Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis
Guideline recommendations and health policy decisions rely on evidence from clinical and epidemiological studies. Adequate methodology and appropriate conclusions are essential to support healthcare and health policy decisions. An analysis of body mass index and mortality by the Global BMI Mortality...
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| Format: | Article |
| Language: | English |
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Wiley
2019-02-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jcsm.12378 |
| _version_ | 1797205028865310720 |
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| author | Katherine M. Flegal John P.A. Ioannidis Wolfram Doehner |
| author_facet | Katherine M. Flegal John P.A. Ioannidis Wolfram Doehner |
| author_sort | Katherine M. Flegal |
| collection | DOAJ |
| description | Guideline recommendations and health policy decisions rely on evidence from clinical and epidemiological studies. Adequate methodology and appropriate conclusions are essential to support healthcare and health policy decisions. An analysis of body mass index and mortality by the Global BMI Mortality Collaboration (GBMC) concluded that the association of excess body weight with higher mortality was similar worldwide and that overweight and obesity should be combated everywhere. To reach this conclusion, the GBMC used highly selected data, rather than a systematic approach. The GBMC initially chose individual participant data from 239 prospective studies with approximately 10.6 million participants. The GBMC then excluded over 60% of data and over 75% of fatal events by eliminating all cases with any reported disease at baseline or smoking history and all events within the first 5 years of follow‐up. After applying these restrictions, the association of overweight with lower mortality was reversed and the association of obesity with higher mortality was increased. Given the major flaws in the selection process, in the adequacy of the data, in the data analysis, and in the interpretation, the GBMC conclusions should be viewed sceptically as a guide to action, either for clinical decisions or for public health in general. The flawed conclusion that overweight is uniformly associated with substantially increased risk of death and thus should be combated in any circumstances may lead not only to unjustified treatment efforts and potential harm in a wide range of clinical conditions but also to a tremendous waste of resources. |
| first_indexed | 2024-04-24T08:44:37Z |
| format | Article |
| id | doaj.art-b9d6353b7ffc4f4eadf3194765a848f2 |
| institution | Directory Open Access Journal |
| issn | 2190-5991 2190-6009 |
| language | English |
| last_indexed | 2024-04-24T08:44:37Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj.art-b9d6353b7ffc4f4eadf3194765a848f22024-04-16T14:04:57ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092019-02-0110191310.1002/jcsm.12378Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysisKatherine M. Flegal0John P.A. Ioannidis1Wolfram Doehner2Stanford Prevention Research Center, Department of Medicine Stanford University School of Medicine Stanford CA USAStanford Prevention Research Center, Department of Medicine Stanford University School of Medicine Stanford CA USADivision of Cardiology and Metabolism; Department of Cardiology (CVK) Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK), Charité‐Universitätsmedizin Berlin Berlin GermanyGuideline recommendations and health policy decisions rely on evidence from clinical and epidemiological studies. Adequate methodology and appropriate conclusions are essential to support healthcare and health policy decisions. An analysis of body mass index and mortality by the Global BMI Mortality Collaboration (GBMC) concluded that the association of excess body weight with higher mortality was similar worldwide and that overweight and obesity should be combated everywhere. To reach this conclusion, the GBMC used highly selected data, rather than a systematic approach. The GBMC initially chose individual participant data from 239 prospective studies with approximately 10.6 million participants. The GBMC then excluded over 60% of data and over 75% of fatal events by eliminating all cases with any reported disease at baseline or smoking history and all events within the first 5 years of follow‐up. After applying these restrictions, the association of overweight with lower mortality was reversed and the association of obesity with higher mortality was increased. Given the major flaws in the selection process, in the adequacy of the data, in the data analysis, and in the interpretation, the GBMC conclusions should be viewed sceptically as a guide to action, either for clinical decisions or for public health in general. The flawed conclusion that overweight is uniformly associated with substantially increased risk of death and thus should be combated in any circumstances may lead not only to unjustified treatment efforts and potential harm in a wide range of clinical conditions but also to a tremendous waste of resources.https://doi.org/10.1002/jcsm.12378Body weightWeight changeHealth policyOutcomeRisk factorEpidemiologic methods |
| spellingShingle | Katherine M. Flegal John P.A. Ioannidis Wolfram Doehner Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis Journal of Cachexia, Sarcopenia and Muscle Body weight Weight change Health policy Outcome Risk factor Epidemiologic methods |
| title | Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis |
| title_full | Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis |
| title_fullStr | Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis |
| title_full_unstemmed | Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis |
| title_short | Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta‐analysis |
| title_sort | flawed methods and inappropriate conclusions for health policy on overweight and obesity the global bmi mortality collaboration meta analysis |
| topic | Body weight Weight change Health policy Outcome Risk factor Epidemiologic methods |
| url | https://doi.org/10.1002/jcsm.12378 |
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