Obesity and self-rated health in middle-aged Danes

To examine the association between obesity and self-rated health among Danish middle-aged adults, both overall and across health-related subgroups.

This population-based cross-sectional study enrolled 87,934 Danish residents aged 50-65 who completed an online questionnaire in 2021, including items on lifestyle behaviors, psychological health, and anthropometric measurements. Self-rated health was assessed using the question, "How do you find your overall health?" and categorized as "good" (combining "excellent", "very good", and "good") and "poor" (combining "less good" and "bad"). We calculated prevalences and prevalence ratios of poor health across BMI levels using Poisson regression adjusted for age, sex, and education level.

Higher BMI levels were strongly associated with the prevalence of poor self-rated health: 10% of participants in the normal-weight group (BMI 18.5-24.9 kg/m²) rated their health as poor, compared to 14% in the overweight group (25.0-29.9 kg/m²), 24% in the obesity class I group (30.0-34.9 kg/m²), and 39% in obesity class II group (≥35 kg/m²). Compared with normal-weight participants, the prevalence ratio for poor health was 3.5 (95% CI 3.4-3.7) among those with obesity class II. The prevalence ratio attenuated in subgroups with histories of depression (1.4 [95% CI 1.3-1.5]), preexisting stress (1.3 [95% CI 1.2-1.4]), diabetes (1.6 [95% CI 1.5-1.8]), and cardiovascular disease (2.0 [95% CI 1.8-2.2]). Increased waist circumference (>102 cm for men and 88 cm for women) showed similar associations with poor self-rated health. Spline models showed a linear increasing prevalence of poor self-rated health at BMI levels above 23 kg/m² and waist circumference above 90 cm in men and 85 cm in women.

In middle-aged adults, a higher BMI level or increased waist circumference was strongly associated with poorer self-rated health. Obesity may indicate an unmet need for addressing health deficits beyond the effects of comorbid diseases.