Severe obesity riskier for Swedish men than American men, suggests thesis

The fact that obesity is a major risk factor for disease and death is well known, as is the fact that obesity is more common in the United States than in Europe. On the other hand, a new thesis at Umeå University shows that obese Swedish men are at greater risk of dying prematurely than equally obese American men. For women, however, the risk picture of obesity is similar in the countries.

"The results are surprising and further research is needed to understand what is driving these relationships. Clearly, severe obesity is a serious health problem in both countries, but other factors seem to play a role in how large the risk increase is with severe obesity, especially for men," says Melissa Scribani, doctoral student at Umeå University.

In her thesis at the Department of Epidemiology and Global Health, Melissa Scribani shows that Swedish men with severe obesity were almost fivefold more likely to die prematurely from cardiovascular disease compared to normal-weight men, while American men with equally severe obesity were 'only' three times as likely to die prematurely. Obese women were also at increased risk of dying prematurely, but there the risk pattern was similar in Sweden and the United States.

Over a 20-year period, younger adults, especially women, accounted for the largest increases in body mass index, BMI, in both Sweden and the United States. The proportion with obesity rose during the period, with the largest increase in the United States.

In her thesis, Melissa Scribani has analyzed data from a ten-year study on weight management in the United States where behaviors, attitudes and perceptions among women aged 26–35 have been surveyed. The study showed that physical activity every day prevented weight gain among the women. Interviews showed that the difficulties in maintaining a healthy diet and physical activity level did not stem from a lack of knowledge about the benefits of healthy choices. Rather, individual conditions such as personal relationships and environmental factors played a role in the ability to eat well and stay in shape. Women who had more supportive relationships and better financial opportunities found it easier to eat healthy and to be physically active.

"Given the clear effects of obesity on health and mortality and the fact that obesity continues to increase among younger adults, weight management efforts should be prioritized. For this to succeed, individual and environmental factors must be taken into account," says Melissa Scribani.

The thesis is based on data from health surveys in the U.S. and health exams in Sweden during the period 1989–2009 with a total of over 27,000 participants, combined with a study of over 90,000 people followed to reveal the risk of obesity-related premature death. A quantitative survey of 568 people and qualitative interviews with 15 women aged 26–35 were used to understand factors that may promote weight maintenance.