Increases in multimorbidity with weight class in the United States

Abstract

Little is known regarding how multimorbidity combinations associated with obesity change with increase in body weight. This study employed data from the national Cerner HealthFacts Data Warehouse to identify changes in multimorbidity patterns by weight class using network analysis. Networks were generated for 154 528 middle-aged patients in the following categories: normal weight, overweight, and classes 1, 2, and 3 obesity. The results show significant differences (P-value<0.05) in prevalence by weight class for all but three of 82 diseases considered. The percentage of patients with multimorbidity (excluding obesity) increases from in 55.1% in patients with normal weight, to 57.88% with overweight, 70.39% with Class 1 obesity, 73.99% with Class 2 obesity, and 71.68% in Class 3 obesity, increasing most substantially with the progression from overweight to class 1 obesity. Most prevalent disease clusters expand from only hypertension and dorsalgia in normal weight, to add joint disorders in overweight, lipidemias in class 1 obesity, diabetes in class 2 obesity, and sleep disorders and chronic kidney disease in class 3 obesity. Recognition of multimorbidity patterns associated with weight increase is essential for true precision care of obesity-associated chronic conditions and can help clinicians identify and address preclinical disease before additional complications arise.

Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study

“…10 In a register-based study of more than 150 000 patients with one or more diseases, the prevalence ratio for multimorbidity (two or more of 82 diseases) between participants with obesity and those with healthy weight was 1•3. 17 Our results support a life course model of disease accumulation, in which excess risk of simple multimorbidity emerges in young adulthood and is followed by complex multimorbidity, which becomes increasingly common from age 45 years. In the Finnish cohorts, there was a three times increased risk of a first obesity-related disease in people with obesity compared with people with healthy weight, which rose to more than 12 times increased risk for the fourth obesity-related disease.…”

“… 10 In a register-based study of more than 150 000 patients with one or more diseases, the prevalence ratio for multimorbidity (two or more of 82 diseases) between participants with obesity and those with healthy weight was 1·3. 17 …”

“…5,6,28 The greater than 12 times increased risk of complex multimorbidity and the five times increased risk of simple multimorbidity associated with obesity in the Finnish cohorts and among those with class 3 obesity in the UK Biobank cohort are similar to effect estimates for multimorbidity from obesity-related diseases in other studies. 10,[14][15][16][17] The IPD-Work multicohort study, which defined multimorbidity as at least two of myocardial infarction, stroke, and type 2 diabetes, found a four times increased risk of multimorbidity in participants with class 1 obesity and an almost 15 times increased risk in the those with class 2 and class 3 obesity compared with participants with healthy weight. 15 Other studies that have used multimorbidity definitions including diseases related and unrelated to obesity have observed lower effect estimates.…”

“…16 A large cohort study of patients aged 45-64 years in the USA found that the most prevalent disease clusters included hypertension and dorsalgia in people with healthy weight; together with joint disorders, dyslipidaemia, type 2 diabetes, sleep disorders, and chronic kidney disease in people who had overweight or obesity. 17 However, few studies have characterised a wide range of obesity-related conditions that result in complex multimorbidity (four or more comorbid diseases). 18 We aimed to examine the risk of common health conditions among people with obesity, determine associations in the emergence of obesity-related conditions, and characterise the role of obesity in the development of complex multimorbidity at older ages.…”

“… 16 A large cohort study of patients aged 45–64 years in the USA found that the most prevalent disease clusters included hypertension and dorsalgia in people with healthy weight; together with joint disorders, dyslipidaemia, type 2 diabetes, sleep disorders, and chronic kidney disease in people who had overweight or obesity. 17 However, few studies have characterised a wide range of obesity-related conditions that result in complex multimorbidity (four or more comorbid diseases). 18…”