Identifying high-risk groups for change in weight and body mass index: population cohort of 11 million measurements in 2.3 million adults

Katsoulis, M.; Lai, A.; Diaz-Ordaz, K.; Gomes, M.; Pasea, L.; Banerjee, A.; Denaxas, S.; Tsilidis, K.; Lagiou, P.; Misirli, G.; Bhaskaran, K.; Wannamethee, G.; Dobson, R.; Batterham, R.; Kipourou, D.-K.; Lumbers, R. T.; Wareham, N. J.; Langenberg, C.; Hemingway, H.

Background: Adult obesity prevention policies, which are largely untargeted, have met with limited success globally. Population groups with the highest risk of weight gain, if they could be reliably identified using readily available information, might benefit from targeted policy. The relative importance of age, sex, ethnicity, geographical region and social deprivation for weight gain is unknown. Methods: We calculated longitudinal changes in BMI over one, five and ten years and investigated transition between BMI categories using 11,187,383 clinically recorded, repeated measures of BMI from population-based electronic health records of 2,328,477 adults in England (1998- 2016). The influence of risk factors was tested using logistic regression. Findings: The youngest adult age group (18-24 years) was more strongly associated with risk of weight gain than older age, male sex, socioeconomic deprivation, ethnicity or geographic region. Among the youngest adults, the top quartile gained 15.9kg in men and 12kg in women at 10 years. The odds of transitioning to a higher BMI category over 10 years were 4-6 times higher in the youngest (18-24 years) compared to oldest (65-74 years) individuals; odds ratio (95% confidence interval) 4.22 (3.85-4.62)) from normal weight to overweight or obesity, 4.60 (4.06-5.22) for overweight to obesity, and 5.87 (5.23-6.59) from obesity to severe obesity in multiple adjusted analyses. Among the youngest adults, socially deprived men were at greater risk of transitioning from normal weight to overweight (72%) and from overweight to obesity (68%) over 10 years. We provide an open access online risk calculator (https://pasea.shinyapps.io/bmi_shiny_app/) and present high resolution obesity risk charts over a 1-, 5- and 10-year follow-up. Interpretation: A radical shift in policy is required to focus on those at highest risk of weight gain - young adults - for individual and population level prevention of obesity and its long-term consequences for health and health care.