title: Impact of body mass index on prevalence of multimorbidity in primary care: cohort study.
abstract: BACKGROUND
  Multimorbidity is the co-occurrence of long-term conditions. Obesity is associated with an increased risk of long-term conditions including type 2 diabetes and depression.
  
  
  OBJECTIVE
  To quantify the association between body mass index (BMI) category and multimorbidity in a large cohort registered in primary care.
  
  
  METHODS
  The sample comprised primary care electronic health records of adults aged ≥30 years, sampled from the Clinical Practice Research Datalink between 2005 and 2011. Multimorbidity was defined as the co-occurrence of ≥2 of 11 conditions affecting seven organ systems. Age- and sex-standardized prevalence of multimorbidity was estimated by BMI category. Adjusted odds ratios associating BMI with additional morbidity were estimated adjusting for socioeconomic deprivation and smoking.
  
  
  RESULTS
  The sample comprised 300 006 adults. After excluding participants with BMI never recorded, data were analysed for 223 089 (74%) contributing 1 374 109 person-years. In normal weight men, the standardized prevalence of multimorbidity was 23%, rising to 27% in overweight, 33% in category I obesity, 38% in category II and 44% in category III obesity. In women, the corresponding values were 28%, 34%, 41%, 45% and 51%. In category III obesity, the adjusted odds, relative to normal BMI, were 2.24 (2.13-2.36) for a first condition; 2.63 (2.51-2.76) for a second condition and 3.09 (2.92-3.28) for three or more conditions. In a cross-sectional analysis, 32% of multimorbidity was attributable to overweight and obesity.
  
  
  CONCLUSIONS
  Multiple morbidity is highly associated with increasing BMI category and obesity, highlighting the potential for targeted primary and secondary prevention interventions in primary care.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Helen P
authors.initials: HP
authors.lastname: Booth
authors.forename: A Toby
authors.initials: AT
authors.lastname: Prevost
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013851:Thinness / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology
keywords: Cardiovascular diseases; comorbidity; diabetes mellitus; family practice; obesity; primary health care.