Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Porter Drive, Palo Alto, CA, 94304, USA.
MathurConsulting LLC, Woodside, CA, USA.
BMC Med. 2024 May 1;22(1):183. doi: 10.1186/s12916-024-03402-2.
Reducing overweight and obesity has been a longstanding focus of public health messaging and physician-patient interactions. Clinical guidelines by major public health organizations describe both overweight and obesity as risk factors for mortality and other health conditions. Accordingly, a majority of primary care physicians believe that overweight BMI (even without obesity) strongly increases mortality risk.
The current evidence base suggests that although both obese BMI and underweight BMI are consistently associated with increased all-cause mortality, overweight BMI (without obesity) is not meaningfully associated with increased mortality. In fact, a number of studies suggest modest protective, rather than detrimental, associations of overweight BMI with all-cause mortality. Given this current evidence base, clinical guidelines and physician perceptions substantially overstate all-cause mortality risks associated with the range of BMIs classified as "overweight" but not "obese." Discrepancies between evidence and communication regarding mortality raise the question of whether similar discrepancies exist for other health outcomes.
Health communication that inaccurately conveys current evidence may do more harm than good; this applies to communication from health authorities to health practitioners as well as to communication from health practitioners to individual patients. We give three recommendations to better align health communication with the current evidence. First, recommendations to the public and health practitioners should distinguish overweight from obese BMI and at this time should not describe overweight BMI as a risk factor for all-cause mortality. Second, primary care physicians' widespread misconceptions about overweight BMI should be rectified. Third, the evidence basis for other potential risks or benefits of overweight BMI should be rigorously examined and incorporated appropriately into health communication.
减少超重和肥胖一直是公共卫生信息传递和医患互动的长期重点。主要公共卫生组织的临床指南将超重和肥胖描述为死亡率和其他健康状况的风险因素。因此，大多数初级保健医生认为超重 BMI（即使没有肥胖）也会强烈增加死亡风险。
目前的证据基础表明，尽管肥胖 BMI 和消瘦 BMI 始终与全因死亡率增加相关，但超重 BMI（无肥胖）与死亡率增加没有明显关联。事实上，许多研究表明超重 BMI 与全因死亡率之间存在适度的保护而非有害的关联。鉴于目前的证据基础，临床指南和医生的看法大大夸大了被归类为“超重”但非“肥胖”的 BMI 范围内与全因死亡率相关的风险。关于死亡率的证据和沟通之间的差异提出了一个问题，即是否存在类似的差异对于其他健康结果。
不准确传达当前证据的健康传播可能弊大于利；这适用于从卫生当局向卫生从业者的传播，以及从卫生从业者向个别患者的传播。我们提出了三项建议，以更好地使健康传播与当前证据保持一致。首先，向公众和卫生从业者的建议应区分超重和肥胖 BMI，目前不应将超重 BMI 描述为全因死亡率的风险因素。其次，应纠正初级保健医生对超重 BMI 的广泛误解。第三，应严格审查超重 BMI 的其他潜在风险或益处的证据基础，并将其适当纳入健康传播。
