese older persons, significant risk factors for incident mobility limitation after adjustment for socio‐demographics and health‐related variables were current and former smoking [hazard ratio (HR) = 1.51; 95% confidence interval (CI), 1.20 to 1.89; HR = 1.40; 95% CI, 1.12 to 1.74), former alcohol intake (HR = 1.30; 95% CI, 1.05 to 1.60), low and medium physical activity (HR = 1.78; 95% CI, 1.45 to 2.18; HR = 1.29, 95% CI, 1.07 to 1.54), and eating an unhealthy diet (HR = 1.57; 95% CI, 1.17 to 2.10). In the obese, only low physical activity was associated with a significantly increased risk of mobility limitation (HR = 1.44; 95% CI, 1.08 to 1.92). Having two or more unhealthy lifestyle factors was a strong predictor of mobility limitation in the non‐obese only (HR = 1.98; 95% CI, 1.61 to 2.43). Overall, obese persons had a significantly higher risk of mobility limitation compared with non‐obese persons, independent of lifestyle factors (HR = 1.73; 95% CI, 1.52 to 1.96). Conclusions: These results underscore the importance of a healthy lifestyle for maintaining function among non‐obese older adults. However, a healthy lifestyle cannot overcome the effect of obesity in obese older adults; this stresses the importance of preventing obesity to protect against mobility loss in older persons.     

Obesity and physical activity among Aboriginal Canadians

Objective: To investigate ethnic differences in obesity and physical activity among Aboriginal and non‐Aboriginal Canadians. Methods and Procedures: The sample included 24,279 Canadians (1,176 Aboriginals, 23,103 non‐Aboriginals) aged 2–64 years from the 2004 Canadian Community Health Survey (CCHS). Adult participants were classified as underweight/normal weight, overweight (BMI 25–29.9 kg/m²) or obese (BMI ≥ 30 kg/m²). Children and youth 2–17 years of age were classified as normal weight, overweight or obese based on the International Obesity Task Force criteria. Leisure‐time physical activity levels over the previous 3 months were obtained by questionnaire in those aged 12–64 years. Results: The prevalence of obesity in adults was 22.9% (men: 22.9%; women: 22.9%), and the prevalence was higher among Aboriginals (37.8%) compared to non‐Aboriginals (22.6%). The prevalence of obesity in children and youth was 8.2% (boys: 9.2%; girls: 7.2%), and the prevalence was higher among Aboriginals (15.8%) compared to non‐Aboriginals (8.0%). In both youth and adults, the odds for obesity were higher among Aboriginals (youth: OR = 2.3 (95% CI: 1.4–3.8); adults: OR = 2.4 (95% CI: 1.6–3.6)) after adjustment for a number of covariates. There were no ethnic differences in the prevalence of physical inactivity; however, physical inactivity was a predictor of obesity in both the Aboriginal and non‐Aboriginal samples. Discussion: The prevalence of obesity is higher among Canadian Aboriginals compared to the rest of the population. Further research is required to better delineate the determinants of obesity and the associated health consequences in this population.     

Prevalence and determinants of obesity in children in public schools of Sintra, Portugal

Objective: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. Methods and Procedures: Cross‐sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast‐feeding, number of daily meals and parents' height and weight data were also collected. Results: One thousand two hundred and twenty‐five children aged 6–10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76–4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59–16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04–0.63); for girls, OR = 0.19 (95% CI: 0.06–0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast‐feeding. Discussion: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.     

Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity

Objective: To evaluate whether or not “uncomplicated” obesity (without associated comorbidities) is really associated with cardiac abnormalities. Research Methods and Procedures: We evaluated cardiac parameters in obese subjects with long‐term obesity, normal glucose tolerance, normal blood pressure, and regular plasma lipids. We selected 75 obese patients [body mass index (BMI) >30 kg/m²], who included 58 women and 17 men (mean age, 33.7 ± 11.9 years; BMI, 37.8 ± 5.5 kg/m²) with a ≥10‐year history of excess fat, and 60 age‐matched normal‐weight controls, who included 47 women and 13 men (mean age, 32.7 ± 10.4 years; BMI, 23.1 ± 1.4 kg/m²). Each subject underwent an oral glucose tolerance test to exclude impaired glucose tolerance or diabetes mellitus, bioelectrical impedance analysis to calculate fat mass and fat‐free mass, and echocardiography. Results: Obese patients presented diastolic function impairment, hyperkinetic systole, and greater aortic root and left atrium compared with normal subjects. No statistically significant differences between obese subjects and normal subjects were found in indexed left ventricular mass (LVM/body surface area, LVM/height^2.7, and LVM/fat‐free mass_kg), and no changes in left ventricular geometry were observed. No statistically significant differences in cardiac parameters between extreme (BMI > 40 kg/m²) and mild obesity (BMI < 35 kg/m²) were observed. Discussion: In conclusion, our data showed that obesity, in the absence of glucose intolerance, hypertension, and dyslipidemia, seems to be associated only with an impairment of diastolic function and hyperkinetic systole, and not with left ventricular hypertrophy.     

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.     

Maternal Obesity and Infant Heart Defects

Objective: This study determined whether obese women have an increased risk of cardiovascular defects in their offspring compared with average weight women. Research Methods and Procedures: In a case‐control study, prospectively collected information was obtained from Swedish medical health registers. The study included 6801 women who had infants with a cardiovascular defect and, as controls, all delivered women (N = 812, 457) during the study period (1992 to 2001). Infants with chromosomal anomalies or whose mothers had pre‐existing diabetes were excluded. Obesity was defined as BMI >29 kg/m², and morbid obesity was defined as BMI >35 kg/m². Comparisons were made with average weight women (BMI = 19.8 to 26 kg/m²). Results: In the group of obese mothers, there was an increased risk for cardiovascular defects compared with the average weight mothers [adjusted odds ratio (OR) = 1.18; 95% CI, 1.09 to 1.27], which was slightly more pronounced for the severe types of cardiovascular defects (adjusted OR = 1.23; 95% CI, 1.05 to 1.44). With morbid obesity, the OR for cardiovascular defects was 1.40 (95% CI, 1.22 to 1.64), and for severe cardiovascular defects, the OR was 1.69 (95% CI, 1.27 to 2.26). There was an increased risk for all specific defects studied among the obese women, but only ventricular septal defects and atrial septal defects reached statistical significance. Discussion: In this sample, a positive association was found between maternal obesity in early pregnancy and congenital heart defects in the offspring. A suggested explanation is undetected type 2 diabetes in early pregnancy, but other explanations may exist.     

Body size phenotypes and inflammation in the Women's Health Initiative Observational Study

Individuals with "metabolically benign" obesity (obesity unaccompanied by hypertension, dyslipidemia, and diabetes) are not at elevated 10-year risk of cardiovascular disease (CVD) compared to normal weight individuals. It remains unclear whether these obese individuals or normal weight individuals with clustering of cardiometabolic factors display heightened immune activity. Therefore, we characterized levels of acute-phase reactants (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count), adhesion molecules (E-selectin, vascular cell adhesion molecule-1), and coagulation products (fibrinogen, plasminogen activator inhibitor-1 (PAI-1)) among four body size phenotypes (normal weight with 0/1 vs. ≥2 metabolic syndrome components/diabetes and overweight/obesity with 0/1 vs. ≥2 metabolic syndrome components/diabetes) in cross-sectional analyses of 1,889 postmenopausal women from the Women's Health Initiative Observational Study (WHI-OS) nested case-control stroke study. Higher levels of all three inflammatory marker categories were found among women with overweight/obesity or ≥2 metabolic syndrome components or diabetes. Compared to normal weight women with 0 or 1 metabolic syndrome components, normal weight women with ≥2 metabolic syndrome components or diabetes were more likely to have ≥3 inflammatory markers in the top quartile (multivariate odds ratio (OR) 2.0, 95% confidence interval (CI): 1.3-3.0), as were overweight/obese women with 0 or 1 metabolic syndrome components (OR 2.3; 95% CI: 1.5-3.5). Overweight/obese women with ≥2 metabolic syndrome components or diabetes had the highest OR (OR 4.2; 95% CI: 2.9-5.9). Despite findings that metabolically benign obese individuals are not at increased 10-year risk of CVD compared to normal weight individuals, the current results suggest that overweight/obese women without clustering of cardiometabolic risk factors still possess abnormal levels of inflammatory markers.     

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.     

Overweight,Obesity, and Binge Eating in a Non‐clinical Sample of Five Brazilian Cities

Objective: To investigate the relationship between obesity/overweight and binge eating episodes (BEEs) in a large nonclinical population. Research Methods and Procedures: Consumers at shopping centers in five Brazilian cities (N = 2858) who participated in an overweight prevention program were interviewed and had weight and height measured to calculate BMI. Results: Prevalence of overweight (BMI = 25 to 29.9 kg/m²) was 46.6% for men and 36.6% for women. Obesity (BMI ≥ 30 kg/m²) was about two‐thirds of the prevalence of overweight. BEEs (subjects who binged one or more times per week over the last 3 months) in normal‐weight individuals was 1.4% for men and 3.9% for women, whereas in overweight/obese, these prevalences were 6.5% and 5.5%, respectively (p < 0.01). After adjustment for age, socioeconomic variables, and childhood obesity, those who reported BEEs had an odds ratio of being overweight/obese of 3.31 (95% confidence interval: 1.11 to 9.85) for men and 1.73 (95% confidence interval: 1.05 to 2.84) for women. Discussion: These findings indicate a strong association between episodes of binge eating and overweight/obesity, mainly among men.     

BMI and Cervical Cancer Screening among White,African‐American,and Hispanic Women in the United States

Objectives: We examined cervical cancer screening by BMI in white, African‐American, and Hispanic women and explored women's reasons for not undergoing screening. Research Methods and Procedures: We used logistic regression to examine Pap testing in the preceding 3 years across BMI groups for white (n = 6419), African‐American (n = 1715), and Hispanic women (n = 1859) age 18 to 75 years who responded to the 2000 National Health Interview Survey. We used bivariable analyses to describe women's reasons for not undergoing testing and examined whether unscreened women received physician recommendations for screening. Results: Of 12, 170 women, 50% were normal weight, 26% were overweight, and 21% were obese. The proportion who reported Pap testing in the last 3 years was 86% in whites, 88% in African Americans, and 78% in Hispanics. After adjustment for sociodemographics, health care access, and illness burden, severely obese white women (BMI = 40+ kg/m²) were significantly less likely to undergo Pap testing (relative risk, 0.92; 95% CI, 0.83 to 0.99) compared with normal weight women. BMI was not associated with screening in African Americans or Hispanics. A higher proportion of obese white women than normal weight women cited putting off the test or embarrassment or discomfort as the primary reason for not undergoing screening. Among the unscreened, obese women were as likely as normal weight women to receive a physician recommendation to undergo screening. Discussion: Disparities in cervical cancer screening by body weight persist for white women with severe obesity. Disparities were not explained by differences in the rate of physician recommendations for screening, but obese white women may be more likely to delay screening or to find screening painful, uncomfortable, or embarrassing than normal weight white women. Efforts to increase screening among obese women should address women's reservations about screening.