2. Relationship Between BMI and the Risk of Death Stevens et al., N Engl J Med 1998. Relative Risk Relative Risk Body Mass Index Body Mass Index Women Men <19.0 19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9 <19.0 19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9

3. Obesity: A heterogeneous condition ≠ Central Obesity Peripheral Obesity Vague 1956, AJCN

4. Men <102 cm ( < 40 in) >102 cm ( > 40 in) BMI (kg/m 2) Class Women < 88 cm ( < 35 in) > 88 cm ( > 35 in) Overweight 25.0 - 29.9 Increased High Obesity 30.0 - 34.9 I High Very High Obesity 35.0 - 39.9 II Very High Very High Extreme Obesity > 40 III Extremely High Health Risk NIH National Heart, Lung and Blood Institute, 1998, Obesity Research. Characterizing Obesity Related Health Risk Waist Circumference BMI + WC = HEALTH RISK

5. Obesity: A heterogeneous condition RR for CVD Low WC Mid WC High WC Low Mid High BMI Rexrode et al. 1998, JAMA RR for Diabetes Low WC Mid WC High WC Low Mid High BMI Wang et al. 2005, AJCN

8. Results: Subject Characteristics Variable Total ( n = 5882) Men ( n = 3001) Women ( n = 2881) Age, y 44.2 ± 0.5 43.3 ± 0.5 45.1 ± 0.5 Waist circumference, cm 95.3 ± 0.4 98.5 ± 0.4 92.1 ± 0.5 BMI, kg/m 2 27.7 ± 0.1 27.6 ± 0.1 27.8 ± 0.2 Impaired fasting glucose, % 24.6 (1.1) 30.3 (1.4) 19.0 (1.1) Diabetes, % 8.1 (0.5) 9.2 (0.7) 7.1 (0.5) Cardiovascular disease, % 7.0 (0.5) 8.0 (0.7) 6.0 (0.6) Hypertension, % 27.3 (0.9) 26.6 (1.2) 28.1 (1.0) High LDL-cholesterol, % 21.6 (0.8) 22.8 (0.9) 20.4 (0.1) Low HDL-cholesterol, % 19.9 (0.8) 27.8 (1.0) 12.0 (0.9) High triglycerides, % 14.7 (0.6) 17.0 (1.0) 12.4 (0.6)

9. Results: WC and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High Waist Circumference Low Med High Waist Circumference Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking

10. Results: WC and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High Waist Circumference Low Med High Waist Circumference Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking, metabolic risk factors and BMI Adjusted for sex, age, race, and smoking

11. Results: BMI and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High BMI Low Med High BMI Adjusted for sex, age, race, and smoking

12. Results: BMI and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High BMI Low Med High BMI Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking, metabolic risk factors and WC Adjusted for sex, age, race, and smoking

13. Results: WC, Cardiometabolic Risk Factors and Diabetes Risk Number of Cardiometabolic Risk Factors Odds Ratio for Diabetes Low WC Moderate WC High WC P trend < 0.001 for both WC and risk factors

14. Results: WC, Cardiometabolic Risk Factors and CVD Risk Number of Cardiometabolic Risk Factors Odds Ratio for CVD Low WC Moderate WC High WC P trend < 0.001 for risk factors, not significant for WC

15. Results: WC, Cardiometabolic Risk Factors and CVD Risk Number of Cardiometabolic Risk Factors Odds Ratio for CVD Low WC Mod WC High WC Odds Ratio for CVD Low Med High Waist Circumference

17. * p<0.05 vs Control Effects of Aerobic Exercise (4 mo) With or Without Weight Loss on Waist Circumference in Obese Men and Women Ross et al. Ann Intern Med (2000) ; Ross et al. Obesity Research (2004) Reduction in Waist Circumference (cm) 0 3 6 9 Obese Men * * Control Weight Loss No Weight Loss Exercise 0 2 4 6 8 * * Obese Women Control Weight Loss No Weight Loss Exercise No Change in BMI No Change in BMI