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Within-Pair Association Between Central Obesity and the Onset of General Obesity Over 17 Years Among Male Twins Discordant for Incident Obesity: Implications for Osteopathic Manipulative Treatment in Obesity Management

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A697–698. doi: Subito , type of study: case control study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

case control study [54]
male [831]
obesity [26]
twins [4]

Abstract:

Context: In U.S. clinical practice, a body mass index (BMI) ≥ 30 kg/m2 is typically used to classify adult general obesity. However, it has been shown that adult central obesity, defined as a waist circumference ≥ 102 cm, is a better biomarker of metabolic health (1). Additionally, measuring waist circumference in addition to BMI in clinical practice has been shown to provide additional insight into health than measuring BMI alone (1). Increased waist circumference, along with metabolic health, can also be used to predict a number of musculoskeletal strains on the human body: previous studies have demonstrated that waist circumference is positively correlated with low back pain intensity in obese patients (2), and that an increased waist-hip ratio and obesity are positively correlated with an increased lumbosacral angle, lumbar lordosis angle, sacral inclination angle, and lumbosacral disc angle (3). These findings highlight the structural dysfunctions that obesity, both general and central, can exert on patients, and these dysfunctions can strongly benefit from osteopathic manipulative treatment (OMT). For instance, OMT can increase the thoracic range of motion, as well as decrease pain and disability from chronic low back pain (4). A previous Australian study found that over twelve years, the incidence of central obesity defined by waist circumference (31.8%) was significantly high compared to general obesity defined with BMI (15.0%) (5); however, it remains unclear if central obesity and waist circumference were associated with the later onset of general obesity when controlling for familial influences that includes genetic impact. Therefore, we aimed to address this unclear research issue in a prospective study of twins discordant for incident general obesity. The insights from our study could guide osteopathic physicians in integrating targeted OMT to address abdominal fat-induced structural dysfunctions as part of a holistic approach to obesity management. Objective: To evaluate the prospective association of central obesity with the later onset of general obesity among Caucasian adult men independent of familial factors. Methods: Twelve monozygotic (MZ) and fourteen dizygotic (DZ) pairs of Caucasian adult male twins discordant for incident general obesity, defined as BMI ≥ 30 kg/m2, were included from the U.S. National Heart, Lung, and Blood Institute Twin Study if discordance occurred after exam 3 in the mid-1980s through 2003, and data on both waist circumference and DNA samples at exam 3 were available. Weight and height were measured at each exam of six exams to calculate BMI: exam 1 (1969-1973), exam 2 (1981–1982), exam 3 (1986–1987), exam 4 (1995–1997), exam 5 (1999–2001), and exam 6 (2001-2003). Adult central obesity was defined as a waist circumference ≥ 102 cm. This discordant twin study design was a specific nested 1:1 matched case-control study. The exact conditional logistic regression model was performed to evaluate the association of central obesity and a continuous waist circumference at exam 3 with incident obesity developed after exams 3 through 6. The statistical significance level was set at α = 0.20 to minimize false negative tests resulting from the small sample size. The R version 4.5.0 software was used to perform all statistical analyses. Results: Among 26 combined MZ and DZ twin pairs, co-twins who were centrally obese at exam 3 had 9 times as fast to develop general obesity over the following 17 years compared to their co-twin brothers without central obesity [hazard ratio (HR) 9 (80% CI 2.33 – 34.8)], independent of familial factors. Additionally, the HR for each 1-cm increase in waist circumference was 1.22 (80% CI 1.11 –1.35) for developing general obesity, independent of familial factors. Conclusion: Central obesity and a higher continuous waist circumference are associated with a higher 17-year risk for incident general obesity, respectively, independent of familial factors. Our findings support the importance of considering central obesity, even in patients who are not generally considered obese in osteopathic practice, and also reinforce the tenet of osteopathic medicine that the body is a unit. Our findings warrant further investigation into the effectiveness of OMT as part of holistic obesity management that includes targeted OMT to address the biomechanical consequences of abdominal fators.


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