Visscher T L S, Heitmann B L, Rissanen A, Lahti-Koski M, Lissner L
1] Research Centre for the Prevention of Overweight (Zwolle), Windesheim University of Applied Sciences and VU University, Zwolle, The Netherlands [2] Institute of Health Sciences, VU University, Amsterdam, The Netherlands [3] Prevention and Public Health Taskforce, European Association for the Study of Obesity, London, UK.
1] Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark [2] National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark [3] The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.
Int J Obes (Lond). 2015 Feb;39(2):189-98. doi: 10.1038/ijo.2014.98. Epub 2014 Jun 9.
Recent epidemiologic papers are presenting prevalence data suggesting breaks and decreases in obesity rates. However, before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) ⩾25 or ⩾30 kg m(-)(2) is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI. Studies concluding that there is a recent break in the obesity epidemic need to be interpreted with caution. Reported studies presenting a break were mostly of short duration. Further, focusing on trends in waist circumference rather than BMI leads to a less optimistic conclusion: the public health problem of obesity is still increasing.
近期的流行病学论文公布了患病率数据，显示肥胖率出现停滞和下降。然而，在得出肥胖流行不再加剧的结论之前，应更全面地讨论所公布数据的有效性。我们仔细研究了近期综述中所呈现的文献，以探讨主要的潜在偏差和失真情况，并深入了解如何解读所提出的肥胖流行可能出现停滞的观点。参与率下降、使用报告而非测量数据、样本量小或缺乏代表性，似乎都无法解释肥胖流行中所呈现的停滞现象。此外，现有证据并不表明仅在社会经济地位较高的群体中肥胖率趋于稳定，也不表明城市化能够解释肥胖流行可能出现的停滞。然而，短期随访可能在一定程度上解释了肥胖流行中明显的停滞或下降现象。另一方面，单纯关注体重指数（BMI）≥25或≥30 kg·m⁻²可能会掩盖肥胖流行的实际加剧情况。而且，在儿童和成人中，腰围趋势总体上呈上升态势，且比BMI趋势更为明显。得出近期肥胖流行出现停滞结论的研究需要谨慎解读。报告显示出现停滞的研究大多持续时间较短。此外，关注腰围趋势而非BMI会得出不那么乐观的结论：肥胖的公共卫生问题仍在加剧。
