Although doctors have long warned about the health risks of being overweight, having just a few extra pounds might offer some benefit.
Obesity is still as lethal as it ever was. The question involves those who have a slightly elevated Body Mass Index.
In an analysis of nearly 100 studies that included approximately 3 million adults, relative to normal weight, overall obesity and higher levels of obesity were both associated with a significantly higher all-cause risk of death, while overweight was associated with significantly lower all-cause mortality, according to a study in the January 2 issue of Journal of the American Medical Association.
“Estimates of the relative mortality risks associated with normal weight, overweight and obesity may help to inform decision making in the clinical setting,” according to background information in the article.
Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Centers for Disease Control and Prevention, and colleagues conducted a study to compile and summarize published analyses of BMIs and all-cause mortality that provide hazard ratios for standard BMI categories.
For the review and meta-analysis, the researchers identified 97 studies that met inclusion criteria, which provided a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.
All-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25).
The researchers found that the summary HRs indicated a 6 percent lower risk of death for overweight; a 18 percent higher risk of death for obesity (all grades); a 5 percent lower risk of death for grade 1 obesity; and a 29 percent increased risk of death for grades 2 and 3 obesity.
The authors note that the finding that grade 1 obesity was not associated with higher mortality suggests that that the excess mortality in obesity may predominantly be due to elevated mortality at higher BMI levels.
The researchers add that their findings are consistent with observations of lower mortality among overweight and moderately obese patients.
“Possible explanations have included earlier presentation of heavier patients, greater likelihood of receiving optimal medical treatment, cardioprotective metabolic effects of increased body fat, and benefits of higher metabolic reserves,” the authors concluded.
The use of predefined standard BMI groupings can facilitate between-study comparisons, the authors conclude.
In a companion editorial, Drs. Steven B. Heymsfield and William T. Cefalu, of the Pennington Biomedical Research Center, point out that the presence of a wasting disease, heart disease, diabetes, renal dialysis or older age are all associated with an inverse relationship between BMI and mortality rate, an observation termed the “obesity paradox” or “reverse epidemiology.”
“The optimal BMI linked with lowest mortality in patients with chronic disease may be within the overweight and obesity range,” they wrote. “Even in the absence of chronic disease, small excess amounts of adipose tissue may provide needed energy reserves during acute catabolic illnesses, have beneficial mechanical effects with some types of traumatic injuries, and convey other salutary effects that need to be investigated in light of the studies by Flegal et al and others.”
The editorial points out that not all patients classified as being overweight or having grade 1 obesity, particularly those with chronic diseases, can be assumed to require weight loss treatment. They assert that establishing BMI is only the first step toward a more comprehensive risk evaluation.
