Association of Obesity Severity With Cardiometabolic and Renal Disease Burden in the United States.

Abstract

This study examined the association between obesity severity and cardiometabolic and renal disease, using BMI as a surrogate for obesity severity. This is a cross-sectional study using data from the United States Behavioral Risk Factor Surveillance System (BRFSS), 2011-2023. Survey-weighted logistic regression estimated odds ratios (OR) for the diagnosis of diabetes, hypertension, hyperlipidemia, kidney disease, myocardial infarction, stroke, and coronary artery disease among increasing BMI categories. Higher BMI was associated with increased odds of all conditions. For BMI ≥ 50 kg/m², odds were notably elevated for diabetes (OR 8.32; 95% CI: 7.78-8.91), hypertension (OR 6.07; 95% CI: 5.58-6.61), and kidney disease (OR 3.60; 95% CI: 3.21-4.03). The odds of cardiovascular disease also rose substantially, including myocardial infarction (OR 2.89; 95% CI: 2.56-3.28) and coronary artery disease (OR 3.44; 95% CI: 3.08-3.84). Mean age at diabetes diagnosis decreased with increasing BMI, from 52.2 years in Class I to 45.3 years in Class IV obesity. Obesity severity is incrementally associated with cardiometabolic and renal disease burden, particularly among adults with BMI ≥ 50 kg/m². These findings highlight the urgent need for early, aggressive interventions targeting individuals with all classes of obesity.