SUMMARY The relationship between the degree of obesity and the incidence of cardiovascular disease (CVD) THE IMPORTANCE of body weight, body mass and other measures of adiposity in the prediction of cardiovascular disease (CVD) has been the subject of longstanding debate. Many studies have shown that the incidence of certain types of CVD, particularly coronary heart disease and stroke, is greater in heavier persons,'`but only a few suggest that any obesity index makes an additional contribution to risk once the levels of coexisting risk factors are taken into account. '.2'4 Obesity is associated with elevated blood pressure, blood lipids and blood glucose,7 1 and changes in body weight are coincident with changes in these risk factors for disease.", 113 Thus, the consensus has been that the increased risk among heavier persons is due primarily to the influence of the associated risk factor profile and not to the degree of obesity per se. The existing data have also been interpreted to suggest that obesity is benign when it exists without other major risk factors for CVD.In this report, we reexamine the obesity question and describe the influence of relative weight on the 26-year incidence of CVD in Framingham men and women. Earlier results from this study suggested that the degree of obesity is not a potent independent risk factor for CVD in general, particularly among women. 14, 15 However, these conclusions were based on analyses of the influence of relative weight over shorter periods of follow-up and may not have conveyed the true impact of disease risk.Such a reevaluation appears timely in view of the current revisions to the original Metropolitan Life In-

Smoking, body-mass index, and exercise patterns in midlife and late adulthood are predictors of subsequent disability. Not only do persons with better health habits survive longer, but in such persons, disability is postponed and compressed into fewer years at the end of life.

Greater prevalence of nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis and depression, contributes substantially to greater disability and diminished quality of life among aging women compared with men.

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