Does Obesity Contribute as Much to Morbidity as Poverty or Smoking?

Objectives: The prevalence of obesity is increasing in America, but its impact on morbidity relative to other health risks is unclear. This paper compares the effects of overweight, poverty, smoking, and problem drinking on occurrence of chronic conditions and health-related quality-of-life. Methods: Nationally representative household telephone survey of 9585 adults fielded in 1998, using self-reported measures of height and weight (body mass index, BMI), poverty (below federal poverty level), smoking status, recent problem drinking, major chronic conditions, and health-related quality-of-life by SF-12 global scales. Regression analyses were used to estimate effects of health risk factors on morbidity. Results: 36% of adults are overweight but not obese (25<=BMI<30) and another 23% are obese (BMI>=30). Controlling for demographics, obesity is associated with more chronic conditions and worse physical health-related quality of life (p's <.01). While lifetime smoking history and poverty also significantly predict having chronic conditions, their effect sizes are significantly smaller. Even after controlling for chronic conditions, obesity predicts physical health-related quality of life, in that case with an effect size similar to poverty for both men and women and similar to smoking for men and larger than smoking for women. The effect of problem drinking is always smaller. Conclusions: Obesity is highly prevalent and associated with at least as much morbidity in terms of chronic medical conditions and reduction in physical health-related quality-of-life as are poverty, smoking, and problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.