Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK

Abstract

Background Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified. Methods This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes. Results 264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8 kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06 kg/m2 (± 3.8)). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98–3.57) for heart failure, HR of 2.72 (2.58–2.87) for all-cause mortality and HR of 3.31 (2.84–3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors. Conclusion The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.

Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study

“…Lastly, overweight and obesity were determined using BMI at baseline and we did not take account of changes in BMI over time. We know, however, from previous analyses of BMI trajectory in this study population, and in other obese populations, that BMI of obese individuals does not change significantly over time [ 21 – 23 ].…”

Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study

“…In past studies, BMI was examined [ 31 , 34 , 35 ] as a factor related to mortality [ 36 , 37 ] and malnutrition, and mortality was discussed based on BMI measured at a point in time. However, our study showed that by continuously measuring BMI and EI and examining the resulting trajectories and their relationship, instead of treating each parameter as a separate predictor, mortality risks could be identified with more accuracy.…”

High Rates of Multimorbidity Reported Among People of Color Despite Healthy Weight

“… 38 Recent studies from United Kingdom and the United States provide evidence for the reliability of self-reported BMI from self-reported height and weight measurements 39 and that for the vast majority of the population, BMI categories are fairly stable over time. 40 Analyses were limited to only five race/ethnicity categories and five chronic conditions. However, future studies should also look at these patterns for other racial groups and chronic conditions.…”