Obesity and risk for death due to motor vehicle crashes

Seat belt use among overweight and obese adolescents

Motor vehicle crashes are the leading cause of death for adolescents. Previous studies with adults found an association between weight status and decreased use of seat belts. Research has also found significantly higher morbidity and mortality rates in obese individuals who are involved in motor vehicle crashes. If these relationships hold true in obese adolescents they represent additional risk factors for complications from motor vehicle trauma. Given the prevalence of obesity in adolescents (17.4%) and the increased risk of harm associated with obese individuals involved in motor vehicle crashes, this study explored whether there was an association between obesity in adolescents and their use of seat belts. Initial investigation found that rarely/never wearing seat belts was significantly greater for African Americans (22.6%), 18 years of age or older (19.4%), lived with adults other than both parents (15.7%), and males (15.4%). Bivariate logistic regression analysis controlling for demographic variables found that there was no statistically significant difference between overweight and normal weight adolescents. However, obese students were 1.72 times as likely as normal weight students to never or rarely wear their seat belts when riding in a car as a passenger. In particular, obese females and obese students in the middle school age ranges were statistically significantly more likely than normal weight students to never or rarely wear their seat belts.

Obesity, ergonomics and public health

Obesity within today's workforce is increasingly recognized as a challenge for both public health professionals and ergonomists. The two disciplines share a scientific, evidence-based approach to practice and now have the opportunity to address a common health issue, namely obesity. This paper shows, through an overview of the current literature, how and where obesity is impacting on the workplace and how the health of the workforce is being affected. Ergonomics and public health priorities have been mapped and challenges suitable for the application of existing knowledge and further research have been identified. Areas of common endeavour, for example how sedentary work may be exacerbating obesity, have been identified as candidate topics for joint activity by ergonomists and public health professionals.

Trauma in obese patients: implications for nursing practice

Recently, the impact of obesity on the outcomes of trauma patients has been the focus of several investigations. There have been several studies addressing the impact of obesity on trauma patients. These studies have explicated the impact of obesity on negative outcomes of trauma patients. Several studies have identified a relationship between obesity and injury pattern, increased complications in outcomes related to surgical procedures, and increase mortality and morbidity rates in obese trauma patients. However, the literature in nursing management in this patient population is virtually nonexistent and vague. The purpose of this article is to delineate the nursing implications of obesity in trauma patients and to provide guidelines for care of obese trauma patients.

Obesity and non-fatal motor vehicle crash injuries: sex difference effects

Background

Obesity and motor vehicle crash (MVC) injuries are two parallel epidemics in the United States. An important unanswered question is if there are sex differences in the associations between the presence of obesity and non-fatal MVC injuries.

Objectives

To further understand the association between obesity and non-fatal motor vehicle crash injuries, particularly the sex differences in these relations.

Methods

We examined this question by analyzing data from the 2003 to 2007 National Automotive Sampling System Crashworthiness Data System (NASS CDS). A total of 10, 962 drivers who were aged 18 years or older and who survived frontal collision crashes were eligible for study.

Results

Male drivers experienced a lower rate of overall non-fatal MVC injuries than did female drivers (38.1% vs. 52.2%) but a higher rate of severe injuries (0.7% vs. 0.2%). After adjusting for change in velocity (ΔV) during the crashes, obese male drivers showed a much higher risk [logistic coefficients of BMI for moderate, serious, and severe injury are 0.0766, 0.1470, and 0.1792, respectively; all p<0.05] of non-fatal injuries than did non-obese male drivers and these risks increased with injury severity. Non-fatal injury risks were not found to be increased in obese female drivers. The association between obesity and risk of non-fatal injury was much stronger for male drivers than for female drivers.

Conclusion

The higher risk of non-fatal MVC injuries in obese male drivers might result from their different body shape and fat distribution compared with obese female drivers. Our findings should be considered for obesity reduction, traffic safety evaluation and vehicle design for obese male drivers and provide testable hypotheses for future studies.

Influence of obesity on mortality of drivers in severe motor vehicle crashes

PURPOSE

The purpose of the study was to investigate the relationship between obesity and mortality of drivers in severe motor vehicle crashes involving at least one fatality.

BASIC PROCEDURES

Fatalities were selected from 155,584 drivers included in the 2000-2005 Fatality Analysis Reporting System. Drivers were stratified by body mass index, confounders were adjusted for, and multiple logistic regression was used to determine the odds ratio (OR) of death in each body mass index class compared with normal weight.

MAIN FINDINGS

The adjusted risk of death from lowest to highest, reported as the OR of death compared with normal weight with 95% confidence intervals, was as follows: (1) overweight (OR, 0.952; 0.911-0.995; P = .0293), (2) slightly obese (OR, 0.996; 0.966-1.026; P = .7758), (3) normal weight, (4) underweight (OR, 1.115; 1.035-1.201; P = .0043), (5) moderately obese (OR, 1.212; 1.128-1.302; P < .0001), and (6) morbidly obese (OR, 1.559; 1.402-1.734; P < .0001).

PRINCIPAL CONCLUSIONS

There is an increased risk of death for moderately obese, morbidly obese, and underweight drivers and a decreased risk in overweight drivers.

Bariatric trauma

The traumatised bariatric patient presents unique challenges and difficulties. Approximately 25% of adults in the United Kingdom are obese and 2% are morbidly obese. With an increasing incidence of obesity, understanding the specific challenges of managing the traumatised obese patient is vital for trauma practitioners.

Is there really a "cushion effect"?: a biomechanical investigation of crash injury mechanisms in the obese

The objective of this study was to document the motion and potential injury mechanisms of obese occupants in frontal car crashes compared to a control group of nonobese occupants in controlled laboratory impacts. Eight cadavers were divided into obese (n = 3) and a nonobese (n = 5) groups and exposed to a 48 km/h impact. High speed digital video documented the motion of the belted subjects. Compared to the nonobese cohort, the obese exhibited a characteristically different set of motions. As expected, the obese (heavier) subjects experienced greater maximum forward displacement (excursion) before their motion was arrested by the restraint. In addition, the obese exhibited a different distribution of excursions among body segments. The primary difference between the cohorts was substantially larger hip excursion in the obese (452 +/- 83 mm vs. 203 +/- 42 mm, P < 0.01), which was the proximate cause of a tendency of the obese cadavers' torsos to pitch forward less during impact. Some of the published epidemiology can be elucidated by the results reported here. The increased hip excursion and concomitant decreased torso pitch may reduce the risk of the head striking some component of the vehicle interior. Furthermore, the reclined torso during belt loading may increase the risk of rib and pulmonary trauma because the load is concentrated on the compliant and vulnerable lower thorax and less on the stiff upper ribs and clavicle. The lower extremities also experience increased excursion as a result of this hip excursion, and thus an increased risk of a hard contact and resulting injury.

BMI and risk of serious upper body injury following motor vehicle crashes: concordance of real-world and computer-simulated observations

BACKGROUND

Men tend to have more upper body mass and fat than women, a physical characteristic that may predispose them to severe motor vehicle crash (MVC) injuries, particularly in certain body regions. This study examined MVC-related regional body injury and its association with the presence of driver obesity using both real-world data and computer crash simulation.

METHODS AND FINDINGS

Real-world data were from the 2001 to 2005 National Automotive Sampling System Crashworthiness Data System. A total of 10,941 drivers who were aged 18 years or older involved in frontal collision crashes were eligible for the study. Sex-specific logistic regression models were developed to analyze the associations between MVC injury and the presence of driver obesity. In order to confirm the findings from real-world data, computer models of obese subjects were constructed and crash simulations were performed. According to real-world data, obese men had a substantially higher risk of injury, especially serious injury, to the upper body regions including head, face, thorax, and spine than normal weight men (all p<0.05). A U-shaped relation was found between body mass index (BMI) and serious injury in the abdominal region for both men and women (p<0.05 for both BMI and BMI(2)). In the high-BMI range, men were more likely to be seriously injured than were women for all body regions except the extremities and abdominal region (all p<0.05 for interaction between BMI and sex). The findings from the computer simulation were generally consistent with the real-world results in the present study.

CONCLUSIONS

Obese men endured a much higher risk of injury to upper body regions during MVCs. This higher risk may be attributed to differences in body shape, fat distribution, and center of gravity between obese and normal-weight subjects, and between men and women. Please see later in the article for the Editors' Summary.

Survival in fatal road crashes: body mass index, gender, and safety belt use

BACKGROUND

This study evaluated the associations of body mass index (BMI), gender, and use of safety belts with the survival of drivers involved in fatal road crashes.

METHOD

The census data of all U.S. fatal crashes that did not involve pedestrians, bicyclists, or motorcyclists were examined for an 11-year period.

RESULTS

If involved in a crash with one or more fatalities, the odds of female drivers being among the fatalities are 1.28 times higher than those of male drivers, and the odds of unbelted drivers being among the fatalities are 5.43 times higher than those of belted drivers. The relationship of survivability to BMI depends on the gender and safety belt use of the driver.

CONCLUSIONS

For male drivers, increased BMI appears beneficial when safety belts are used but detrimental when not used. For belted female drivers, normal BMI is associated with the lowest odds of being killed, and both increased and decreased BMIs increase the odds. For unbelted female drivers, no reliable trends were present among the BMI categories.

A noncontiguous 2-level spinal injury in a young female driver due to a 3-point seat belt restraint

OBJECTIVES

The purpose of this case is to describe noncontiguous fracture and dislocations of the thoracolumbosacral spine in a 23-year-old female driver with a 3-point seat belt restraint.

CLINICAL FEATURES

A 23-year-old woman presented to us after a motor vehicle accident while driving with a 3-point seat belt restraint. She was neurologically intact except for loss of motor function in the distribution of the L5 nerve root in the right lower limb. Computed tomography and magnetic resonance imaging showed fracture and dislocation of T3 with considerable retrolisthesis and complete anterolisthesis of L5 over the sacrum.

INTERVENTION AND OUTCOME

Both fractures were reduced and fixed with bone graft and instrumentation. She was discharged a month later without any further neurologic deterioration.

CONCLUSIONS

To our knowledge, this case is the first report in the literature of a seat belt safety restraint causing 2 noncontiguous fracture dislocations of the spine. Although the consensus is that seat belts can prevent most spine injuries, this case shows that the seat belt can be a contributor to spine injury. It shows that the shoulder-lap restraint can act as 2 fulcrums at the upper and lower bands causing 2 separate fracture dislocations. A thorough radiologic evaluation of the spine with respect to the clinical findings is mandatory in seat belt-restrained road traffic accidents cases.

Overweight children: are they at increased risk for severe injury in motor vehicle collisions?

BACKGROUND

Obesity is an epidemic in the United States. The relationship between traumatic injury and obesity in children is not well-studied. We hypothesized that overweight children suffer more severe injuries, different distributions of injuries and improper use of restraints in motor vehicle collisions.

METHODS

We conducted a secondary analysis of the CIREN database of motor vehicle collisions of subjects 2-17 years old. Overweight was defined as a BMI percentile for age >85%. Significant injury was an Injury Severity Score (ISS) >15 or an Abbreviated Injury Scale (AIS) score greater than one. Further analysis looked at injuries classified as head, trunk, or extremities and appropriateness of restraints. Odds ratios compared the overweight to lean groups.

RESULTS

335 subjects met inclusion criteria with 35.5% of cases being overweight. For significant injury, overweight cases had an odds ratio of 1.2 [95% CI: 0.8-1.9]. Analysis by AIS for overall significant injury and to specific body regions also did not show any significant associations. Overweight versus lean subjects had an odds ratio of 1.3 [95% CI: 0.8-2.1] for improper use of restraints.

CONCLUSIONS

We found no significant relationship between pediatric injury severity, distribution of injuries, or restraint use and being overweight. Limitations of this study were the small sample size in this database and the large number of unrestrained subjects.

Relationship between simple reaction time and body mass index

The aim was to establish the relationship between simple reaction time in motor response in young adults in relation to their body physique, as represented by body mass index. Forty-five young male participants were allocated to one of three anthropometric groups, based on their body mass index. Participants performed 100 reaction-time trials with instructions to move a joystick, as quickly as possible, as soon as they detected a single star appearing in the centre of a monitor. All data were statistically selected into seven intervals and data from the mode frequency interval were precisely analysed. Participants from the group with greater body mass index reacted significantly slower than others. We did not record group lateral differences based on simple reaction time in each selected group. We recommend for future researchers the importance of identification of the level of body mass index of participants prior to testing them for effectiveness of simple sensori-motor reactions.

A framework for the concurrent consideration of occupational hazards and obesity

Occupational hazards and obesity can lead to extensive morbidity and mortality and put great financial burden on society. Historically, occupational hazards and obesity have been addressed as separate unrelated issues, but both are public health problems and there may be public health benefits from considering them together. This paper provides a framework for the concurrent consideration of occupational hazards and obesity. The framework consists of the following elements: (i) investigate the relationship between occupational hazards and obesity, (ii) explore the impact of occupational morbidity and mortality and obesity on workplace absence, disability, productivity and healthcare costs, (iii) assess the utility of the workplace as a venue for obesity prevention programs, (iv) promote a comprehensive approach to worker health and (v) identify and address the ethical, legal and social issues. Utilizing this framework may advance the efforts to address the major societal health problems of occupational hazards and obesity.

Crash injury risks for obese occupants using a matched-pair analysis

OBJECTIVE

The automotive safety community is questioning the impact of obesity on the performance and assessment of occupant protection systems. This study investigates fatality and serious injury risks for front-seat occupants by body mass index (BMI) using a matched-pair analysis. It also develops a simple model for the change in injury risk with obesity.

METHODS

A simple model was developed for the change in injury risk with obesity. It included the normal mass (m) and stiffness (k) of the body resisting compression during a blunt impact. Stiffness is assumed constant as weight is gained (Delta m). For a given impact severity, the risk of injury was assumed proportional to compression. Energy balance was used to determine injury risks with increasing mass. NASS-CDS field data were analyzed for calendar years 1993-2004. Occupant injury was divided into normal (18.5 kg/m2 < or = BMI < 25.0 kg/m2) and obese (BMI > o= 30 kg/m2) categories. A matched-pair analysis was carried out. Driver and front-right passenger fatalities or serious injuries (MAIS 3+) were analyzed in the same crash to determine the effect of obesity. This also allowed the determination of the relative risk of younger (age < or = 55 years), older (age >55 years), male, and female drivers that were obese compared to normal BMI. The family of Hybrid III crash test dummies was evaluated for BMI and the amount of ballast was determined so they could represent an obese or morbidly obese occupant.

RESULTS

Based on the simple model, the relative injury risk (r) for an increase in body mass is given by: r = (1 + Delta m / m)(0.5). For a given stature, an obese occupant (BMI = 30-35 kg/m2) has 54-61% higher risk of injury than a normal BMI occupant (22 kg/m2). Matched pairs showed that obese drivers have a 97% higher risk of fatality and 17% higher risk of serious injury (MAIS 3+) than normal BMI drivers. Obese passengers have a 32% higher fatality risk and a 40% higher MAIS 3+ risk than normal passengers. Obese female drivers have a 119% higher MAIS 3+ risk than normal BMI female drivers and young obese drivers have a 20% higher serious injury risk than young normal drivers. This range of increased risk is consistent but broader than predicted by the simple injury model. The smallest crash test dummies need proportionately more ballast to represent an obese or morbidly obese occupant in the evaluation of safety systems. The 5% female Hybrid III has a BMI = 20.4 kg/m2 and needs 22 kg of ballast to represent an obese and 44.8 kg to represent a morbidly obese female, while the 95% male needs only 1.7 and 36.5 kg, respectively.

CONCLUSIONS

Obesity influences the risk of serious and fatal injury in motor vehicle crashes. The effect is greatest on obese female drivers and young drivers. Since some of the risk difference is related to lower seatbelt wearing rates, the comfort and use of seatbelt extenders should be examined to improve wearing rates. Also, crash testing with ballasted dummies to represent obese and morbidly obese occupants may lead to refined safety systems for this growing segment of the population.

The influence of body mass index on thoracic injuries in frontal impacts

For this study, a comprehensive analysis was performed to assess the influence of body mass index on thoracic injury potential. The data for this study were obtained from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) database for years 1993-2005. Obese occupants had a 26 and 33% higher risk of AIS > or = 2 and AIS > or = 3 thoracic injury when compared to lean occupants. The increased risk of AIS > or = 3 injury due to obesity was slightly higher for older occupants, but the influence of age was greater than that of obesity. The increase in injury potential was higher for unbelted obese occupants than unbelted. Non-parametric and parametric risk curves were developed to estimate the risk of thoracic injury based on occupant BMI, belt use and delta-V. Overall, increase in thoracic injury risk due to obesity is more prominent in males and older occupants and for occupants sustaining AIS > or = 3 thoracic injuries.

BMI and seatbelt use

OBJECTIVE

Seatbelt use among obese persons may be reduced because seatbelts are uncomfortable. We investigated the association between obesity and seatbelt use with data from the 2002 Behavioral Risk Factor Surveillance System Survey.

RESEARCH METHODS AND PROCEDURES

Multivariable logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs) for seatbelt use among overweight (BMI, 25.0 to 29.9), obese (BMI, 30.0 to 39.9), and extremely obese (BMI >or= 40.0) persons, relative to a non-overweight/non-obese reference group (BMI <or= 24.9), adjusted for age, race, gender, education, and state seatbelt law.

RESULTS

Adjusted odds ratios for seatbelt use were 0.89 (95% CI, 0.85 to 0.93) for overweight, 0.69 (0.66 to 0.73) for obese, and 0.45 (95% CI, 0.40 to 0.50) for extremely obese persons. Interaction effects were evident for all covariates, with stronger associations between increasing BMI and decreasing seatbelt use for women, increasing age, higher education, and residence in states with a secondary seatbelt law. There was a linear decrease in seatbelt use with increasing BMI for all subgroups except persons 18 to 24 years old.

DISCUSSION

Lack of seatbelt can be added to the list of risk factors associated with obesity. Effective preventive interventions are needed to promote seatbelt use among overweight and obese persons.

A comparison of the characteristics of injuries between obese and non-obese inpatients

OBJECTIVE

The objective was to compare characteristics of injuries between a sample of U.S. obese and non-obese inpatients.

METHODS

Discharge records from the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Use Project were analyzed to identify records including an International Classification of Diseases, Ninth Revision, Clinical Modification injury diagnosis code (ICD-9-CM). Records with an exclusive obesity comorbidity were isolated, and proportionate injury ratios with 95% confidence intervals were calculated to compare the demographics and injury characteristics between obese and non-obese persons hospitalized for an injury.

RESULTS

A total of 160,707 discharge records were analyzed. Type and cause of injury that required hospitalization were significantly associated with obesity status (p < 0.001). Sprains, strains, and dislocations represented significantly higher proportions of injury-related hospitalizations among obese persons compared with non-obese persons. By cause of injury, injuries among obese persons were more frequently due to falls, overexertion, and poisonings compared with non-obese persons.

DISCUSSION

Injuries that required hospitalization among obese persons may have injury characteristics distinct from injuries among non-obese persons.

Review of traffic accident cases presenting to an adult emergency service in Turkey

INTRODUCTION

Traffic accidents cause the death of millions in the world each year. Learning about the characteristics of the casualties involved in such accidents, which constitute a very important health problem, is essential in terms of measures to be taken. They may have substantial humanitarian and economic impact.

MATERIALS AND METHODS

In this study, injured patients who had been involved in traffic accidents presenting to the adult Emergency service of Gazi University Hospital (Ankara, Turkey) in the 3-month period between 1st of March and 31st of May 2006, were examined, and review of a range of factors including the effects of age, gender, mode of transport to the hospital, type and regions of injury, time of injury, and presence of factors such as alcohol and alike was undertaken.

FINDINGS

A total eight thousand and eight hundred patients presented to our emergency department within the study period. Two hundred and sixty-two (3%) of these patients were injuries sustained in crashes. 38.2% (100) of the patients were women, and 61.8% (162) were men. The most frequently presenting age group was the under-25 age group with 27.9%. The highest attendence in Emergency Medicine Departments due to crashes was the period between 18:00h and 24:00h, (34.4% (n=90)). The most frequent presentations were of those of patients sitting in the front seats (driver or passenger) with 48.5% (n=127). 60.3% (n=158) of the injured were conveyed to the hospital by the ambulances of the national emergency call system. The great majority of injuries (54.9%, n=149) were patients with multiple traumas- also involving the head and the neck regions. Alcohol levels were determined in 59.6% of the cases, and in 19 cases the alcohol level was found to be higher than the legal limit of 50mg/dL. 1.1% (n=3) of the injured cases died in the emergency service, 8.4% were hospitalized in relevant clinics, 0.8% were referred, and 89.7% (n=235) were followed-up in the emergency room for various periods of time, and then discharged.

CONCLUSION

Traffic accidents constitute a very important health problem for the public health. Treatment of the injured individuals, and losses from the work force are significant for developing countries like our country. Studies directed towards the causes of traffic accidents will play a very important role in determining the measures to decrease or prevent such crashes.

Associations between sociodemographics and safety belt use in states with and without primary enforcement laws

OBJECTIVES

secondary enforcement laws (police may issue a safety belt citation only if the vehicle has been stopped for another reason).

METHODS

We analyzed 2002 Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia. We performed multivariable, log-linear regression analyses to assess the effect of sociodemographic characteristics and safety belt laws on safety belt use. Analyses were stratified by the type of enforcement permitted by state laws.

RESULTS

Reported safety belt use was higher in states that had primary versus secondary enforcement laws, both overall and for each sociodemographic characteristic examined. Safety belt use was 85% in states that had primary enforcement laws and 74% in states that had secondary enforcement laws. Cross-sectional data suggested that primary enforcement laws may have the greatest effect on sociodemographic groups that reported lower levels of safety belt use.

CONCLUSIONS

Primary enforcement laws are an effective population-based strategy for reducing disparities in safety belt use and may, therefore, reduce disparities in crash-related injuries and fatalities.

The relationship between obesity and injuries among U.S. adults

PURPOSE

To quantify the relationship between body mass index (BMI) and rates of medically attended injuries by mechanism (overall, fall, motor vehicle, and sport-related) and by nature (strain/sprain, lower extremity fracture, and dislocations), and between BMI and injury treatment costs.

DESIGN

Cross-sectional analysis. SETTING. The noninstitutionalized population of the United States.

SUBJECTS

The 1999-2000, 2000-2001, and 2001-2002 waves of the Medical Expenditure Panel Survey, a large, nationally representative dataset, were combined to create the analysis sample. The final sample included 42,304 adults. MEASURES. Medically attended injury rates by mechanism and nature of injury and related treatment costs.

ANALYSIS

Logistic regressions were used to separately estimate the odds of sustaining any injury by mechanism or by nature for overweight (25 < BMI : 29.9) and three categories of obese individuals compared with those who were normal weight. A second set of regressions tested whether, given that an injury occurred, obese individuals had greater injury treatment costs. RESULTS. Slightly more than one in five adults sustain an injury each year that requires medical treatment. The odds of sustaining an injury are 15% (overweight) to 48% (Class III obesity) greater among those with excess weight. Conditional on sustaining an injury, BMI did not have a significant impact on injury treatment costs.

CONCLUSION

Our findings show a clear association between BMI and the probability of sustaining an injury. If increasing BMI is causing the rise in injury rates, then the incidence of injuries, including those related to falls, sprains/strains, lower extremity fractures, and joint dislocations, are likely to increase as the prevalence of obesity increases.

Short sleep is associated with obesity among truck drivers

Recent studies suggest that short-sleep duration is independently associated with obesity in the general population. The population of truck drivers is of particular interest, because they frequently work irregular shifts that in turn are associated with short-sleep duration. In addition, truck drivers have a high prevalence of sedentary habits, poor diet, and obesity. The present study aimed at verifying the association between sleep patterns and factors associated with obesity in this population. The study sample consisted in 4,878 truck drivers who participated in a campaign promoted by a highway company in the State of São Paulo, Brazil. This campaign offered highway truck drivers a medical and laboratorial evaluation. The truck drivers completed a questionnaire concerning demographic data, sleep duration, consumption of medications, and medical problems, such as diabetes, cardiopathy, and hypertension; as well as the Berlin questionnaire, which is able to discriminate low and high risk for obstructive sleep apnea. Blood samples were collected to measure glucose and cholesterol levels. Also, body weight and height were registered to calculate the body mass index (BMI). The mean age (+/-SD) of the truck drivers studied was 40+/-10 years. Out of the truck drivers analyzed, 28.3% (n = 1,379) had a BMI > or =30.0 Kg/m2 (obesity). Among the 4,878 drivers included in the study, 1,199 (24.6%) were on medications and 334 (6.8%) were diabetic. Drivers (26.9%) with the greater BMI had a short sleep length. The independent factors associated with obesity were sleep duration <8 h/day (OR = 1.24), age >40 years (OR = 1.20), glucose levels >200 (OR = 2.02), cholesterol levels >240 (OR = 1.57), snoring (OR = 1.74), and hypertension (OR = 2.14). Smoking was not associated with obesity (OR = 0.69), and diabetes was considered a control variable. In conclusion, this study supports the hypothesis that short sleep duration as well as age >40 years are independently associated with obesity. This particular combination (short-sleep duration and obesity) is independently associated with several healthcare problems, including high levels of cholesterol, glucose, snoring, and hypertension. However, due to the cross-sectional nature of this study, no cause-effect relationship can be drawn from these results.

Management of the obese trauma patient

Obese persons are more likely to be involved in vehicle accidents, probably because of the presence of sleep apnea. They are more likely to suffer chest, pelvis, and extremity fractures. Mildly overweight persons are less prone to intra-abdominal injury because of the protective effect of the abdominal fat, known as the cushion effect. Obese trauma patients are far more likely to develop in-hospital complications, especially pulmonary, renal, and thromboembolic complications. The BMI is an independent risk factor for morbidity and mortality after trauma. Because only limited data exist about the right clinical approach to obese trauma patients, it is necessary to rely on general knowledge about treating obese patients in the ICU. More research is needed to improve the treatment of obese trauma patients.