Neovius K, Johansson K, Rössner S, Neovius M
Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Obes Rev. 2008 Nov;9(6):572-81. doi: 10.1111/j.1467-789X.2008.00502.x. Epub 2008 Jun 1.
Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)-disability pension relation. In cross-sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J-shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle-aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.
在许多国家，残疾抚恤金会带来巨大的社会成本。在瑞典，导致此类生产力损失的三大主要因素是肌肉骨骼疾病、循环系统疾病和精神疾病，所有这些都与体重状况密切相关。我们确定了16项研究体重指数（BMI）与残疾抚恤金关系的研究。在横断面研究中，与正常体重的受试者相比，肥胖者中残疾抚恤金领取者的比例明显更高。在纵向研究中，不同年龄段的男性和女性普遍发现BMI与残疾抚恤金呈J形关系。肥胖状态的不同定义使解释变得复杂，因为几项研究将体重过轻和正常体重的人群混在一起，而这两类人群似乎有着不同的残疾抚恤金风险。在中年男性中，仅超重和肥胖人群因循环系统疾病导致的相对风险升高，而体重过轻和超重人群因精神疾病导致的关联相似，但肥胖人群的关联要高得多。在男女两性中，循环系统疾病导致的风险呈单调增加，呼吸系统疾病导致的风险呈单调下降。在干预研究中，手术后报告了残疾抚恤金发生率降低和有酬就业率提高的情况。总之，BMI与残疾抚恤金显著相关，但因果关系的方向可能因潜在病因而异。干预措施对病态肥胖者有积极的生产力影响，但对超重者是否如此仍有待证实。
