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Gender differences

Reduction in female obesity-related mortality revealed

Advances in medicine, screening procedures and interventions may have reduced the excess mortality associated with Grade 1 obesity

There is evidence of a decline in the obesity years of life lost (YLL) association across all ages for women, especially Caucasian women, according to findings from the University of Alabama at Birmingham. The outcomes, reported in Obesity Reviews, also showed that despite Grade 1 obesity (BMI30< 35) longevity has not continued to reduce over calendar time in older white men, but this was not true in younger or middle-age men with the same BMI.

“Analyses of the National Health and Nutrition Examination Surveys suggested that the harmful effects of obesity may have decreased over calendar time, while some other studies suggested that this might not be the case,” said Dr Tapan Mehta, assistant professor in the School of Health Professions and lead author on this study. “Findings have been inconsistent, and previous studies have limitations such as confounding due to length of follow-up, recency of BMI measurement, age-related-effect modification and stable study-level factors.”

The researchers selected and collected individual-level data for 17 US prospective studies that spanned different calendar times and mortality follow-up periods and conducted a meta-analysis that adjusted for the limiting factors of previous studies.

For each BMI category, they estimated the YLL change between 1970 and 1990. Because of low sample sizes for African–American, the results are reported on Caucasian people.

Among men aged ≤60 years YLL for grade 1 obesity increased by 0.72 years (p< 0.001) and by 1.02 years (p= 0.01) for grade 2–3 obesity. For men aged >60, YLL for grade 1 obesity decreased by 1.02 years (p< 0.001) and increased by 0.63 years for grade 2–3 obesity (p=0.63).

Among women aged ≤60, YLL for grade 1 obesity decreased by 4.21 years (p< 0.001) and by 4.97 years (p< 0.001) for grade 2–3 obesity. In women aged >60, YLL for grade 1 obesity decreased by 3.98 years (p< 0.001) and by 2.64 years (p= 0.001) for grade 2–3 obesity.

“One of the possibilities our findings suggest, but do not prove, is that advances in medicine, screening procedures and interventions may have reduced the excess mortality associated with Grade 1 obesity; there are yet other explanations, as well,” added Mehta. “More research needs to be done to directly evaluate some of these explanations; for example, evaluating which treatments have reduced the association of obesity with mortality would help us identify and focus on strategies that seem to be working.”

As more longitudinal data on minorities becomes available, Mehta says they will be able to evaluate the same obesity-related mortality question with rigorous study design and methods. The role and trends in gender gaps and disparities in medical care are an area of study that would build upon this work.

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