Person: Razak, Fahad
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Razak
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Fahad
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Razak, Fahad
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Publication Change in the Body Mass Index Distribution for Women: Analysis of Surveys from 37 Low- and Middle-Income Countries(Public Library of Science (PLoS), 2013) Razak, Fahad; Corsi, Daniel; Subramanian, SankaranBackground There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI≥25.0 kg/m2) and obese (BMI≥30.0 kg/m2). Previous analyses, however, have failed to report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points. Methods and Findings We used nationally representative surveys of women between 1991–2008, in 37 low- and middle-income countries from the Demographic Health Surveys ([DHS] n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37). Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution. Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight. Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings. Conclusions Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just average trends or single parameters.Publication Going beyond the disability-based morbidity definition in the compression of morbidity framework(Co-Action Publishing, 2014) Beltrán-Sánchez, Hiram; Razak, Fahad; Subramanian, S. V.Background: As originally proposed by Fries, conceptualizing morbidity solely through associated functional limitation/disability (FL/D) remains the most widely accepted metric to assess whether increases in longevity have been accompanied by a compression of morbidity. Objective: To propose a departure from a highly restrictive FL/D-based definition of “morbidity” to a broader view that considers the burden of chronic diseases even when no overt FL/D occur. Design: We outline three reasons why the current framework of compression of morbidity should be broadened to also consider morbidity to be present even when there are no overtly measurable FL/D. We discuss various scenarios of morbidity compression and morbidity expansion under this broader rubric of morbidity. Conclusion: The rationale to go beyond a purely FL/D-based definition of morbidity includes: (1) substantial damage from chronic disease that can develop prior to overt FL/D symptoms occurring; (2) multiple costs to the individual and society that extend beyond FL/D, including medication costs, health care visits, and opportunity costs of lifelong treatment; and (3) psychosocial and stress burden of being labeled as diseased and the consequence for overall well-being. Adopting this broader definition of morbidity suggests that increases in longevity have been possibly accompanied by an expansion of morbidity, in contrast to Fries’ original hypothesis that morbidity onset (based on only FL/D) would be delayed to a greater extent than increases in survival. There is an urgent need for better data and more research to document morbidity onset and its link with increases in longevity and assess the important question on whether populations while living longer are also healthier.Publication Urban Development in Sub-Saharan Africa: Bearer of Goods and Risks(Public Library of Science, 2014) Razak, Fahad; Berkman, LisaFahad Razak and Lisa Berkman discuss the implications of the study by Riha and colleagues for research into urbanization and the development of noncommunicable diseases. Please see later in the article for the Editors' SummaryPublication Patterns of Weight Gain in Middle-Aged and Older US Adults, 1992–2010(Lippincott Williams & Wilkins, 2015) Stenholm, Sari; Vahtera, Jussi; Kawachi, Ichiro; Pentti, Jaana; Halonen, Jaana I.; Westerlund, Hugo; Razak, Fahad; Subramanian, S. V.; Kivimäki, MikaBackground: Cross-sectional analyses of national data have found that persons with high baseline body mass index (BMI) gain weight faster than persons at the median and that those whose weight was below the median gain very little weight. However, it is not clear whether these population-level changes reflect patterns at the individual level. Methods: We examined longitudinal changes in BMI in initially underweight, normal-weight, overweight, and obese US men and women using individual-level repeat data from the Health and Retirement Study (n = 15,895; age range, 40–69 years at baseline). Linear mixed-effect regression was used to model 6-year change in self-reported BMI during 4 study periods (1992/1994–1998/2000, 1996/1998–2002/2004, 2000/2002–2006/2008, and 2004–2010). Results: In the first 6-year period, the mean increase in BMI was greatest among persons who were initially normal weight (0.3 kg/m2 [95% confidence interval = 0.2 to 0.4]) and overweight (0.2 kg/m2 [0.1 to 0.3]). Weight gain accelerated in these groups with each subsequent period. Weight gain was less for initially class-I obese participants, and a net decrease in BMI was observed for class-III obese participants. Conclusion: These analyses suggest that the change in mean BMI among middle-aged and older US adults between 1992 and 2010 resulted mainly from accelerated weight gain among persons who were initially normal weight and overweight.