Okosun I S, Choi S, Matamoros T, Dever G E
Department of Community Medicine, Mercer University School of Medicine, 1550 College Street, Macon, GA 31207, USA.
Prev Med. 2001 May;32(5):429-36. doi: 10.1006/pmed.2001.0840.
Although the evidence linking obesity with many chronic diseases is well established, the relationship with self-rated health is not clear. Self-rating of health is a broad summary measure of different domains of health that include psychosocial domain. The aims of this study were to examine the relationship between obesity and self-rated health and the degree of agreement between patients' self-rated health status and physicians' impression of patients' health in a representative sample of healthy noninstitutionalized American adults.
Data (n = 10, 298) used for this analysis were obtained from the Third National Health and Nutrition Examination Survey. Normal weight was defined as BMI 18.5-24.9 kg/m(2) and preobesity was defined as BMI 25-29.9 kg/m(2). Moderate (class I) obesity was defined as BMI 30-34.9 kg/m(2) and severe (class II) obesity as BMI > or =35 kg/m(2). Self-rated health conditions were categorized as excellent, very good, good, fair, or poor. Agreement between physicians' impression and self-rated health and a linear relationship between obesity and individual perceived health were quantified using kappa and gamma statistics, respectively. Using the logistic regression analysis, odds of reporting reduced health in preobese, class I obese, and class II obese individuals were compared with those for normal-weight individuals, adjusting for age, current smoking, and alcohol intake. The contribution of obesity to ethnic differences in reduced self-rated health was determined by comparing blacks with whites and Hispanics with whites fitted in multiple logistic regression models.
Among both men and women, there was a statistically significant linear association between obesity and self-rated health (P < 0.05). The proportion of subjects reporting excellent health tended to decrease with increasing level of obesity in the three ethnic groups. In the three ethnic groups, the degrees of concordance between self-rated health and physicians' impressions were poor and decreased with increasing obesity level. In each ethnic group, class II obesity was associated with approximately twofold increased odds of reporting reduced health compared with normal-weight individuals. Compared to whites, black and Hispanic races/ethnicities were respectively associated with 23 and 175% increased odds of reduced self-rated health among men. The corresponding values for women were 45 and 177%, respectively.
The results of this study provide evidence that obesity has a negative impact on self-rated health among adults, even in the absence of chronic disease conditions. The results of this investigation also underscore the need to craft national preventive strategies to curb obesity in these at-risk population groups.
尽管肥胖与许多慢性疾病之间的关联已有充分证据，但肥胖与自我评估健康状况之间的关系尚不清楚。自我评估健康状况是对包括心理社会领域在内的不同健康领域的广泛综合衡量。本研究的目的是在具有代表性的健康非机构化美国成年人样本中，研究肥胖与自我评估健康状况之间的关系，以及患者自我评估健康状况与医生对患者健康状况印象之间的一致程度。
用于本分析的数据（n = 10298）来自第三次全国健康和营养检查调查。正常体重定义为体重指数（BMI）18.5 - 24.9 kg/m²，超重定义为BMI 25 - 29.9 kg/m²。中度（I类）肥胖定义为BMI 30 - 34.9 kg/m²，重度（II类）肥胖定义为BMI≥35 kg/m²。自我评估健康状况分为优秀、非常好、好、一般或差。医生的印象与自我评估健康状况之间的一致性以及肥胖与个体感知健康之间的线性关系分别使用kappa和gamma统计量进行量化。使用逻辑回归分析，将超重、I类肥胖和II类肥胖个体报告健康状况下降的几率与正常体重个体进行比较，并对年龄、当前吸烟情况和饮酒量进行调整。通过比较纳入多元逻辑回归模型的黑人和白人以及西班牙裔和白人，确定肥胖对自我评估健康状况下降的种族差异的影响。
在男性和女性中，肥胖与自我评估健康状况之间均存在统计学上显著的线性关联（P < 0.05）。在三个种族群体中，报告健康状况优秀的受试者比例往往随着肥胖程度的增加而下降。在这三个种族群体中，自我评估健康状况与医生印象之间的一致程度较差，且随着肥胖程度的增加而降低。在每个种族群体中，与正常体重个体相比，II类肥胖个体报告健康状况下降的几率增加了约两倍。与白人相比，黑人男性和西班牙裔男性自我评估健康状况下降的几率分别增加了23%和175%。女性的相应数值分别为45%和177%。
本研究结果提供了证据，表明即使在没有慢性病的情况下，肥胖对成年人的自我评估健康状况也有负面影响。本调查结果还强调了制定国家预防策略以遏制这些高危人群肥胖的必要性。
