This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (1033)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Obesity  • Hypertension  • Alert me on articles by topic

Aviva Must, PhD; Jennifer Spadano, MS; Eugenie H. Coakley, MA, MPH; Alison E. Field, ScD; Graham Colditz, MD, DrPH; William H. Dietz, MD, PhD

JAMA. 1999;282:1523-1529.

Context  Overweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions.

Objective  To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population.

Design and Setting  Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994.

Participants  A total of 16,884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] 25 kg/m²) based on National Institutes of Health recommended guidelines.

Main Outcome Measures  Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis.

Results  Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m² or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m² and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.

Conclusions  Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.

Author Affiliations: Department of Family Medicine and Community Health, Tufts University School of Medicine (Dr Must); US Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University (Dr Must and Ms Spadano); Departments of Nutrition (Ms Coakley) and Epidemiology (Ms Coakley and Dr Colditz), Harvard School of Public Health; Channing Laboratory (Drs Field and Colditz), Brigham and Women's Hospital and Harvard Medical School; and Department of Pediatric Gastroenterology and Nutrition, New England Medical Center (Dr Dietz), Boston, Mass; and Division of Nutrition and Physical Activity, Center for Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Dietz).

RELATED ARTICLE

October 27, 1999
JAMA. 1999;282(16):1593-1594.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Insulin-Induced Gene 2 Involvement in Human Adipocyte Metabolism and Body Weight Regulation
Krapivner et al.
J. Clin. Endocrinol. Metab. 2008;93:1995-2001.
ABSTRACT | FULL TEXT  

Common Variation in the FTO Gene Alters Diabetes-Related Metabolic Traits to the Extent Expected Given Its Effect on BMI
Freathy et al.
Diabetes 2008;57:1419-1426.
ABSTRACT | FULL TEXT  

Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Petry et al.
Psychosom. Med. 2008;70:288-297.
ABSTRACT | FULL TEXT  

Relations of Thyroid Function to Body Weight: Cross-sectional and Longitudinal Observations in a Community-Based Sample
Fox et al.
Arch Intern Med 2008;168:587-592.
ABSTRACT | FULL TEXT  

The Relationship of Older Adults' Activities and Body Mass Index
Kristi Rahrig Jenkins and Fultz
J Aging Health 2008;20:217-234.
ABSTRACT  

Which Measures of Obesity Are Related to Depressive Symptoms and in Whom?
Lim et al.
Psychosomatics 2008;49:23-28.
ABSTRACT | FULL TEXT  

Maternal obesity at conception programs obesity in the offspring
Shankar et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2008;294:R528-R538.
ABSTRACT | FULL TEXT  

Obesity and risk of job disability in male firefighters
Soteriades et al.
Occup Med (Lond) 2008;0:kqm153v1-kqm153.
ABSTRACT | FULL TEXT  

Immigration and Generational Trends in Body Mass Index and Obesity in the United States: Results of the National Latino and Asian American Survey, 2002 2003
Bates et al.
Am. J. Public Health 2008;98:70-77.
ABSTRACT | FULL TEXT  

Variants in the Fat Mass and Obesity-Associated (FTO) Gene Are Not Associated With Obesity in a Chinese Han Population
Li et al.
Diabetes 2008;57:264-268.
ABSTRACT | FULL TEXT  

Sonographic Assessment of Regional Adiposity
Vlachos et al.
Am. J. Roentgenol. 2007;189:1545-1553.
ABSTRACT | FULL TEXT  

Body Mass Index and Risk of Parkinson's Disease: A Prospective Cohort Study
Logroscino et al.
Am J Epidemiol 2007;166:1186-1190.
ABSTRACT | FULL TEXT  

The Changing Relationship of Obesity and Disability, 1988-2004
Alley and Chang
JAMA 2007;298:2020-2027.
ABSTRACT | FULL TEXT  

Differences In Disease Prevalence As A Source Of The U.S.-European Health Care Spending Gap
Thorpe et al.
Health Aff (Millwood) 2007;26:w678-w686.
ABSTRACT | FULL TEXT  

State of the Art Review: Long-term Pharmacotherapy for Overweight and Obesity: A Review of Sibutramine, Orlistat, and Rimonabant
Dunican et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:367-388.
ABSTRACT  

HDL-cholesterol and physical performance: results from the ageing and longevity study in the sirente geographic area (ilSIRENTE Study)
Landi et al.
Age Ageing 2007;36:514-520.
ABSTRACT | FULL TEXT  

Body Composition in Children and Adolescents Born after in Vitro Fertilization or Spontaneous Conception
Ceelen et al.
J. Clin. Endocrinol. Metab. 2007;92:3417-3423.
ABSTRACT | FULL TEXT  

School-Based Overweight Preventive Intervention Lowers Incidence of Disordered Weight-Control Behaviors in Early Adolescent Girls
Austin et al.
Arch Pediatr Adolesc Med 2007;161:865-869.
ABSTRACT | FULL TEXT  

Men's body mass index and infertility
Nguyen et al.
Hum Reprod 2007;22:2488-2493.
ABSTRACT | FULL TEXT  

Underdiagnosis of Hypertension in Children and Adolescents
Hansen et al.
JAMA 2007;298:874-879.
ABSTRACT | FULL TEXT  

One hundred pound weight losses with an intensive behavioral program: changes in risk factors in 118 patients with long-term follow-up
Anderson et al.
Am. J. Clin. Nutr. 2007;86:301-307.
ABSTRACT | FULL TEXT  

Weight-Related Increases in Hypertension, Hypercholesterolemia, and Diabetes Risk in Normal Weight Male and Female Runners
Williams et al.
Arterioscler. Thromb. Vasc. Bio. 2007;27:1811-1819.
ABSTRACT | FULL TEXT  

Meta-analysis: The Effect of Dietary Counseling for Weight Loss
Dansinger et al.
ANN INTERN MED 2007;147:41-50.
ABSTRACT | FULL TEXT  

Bariatric Surgery for Patients With Diabetes
Eckhauser et al.
Clin. Diabetes 2007;25:83-89.
ABSTRACT | FULL TEXT  

The Physiology of Body Weight Regulation: Are We Too Efficient for Our Own Good?
Dokken and Tsao
Diabetes Spectr. 2007;20:166-170.
ABSTRACT | FULL TEXT  

Prevalence And Trends In Obesity Among Aged And Disabled U.S. Medicare Beneficiaries, 1997-2002
Doshi et al.
Health Aff (Millwood) 2007;26:1111-1117.
ABSTRACT | FULL TEXT  

Chibby Promotes Adipocyte Differentiation through Inhibition of {beta}-Catenin Signaling
Li et al.
Mol. Cell. Biol. 2007;27:4347-4354.
ABSTRACT | FULL TEXT  

National trends in the use and costs of anti-obesity medications in England 1998-2005
Srishanmuganathan et al.
J Public Health (Oxf) 2007;29:199-202.
ABSTRACT | FULL TEXT  

Short-term Effects of School-Based Weight Gain Prevention Among Adolescents
Singh et al.
Arch Pediatr Adolesc Med 2007;161:565-571.
ABSTRACT | FULL TEXT  

Obesity, Inflammation, and Periodontal Disease
Pischon et al.
J. Dent. Res. 2007;86:400-409.
ABSTRACT | FULL TEXT  

Predicting Energy Expenditure in Extremely Obese Women
Dobratz et al.
JPEN J Parenter Enteral Nutr 2007;31:217-227.
ABSTRACT | FULL TEXT  

A Novel Inhibitory Protein in Adipose Tissue, the Aldo-Keto Reductase AKR1B7: Its Role in Adipogenesis
Tirard et al.
Endocrinology 2007;148:1996-2005.
ABSTRACT | FULL TEXT  

Motivational Interviewing Improves Weight Loss in Women With Type 2 Diabetes
West et al.
Diabetes Care 2007;30:1081-1087.
ABSTRACT | FULL TEXT  

African-American and Hispanic ethnicities, renal involvement and obesity predispose to hypertension in systemic lupus erythematosus: results from LUMINA, a multiethnic cohort (LUMINAXLV)
Chaiamnuay et al.
Ann Rheum Dis 2007;66:618-622.
ABSTRACT | FULL TEXT  

Obesity and Workers' Compensation: Results From the Duke Health and Safety Surveillance System
Ostbye et al.
Arch Intern Med 2007;167:766-773.
ABSTRACT | FULL TEXT  

The Effect of Obesity on Disability vs Mortality in Older Americans
Al Snih et al.
Arch Intern Med 2007;167:774-780.
ABSTRACT | FULL TEXT  

Diet, Exercise, and C-Reactive Protein Levels in People With Abdominal Obesity: The ATTICA Epidemiological Study
Pitsavos et al.
ANGIOLOGY 2007;58:225-233.
ABSTRACT  

Overweight, Obesity, and Incident Asthma: A Meta-analysis of Prospective Epidemiologic Studies
Beuther and Sutherland
Am. J. Respir. Crit. Care Med. 2007;175:661-666.
ABSTRACT | FULL TEXT  

Trends in Childhood Obesity Research: A Brief Analysis of NIH-Supported Efforts
Huang and Horlick
J Law Med Ethics 2007;35:148-153.
 

Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study
Gaskins et al.
J Am Board Fam Med 2007;20:124-134.
ABSTRACT | FULL TEXT  

Increases in Adiponectin Predict Improved Liver, but Not Peripheral, Insulin Sensitivity in Severely Obese Women During Weight Loss
Lin et al.
Diabetes 2007;56:735-742.
ABSTRACT | FULL TEXT  

Australian parents' views on their 5-6-year-old children's food choices
Campbell et al.
HEALTH PROMOT INT 2007;22:11-18.
ABSTRACT | FULL TEXT  

Internal Hernia After Gastric Bypass: Sensitivity and Specificity of Seven CT Signs with Surgical Correlation and Controls
Lockhart et al.
Am. J. Roentgenol. 2007;188:745-750.
ABSTRACT | FULL TEXT  

Androgen inactivation and steroid-converting enzyme expression in abdominal adipose tissue in men
Blouin et al.
J Endocrinol 2006;191:637-649.
ABSTRACT | FULL TEXT  

Estimating the Energy Gap Among US Children: A Counterfactual Approach
Wang et al.
Pediatrics 2006;118:e1721-e1733.
ABSTRACT | FULL TEXT  

African american culture and hypertension prevention.
Peters et al.
West J Nurs Res 2006;28:831-854.
ABSTRACT  

Health Problems and Medical Utilization Associated With Gambling Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Morasco et al.
Psychosom. Med. 2006;68:976-984.
ABSTRACT | FULL TEXT  

Linoleic and Oleic Acids Alter the Licking Responses to Sweet, Salt, Sour, and Bitter Tastants in Rats
Pittman et al.
Chem Senses 2006;31:835-843.
ABSTRACT | FULL TEXT  

Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status
Shah et al.
J. Clin. Endocrinol. Metab. 2006;91:4223-4231.
ABSTRACT | FULL TEXT  

Role of Transcription Factor NFAT in Glucose and Insulin Homeostasis
Yang et al.
Mol. Cell. Biol. 2006;26:7372-7387.
ABSTRACT | FULL TEXT  

Development and Implementation of a Food Store-Based Intervention to Improve Diet in the Republic of the Marshall Islands
Gittelsohn et al.
Health Promot Pract 2006;7:396-405.
ABSTRACT  

Low-Dose Orlistat Effects on Body Weight of Mildly to Moderately Overweight Individuals: A 16 Week, Double-Blind, Placebo-Controlled Trial
Anderson et al.
The Annals of Pharmacotherapy 2006;40:1717-1723.
ABSTRACT | FULL TEXT  

Gender and the Burden of Disease Attributable to Obesity
Muennig et al.
Am. J. Public Health 2006;96:1662-1668.
ABSTRACT | FULL TEXT  

The Relations of Body Composition and Adiposity Measures to Ill Health and Physical Disability in Elderly Men
Ramsay et al.
Am J Epidemiol 2006;164:459-469.
ABSTRACT | FULL TEXT  

Cannabinoid-1 Receptor Antagonist, Rimonabant, for Management of Obesity and Related Risks
Gadde and Allison
Circulation 2006;114:974-984.
FULL TEXT  

Intake of sugar-sweetened beverages and weight gain: a systematic review.
Malik et al.
Am. J. Clin. Nutr. 2006;84:274-288.
ABSTRACT | FULL TEXT  

Culturally Sensitive Treatment of Metabolic Syndrome in Asian Americans
Ozawa et al.
Home Health Care Management Practice 2006;18:394-402.
ABSTRACT  

Dietary Energy Density Is Associated with Overweight Status among 5 Ethnic Groups in the Multiethnic Cohort Study
Howarth et al.
J. Nutr. 2006;136:2243-2248.
ABSTRACT | FULL TEXT  

Preventing Cardiovascular Disease and Diabetes: A call to action from the American Diabetes Association and the American Heart Association
Eckel et al.
Diabetes Care 2006;29:1697-1699.
FULL TEXT  

Preventing Cardiovascular Disease and Diabetes: A Call to Action From the American Diabetes Association and the American Heart Association
Eckel et al.
Circulation 2006;113:2943-2946.
FULL TEXT  

Trends in the Incidence of Type 2 Diabetes Mellitus From the 1970s to the 1990s: The Framingham Heart Study
Fox et al.
Circulation 2006;113:2914-2918.
ABSTRACT | FULL TEXT  

Obesity Among US Urban Preschool Children: Relationships to Race, Ethnicity, and Socioeconomic Status
Whitaker and Orzol
Arch Pediatr Adolesc Med 2006;160:578-584.
ABSTRACT | FULL TEXT  

A quantitative trait locus (QTL) on chromosome 6q influences birth weight in two independent family studies
Arya et al.
Hum Mol Genet 2006;15:1569-1579.
ABSTRACT | FULL TEXT  

Increasing Body Mass Index and Obesity in the Incident ESRD Population
Kramer et al.
J. Am. Soc. Nephrol. 2006;17:1453-1459.
ABSTRACT | FULL TEXT  

Risk factors for cardiovascular disease and hormone therapy in women
Collins
Heart 2006;92:iii24-iii28.
FULL TEXT  

Prevalence and risk factors associated with obesity in the elderly in Barbados.
Carter et al.
J Aging Health 2006;18:240-258.
ABSTRACT  

Abdominal adiposity is a stronger predictor of insulin resistance than fitness among 50-95 year olds.
Racette et al.
Diabetes Care 2006;29:673-678.
ABSTRACT | FULL TEXT  

Long-term Changes in Blood Pressure in Extremely Obese Patients Who Have Undergone Bariatric Surgery.
Fernstrom et al.
Arch Surg 2006;141:276-283.
ABSTRACT | FULL TEXT  

Is Brain Natriuretic Peptide Production Decreased in Obese Subjects?
van Kimmenade et al.
J Am Coll Cardiol 2006;47:886-887.
FULL TEXT  

Body Weight and Mortality Among Men and Women in China
Gu et al.
JAMA 2006;295:776-783.
ABSTRACT | FULL TEXT  

Midlife Body Mass Index and Hospitalization and Mortality in Older Age
Yan et al.
JAMA 2006;295:190-198.
ABSTRACT | FULL TEXT  

Cardiac Myocyte Apoptosis Is Associated With Increased DNA Damage and Decreased Survival in Murine Models of Obesity
Barouch et al.
Circ. Res. 2006;98:119-124.
ABSTRACT | FULL TEXT  

A Semiparametric Analysis of the Relationship of Body Mass Index to Mortality
Gronniger
Am. J. Public Health 2006;96:173-178.
ABSTRACT | FULL TEXT  

Roux-en-Y Gastric Bypass Surgery for Morbid Obesity: Evaluation of Postoperative Extraluminal Leaks with Upper Gastrointestinal Series
Carucci et al.
Radiology 2006;238:119-127.
ABSTRACT | FULL TEXT  

License to Run: Exercise Impacts Functional Plasticity in the Intact and Injured Central Nervous System by Using Neurotrophins
Vaynman and Gomez-Pinilla
Neurorehabil Neural Repair 2005;19:283-295.
ABSTRACT  

Impact of Perinatal Weight Change on Long-Term Obesity and Obesity-Related Illnesses
Rooney et al.
Obstet Gynecol 2005;106:1349-1356.
ABSTRACT | FULL TEXT  

Maternal Outcomes in Pregnancies Complicated by Obesity
Robinson et al.
Obstet Gynecol 2005;106:1357-1364.
ABSTRACT | FULL TEXT  

Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus
Wilson et al.
Circulation 2005;112:3066-3072.
ABSTRACT | FULL TEXT  

Endothelial t-PA release is impaired in overweight and obese adults but can be improved with regular aerobic exercise
Van Guilder et al.
Am. J. Physiol. Endocrinol. Metab. 2005;289:E807-E813.
ABSTRACT | FULL TEXT  

Obesity and Psychiatric Disorders: Frequently Encountered Clinical Questions
McIntyre and Konarski
Focus 2005;3:511-519.
ABSTRACT | FULL TEXT  

Rapid Progression From Pre-diabetes to Severely Ill Diabetes While Under "Expert Care": Suggestions for Improved Screening for Disease Progression
Danish and West
Diabetes Spectr. 2005;18:229-239.
ABSTRACT | FULL TEXT  

A Comparison of Meal Replacements and Medication in Weight Maintenance after Weight Loss
LeCheminant et al.
J. Am. Coll. Nutr. 2005;24:347-353.
ABSTRACT | FULL TEXT  

Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey
Ellaway et al.
BMJ 2005;331:611-612.
FULL TEXT  

Associations Between Obesity and Receipt of Screening Mammography, Papanicolaou Tests, and Influenza Vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study
Ostbye et al.
Am. J. Public Health 2005;95:1623-1630.
ABSTRACT | FULL TEXT  

F-DIO obesity-prone rat is insulin resistant before obesity onset
Levin et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2005;289:R704-R711.
ABSTRACT | FULL TEXT  

Severe Obesity: A Growing Health Concern A.S.P.E.N. Should Not Ignore
Shikora
JPEN J Parenter Enteral Nutr 2005;29:288-297.
ABSTRACT | FULL TEXT  

Weight Management Using Lifestyle Modification in the Prevention and Management of Type 2 Diabetes: Rationale and Strategies
The American Diabetes Association et al.
Clin. Diabetes 2005;23:130-136.
FULL TEXT  

Obesity, Inactivity, and the Prevalence of Diabetes and Diabetes-Related Cardiovascular Comorbidities in the U.S., 2000-2002
Sullivan et al.
Diabetes Care 2005;28:1599-1603.
ABSTRACT | FULL TEXT  

Adipose Tissue Metabolism and CD11b Expression on Monocytes in Obese Hypertensives
Boschmann et al.
Hypertension 2005;46:130-136.
ABSTRACT | FULL TEXT  

Variations in Coronary Procedure Utilization Depending on Body Mass Index
Yancy et al.
Arch Intern Med 2005;165:1381-1387.
ABSTRACT | FULL TEXT  

Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Peralta et al.
Hypertension 2005;45:1119-1124.
ABSTRACT | FULL TEXT  

Ultrasonographic confirmation of carotid artery atheromas diagnosed via panoramic radiography
FRIEDLANDER et al.
Journal of the American Dental Association 2005;136:635-640.
ABSTRACT | FULL TEXT  

Outcome of Morbid Obesity in the Intensive Care Unit
Yaegashi et al.
J Intensive Care Med 2005;20:147-154.
ABSTRACT  

Body Fat Distribution and Long-Term Risk of Stroke Mortality
Tanne et al.
Stroke 2005;36:1021-1025.
ABSTRACT | FULL TEXT  

The Association of Obesity, Cytokine Levels, and Depressive Symptoms With Diverse Measures of Fatigue in Healthy Subjects
Lim et al.
Arch Intern Med 2005;165:910-915.
ABSTRACT | FULL TEXT  

Insulin-Mediated Upregulation of the Renin Angiotensin System in Human Subcutaneous Adipocytes Is Reduced by Rosiglitazone
Harte et al.
Circulation 2005;111:1954-1961.
ABSTRACT | FULL TEXT