The European Association for the Study of Obesity (EASO) recently introduced a new framework to define obesity that incorporates anthropometric measures beyond body mass index (BMI) and clinical comorbidities. However, this framework has not been validated. To describe the distribution of overweight and obesity and determine the prevalence of complications and association of obesity with all-cause mortality using BMI categories and the new EASO framework. Cross-sectional and longitudinal analysis. NHANES (National Health and Nutrition Examination Survey) from 1999 to 2018 linked to mortality data. A representative sample of the adult population in the United States aged 18 to 79 years. Obesity defined using BMI categories was compared with the new EASO definition. The study population included 44 030 adults. On the basis of the new EASO definition, 18.8% of adults who were previously defined as overweight based on BMI alone were now considered persons with obesity (PWO). Similar mortality risk was found among the newly identified PWO and persons with normal weight (hazard ratio [HR], 0.98 [95% CI, 0.87 to 1.10]), whereas higher risk was seen among persons with BMI of 30 kg/m² or greater (HR, 1.19 [CI, 1.08 to 1.32]). However, when compared with persons with normal weight who did not have major morbidities, a higher risk was seen among the newly identified PWO (HR, 1.50 [CI, 1.20 to 1.88]), although this higher risk was no greater than the higher risk seen among persons with normal weight and comorbidities (HR, 1.74 [CI, 1.34 to 2.22]). Excess risk was seen among PWO compared with persons with overweight according to both the new EASO framework and the traditional BMI definition. The most prevalent complications among the newly identified PWO were hypertension (79.9%), arthritis (33.2%), diabetes (15.6%), and cardiovascular disease (10.5%). Residual confounding; body weight assessed at a single time point. The new EASO framework may provide a more sensitive tool to diagnose obesity than the traditional BMI definition, but whether these newly identified adults with obesity would benefit comparably to obesity treatment as those traditionally included in treatment trials is uncertain. Ariel University and the Holon Institute of Technology, Israel.

Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce.

With increasing diabetes prevalence worldwide, an impending diabetes “pandemic” has been reported. However, definitions of incident cases and the population at risk remain varied and ambiguous. This study analyzed trends in mortality and screening that contribute to diabetes prevalence and incidence, distinguishing between new incident cases and newly detected cases. In an integrated provider-and-payer-system covering 53% of Israel’s population, a composite diabetes case-finding algorithm was built using diagnoses, lab tests, and antidiabetic medication purchases from the organization’s electronic medical record database. Data were extracted on adult members aged 26+ each year from January 1, 2004 through December 31, 2012. Rates of diabetes prevalence, incidence, screening, and mortality were reported, with incidence rates evaluated among the total, “previously-screened,” and “previously-unscreened” at-risk populations. There were 343,554 diabetes cases in 2012 (14.4%) out of 2,379,712 members aged 26+. A consistent but decelerating upward trend in diabetes prevalence was observed from 2004-2012. Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002). Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004). The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable. The increase in diabetes prevalence is decelerating despite declining mortality and increasing testing rates. A decline in previously-screened incident cases and a shrinking pool of previously-unscreened members suggests that diabetes trends in Israel are moving toward equilibrium, rather than a growing epidemic.