American Journal of Clinical Nutrition, Vol 55, 516S-523S, Copyright © 1992 by The American Society for Clinical Nutrition, Inc

REVIEW ARTICLES

Mortality of severely obese subjects

LV Sjostrom
Medical Department, University of Goteborg, Sahlgrenska Hospital, Sweden.

All large prospective studies (n greater than 20,000) and several smaller studies have found that severe obesity [body mass index (BMI) greater than or equal to 35 kg/m2] is associated with approximately a twofold increase in total mortality and in a severalfold increase in mortality due to diabetes, cerebro-, and cardiovascular disease, and certain forms of cancer. Studies that have not been able to confirm this have been small and/or short term, have failed to control for smoking or early mortality, have controlled for intermediate risk factors in an inappropriate way, or have a reduced internal validity due to misclassification biases. As compared with BMI, abdominal obesity is a stronger predictor of mortality in most studies available. The incidence of sudden death unexplained by autopsy may be up to 40 times higher in severely obese subjects as compared with the general population. A small weight increase since the age of 18 is associated with a decreased risk whereas weight increases greater than 10 kg are associated with an increased mortality. The total mortality ratio for severe obesity decreases from 55 y of age and is not detectable above 80 y of age. Studies lacking adequate control groups indicate that a sustained weight loss may induce a reduced mortality but results from controlled intervention studies are so far not available.

This article has been cited by other articles:

				R. de Mutsert, M. B. Snijder, F. van der Sman-de Beer, J. C. Seidell, E. W. Boeschoten, R. T. Krediet, J. M. Dekker, J. P. Vandenbroucke, F. W. Dekker, and for the Netherlands Cooperative Study on the Adequ Association between Body Mass Index and Mortality Is Similar in the Hemodialysis Population and the General Population at High Age and Equal Duration of Follow-Up J. Am. Soc. Nephrol., March 1, 2007; 18(3): 967 - 974. [Abstract] [Full Text] [PDF]

				Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]

				Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]

				D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]

				D. E. Ray, S. C. Matchett, K. Baker, T. Wasser, and M. J. Young The Effect of Body Mass Index on Patient Outcomes in a Medical ICU Chest, June 1, 2005; 127(6): 2125 - 2131. [Abstract] [Full Text] [PDF]

				C. L. White, H. D. Braymer, D. A. York, and G. A. Bray Effect of a high or low ambient perinatal temperature on adult obesity in Osborne-Mendel and S5B/Pl rats Am J Physiol Regulatory Integrative Comp Physiol, May 1, 2005; 288(5): R1376 - R1384. [Abstract] [Full Text] [PDF]

				L. Sjostrom, A.-K. Lindroos, M. Peltonen, J. Torgerson, C. Bouchard, B. Carlsson, S. Dahlgren, B. Larsson, K. Narbro, C. D. Sjostrom, et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery N. Engl. J. Med., December 23, 2004; 351(26): 2683 - 2693. [Abstract] [Full Text] [PDF]

				T. Ezri, V. Hazin, D. Warters, P. Szmuk, and A. A. Weinbroum The Endotracheal Tube Moves More Often in Obese Patients Undergoing Laparoscopy Compared with Open Abdominal Surgery Anesth. Analg., January 1, 2003; 96(1): 278 - 282. [Abstract] [Full Text] [PDF]

				J. Stevens, Juhaeri, and J. Cai Changes in Body Mass Index Prior to Baseline among Participants Who Are Ill or Who Die during the Early Years of Follow-up Am. J. Epidemiol., May 15, 2001; 153(10): 946 - 953. [Abstract] [Full Text] [PDF]

				J. P. Adams and P. G. Murphy Obesity in anaesthesia and intensive care Br. J. Anaesth., July 1, 2000; 85(1): 91 - 108. [Full Text] [PDF]

				A. Rosengren, H. Wedel, and L. Wilhelmsen Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality: A prospective population study Eur. Heart J., February 2, 1999; 20(4): 269 - 277. [Abstract] [PDF]

				N. J. O. Birkmeyer, D. C. Charlesworth, F. Hernandez, B. J. Leavitt, C. A. S. Marrin, J. R. Morton, E. M. Olmstead, and G. T. O'Connor Obesity and Risk of Adverse Outcomes Associated With Coronary Artery Bypass Surgery Circulation, May 5, 1998; 97(17): 1689 - 1694. [Abstract] [Full Text] [PDF]