Obesity Epidemiology

256 EPIDEMIOLOGIC STUDIES OF CONSEQUENCES OF OBESITYand valid in population samples, future studies that focus on population subgroups willrequire psychometric validation of the measures within the subgroups analyzed.ConclusionsIn summary, assessing the consequences of obesity on HRQOL plays an importantrole in evaluating the impact of obesity on individual and population health. To date, avariety of studies, conducted primarily in adults and using cross-sectional designs, hasattempted to evaluate the associations between obesity and HRQOL. The general validityof the HRQOL instruments used in these studies has been demonstrated, while themajority of studies conducted in general population samples suggest deleterious effectsof obesity across multiple dimensions of HRQOL.Additional studies in children and adolescents, and the application of prospectivestudy designs, including assessments of weight change as a predictor of HRQOL change,would be particularly valuable. Future epidemiologic studies should also further explorepossible effect modification of the associations of obesity with HRQOL by age and gender,as well as test for heterogeneous effects according to race/ethnicity and SES. Giventhe stigma and prejudice faced by obese individuals in society, it is important to documentwhich groups of individuals (e.g., women, racial minorities, as well as individuals fromlower SES groups) are at particular risk of paying the psychosocial penalty of beingoverweight. Interventions to reduce “fat bias,” and to assist vulnerable individuals to loseweight, should be targets of priority.References1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesityamong US adults, 1999-2000. JAMA. 2002;288:1723-1727.2. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington,DC: The National Academies Press; 2004.3. James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. ObesRes. 2001;9(Suppl 4);228S-233S.4. National Institutes of Health. Clinical Guidelines on the Identifi cation, Evaluation,and Treatment of Overweight and Obesity in Adults. Bethesda, MD: US Departmentof Health and Human Services; 1998.5. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med.1996;334:835-840.6. World Health Organization. Constitution and Charter. Geneva: World Health Organization;1948.7. US Department of Health and Human Services. Healthy People 2010: Understandingand Improving Health. 2nd ed. Washington, DC: US Government PrintingOffice; 2000.8. Roberts RE, Strawbridge WJ, Deleger S, Kaplan GA. Are the fat more jolly? AnnBehav Med. 2002;24:169-180.9. Palinkas LA, Wingard DL, Barrett-Connor E. Depressive symptoms in overweightand obese older adults: a test of the “jolly fat” hypothesis. J Psychosom Res.1996;40:59-66.10. Crisp AH, McGuiness B. Jolly fat: relations between obesity and psychoneurosis ingeneral population. BMJ. 1976;1:7-9.11. Magnusson PK, Rasmussen F, Lawlor DA, Tynelius P, Gunnell D. Association ofbody mass index with suicide mortality: a prospective cohort study of more than onemillion men. Am J Epidemiol. 2006;163:1-8.