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Is There a Relationship Between Obesity and Respiratory Illnesses in Adults?

  • Authors: News Author: Terry L. Kamps, PhD; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 5/26/2023
  • Valid for credit through: 5/26/2024, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for primary care physicians, pulmonary medicine specialists, nurses, physician assistants, and other members of the healthcare team who care for adults at risk for chronic respiratory illness.

The goal of this activity is for learners to be better able to evaluate the relationship between body mass index (BMI), waist circumference (WC), and chronic respiratory illness.

Upon completion of this activity, participants will:

  • Assess the potential value of the clinical measurement of WC
  • Evaluate the relationship among BMI, WC, and chronic respiratory illness
  • Outline implications for the healthcare team


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News Author

  • Terry L. Kamps, PhD

    Freelance writer, Medscape


    Terry L. Kamps, PhD, has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: Boehringer Ingelheim; GlaxoSmithKline; Johnson & Johnson

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

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This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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Is There a Relationship Between Obesity and Respiratory Illnesses in Adults?

Authors: News Author: Terry L. Kamps, PhD; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 5/26/2023

Valid for credit through: 5/26/2024, 11:59 PM EST


Clinical Context

Approximately 42% of US adults have obesity as defined by a body mass index (BMI) of ≥ 30 kg/m2; yet a minority of these individuals actually do not have increased adiposity but instead have larger muscle mass. Waist circumference (WC) is a simple office-based tool that can more accurately distinguish abdominal obesity, but a study of more than 700,000 electronic health records among adults aged at least 40 years in Canada found that just 11.5% of patients had a WC recorded. This percentage increased to 23.7% among individuals who qualified for overweight or obesity by BMI.

A review by the International Atherosclerosis Society (IAS) and International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity recommends that waist circumference is important enough to become part of routine vital signs gathered on adult patients. Their statement, which was published in the February 4, 2020 issue of Nature Reviews Endocrinology[1]noted that mortality is increased with higher degrees of WC, regardless of BMI. In fact, when WC and BMI are considered as continuous variables in the same risk prediction model, WC become more predictive of adverse health events, whereas BMI weakens as a risk predictor. Waist circumference is most potent as a predictor of adverse outcomes after correction for BMI.

One of the negative health outcomes associated with elevated BMI is asthma and chronic respiratory symptoms. The current study by Kisiel and colleagues assessed the relationship between both BMI and WC and chronic respiratory illness among adults.

Study Synopsis and Perspective

A recent Swedish study found that both abdominal and general obesity were independently associated with respiratory illnesses, including asthma and self-reported chronic obstructive pulmonary disease (COPD).

Researchers assessed relationships between respiratory conditions with characterized obesity types in adults using self-report surveys from participants originally enrolled in the European Community Respiratory Health Survey (ECRHS) investigating asthma, allergy, and risk factors. The Respiratory Health in Northern Europe (RHINE) III provides a second follow-up substudy of ECRHS focused on 2 forms of obesity associated with respiratory illnesses.

Obesity is a characteristic risk factor linked to respiratory ailments such as asthma and COPD. High BMI and WC provide quantitative measurements for defining conditions of comprehensive general and abdominal obesity, respectively.

Although both types of obesity have been associated with asthma incidence, studies on their independent impact on this disease have been limited. Previous reports on abdominal obesity associated with asthma have been inconsistent when considering sexes in the analysis. In addition, COPD and related outcomes differed between abdominal and general obesity, indicating a need to discover whether self-reported WC abdominal obesity and BMI-based general obesity are independently associated with respiratory symptoms, early and late-onset asthma, COPD, chronic bronchitis, rhinitis, and sex, Marta A. Kisiel, MD, PhD, of the department of environmental and occupational medicine, Uppsala, Sweden, and colleagues wrote.

In a prospective study published in the journal Respiratory Medicine,[2] the researchers reported on a cross-sectional investigation of responses to a questionnaire similar to one used 10 years earlier in the RHINE II study. Questions required simple yes/no responses that covered asthma, respiratory symptoms, allergic rhinitis, chronic bronchitis, and COPD. Additional requested information included age of asthma onset, potential confounding variables of age, smoking, physical activity, and highest education level, weight and height for BMI calculation, and WC measurement with instructions and a provided tape measure.

The population of the RHINE III study conducted from 2010 to 2012 comprised 12,290 participants (53% response frequency) obtained from a total of 7 research centers located in 5 northern European countries. Obesity categorization classified 1837 (6.7%) participants as generally obese based on a high BMI ≥ 30 kg/m2 and 4261 (34.7%) as abdominally obese by WC measurements ≥ 102 cm for men and ≥ 88 cm for women. Of the 4261 total participants, 1669 met both general and abdominal obesity criteria. Mean age was in the low 50s range, and the obese population consisted of more women than men.

Simple linear regression revealed that BMI and WC were highly correlated, and both were associated with tested respiratory conditions when adjusted for confounding variables. Differences with respect to WC and BMI were independently associated with most of the examined respiratory conditions when WC was adjusted for BMI and vice versa. Neither early onset asthma nor allergic rhinitis were associated with WC, BMI, or abdominal or general obesity.

A significantly high proportion of individuals with general and abdominal obesity experienced a variety of defined respiratory symptoms, had asthma, chronic bronchitis, or COPD. An independent association of abdominal obesity (with or without general obesity) was found to occur with respiratory symptoms, asthma, late-onset asthma, and chronic bronchitis.

Adjusting for abdominal obesity, general obesity showed an independent and significant association with respiratory symptoms, asthma, adult-onset asthma, and COPD. An analysis stratified by sex indicated a significant association of abdominal and general obesity with asthma in women presented as an odds ratio (OR) of 1.56 (95% CI: 1.3, 1.87) and 1.95 (95% CI: 1.56, 2.43), respectively, compared with men, with an OR of 1.22 (95% CI: 0.97, 3.17) and 1.28 (95% CI: 0.97, 1.68), respectively. The association of abdominal and general obesity with COPD was also stronger in women compared with men.

The researchers concluded that "both general and abdominal obesity [were] independent of each other associated with respiratory symptoms in adults."

There is also a distinct difference between women and men for the association of self-reported asthma and COPD with abdominal and general obesity.

The large randomly selected sample size of participants from research centers located in 5 northern European countries was considered a major strength of this study, as it permitted simultaneous adjustment for multiple potential confounders. Several limitations were acknowledged, including absence of data on obstructive respiratory disease severity, WC measurements not being performed by trained staff, and self-reported height and weight measurements.

The authors have disclosed no relevant financial relationships.

Study Highlights

  • Investigators drew study data from the Respiratory Health in Northern Europe III cohort. This study was designed to assess the prevalence of respiratory symptoms and chronic respiratory illnesses among adults in Northern Europe.
  • Study participants completed a questionnaire regarding multiple respiratory symptoms in the past 12 months; the presence of asthma attacks or the use of asthma medications; and the presence of COPD, allergic rhinitis, and chronic bronchitis.
  • Participants performed their own measurements of BMI and WC. The main study analysis examined these variables and their impact on respiratory symptoms and conditions.
  • The study analysis was adjusted to account for smoking status, physical activity, and highest educational attainment.
  • 12,290 adults completed the study requirements. The mean age of participants was slightly older than 50 years, and the majority of the cohort was female.
  • 34.7% of participants had abdominal obesity, as defined by a WC ≥ 102 cm among men and ≥ 88 cm among women.
  • 6.7% of participants had obesity as defined by a BMI of ≥ 30 kg/m2; 13.6% of participants had obesity as defined by both BMI and WC.
  • Men were more likely to have obesity based on BMI, whereas women had higher rates of obesity based on WC.
  • Both elevated BMI and WC were associated with higher rates of wheezing and nocturnal dyspnea, as well as elevated prevalence rates of asthma, COPD, and chronic bronchitis.
  • Allergic rhinitis was less prevalent among participants among participants with abdominal obesity (high WC).
  • Abdominal obesity was not associated with COPD when adjusted for general obesity (high BMI), but it remained significantly associated with asthma, chronic bronchitis, and respiratory symptoms.
  • Neither form of obesity was associated with a higher risk for allergic rhinitis or early-onset asthma before the age of 18 years.
  • The association between general and abdominal obesity and prevalent COPD and asthma was significant among women but not men. In contrast, respiratory symptoms were more common among both women and men with general or abdominal obesity.
  • In analyses adjusted for BMI and WC, BMI appeared to have a stronger association with asthma and COPD vs WC.

Implications for the Healthcare Team

  • Among adults, mortality is increased with higher degrees of WC, regardless of BMI. In fact, when WC and BMI are considered as continuous variables in the same risk prediction model, WC become more predictive of adverse health events, whereas BMI weakens as a risk predictor. Therefore, a task force recommended routine inclusion of WC as part of the vital signs for adults; however, just 11.5% of adults in a Canadian study had WC recorded in their health record.
  • The current study by Kisiel and colleagues suggested that both elevated BMI and high WC are associated with increased respiratory symptoms and the prevalence of asthma, COPD, and chronic bronchitis. The association between obesity and the prevalence of asthma and COPD was significant among women but not men.
  • The healthcare team should consider routine measurement of WC and bear in mind its association with chronic respiratory illness.


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