Being Overweight May Not Be Associated with Early Death, Study Says

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Being overweight as defined by the body mass index rating scale is not linked to an increase in death when considered separately from other health issues, a new study found.

Also known as BMI, the calculation measures a person’s body fat based on height and weight. As currently used, the BMI scale divides adult populations into various degrees of body fat.

An adult is considered “overweight” if their BMI falls between 25 and 29.9, while a “healthy” or “normal” weight is defined as a BMI between 18.5 and 24.9, according to the US Centers for Disease Control and Prevention. A BMI of 30 or higher is considered obese.

“The real message of this study is that overweight as defined by BMI is a poor indicator of mortality risk, and that BMI in general is a poor indicator of health risk and should be supplemented with information such as waist circumference, other measures of adiposity (fat), and weight trajectory,” said study first author Dr. Aayush Visaria, an internal medicine resident physician at the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

Being overweight may not lead to an early death, but may add to the risk of chronic disease, experts say.

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However, limitations of the study make it hard to determine if the findings are due to BMI or other factors, according to experts not involved with the new research.

“The use of the word ‘overweight’ is misleading here, as it excludes anyone with a BMI above 30. In lay language ‘overweight’ would usually be interpreted as anyone with a weight above ‘normal’ and would include obese patients,” said Dr. Baptiste Leurent, a lecturer in medical statistics at University College London, in a statement.

“This paper found an unequivocal association between BMI and mortality, before and after adjustment for risk factors,” said Leurent, who was not involved in the study.

In addition, observational studies can only show an association, not causation, said Dr. Robert H. Shmerling, senior faculty editor for Harvard Health Publishing, a subsidiary of Harvard Medical School in Boston.

“They looked at death rates, but there are other outcomes that are also important that they didn’t look at, such as quality of life or the development of new comorbidities such as new cases of diabetes or heart disease,” said Shmerling, who was not involved in the study.

Death vs. disease

In the new study, published Wednesday in the journal PLOS ONE, researchers analyzed data gathered on over 554,000 non-pregnant Americans older than age 20 from the 1999-2018 National Health Interview Survey and the 2019 US National Death Index. 

Visaria and his coauthor, Dr. Soko Setoguchi, a professor of medicine and epidemiology at the Rutgers Robert Wood Johnson Medical School and Rutgers School of Public Health, then compared BMI levels with deaths that occurred over the next 20 years.

The risk of death did rise by 18% to 108% for most people with BMI levels higher than 27.5, Visaria said, with risk rising as weight increased in a U-shaped curve.

There was one exception: adults older than age 65. There was no significant increase in mortality for any older adult with a BMI of between 22.5 and 34.9 — a range that included those with normal weight, overweight and obesity.

“This paper does not add anything new,” said Naveed Sattar, a professor of cardiovascular and metabolic health at the University of Glasgow in Scotland, who was not involved in the study.

“We know that BMI often displays a U shaped curve with mortality, but this is due to many people (particularly older) at lower end of the BMI range having unintentional weight loss due to illness,” Sattar said in a statement.

Weight loss often goes hand in hand with development of dementia, cancer and accompanying loss of appetite in an older population. Prior research has found losing as little as 5% of body mass increased the risk of premature death among adults 65 and older, especially for men.

The most significant finding, Visaria said, was for people between ages 20 and 65 whose BMI was between 24.5 and 27.5 — the lower end of the overweight scale. There was no significant increase in the risk for death.

However, the risk of future disease is “probably a more important measure of health than all cause mortality,” said Tom Sanders, professor emeritus of nutrition and dietetics at King’s College London, who was not involved in the study.

“The main hazard of overweight (BMI 25 - 29.9) and moderate obesity (BMI 30-35) is a three times greater risk of developing diabetes which contributes to cardiovascular disease, renal failure and blindness,” he said in a statement.

While the study did control for smoking and a variety of other diseases linked to early death, that information was only gathered once for each person in the survey. Therefore, the study could not follow that person to see if he or she later developed conditions such as hypertension or diabetes that might contribute to death — a limitation of the study, Visaria told CNN in an email.

“They also didn’t look at the cause of death — it might have been from a car accident or something not health-related,” said Shmerling, who is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center in Boston.

“In addition, if you look at the big picture findings, they did find an increase of mortality with obesity — so it’s not as if they’ve refuted the usefulness of BMI for all purposes,” he said.

It’s also possible, said Shmerling, that people in the overweight category visit the doctor more often, make lifestyle changes — such as increasing exercise or adopting a healthier diet — and get medical care so they don’t develop diabetes, heart disease or other comorbidities.

“Death due to obesity may be due to development of morbidities like heart disease, but obesity is also its own independent disease that we know can independently increase risk of death,” Visaria said. “The issue is how we diagnose obesity which may not be representative of the risks.”

Waist circumference is a key measure

In addition to BMI, Visaria said the study also looked at data that measured waist circumference, or the thickest part of the stomach. Results showed using waist circumference “significantly modifies the association between BMI and all-cause mortality,” he said.

“People with elevated waist circumference had higher risk of mortality compared to normal waist circumference within the same BMI groups,” Visaria said in an email. “In the overweight BMI range (25-29.9), the risk of mortality was 17-27% higher among people with elevated waist circumference compared to lower waist circumference.”

That type of deep fat that surrounds the body’s organs, often called belly or visceral fat, has been linked to a 39% higher risk for dementia in older women and heart disease,frailty and early death in both sexes.

Measuring waist circumference should be paired with stepping on a scale as part of any health assessment, according to guidelines published in April 2021 by the American Heart Association. Abdominal obesity, as it is known, is defined as a waist circumference of 40 inches (102 centimeters) or above for men, and 35 inches (88 centimeters) or above for women.

The American Medical Association also recently adopted new guidelines calling for physicians to use more than BMI when evaluating an individual’s health.

“BMI is based primarily on data collected from previous generations of non-Hispanic white populations,” the AMA wrote. While it’s “significantly correlated with the amount of fat mass in the general population, (it) loses predictability when applied on the individual level.”

The use of BMI as a measure of potential health risk may not disappear from clinical practice as it does have a place in a thorough workup — but it should not be the only measure, Visaria said.

However, any discussion over how fat mass is measured does not change what science knows about the impact of excess weight upon the body, experts say.

“We know from other evidence that the higher our weight, the greater the risks of developing multiple conditions,” said the University of Glasgow’s Sattar.

“These conditions in turn adversely influence people’s quality of life and their happiness,” Sattar said in a statement. “It is these ‘quality of life’ metrics we need to focus more on, and, if possible, try to improve with relevant interventions at multiple stages of life.”

Most common causes of health data breaches in the last three months

Most common causes of health data breaches in the last three months

In April 2023, Point32Health experienced a ransomware attack that caused widespread system outages. The second-largest health insurer in Massachusetts, Point32Health serves more than 2 million people, including those with Tufts Health Plan and Harvard Pilgrim Health Care policies, many of whom were enrolled in Medicare.

Though this may initially seem like an unusual occurrence, health data breaches are not uncommon in our increasingly digitized world. In 2022 alone, there were 707 health data breaches where more than 500 records were compromised; from January to May 2023, 273 breaches occurred.

On average, a health data breach in 2023 compromises just shy of 150,000 records, while the average breach size in 2022 was closer to 75,000. In light of this growing crisis, Stacker investigated the most common causes of health data breaches from March to May 2023, using data from the HIPAA Journal's monthly Healthcare Data Breach Reports.

Read on to see how your health data can be compromised and what happened to those made vulnerable by data breaches.

Monkey Business Images // Shutterstock

#4. Improper disposal

- Number of breaches, March-May 2023: 3 (1.6%)

--- March 2023: 1 (1.6%)

--- April 2023: 1 (1.9%)

--- May 2023: 1 (1.3%)

Improper disposal data breaches can occur when a hard drive that holds patient health data isn't properly wiped and destroyed before it leaves the hands of the health provider. The Health Insurance Portability and Accountability Act outlines a few options for permanently deleting patient data stored on hard drives, including using software to overwrite the data, putting the drive through a process called magnetic purging, or destroying the hard drive through shredding, melting, or incinerating.

In September 2021, a large health data breach caused by improper disposal occurred when HealthReach Community Health Centers in Waterville, Maine, used a third-party service to dispose of several hard drives. This caused more than 115,000 individuals to have their health data jeopardized, with more than 100,000 of those individuals residing in Maine. After the incident, those impacted were provided with reimbursement insurance policies and various data and identity protection services.

zentilia // Shutterstock

#3. Theft

- Number of breaches, March-May 2023: 5 (2.6%)

--- March 2023: 1 (1.6%)

--- April 2023: 2 (3.8%)

--- May 2023: 2 (2.7%)

Data has to be stored somewhere, and when that equipment is stolen, it constitutes a theft data breach. Though these types of breaches are rarer than others, they can occur whenever someone comes into contact with a computer, hard drive, or other storage receptacle containing patient data.

The Valley Hope Association, a nonprofit organization that provides addiction treatment in Kansas, reported that, on Dec. 30, 2015, an employee's laptop was stolen from their car, impacting the data of upwards of 50,000 patients. The data on the laptop included Social Security numbers, insurance information, state identification and driver's license numbers, and other personally identifying and sensitive information.

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#2. Unauthorized access/disclosure

- Number of breaches, March-May 2023: 38 (20.0%)

--- March 2023: 14 (22.2%)

--- April 2023: 13 (25.0%)

--- May 2023: 11 (14.7%)

A patient is generally made aware of every individual or entity allowed access to their medical records. This can include their doctors, nurses, other medical staff, and other authorized individuals the patient designates, such as a spouse, other family member, close friend, or caretaker. Any instance when a person not given explicit permission to access a patient's medical records gains access constitutes an unauthorized access or disclosure data breach, and medical providers must report it.

At times, these breaches are as simple as a provider mistakenly handing the wrong medical forms to a colleague or patient or a doctor's office disclosing information about the status of a patient to the incorrect family member. However, these issues can become much more serious if someone deliberately accesses information they're unauthorized to see, such as when an unauthorized user gained access to a Merritt Healthcare Advisors employee's email account from July 30 to Aug. 25, 2022.

Monkey Business Images // Shutterstock

#1. Hacking/IT incident

- Number of breaches, March-May 2023: 144 (75.8%)

--- March 2023: 47 (74.6%)

--- April 2023: 36 (69.2%)

--- May 2023: 61 (81.3%)

Hacking incidents constitute the largest share of health data breaches and have notably risen since the beginning of the COVID-19 pandemic. Cybersecurity experts have recently raised concerns about the startling 385 million patient records exposed since 2010. Often, hacking incidents are perpetrated by cybercriminals looking for ransoms in exchange for restoring access to or returning sensitive records.

One of the largest health data hacking breaches ever occurred in 2014, when a group of cybercriminals believed to be based in China compromised the digital records of Community Health Systems. About 4.5 million individuals were impacted during this single data breach, a wake-up call to data and information technology professionals to be more cognizant of potential software vulnerabilities that might be exploited by sophisticated malware.

Data reporting by Emilia Ruzicka. Story editing by Brian Budzynski. Copy editing by Paris Close. Photo selection by Abigail Renaud.

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