Experts recommend a blend of diets, emphasizing portion control, calorie-counting, self-monitoring, and gradual increases in activity, starting with everyday activities. Encourage patients to choose foods they like to eat within the context of varied, healthy choices; adherence will improve and so will success. Successful weight loss results from a combination of motivation, physical activity, and caloric restriction.
Maintaining weight loss requires a lifelong commitment to balance caloric intake and energy expenditure. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Jennifer B. Clinical Diabetes Jan; 22 1 : 1 - 2. Previous Next.
Footnotes American Diabetes Association. JAMA : —, USA Today October 14, Obes Res 6 Suppl. Back to top. In this Issue January , 22 1.
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Share This Article: Copy. Changes that were due to the risk of exposure to elevated BMI and aging of the population were roughly equal in terms of their contribution to the percent changes in BMI-related deaths and disability-adjusted life-years globally from through In , the age-standardized rates of BMI-related deaths and disability-adjusted life-years were greatest in countries with high-middle SDI levels, with a rate of death of The rates of both measures were lowest in countries with high SDI levels, with a rate of death of The rate of BMI-related deaths increased between and at all SDI levels, with the highest observed rate of The age-standardized rates of death in countries with high or high-middle SDI decreased between and ; in the lowest quintiles of SDI, age-standardized BMI-related rates of death increased.
With increasing SDI levels, the contribution of risk-deleted mortality to the percent change in BMI-related deaths increased, whereas the contribution of population growth to the percent change in BMI-related deaths decreased Figure 4. The contribution of risk exposure to the percent change in BMI-related deaths was also generally inversely related to the SDI. Patterns in the breakdown of the sources of change in BMI-related disability-adjusted life-years were parallel to those observed for mortality.
In a disease-specific breakdown, risk-deleted mortality and disability-adjusted life-years showed a declining trend for most causes across all SDI levels Table S5 in the Supplementary Appendix. The largest decreases in the risk-deleted rates of death and disability-adjusted life-years were observed for cardiovascular disease, whereas cancers and musculoskeletal disorders showed the least decline. In , among the 20 most populous countries, the highest rates of BMI-related death and disability-adjusted life-years were observed in Russia, and the lowest rates were observed in the Democratic Republic of Congo Fig.
S3 in the Supplementary Appendix. Between and , the greatest percent changes in age-standardized BMI-related deaths and disability-adjusted life-years occurred in Bangladesh, with relative increases of During the same period, Turkey had the largest significant decrease in age-standardized BMI-related burden, with a decrease of In our systematic evaluation of the health effects of high BMI, we found that excess body weight accounted for about 4 million deaths and million disability-adjusted life-years worldwide in The prevalence of obesity has increased during the past three decades and at a faster pace than the related disease burden.
However, both the trend and magnitude of the BMI-related disease burden vary widely across countries. Among the leading health risks that were assessed in the Global Burden of Disease study, high BMI continues to have one of the highest rates of increase.
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Across levels of development, the prevalence of obesity has increased over recent decades, which indicates that the problem is not simply a function of income or wealth. During the past decade, researchers have proposed a range of interventions to reduce obesity. In recent years, some countries have started to implement some of these policies, 1 but no major population success has yet been shown. Many of the countries with the highest increases in the prevalence of obesity are those that have a low or middle SDI and simultaneously have high rates of other forms of malnutrition.
These countries generally have limited financial resources for nutrition programs and mostly rely on external donors whose programs often preferentially target undernutrition; consequently, food security frequently takes precedence over obesity in these countries. Our study showed a greater increase in the rate of exposure to high BMI than in the rate of the related disease burden. This difference was driven mainly by the decline in risk-deleted mortality, particularly for cardiovascular disease; factors such as improved treatment or changes in other risks have resulted in decreases in the rate of cardiovascular disease despite increases in BMI.
Existing evidence-based policies, even if fully implemented, are unlikely to rapidly reduce the prevalence of obesity. Clinical interventions, however, have proved to be effective in controlling high levels of systolic blood pressure, cholesterol, and fasting plasma glucose — the major risk factors for cardiovascular disease.
A recent pooled cohort analysis involving 1. Although some studies have suggested that overweight is associated with a lower risk of death from any cause than is a normal range of BMI 18 to 25 , 2,10 recent evidence from a meta-analysis 14 and pooled analysis 9 of prospective observational studies showed a continuous increase in the risk of death associated with a BMI of more than These studies are particularly notable since they addressed major sources of bias in previous studies i.
In addition, the pooled-cohort analysis controlled for the same set of covariates, provided cause-specific relative risks, and evaluated the relationship between BMI and mortality across different regions. The balance of evidence thus supports our minimum risk level of 20 to 25 for BMI. At the same time, to date, there remains insufficient evidence to support the argument that the most beneficial level of BMI should vary according to geographic location or ethnic group 9 because of differences in the relationship between BMI and body-fat distribution.
Although high BMI is a major risk factor contributing to years lived with disability globally, and the economic costs associated with treatment are substantial, 24 these nonfatal but debilitating health outcomes have received comparatively little policy attention.
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Weight loss is beneficial in the prevention and treatment of musculoskeletal pain. Our systematic evaluation of prospective observational studies showed sufficient evidence supporting a causal relationship between high BMI and cancers of the esophagus, colon and rectum, liver, gallbladder and biliary tract, pancreas, breast, uterus, ovary, kidney, and thyroid, along with leukemia.
We included leukemia on the basis of a systematic review and meta-analysis of 21 prospective cohort studies. However, since high BMI was the exposure of interest in our analysis, we included the protective effect of high BMI on breast cancer in premenopausal women. We did not evaluate the effect of high BMI on gastric cancer cardia and meningioma because of a lack of sufficient data to separately estimate the incidence and mortality of these cancers at the population level. Our study has several important strengths.
We have addressed the major limitations of previous studies by including more data sources and quantifying the prevalence of obesity among children. We also systematically evaluated the strength of evidence for the causal relationship between high BMI and health outcomes and included all BMI—outcome pairs for which sufficient evidence with respect to causal relationship was available. We used a beta distribution to characterize the distribution of BMI at the population level, a method that captures the proportion of the population with high BMI more accurately than other distributions.
We quantified the trends in high BMI and the associated disease burden across levels of development and estimated the contribution of demographic transition and epidemiologic transition to changes in BMI-related burden. The potential limitations of our study should also be considered. We used both self-reported and measured data with respect to height and weight and corrected the bias in self-reported data using measured data at each age, sex, and geographic region. To apply a consistent definition for childhood overweight and obesity across sources, we used the definition of the International Obesity Task Force and excluded studies that used the WHO definition.
We did not propagate the uncertainty in the age pattern and sex pattern that were used to split the aggregated data. We did not incorporate the uncertainty of the BMI regression coefficients in our analysis. Data were sparse for some locations, particularly in earlier years, and estimates in these locations were based on country-level covariates and regional data. We did not identify a consistent pattern in the relationship between nationally representative data and data representing only urban or rural areas and were not able to correct those data for potential bias.
We did not evaluate the trends in other measures of adiposity that may better relate to specific health outcomes, including waist circumference and waist-to-hip ratio. Since we obtained the effect size of BMI on health outcomes from prospective observational studies, the possibility of confounding by lifestyle habits cannot be excluded.
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Our estimation of relative risks did not capture possible differences owing to ethnic group and did not account for the possibility of geographic variation in relative-risk curves or the lowest-risk BMI. In addition, these studies generally excluded people with prevalent chronic diseases from the analysis of relative-risk estimation.
Thus, our estimates represent the effect of BMI among persons without underlying diseases. This issue might be particularly important for older age groups, in which the prevalence of chronic disease increases. Finally, other probable complications or forms of BMI-related burden e. In conclusion, our study provides a comprehensive assessment of the trends in high BMI and the associated disease burden. Our results show that both the prevalence and disease burden of high BMI are increasing globally.
These findings highlight the need for implementation of multicomponent interventions to reduce the prevalence and disease burden of high BMI. Disclosure forms provided by the authors are available with the full text of this article at NEJM. This is the New England Journal of Medicine version of record, which includes all Journal editing and enhancements. Address reprint requests to Dr.
The names, academic degrees, and affiliations of the authors, who are members of the Global Burden of Disease GBD Obesity Collaborators, are listed in the Appendix. The authors assume responsibility for the content and integrity of this article. Forouzanfar, Ph. Reitsma, B. Mokdad, Ph.
Salama, M. Abate, M. Ahmed, M. Amare, M. Amegah, Ph. Amrock, M. Anjana, M.