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Johns Hopkins University-led research has found that obesity, particularly severe obesity, is strongly associated with the incidence of 16 common health outcomes, reports Medical Xpress.
Strong associations were observed for obstructive sleep apnea, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease.
In the study published in NEJM Evidence, researchers conducted a longitudinal cohort study to understand how different levels of obesity relate to a wide array of health conditions across a diverse US population.
Data were analyzed from 270,657 participants enrolled in the All of Us research program, launched by the National Institutes of Health in 2025.
Participants contributed electronic health records, physical measurements, and survey data. Body mass index (BMI) was calculated at enrollment and used to classify individuals as normal weight, overweight, or obese, with further stratification into obesity classes I, II, and III.
Sixteen pre-identified health conditions were evaluated: hypertension, type 2 diabetes, hyperlipidemia or dyslipidemia, heart failure, atrial fibrillation, atherosclerotic cardiovascular disease, chronic kidney disease, pulmonary embolism, deep vein thrombosis, gout, liver disease linked to metabolic dysfunction, biliary calculus, obstructive sleep apnea, asthma, gastroesophageal reflux disease, and osteoarthritis.
Obesity was present in 42.4% of the study population, including 21.2% with class I obesity, 11.3% with class II, and 9.8% with class III.
Prevalence and incidence rates increased progressively with higher obesity classes for all 16 health outcomes. Observed associations with class III obesity were strongest for obstructive sleep apnea (hazard ratio 10.94), type 2 diabetes mellitus (7.74), and metabolic dysfunction–associated liver disease (6.72). Weaker associations were found for asthma (2.14), osteoarthritis (2.06), and atherosclerotic cardiovascular disease (1.96).
Population-attributable fractions showed that obesity explained 51.5% of obstructive sleep apnea cases and 36.3% of metabolic liver disease cases, and 14% of all osteoarthritis cases in the study population were estimated to be attributable to obesity.
Increased risk, particularly at higher severity levels, was associated with all 16 health outcomes studied.