Association of Obesity Severity With Cardiometabolic and Renal Disease Burden in the United States

Abstract

Objective: This study examined the association between obesity severity and cardiometabolic and renal disease, using BMI as a surrogate for obesity severity. Methods: This is a cross-sectional study using data from the United States Behavioral Risk Factor Surveillance System (BRFSS), 2011–2023. Survey-weighted logistic regression estimated odds ratios (OR) for the diagnosis of diabetes, hypertension, hyperlipidemia, kidney disease, myocardial infarction, stroke, and coronary artery disease among increasing BMI categories. Results: Higher BMI was associated with increased odds of all conditions. For BMI ≥ 50 kg/m2, odds were notably elevated for diabetes (OR 8.32; 95% CI: 7.78–8.91), hypertension (OR 6.07; 95% CI: 5.58–6.61), and kidney disease (OR 3.60; 95% CI: 3.21–4.03). The odds of cardiovascular disease also rose substantially, including myocardial infarction (OR 2.89; 95% CI: 2.56–3.28) and coronary artery disease (OR 3.44; 95% CI: 3.08–3.84). Mean age at diabetes diagnosis decreased with increasing BMI, from 52.2 years in Class I to 45.3 years in Class IV obesity. Conclusions: Obesity severity is incrementally associated with cardiometabolic and renal disease burden, particularly among adults with BMI ≥ 50 kg/m2. These findings highlight the urgent need for early, aggressive interventions targeting individuals with all classes of obesity.