Increases in multimorbidity with weight class in the United States

Abstract

Little is known regarding how multimorbidity combinations associated with obesity change with increase in body weight. This study employed data from the national Cerner HealthFacts Data Warehouse to identify changes in multimorbidity patterns by weight class using network analysis. Networks were generated for 154 528 middle-aged patients in the following categories: normal weight, overweight, and classes 1, 2, and 3 obesity. The results show significant differences (P-value<0.05) in prevalence by weight class for all but three of 82 diseases considered. The percentage of patients with multimorbidity (excluding obesity) increases from in 55.1% in patients with normal weight, to 57.88% with overweight, 70.39% with Class 1 obesity, 73.99% with Class 2 obesity, and 71.68% in Class 3 obesity, increasing most substantially with the progression from overweight to class 1 obesity. Most prevalent disease clusters expand from only hypertension and dorsalgia in normal weight, to add joint disorders in overweight, lipidemias in class 1 obesity, diabetes in class 2 obesity, and sleep disorders and chronic kidney disease in class 3 obesity. Recognition of multimorbidity patterns associated with weight increase is essential for true precision care of obesity-associated chronic conditions and can help clinicians identify and address preclinical disease before additional complications arise.

Keywords: multimorbidity; network analysis; precision care.

FIGURE 1

Networks of prevalent multimorbidity combinations for each weight class

FIGURE 2

Number of diseases by clinical disease category and weight class

FIGURE 3

Differences in cluster groupings by weight class. Labels represent the most central node in each cluster

FIGURE 4

Associations among prevalent multimorbidity clusters by weight class. A, Associations between pairs of adjacent weight class networks assessed by quadratic assignment procedure (QAP), and B, Similarity between disease clusters across weight classes assessed by normalized mutual information (NMI) scores

FIGURE 5

Evolution of multimorbidity network structure with increase in weight class. NW represents the communities the normal weight network, OW represents the overweight network, OC1 represents the class 1 obesity network, OC2 represents the class 2 obesity network, and OC3 represents the class 3 obesity network