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Abdominal obesity and mortality risk among men in nineteenth-century North America
1Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
A 19th-century study revealed that abdominal obesity in men significantly increased mortality risk. This historical data confirms that excess abdominal fat, a key indicator of health risk, impacts longevity.
Area of Science:
- Epidemiology
- Public Health
- Historical Medical Research
Background:
- The medical community has recently focused on adverse body-fat distribution, such as android and visceral fat.
- Nineteenth-century actuarial data from 34 North American insurance companies (1870-1899) examined body-fat distribution and mortality in men.
Observation:
- Risk classes were defined by weight-for-height or abdominal obesity (abdominal girth exceeding chest girth).
- Mortality rates for these risk classes were compared to period-specific actuarial tables.
- New analyses focus on the mortality impact of abdominal obesity within historical datasets.
Findings:
- Among 163,567 overweight men, abdominal obesity prevalence rose with age and degree of overweight.
- Moderately overweight men with abdominal obesity had 133% of expected mortality (vs. 112% without).
- Severely overweight men with abdominal obesity had 152% of expected mortality (vs. 135% without).
Implications:
- This 19th-century study was likely the first to demonstrate body-fat distribution's influence on longevity.
- Abdominal enlargement, not necessarily upper-body fat distribution, is a major health hazard.
- Future research should identify the abdominal obesity index that best predicts disease outcomes.
Abstract:
The health consequences of an adverse body-fat distribution (e.g., android, upper-body, visceral) have only recently concerned the medical community. Ninety years ago, however, actuarial study demonstrated the relationship of body-fat distribution to the mortality experience of insured, North American men. Thirty-four insurance companies pooled their data on males issued life policies between 1870 and 1899. Special classes of risk were defined by weight for height at baseline or by the observation that abdominal girth exceeded the girth of the expanded chest (abdominal obesity). The mortality experience of each risk class was compared to an age-stratified, actuarial table of the period. We present new analyses of these historical data relating specifically to the mortality impact of abdominal obesity. Among 163,567 overweight men, the prevalence of abdominal obesity increased with age and with degree of overweight. Among moderately overweight men, those with abdominal obesity experienced 133% of the expected mortality rate compared to 112% of the expected mortality for those who were not abdominally obese. Severely overweight men with abdominal obesity experienced 152% of the expected mortality compared to 135% of the expected mortality for severely overweight men who were not abdominally obese. We believe this nineteenth-century, acturial study of waist and chest girths was the first demonstration that body-fat distribution can influence longevity. These early actuarial findings, taken with more recent reports, establish that abdominal enlargement, but not necessarily an 'upper-body' fat distribution, constitutes a major health hazard. Future research must establish which abdominal-obesity index best predicts disease outcomes.