Researchers take a new look at insurance data from the 1800s

Abdominally obese men living in the late 1800s were not only at higher risk for death than other overweight men, but their risk was acknowledged by insurance company statisticians -- half a century before it was acknowledged by the medical community, report obesity researchers in a recent issue of the International Journal of Obesity.

Researchers at the School of Medicine and the U.S. Centers for Disease Control and Prevention (CDC) plowed through data collected by 34 insurance companies that issued life insurance policies to men in the United States and Canada between 1870 and 1899. More than 163,000 policyholders were deemed overweight. Of the overweight men, those whose body fat was distributed around their abdomen had a higher risk of death than other overweight men. Among the severely overweight men, those with abdominal obesity had a 52 percent increased risk of death, whereas those without abdominal obesity had only a 35 percent greater risk compared to the general population.

"We believe this 19th-century, actuarial study of waist and chest girths was the first demonstration that body-fat distribution can influence longevity," said authors of the current study, Henry S. Kahn, associate professor of family and preventive medicine, and David F. Williamson of the Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC. "These early actuarial findings, taken with more recent reports, establish that abdominal enlargement, but not necessarily an `upper-body' fat distribution, constitutes a major health hazard."

Current population-based research confirms that decreased survival in persons with abdominal obesity is caused by cardiovascular diseases or by cancer.

"The mortality reports included in these (19th century) data could not have offered details on ischemic heart disease because they were collected more than a decade before the earliest clinical descriptions of myocardial infarction (heart attack)," according to the authors.

The early study also found an age-related pattern in the abdominally obese. "Abdom-inal obesity, at least among men, tends to increase with age and with the degree of overweight," the authors said. "The consistency with current data suggests that modern observations are not merely the result of culture or circumstances limited to the late 20th century."

The authors used the original study's definition to categorize men as abdominally obese; that is, if the girth of the abdomen is greater than the girth of the chest expanded.

"Adverse body-fat distributions have been described as `android' or `upper-body'" the authors said. "The lay press has pointed out the hazard of being shaped like an `apple' (as opposed to a `pear'). However, most scientific reports in this area have employed quantitative, anthropometric indices of body-fat distribution such as the waist-to-hip or the waist-to-thigh girth ratio."

The researchers also noted some interesting biases in the 19th century study. No information was collected on "tobacco use, blood pressure, habitual diet or other factors that could be related to blood lipid levels." The data almost exclusively related to white males; the class defined as `colored' comprised less than one percent of the insured group, and women were not included at all.

"It remains to be determined, however, if the regimens recommended for prevention of overweight (dietary change and increased physical activity) are the same as the regimens that will prevent abdominal obesity." Kahn said.

-- Lorri Preston