Identifying adults at high-risk for change in weight and BMI

Summary

Background: Targeted obesity prevention policies would benefit from the identification of population groups with the highest risk of weight gain. The relative importance of adult age, sex, ethnicity, geographical region, and degree of social deprivation on weight gain is not known. We aimed to identify high-risk groups for changes in weight and BMI using electronic health records (EHR).

Methods: In this longitudinal, population-based cohort study we used linked EHR data from 400 primary care practices in England, accessed via the CALIBER programme. Eligible participants were aged 18–74 years, were registered at a general practice clinic, and had BMI and weight measurements recorded between Jan 1, 1998, and June 30, 2016, during the period when they had eligible linked data with at least 1 year of follow-up time. We calculated longitudinal changes in BMI over 1, 5, and 10 years, and investigated the absolute risk and odds ratios (ORs) of transitioning between BMI categories (underweight, normal weight, overweight, obesity class 1 and 2, and severe obesity [class 3]), as defined by WHO. The associations of demographic factors with BMI transitions were estimated by use of logistic regression analysis, adjusting for baseline BMI, family history of cardiovascular disease, use of diuretics, and prevalent chronic conditions.

Findings We included 2 092 260 eligible individuals with more than 9 million BMI measurements in our study. Young adult age was the strongest risk factor for weight gain at 1, 5, and 10 years of follow-up. Compared with the oldest age group (65–74 years), adults in the youngest age group (18–24 years) had the highest OR (4.22 [95% CI 3.86–4.62]) and greatest absolute risk (37% vs 24%) of transitioning from normal weight to overweight or obesity at 10 years. Likewise, adults in the youngest age group with overweight or obesity at baseline were also at highest risk to transition to a higher BMI category; OR 4.60 (4.06–5.22) and absolute risk (42% vs 18%) of transitioning from overweight to class 1 and 2 obesity, and OR 5.87 (5.23–6.59) and absolute risk (22% vs 5%) of transitioning from class 1 and 2 obesity to class 3 obesity. Other demographic factors were consistently less strongly associated with these transitions

Interpretation A radical shift in policy is required to focus on individuals at the highest risk of weight gain (i.e, young adults aged 18–24 years) for individual-level and population-level prevention of obesity and its long-term consequences for health and health care.


For more details, see our paper

M Katsoulis, AG Lai, K Diaz-Ordaz, M Gomes, L Pasea, A Banerjee, S Denaxas, K Tsilidis, P Lagiou, G Misirli, K Bhaskaran, G Wannamethee, R Dobson, RL Batterham, DK Kipourou, RT Lumbers, L Wen, N Wareham, C Langenberg*, H Hemingway*. Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records. Lancet Diabetes Endocrinol (2021)
https://doi.org/10.1016/S2213-8587(21...


and our BMI change risk calculator: http://bmi.caliberresearch.org/