Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study

Abstract

Background Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Methods US adults aged 18-75 years who had ≥3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index. Results We included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2). Conclusions The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised.

To Screen or Not to Screen? At Which BMI Cut Point? Comment on “Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study”

“…Furthermore, cardiological risk factors, including obesity, were additionally assessed. Like the study by Liu et al [ 1 ], we found a positive association between obesity and myocardial ischemia. However, we also found a correlation between obesity and depression/anxiety and myocardial ischemia [ 2 ].…”

“…In any event, I agree with the conclusions of Liu et al [ 1 ] that additional studies may be needed to establish which comorbidities need to be screened in patients with overweight for appropriate management.…”

“…In their article, Liu et al [ 1 ] investigated if there are BMI cut points for various obesity-associated comorbidities. For this purpose, they evaluated 243,332 patients aged 18 to 75 years, documented in the electronic health record, who had at least 3 in-person clinical visits over a 2-year period.…”

“…For this purpose, they evaluated 243,332 patients aged 18 to 75 years, documented in the electronic health record, who had at least 3 in-person clinical visits over a 2-year period. The authors reported a significant correlation and calculated cutoff points of BMI with 6 comorbidities, including coronary artery disease, hypertension, hyperlipidemia, obstructive sleep apnea, osteoarthritis, and type 2 diabetes mellitus [ 1 ]. Interestingly, no association was found with anxiety and depression.…”

Authors’ Reply to: To Screen or Not to Screen? At Which BMI Cut Point? Comment on “Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study”

“…We thank our colleague from Greece [ 1 ] for her interest in our article [ 2 ]. Similar to our study, Fotopoulos et al [ 3 ] found an association between obesity and coronary artery disease (CAD) in their analysis of patients undergoing cardiac stress tests.…”