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A break in the obesity epidemic? Explained by biases or misinterpretation of the data?

Abstract

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 m2 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.

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Acknowledgements

This study was initiated after a debate on the topic that was held at a symposium during the International Congress on Obesity in Stockholm, Sweden, hosted by the EASO’s Prevention and Public Health Taskforce. The symposium, and thus this review, would not have been possible without support from the European Association for the Study of Obesity (EASO) and the active support by its managing director, Euan Woodward.

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Correspondence to T L S Visscher.

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The university to which TLSV belongs is involved in an EU-programme entitled EPODE for the Promotion of Health Equity. The general goal of EPODE is to reduce childhood obesity rates in communities and performing research thereof. The remaining authors declare no conflict of interest.

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Visscher, T., Heitmann, B., Rissanen, A. et al. A break in the obesity epidemic? Explained by biases or misinterpretation of the data?. Int J Obes 39, 189–198 (2015). https://doi.org/10.1038/ijo.2014.98

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