Understanding the risk of developing weight-related complications associated with different body mass index categories: a systematic review

Abstract

Background Obesity and overweight are major risk factors for several chronic diseases. There is limited systematic evaluation of risk equations that predict the likelihood of developing an obesity or overweight associated complication. Predicting future risk is essential for health economic modelling. Availability of future treatments rests upon a model’s ability to inform clinical and decision-making bodies. This systematic literature review aimed to identify studies reporting (1) equations that calculate the risk for individuals with obesity, or overweight with a weight-related complication (OWRC), of developing additional complications, namely T2D, cardiovascular (CV) disease (CVD), acute coronary syndrome, stroke, musculoskeletal disorders, knee replacement/arthroplasty, or obstructive sleep apnea; (2) absolute or proportional risk for individuals with severe obesity, obesity or OWRC developing T2D, a CV event or mortality from knee surgery, stroke, or an acute CV event. Methods Databases (MEDLINE and Embase) were searched for English language reports of population-based cohort analyses or large-scale studies in Australia, Canada, Europe, the UK, and the USA between January 1, 2011, and March 29, 2021. Included reports were quality assessed using an adapted version of the Newcastle Ottawa Scale. Results Of the 60 included studies, the majority used European cohorts. Twenty-nine reported a risk prediction equation for developing an additional complication. The most common risk prediction equations were logistic regression models that did not differentiate between body mass index (BMI) groups (particularly above 40 kg/m2) and lacked external validation. The remaining included studies (31 studies) reported the absolute or proportional risk of mortality (29 studies), or the risk of developing T2D in a population with obesity and with prediabetes or normal glucose tolerance (NGT) (three studies), or a CV event in populations with severe obesity with NGT or T2D (three studies). Most reported proportional risk, predominantly a hazard ratio. Conclusion More work is needed to develop and validate these risk equations, specifically in non-European cohorts and that distinguish between BMI class II and III obesity. New data or adjustment of the current risk equations by calibration would allow for more accurate decision making at an individual and population level.

Cost-effectiveness of weight-management pharmacotherapies in Canada: a societal perspective

“…As neither of the risk algorithms used were estimated in Canadian populations, it is uncertain whether the overall level of risk applied in the model, as well as the reduction in risk, is fully generalizable. Based on a recent systematic literature review [ 87 ], there are presently no risk equations specific to the Canadian population. Furthermore, to the best of our knowledge, there are no marked differences in risk factors leading to CVD or T2D between the Canadian and UK populations [ 88 ].…”

A bariátriai műtétek egészségpolitikai szerepe a 2-es típusú cukorbetegségben szenvedő elhízott betegek ellátásában

“…Az elhízás egészségügyi jelentősége jól ismert [1,2], gyakorisága pedig népegészségügyi problémává teszi: az elmúlt mintegy 40 évben az életkorra standardizált prevalenciája a Föld teljes népességében és Európában is a 3-szorosára növekedett [3]. Magyarország a legmagasabb prevalenciájú országok között foglalt helyet Európában: 2014-ben a 3., 2019-ben a 2. lett a túlsúly gyakoriságában [4].…”

The effect of intermittent fasting on microbiota as a therapeutic approach in obesity

“…The classification is further subdivided into three classes. Class I individuals have a BMI between 30.0–34.9 kg/m2; Class II, between 35.0–39.9 kg/m 2 ; and Class III, a BMI of more than or equal to 40 kg/m 2 ( 3 , 4 ). Class II/III obesity presents higher risks of all-cause mortality, severe health effects, and limits in daily living activities when compared to class I obesity.…”

“…Furthermore, obesity is a public health challenge for societies and healthcare systems across the world ( 7 ). It is one of the main risk factors for several chronic diseases, including gout, osteoarthritis, hypertension, coronary heart disease, stroke, certain cancers, type 2 diabetes, gallbladder disease, and pulmonary diseases ( 3 , 8 ). In 2016, the estimated prevalence of obesity was 13% (11% of men and 15% of women) ( 9 ).…”