From 1999-2014,
obesity prevalence increased among adults and youth. Obese individuals may be uniquely susceptible to the proinflammatory effects of
ozone because obese humans and animals have been shown to experience a greater decline in lung function than normal-weight subjects.
Obesity is independently associated with limitations in lung mechanics with increased
ozone dose. However, few epidemiologic studies have examined the interaction between excess weight and
ozone exposure among adults. Using PubMed keyword searches and reference lists, we reviewed epidemiologic evidence to identify potential response-modifying factors and determine if obese or
overweight adults are at increased risk of
ozone-related health effects. We initially identified 170 studies, of which seven studies met the criteria of examining the interaction of excess weight and
ozone exposure on cardiopulmonary outcomes in adults, including four short-term
ozone exposure studies in controlled laboratory settings and three community epidemiologic studies. In the studies identified,
obesity was associated with decreased lung function and increased inflammatory mediators. Results were inconclusive about the effect modification when data were stratified by sex. Obese and
overweight populations should be considered as candidate at-risk groups for epidemiologic studies of cardiopulmonary health related to air pollution exposures. Air pollution is a modifiable risk factor that may decrease lung function among obese individuals with implications for environmental and occupational health policy.