Wednesday October 6 6:58 PM ET

Being overweight increases risk of death

By Merritt McKinney

NEW YORK, Oct 06 (Reuters Health) -- People who are overweight have a significantly greater risk of early death from all causes, including heart disease and cancer, according to a long-term study of more than one million people in the US.

The odds are most dismal in the heaviest people, who are at least two times more likely to die early than slimmer folks, researchers report.

``People don't really appreciate that being overweight is deleterious to their health,'' the study's lead author, Dr. Eugenia E. Calle, told Reuters Health in an interview. ``Your risk of dying early increases the heavier you are.''

``The message just hasn't gotten out there,'' she said.

In the 14-year study, men and women who were overweight, regardless of age, were more likely to die than thinner people, Calle and her colleagues at the American Cancer Society in Atlanta, Georgia, report in the October 7th issue of The New England Journal of Medicine.

However, the link between being overweight and the risk of dying was weaker in blacks, especially women, according to the report. The findings are not different than previous studies Calle said in the interview, but the study ``is a bit more comprehensive because it's so large.''

Calle's team based the findings on data from the Cancer Prevention Study II, a study of 1,184,657 adults in the United States. In a questionnaire, participants were asked to provide their current height and weight as well as their weight one year previously. From this information, the researchers calculated each person's body-mass index (BMI), a measure of obesity that takes into account both weight and height.

A BMI between 18.5 and 24.9 is considered normal, 25.0 to 29.9 is overweight, and 30 and above is obese. About one out of every five adults in the United States has a BMI of 30 or more.

Death rates were lowest in people whose BMIs fell into a certain range, 23.5 to 24.9 in men and 22.0 and 23.4 in women. However, a somewhat larger range, 22.0 to 26.4 for men and 20.5 and 24.9 in women, fell into the low-risk group, according to the report.

Compared to those at lowest risk, white men and women who had the highest BMIs were 2.58 and 2.0 times, respectively, more likely to die during the study, the findings show.

``The risk of death increased with an increasing body-mass index in all age groups and for all categories of causes of death,'' the authors write.

But the link between death risk and obesity was not as strong in black men, Calle and colleagues note. However, they point out that there may not have been enough extremely obese black men in the study to determine an accurate risk.

Overweight black women did not have a statistically significant increased risk of death, the authors report. Why this is true is uncertain, according to the researchers, although previous research has shown the same results, they note.

In an editorial that accompanies the study, Dr. David F. Williamson, of the Centers for Disease Control and Prevention in Atlanta, Georgia, notes that it is time to take additional steps besides encouraging individual patients to change their lifestyles.

``There is now an opportunity for clinical medicine and public health agencies to begin a dialogue about the prevention of obesity with hitherto unrecognized partners... (such as) food marketers and manufacturers, public and private purchasers of healthcare, large employers, transportation agencies, urban planners, and real estate developers'' he writes.

A number of societal changes, such as building more sidewalks and parks as well as encouraging employees to be physically active at work, may help Americans keep their weight under control, he notes.

SOURCE: The New England Journal of Medicine 1999;341:1097-1105, 1140-1141.

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