Eating Disorders and Obesity: A Comprehensive Handbook

By Christopher G. Fairburn; Kelly D. Brownell | Go to book overview

76
Epidemiology of Health Risks
Associated with Obesity

HEALTH RISKS AND EXCESS WEIGHT

JOANN E. MANSON

PATRICK J. SKERRETT

WALTER C. WILLETT

The relationship of body weight and total mortality, as well as the risk of developing several chronic diseases, have been examined in numerous epidemiological studies that provide insight into biological relationships and are used to develop ranges of desirable weights. Defining these ranges and applying them to individuals are controversial topics (see Chapters 75 and 91). In this chapter, we examine methodological issues, review known associations, and attempt to synthesize available data regarding desirable weights.


Measures of Body Weight in Epidemiological Studies

Measuring body fat, which is diffuse and inaccessible, is possible but difficult (see Chapter 11). While fairly precise estimates can be made using hydrodensitometry, dual-energy X-ray absorptiometry, and computed tomography (CT) or magnetic resonance imaging (MRI), these measures are time-consuming and expensive. Because many thousands of subjects are needed for epidemiological studies relating adiposity to health outcomes, simpler, more widely available measures that combine weight and height are generally employed. Most frequently used is the Quetelet index, more commonly known today as the body mass index (BMI = weight in kilograms divided by the square of height in meters). To make them more understandable, BMIs are often converted to weight-for-height tables, or nomograms. BMIs are generally reliable because measures of weight and height tend to be quite accurate, even when self-reported. While the BMI has been criticized because it does not distinguish fat mass from lean mass, this simple measure is highly correlated with fat mass in young and middle-age adults (r = approximately 0.9 for both men

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