J L Gutiérrez-Fisac

A simple estimate of mortality attributable to excess weight in the European Union

Objective: To estimate the current burden of mortality attributable to excess weight in the European Union (EU).Methods: Prevalence of overweight (body mass index, BMI 25–29.9u2005kg/m2) and obesity (BMI ≥30u2005kg/m2) were based on self-reported data from a survey with samples representative of the 15 EU Member States in 1997. Primary source of relative risk (RR) of death by BMI was the first American Cancer Prevention Study (CPS I). Additional calculations were performed to account for effect of smoking (using CPS I data for non- or never-smokers), for pre-existing illness (using the second CPS, CPS II, data for healthy never-smokers) and using RRs derived from European rather than US data (using data from a meta-analysis of prospective studies). Mortality attributable to excess weight was calculated by combining the prevalences of overweight and obesity, the RRs, and the number of deaths in the EU countries.Results: Annual deaths attributable to overweight and obesity totalled approximately 279u2005000 when RRs for all subjects were used. When RRs for nonsmokers only were applied to the entire population, about 304u2005000 deaths were attributable to excess weight. In analyses using RRs which controlled for both smoking and history of disease, the number of deaths attributable to excess weight was estimated at about 337u2005000 based on European data and at about 401u2005000 based on US data. In the EU, therefore, a minimum of 279u2005000 deaths were attributable to excess weight (7.7% of all deaths, varying from 5.8% for France through 8.7% for the UK). More attributable deaths occurred among the obese (175u2005000) than among the overweight (104u2005000). Around 70% were cardiovascular disease deaths (195u2005000) and 20% cancer deaths (53u2005000).Conclusion: Mortality attributable to excess weight is a major public health problem in the EU. At least one in 13 annual deaths in the EU are likely to be related to excess weight.Sponsorship: This study has been partially funded by Madrid Regional Authority (Comunidad de Madrid) grant no. 08.4/0011/2000.

Increasing prevalence of overweight and obesity among Spanish adults, 1987–1997

OBJECTIVE: To study the trend in the prevalence of obesity and overweight in Spanish men and women 25–64u2005y of age between 1987 and 1997.DESIGN: Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997.SUBJECTS: 14,676 and 7004 adults aged 25–64 who were representative of the Spanish population in 1987 and 1995/1997.MEASURES: Body mass index (BMI) calculated from self-reported weight and height. Overweight is defined as BMI=27–29.9u2005kg/m2 and obesity as BMI≥30u2005kg/m2.RESULTS: Between 1987 and 1995/97, the prevalence of overweight in the Spanish population aged 25–64 increased by 2.2% (P<0.01); the increase was greater in men (3.8%; P<0.01) than in women (0.6%; P>0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P<0.01) and women (2.3%; P<0.05) aged 25–34. During the same period, the prevalence of obesity increased by 3.9% (P<0.01), 4.6% in men (P<0.01) and 3.2% in women (P<0.01). The largest increases were seen in men aged 45–54 (6.5%, P<0.01) and in women aged 25–34 (2.2%, P<0.05). By educational level, the prevalence of overweight increased significantly in men with fewer than 12u2005y of education (4.7%, P<0.01). Obesity increased by 4.6% (P<0.01) and by 4.9% (P<0.01) in men and women with fewer than 12u2005y of education, respectively.CONCLUSIONS: The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial.

Relation between body weight and health-related quality of life among the elderly in Spain

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60u2009y and over in Spain.RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60u2009y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease.RESULTS: Mean age of the study population was 70.9u2009y for men and 72.2u2009y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5–24.9u2009kg/m2), frequency of suboptimal physical functioning was higher among obese subjects (BMI≥30u2009kg/m2), both male (OR: 1.91; 95% CI: 1.22–3.00) and female (OR: 2.58; 95% CI: 1.59–4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25–29.9u2009kg/m2) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60–74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102u2009cm in men and >88u2009cm in women).CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74u2009y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Trends in overweight and misperceived overweight in Spain from 1987 to 2007.

Objective:To examine trends in overweight and misperceived overweight in adults (⩾20 years) and children (5–15 years) of Spain from 1987 to 2007.Methods:Data were obtained from five cross-sectional studies, representative of the population of Spain in 1987, 1995, 1997, 2001 and 2006/2007. Self-reported weight and height were used to obtain the body mass index (BMI). Overweight was defined in adults as BMI of ⩾25u2009kgu2009m–2, and in children using age- and sex-specific BMI cutoffs proposed by the International Obesity Task Force. People with overweight were considered to have misperceived overweight when adults considered their weight or their childs weight to be normal or less than normal.Results:From 1987 to 2006/2007, the prevalence of overweight increased in absolute terms by 14.1% in men and 10.3% in women. Concurrently, the frequency of misperceived overweight remained relatively stable, approximately 35% in men, but rose from 16.5 to 20.8% in women. From 1995/1997 to 2006/2007, the prevalence of overweight increased in absolute terms by 3.2% in boys and 4.6% in girls. Over the same period, there was an absolute 8% increase in misperception of overweight among children of both sexes. As a result, during 2006/2007, approximately 60% of parents did not correctly perceive the weight status of their overweight children. Moreover, misperceived overweight was highest for younger children, and for those whose parents had a higher education.Conclusions:The obesity epidemic in Spain has been accompanied by an increased misperception of overweight in women and children of both sexes. Our results warn of the low familys readiness to modify the environment and lifestyle needed to control overweight.

Determinants of geographical variations in body mass index (BMI) and obesity in Spain.

OBJECTIVE:To identify the factors associated with geographic variations in Body Mass Index (BMI) and obesity in Spain.DESIGN:Cross-sectional, ecological analysis using data on illiteracy rate (per 1000 population), energy intake (kcal//person/-4/d), sedentary population (%), smoking population (%), alcohol consumption (g/person/d), and percentage of population aged 65u2005y or over, for Spain’s 50 provinces.SUBJECTS:Non-institutionalized population aged 16u2005y or over.MEASUREMENTS:Median BMI and percentage of population with obesity, defined as BMI>30u2005kg/m2.RESULTS:There was a clear geographical pattern, with some areas in the south and north-west of the country registering the highest BMI and prevalence of obesity and a north–south pattern on illiteracy per 1000 population. Multivariate regression analysis showed that illiteracy, sedentary lifestyle and energy intake explain 35% and 14% of the variation in BMI and obesity, respectively. Illiteracy proved to be the variable most associated with both BMI (regression coefficient (β=0.01; P=0.005) and obesity (β0.05; P=0.013). Sedentary lifestyle showed a statistically significant relationship with BMI (β=0.01; P=0.03), but not with obesity (β=0.03; P=0.581). Energy intake exhibited a relationship with BMI (β<0.01 P=0.03) that lost statistical significance when adjusted for age.CONCLUSION: Geographical variations in BMI in Spain are partly explained by illiteracy, sedentary lifestyle and, to a lesser extent, energy intake, whereas regional variations in obesity are related only to the educational level of the population.

The relationship of overweight and obesity with subjective health and use of health-care services among Spanish women

OBJECTIVE: To examine the relationship of overweight and obesity with subjective health and use of health-care services among women in Spain.METHODS: Data were drawn from the 1993 Spanish National Health Survey, covering a 13u2005244-woman sample representative of the non-institutionalised Spanish population aged 16u2005y and over. Information was collected through home-based interviews. Multiple logistic regression models were used to calculate odds ratios for suboptimal health (fair, poor or very poor) and utilisation of health-care services by women with normal weight (BMI 18.5–24.9u2005kg/m2), overweight (BMI 25.0–29.9u2005kg/m2) and obesity (BMI≥30u2005kg/m2). Analyses were adjusted for age, education level, occupation, civil status, social support, tobacco use, alcohol consumption, physical activity at work and during leisure time, job status and town of residence.RESULTS: Frequency of suboptimal health was higher in women with overweight (OR 1.7; 95% CI 1.5–1.9) and obesity (OR 2.1; 95% CI 1.8–2.5) than in those with normal weight. Overweight and obese women visited the physician, used hospital emergency services and took medication with greater frequency than did women of normal weight. There was a positive dose–response relationship (P<0.05) of BMI≥18.5u2005kg/m2 with suboptimal health and utilisation of health-care services. These associations were not wholly explained by BMI-related risk factors and chronic diseases, since their statistical significance remained unchanged and their magnitude was only slightly reduced after adjustment for those factors. The association of overweight and obesity with the use of health-care services did not vary with age, educational level or presence of chronic disease.CONCLUSION: Overweight and obese women have worse subjective health and make greater use of health-care services. This finding is an additional argument for implementing weight-control programmes in Spain.

Changes in body weight and health-related quality-of-life in the older adult population.

BACKGROUND:No other study has ascertained the short-term impact of weight change on health-related quality-of-life (HRQL) on a national sample of older adults.OBJECTIVE:To examine the relationship between change in body weight and HRQL among the older adult population.METHODS:We carried out a prospective study from 2001 to 2003 of a cohort of 2364 persons, representative of the noninstitutionalised Spanish population aged 60u2009y and over. Weight changes during the period 2001–2003 were self-reported, and HRQL in 2003 was measured with the SF-36 questionnaire. Analyses adjusted for the principal confounders.RESULTS:Among nonobese women (body mass index (BMI) 18.5–29.9u2009kg/m2), and compared to those who underwent no important weight change, weight loss was associated with a clinically significant worsening in the role-physical, vitality, and social functioning SF-36 scales. Among obese women (BMI≥30u2009kg/m2), weight gain led to a reduction in HRQL for four of the eight SF-36 scales, while weight loss was associated with worse scores in role-emotional and mental health scales. Results were usually similar for men, though of lower magnitude. In both sexes, weight change was associated with a reduction of over 5 points on several physical and mental scales of the SF-36, which indicates a clinically relevant worsening in HRQL.CONCLUSION:Weight change is associated with worse HRQL among the older adults, principally women. From the stance of HRQL, it is desirable to prevent weight gain, especially among the obese, and weight loss, especially among the nonobese.

Obesity and socioeconomic position measured at three stages of the life course in the elderly

Objective: To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly.Design: Cross-sectional study carried out in 2000–2001.Subjects: In total, 4009 subjects aged 60u2009y and older, representative of the Spanish noninstitutionalised population.Research Methods and Procedures: We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two.Results: In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables.Conclusions: In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

Self-perception of being overweight in Spanish adults

Objective: To describe the frequency, distribution and trend in misperceived overweight and obesity.Design: Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population.Setting: Spanish adult population aged 20u2005y and over.Subjects and interventions: A total of 11u2009496 men and women aged 20u2005y and over with a body mass index (BMI) ≥25u2005kg/m2.Main outcome measures: Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height.Results: Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64u2005y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25–26.9u2005kg/m2 in 1995/1997 did not perceive themselves to be overweight.Conclusions: Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

Socioeconomic Variation in the Magnitude of the Association between Self-Rated Health and Mortality

PURPOSEnTo assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude.nnnMETHODSnWe used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category.nnnRESULTSnThe relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions.nnnCONCLUSIONSnSocioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.