Obesity is the second leading cause of preventable death (second only to tobacco smoking) in the United States, accounting for about 300,000 deaths yearly. The relationship between body weight and disease risk is continuous, and except for very underweight people, the risk of disease increases as weight increases. The consequences of obesity on health are many, particularly among women who are extremely obese. The NHLBI guidelines 1 document an increase in morbidity associated with overweight or obesity for individuals with hypertension, type 2 diabetes, coronary heart disease (CHD), stroke, gallbladder disease, osteoarthritis, sleep apnea, and some cancers. For example, in the United States, at least one-third of all hypertension is related to excess weight. The prevalence of high blood pressure among obese women is doubled, at 32.2 percent compared with a prevalence in normal-weight women of 16.5 percent; this translates into an increased risk for CHD and stroke for obese women. In addition, 88 percent to 97 percent of cases of type 2 diabetes occur in overweight persons, hyperlipidemia is one-and-a-half times more likely in overweight people compared with normal-weight persons, and there is a direct linear relationship between BMI above 27 and death from CHD.

Similarly, obese women have three times the risk for CHD, twice the risk for ischemic stroke, twice the risk for colon cancer, and three times the risk for endometrial cancer as normal-weight women. Obesity also increases the risk of maternal and fetal adverse health consequences during pregnancy. Obese women are more likely to develop gestational diabetes 00 percent incidence among obese pregnant women) and hypertension during pregnancy. Obesity in pregnancy is also associated with an increased risk of congenital malformations, particularly neural tube defects. shows the consequences of increasing weight on a person’s health.

The relationship between overweight and mortality is less certain than for obesity. The NHLBI guidelines suggest that mortality from all causes, particularly cardiovascular diseases, is increased for obese individuals by 50 percent to 100 percent compared with normal-weight individuals; for overweight individuals there is little effect of weight on mortality. A recent German study (N = 6193; 4602 women) of the long-term effect (patients were followed an average of 14 years) of obesity on mortality found that the mortality of moderately obese women and men was not different from the mortality of the general population. However, for the gross or morbidly obese, mortality was increased and 57 percent of deaths of morbidly obese women could be attributed to their obesity.

One of the goals of the Healthy People 2000 report was to reduce the health consequences of poor nutritional and activity habits of the population. Despite the proliferation of health clubs, a 300-fold increase in work site health programs, better food labeling, and improved consumer awareness about the importance of healthy diets, progress toward the goals for both physical activity and dietary health has gone in a negative. rather than positive direction. The rates of obesity. for both adults and adolescents have continued. to increase, while the percentage of adults and adolescents who engage in regular physical activity has declined. Clearly, because of the health implications of weight problems and inactivity, health care providers must continue to find better ways to motivate patients to lose weight.

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