Sturm R
RAND, 1776 Main Street, Santa Monica, CA 90401, USA.
Public Health. 2007 Jul;121(7):492-6. doi: 10.1016/j.puhe.2007.01.006. Epub 2007 Mar 30.
It is well known that citizens of developed countries are more likely to be overweight than they were 20 years ago. The most serious health problems are not associated with overweight or moderate obesity, however, but with clinically severe or morbid obesity (e.g. more than 100 pounds (45kg) overweight). There is no reason to expect that morbid obesity trends parallel overweight or moderate obesity. If morbid obesity is a rare pathological condition that has biological causes, the more than 10-fold increase in bariatric surgery procedures over the past eight years in the USA could have even lowered the prevalence of morbid obesity-and may very well stem the problem in other countries.
To estimate trends for extreme weight categories (BMI>40 and >50) for the period between 1986 and 2005 in the USA, and to investigate whether trends have changed since 2000.
Data from The Behavioral Risk Factor Surveillance System (a random-digit telephone survey of the household population of the USA), for the period from 1986 to 2005, were analysed. The main outcome measure was body mass index (BMI), calculated from self-reported weight and height.
From 2000 to 2005, the prevalence of obesity (self-reported BMI over 30) increased by 24%. However, the prevalence of a (self-reported) BMI over 40 (about 100 pounds (45kg) overweight) increased by 50% and the prevalence of a BMI over 50 increased by 75%, two and three times faster, respectively. The heaviest BMI groups have been increasing at the fastest rates for 20 years.
The prevalence of clinically severe obesity is increasing at a much faster rate among adults in the USA than is the prevalence of moderate obesity. This is consistent with the public health idea that the population weight distribution is shifting, which disproportionately increases extreme weight categories. Because comorbidities and resulting service use are much higher among severely obese individuals, the widely published trends for overweight/obesity underestimate the consequences for population health. The aggressive and costly expansion of bariatric surgery in recent years has had no visible effect on containing morbid obesity rates in the USA.
众所周知，发达国家的公民比20年前更易超重。然而，最严重的健康问题并非与超重或中度肥胖相关，而是与临床重度或病态肥胖（如超重超过100磅（45千克））有关。没有理由认为病态肥胖趋势与超重或中度肥胖趋势平行。如果病态肥胖是一种由生物学原因导致的罕见病理状况，那么美国在过去八年中减肥手术数量超过10倍的增长甚至可能降低了病态肥胖的患病率——而且很可能在其他国家遏制这一问题。
估计1986年至2005年期间美国极端体重类别（体重指数>40和>50）的趋势，并调查自2000年以来趋势是否发生了变化。
分析了1986年至2005年期间来自行为危险因素监测系统（对美国家庭人口进行的随机数字电话调查）的数据。主要结局指标是根据自我报告的体重和身高计算得出的体重指数（BMI）。
从2000年到2005年，肥胖（自我报告的BMI超过30）患病率增加了24%。然而，（自我报告的）BMI超过40（约超重100磅（45千克））的患病率增加了50%，BMI超过50的患病率增加了75%——分别快了两倍和三倍。最肥胖的BMI组在20年里增长速度最快。
在美国成年人中，临床重度肥胖的患病率增长速度比中度肥胖的患病率快得多。这与人口体重分布正在变化的公共卫生观点一致，这种变化不成比例地增加了极端体重类别。由于重度肥胖个体的合并症和由此产生的医疗服务使用要高得多，广泛公布的超重/肥胖趋势低估了对人群健康的影响。近年来减肥手术的积极且昂贵的扩张在美国对遏制病态肥胖率没有产生明显效果。
