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Arch Intern Med. 1999 Apr 26;159(8):837-43.

Impairment of health and quality of life using new US federal guidelines for the identification of obesity.

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Department of Human Nutrition, University of Glasgow, Glasgow Royal Infirmary, Scotland.



Estimating total burdens of disease associated with overweight and obesity has been hampered by a lack of consistent published data using standardized body mass index (BMI or Quetelet index [calculated as weight in kilograms divided by the square of the height in meters: weight (kg)/[height x (m)2]]) diagnostic criteria, and by poorly standardized reference populations.


Symptoms of respiratory insufficiency, low back pain, non-insulin-dependent diabetes mellitus, cardiovascular risk factors, and physical functioning using SF-36 questionnaire were determined in a cross-sectional representative survey of 5887 men and 7018 women aged 20 to 59 years from the Netherlands and analyzed using BMI criteria of the National Institutes of Health and the World Health Organization guidelines.


The prevalences of cardiovascular risks were higher in men than women, but the other health outcomes were more frequent in women. Virtually all health outcomes considered were significantly influenced by BMI. A BMI of 25 to 30 kg/m2 had a generally greater impact on odds ratios for health outcomes in women than in men. People with BMI below 25 kg/m2 were considered the reference group, with low prevalence of symptoms of obesity-related diseases and good quality of life. Between 25 to 30 kg/m2, the prevalences of these were all increased, and above 30 kg/m2 greatly increased. After adjustments for age and lifestyle factors, odds ratios (95% confidence intervals [95% CI]) in those with a BMI of 30 kg/m2 or higher were 3.5 (95% CI, 2.8-4.4) in men and 3.3 (95% CI, 2.8-3.9) in women for shortness of breath when walking upstairs, 4.6 (95% CI, 2.4-8.8) in men and 5.4 (95% CI, 2.8-10.5) in women for non-insulin-dependent diabetes mellitus, 5.5 (95% CI, 4.5-6.6) in men and 2.9 (95% CI, 2.4-3.4) in women for having at least 1 major cardiovascular risk factor. Both men and women with BMI of 30 kg/m2 or higher were twice as likely to have difficulties in performing a range of basic daily physical activities. Compared with women with BMI lower than 25 kg/m2, those with BMI of 30 kg/m2 or higher were 1.5 times more likely to have symptoms of intervertebral disk herniation. Significantly more overweight women had problems associated with low back pain, including hindrance to their daily business, absence from work, and medical consultation.


Health risks for a range of problems are presented using the standard BMI cutoff points. Overweight and obesity are associated with increased risks of chronic diseases, secondary symptoms, and impairment of quality of life.

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