Marcia P Jimenez1, Mark A Green2, S V Subramanian3, Fahad Razak4. 1. Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI. 2. Department of Geography & Planning, University of Liverpool, Liverpool, UK. 3. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA. 4. Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada; St Michael's Hospital, University of Toronto and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA. Electronic address: fahad.razak@mail.utoronto.ca.
Abstract
PURPOSE: Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States. METHODS: We analyzed data from the 2011-2012 wave of the National Health and Nutrition Examination Survey, a nationally representative sample of adults in the United States with detailed physical examination and clinical data (n = 1380). We used cluster analysis to identify subgroups classified as obese according to demographic factors, clinical conditions, and behavioral characteristics. RESULTS: We found significant heterogeneity among participants with obesity according to six distinct clusters (P < .001): affluent men with sleep disorders (16% of sample); older smokers with cardiovascular disease (16%); older women with high comorbidity (20%); healthy white women (13%); healthy non-white women (14%); and active men who drink higher amounts of alcohol (21%). CONCLUSIONS: Obesity in the United States is not a homogeneous condition. Current research and treatment may fail to account for complex and interrelated factors, with implications for prevention strategies and diverse risks of obesity.
PURPOSE: Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States. METHODS: We analyzed data from the 2011-2012 wave of the National Health and Nutrition Examination Survey, a nationally representative sample of adults in the United States with detailed physical examination and clinical data (n = 1380). We used cluster analysis to identify subgroups classified as obese according to demographic factors, clinical conditions, and behavioral characteristics. RESULTS: We found significant heterogeneity among participants with obesity according to six distinct clusters (P < .001): affluent men with sleep disorders (16% of sample); older smokers with cardiovascular disease (16%); older women with high comorbidity (20%); healthy white women (13%); healthy non-white women (14%); and active men who drink higher amounts of alcohol (21%). CONCLUSIONS:Obesity in the United States is not a homogeneous condition. Current research and treatment may fail to account for complex and interrelated factors, with implications for prevention strategies and diverse risks of obesity.
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