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Schätzung der Prävalenz von Übergewicht und Adipositas auf der Grundlage subjektiver Daten zum Body-Mass-Index (BMI)
Abstract
In connection with the increasing importance of chronic diseases the estimation of the prevalence of overweight and obesity becomes more and more important. Today these estimations are usually done via the Body-Mass-Index (BMI). For economic reasons BMI is often obtained by means of questionnaires or interviews. These (subjective) BMI-data show great differences to measured (objective) data. The differences between subjective and objective data and their dependence on age, gender and residence were investigated.
Subjective and objective data show significant differences. On the basis of subjective data too many persons classify themselves as underweight or normal weighted and fewer persons classify themselves as overweight and obese. Variance analysis shows significant influences of gender and age. Women underestimate their BMI more than men. With increasing age the differences also increase.
The estimation of BMI based on subjective data is inaccurate. In this way the prevalence of obesity and overweight are underestimated. That is why subjective data are not useful for clinical and epidemiological research, but it is interesting against the background of health psychology.
... Information from self-reported data concerning body weight and height is often incorrect. Studies from different countries have found that subjects tend to over-report their body height (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and under-report their body weight (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) . Especially older subjects overestimate their height (12,16,20) . ...
... Information from self-reported data concerning body weight and height is often incorrect. Studies from different countries have found that subjects tend to over-report their body height (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and under-report their body weight (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) . Especially older subjects overestimate their height (12,16,20) . ...
... Studies from different countries have found that subjects tend to over-report their body height (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and under-report their body weight (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) . Especially older subjects overestimate their height (12,16,20) . Women in particular assess their weight lower than it actually is (3,10,23) , and men more often over-report their body height (15,20) . ...
Objective:
Epidemiological studies have shown that adults tend to underestimate their weight and overestimate their height. This may lead to a misclassification of their BMI in studies based on self-reported data. The aim of the present study was to assess the validity of self-reported weight and height in Austrian adults.
Design:
Data on weight, height, health behaviour and sociodemographic characteristics of adults were collected in a standardized procedure via a self-filling questionnaire and a medical examination including measurements of weight and height.
Setting:
A publicly accessible out-patient clinic in southern Austria.
Subjects:
Austrian residents (n 473) aged 18 years and older who attended a health check participated in the study.
Results:
The mean difference between reported and measured BMI was not significant in younger adults (<35 years: mean difference -0·21 kg/m2; P < 0·08) but increased significantly with age (≥55 years: mean difference -0·68 kg/m2; P < 0·001). The prevalence of normal weight (BMI = 18·5-24·9 kg/m2) and overweight (BMI = 25·0-29·9 kg/m2) was overestimated based on the self-reported data on BMI, while that for underweight (BMI < 18·5 kg/m2) and obesity (BMI ≥ 30·0 kg/m2) was underestimated (P < 0·001). The self-reported data showed an obesity prevalence of 12·5 %, while measurement showed a prevalence of 15·4 % (P < 0·001).
Conclusions:
Our results indicate that prevalence rates of obesity are probably underestimated for Austrian adults when using self-reported weight and height information. The deviations from the measured data clearly increased with age. Analyses based on self-reported data should therefore be adjusted for the age dependency of the validity.
... Tab. 6 Bewertung von besuchten Schulungen/Kursen der HYDRA-Patienten an den Studientagen(18./20.9.2001); Darstellung der Antwortkategorie "gar nicht geholfen", differenziert nach Alter und Geschlecht der übergewichtigen Patienten (Angaben: n, %) gern, das Problem anzuerkennen, da es ihnen unmöglich erscheint, daran irgendetwas zu ändern. Ein Beleg für diese Annahmen findet sich zum Beispiel in der Untersuchung von Glaesmer & Brähler[23]. In dieser Arbeit wurden die Zusammenhänge von subjektiven Einschätzungen des Gewichts und des BMI zu objektiven Maßen untersucht mit dem Ergebnis, dass die subjektiven Angaben signifikant unter denen der objektiven lagen. ...
... Ein erster Kritikpunkt betrifft die Methodik, mit der der BMI-Wert der Patienten bestimmt wurde. Hierfür wurden die subjektiven Angaben der Patienten herangezogen, was zu einer Unterschätzung der Werte führen kann[23]. Am Stichtag wurden die Studienärzte nicht nach Interventionsstrategien befragt, die direkt auf eine Adipositaserkrankung abzielen. ...
Objectives and Methods: Individual health-related behaviour patterns and lifestyles are strongly associated with the risk of suffering from cardiovascular diseases. Overweight (BMI 25 to 30 kg/m2) and obese patients (BMI ‡ 30 kg/m2) are at particular risk to develop these diseases. Therefore, we investigated whether these patients are more aware of health-related issues and problems than normal-weight patient with data from the HYDRA study on 45,000 subjects. Results: Health knowledge, problem awareness and health behaviour differed significantly among the examined patient groups (normal weight/over- weight/obesity). The overweight and obese patients were aware of potential risk factors for various diseases (e. g. hypertension, diabetes); they recognized their own health-related problems and attended courses to change their problematic health beha- viours more frequently. According to the patients' evaluations, however, these offers of courses are not very helpful. Conclu- sion: Changing the contents and implementations of health courses seems necessary to decrease costs and improve quality in the health care system on a long-term basis.
... Tab. 6 Bewertung von besuchten Schulungen/Kursen der HYDRA-Patienten an den Studientagen(18./20.9.2001); Darstellung der Antwortkategorie "gar nicht geholfen", differenziert nach Alter und Geschlecht der übergewichtigen Patienten (Angaben: n, %) gern, das Problem anzuerkennen, da es ihnen unmöglich erscheint, daran irgendetwas zu ändern. Ein Beleg für diese Annahmen findet sich zum Beispiel in der Untersuchung von Glaesmer & Brähler[23]. In dieser Arbeit wurden die Zusammenhänge von subjektiven Einschätzungen des Gewichts und des BMI zu objektiven Maßen untersucht mit dem Ergebnis, dass die subjektiven Angaben signifikant unter denen der objektiven lagen. ...
... Ein erster Kritikpunkt betrifft die Methodik, mit der der BMI-Wert der Patienten bestimmt wurde. Hierfür wurden die subjektiven Angaben der Patienten herangezogen, was zu einer Unterschätzung der Werte führen kann[23]. Am Stichtag wurden die Studienärzte nicht nach Interventionsstrategien befragt, die direkt auf eine Adipositaserkrankung abzielen. ...
Individual health-related behaviour patterns and lifestyles are strongly associated with the risk of suffering from cardiovascular diseases. Overweight (BMI 25 to 30 kg/m(2)) and obese patients (BMI > or = 30 kg/m(2)) are at particular risk to develop these diseases. Therefore, we investigated whether these patients are more aware of health-related issues and problems than normal-weight patient with data from the HYDRA study on 45,000 subjects.
Health knowledge, problem awareness and health behaviour differed significantly among the examined patient groups (normal weight/overweight/obesity). The overweight and obese patients were aware of potential risk factors for various diseases (e. g. hypertension, diabetes); they recognized their own health-related problems and attended courses to change their problematic health behaviours more frequently. According to the patients' evaluations, however, these offers of courses are not very helpful.
Changing the contents and implementations of health courses seems necessary to decrease costs and improve quality in the health care system on a long-term basis.
... Frühere methodische Studien zur Erhebung des Körpergewichts hatten zum Ziel, das Ausmaß der Abweichung zwischen subjektiv angegebenem und objektiv gemessenen Gewicht der Befragten abzuschätzen (z.B. Jeffrey 1996;Glaesmer/Brähler 2002). In dieser Studie wird dagegen untersucht, ob die subjektiv angegebene Höhe des Körpergewichts bzw. ...
... Unterschätzungen von sensitiven Fragen sind in der Literatur zahlreich dokumentiert. 2 Die Ergebnisse von Jeffrey (1996), Larson (2000) und Glaesmer/Brähler (2002) /Smith 1996). Eine der Analyse zugrundeliegende Annahme ist, dass einige Befragte die Information zur Höhe ihres Körpergewichts als peinlich empfinden. ...
While surveying measured weight is widely unpractical in national samples, self-reported weight is a simple and inexpensive method of collecting data. This paper deals with data quality of reported body weight in the German Socio-Economic Panel Study (SOEP). Previous research shows that data on reported body weight are plagued by systematic misreporting. This bias is said to be the consequence of the sensitive nature of information on body weight. Numerous studies on survey response suggest that certain modes of data collection are more conducive than others for probing sensitive information. This paper investigates the effect of the anonymity of the interview setting, characteristics of the interviewer and respondents’ familiarization with the SOEP, as an indicator of the trust in the relevance and the confidentiality of the survey, as factors that may impinge on reported body weight. Findings of this paper show that refusals of the reported body weight occur infrequently (in less than 1% of the cases). Moreover, characteristics of interviewers account for only a small fraction of the variance in reported body weight (roughly 1 %). Yet the hypothesis that the absence of an interviewer in self administrated interviews increases reported body weight can be confirmed. This interview effect, however, occurred in men only. On average, male respondents in anonymous interview settings report a body weight which is 1 kg more than they would report in other settings. The repeated participation of respondents in the SOEP increases their reported body weight, a finding which suggests a positive panel effect on respondents’ willingness to disclose sensitive information.
... Thus, misclassification appears to be differential rather than non-differential [51]. Conclusions regarding the impact of this bias range from slight to significant [17,20,22,24,38,47,60]. Nevertheless, all agree that more accurate data is preferable. ...
Background
Many studies rely on self-reported height and weight. While a substantial body of literature exists on misreporting of height and weight, little exists on improving accuracy. The aim of this study was to determine, using an experimental design and a comparative approach, whether the accuracy of self-reported height and weight data can be increased by improving how these questions are asked in surveys, drawing on the relevant evidence from the psychology and survey research literatures.
Methods
Two surveys from two separate studies were used to test our hypotheses (Science Survey, n = 1,200; Eating Behaviours Survey, n = 200). Participants were randomly assigned to one of six conditions, four of which were designed to improve the accuracy of the self-reported height and weight data (“preamble”), and two of which served as the control conditions ( “no preamble”). Four hypotheses were tested: (H1) survey participants read a preamble prior to being asked their height and weight will report lower heights and higher weights than those not read a preamble; (H2) the impact of question-wording (i.e., preamble vs. no preamble) on self-reported weight will be greater for participants with higher BMIs; (H3) the impact of question-wording on height will be greater for older participants; (H4) either version of the weight question – standard or “weight-specific”—may result in participants reporting more accurate self-reported weight. One-way MANOVA was conducted to test Hypothesis 1; two-way analysis of variance were conducted to test Hypothesis 2; moderation analysis was used to test Hypothesis 3; independent samples t-test was conducted to test Hypothesis 4.
Results
None of the hypotheses was supported.
Conclusions
This paper provides an important starting point from which to inform further work exploring how question wording can improve self-reported measurement of height and weight. Future research should explore how question preambles may or may not operationalise hypothesised underlying mechanisms, the sensitivity or intrusiveness of height and weight questions, individual beliefs about one’s height and weight, and survey context.
... Moreover, as the BMI cut-off points are set regardless of sex or skeletal frame, some individuals may be wrongly assigned to a weight category, which could have lead to an underestimation of the extent of the overweight problem (Burkhauser and Cawley 2008). Furthermore, compared to objective measurements, a reliance on subjective information on weight and height tends to lead to an underestimation of body mass index (Glaesmer and Brähler 2002). Therefore, the number of overweight and obese people in this study could be underestimated. ...
In Germany, internal migration streams have shaped the population structure quite notably during the past two decades. As selective migration can have a substantial impact on the geographical distribution of health, this paper examines whether internal migrants in Germany are selected regarding their health status. To capture health selection, one measure?i.e. self-rated contentment with health?and two established risk factors for poor health?i.e. smoking and BMI?were included. Applying event history analysis, the health status of migrants was compared to non-migrants, controlling for other individual characteristics. The analyses were based on the German Socio-Economic Panel, a retrospective data set representative of the German population. Results for self-rated health and smoking were inconclusive. While self-rated health was only related to migration in men, smoking was only linked to migration in women. However, there was a clear association between BMI and migration, i.e. the propensity to migrate decreased significantly with increasing weight. The results suggest that BMI is an important indicator of increased susceptibility to ill health, which prevent people from migration. Leaving behind a population who has a greater susceptibility to chronic conditions, selective migration is likely to reinforce the consequences of population ageing and healthcare demand, in particular in regions characterized by outmigration.
... The effects of social desirability and of the mode of data collection must be considered with respect to body height and, particularly, to weight. Many studies have shown that there is a substantial difference between objective measures and survey data concerning body weight and height, which is additionally mediated by the concrete interview situation (e. g., Béland & St-Pierre, 2008;Shields, Grober, & Tremblay, 2008; see also Glaesmer & Brähler, 2002;Kroh, 2004 for Germany). Critical influences on measurement error are the anonymity of the interview situation, the interviewer, repeated measures, and the tendency to provide round numbers in an interview (Kroh, 2004). ...
When analyzing health in an educational study, there are some methodological aspects and problems that must be considered. In this paper, we address questions of data quality in the measurement of health outcomes. It is possible that data quality can be biased by social desirability since questions on health (e. g., on eating disorders or body height and weight) are fairly sensitive items, and accordingly, the impact of the privacy of the setting increases with the sensitivity of the questions. Therefore, we expect mode effects resulting from the way the data are collected. Following a methodological discussion of these issues, empirical analyses are presented. We compare the measuring of body height, weight, BMI, and the likelihood of having an eating disorder in the NEPS with data from reference studies (KiGGS and GEDA from 2010) carried out by the Robert Koch Institute. To conduct the analysis of BMI, we use the Kindergarten cohort, the ninth graders, and the adults’ cohort. The eating disorder scale is compared for ninth graders only. The results show some differences between NEPS data and the reference data, which point towards an influence of the interview situation. In about half of our comparisons, no significant deviations between the datasets can be found. A short section describes some further thoughts on endogeneity problems.
... In Summe hatten demzufolge circa 80 % der primärärztlich behandelten Diabetiker einen BMI > 25 kg/m². Da es sich bei den Angaben von Körpergröße und Gewicht in dieser Studie um selbst berichtete Daten handelt und Menschen dazu tendieren ihre Größe über-und ihr Gewicht zu unterschätzen (Glaesmer & Brahler, 2002), ist die Prävalenzrate real vermutlich noch höher einzuschätzen. ...
Einleitung: Typ-2-Diabetes ist eine chronische Stoffwechselerkrankung, deren Prävalenzrate weltweit massiv ansteigt. In Anbetracht der drastischen gesundheitlichen und ökonomischen Folgen dieses Trends ist die Entwicklung von effektiven Präventionsmaßnahmen ein wichtiges Forschungsziel. Ergebnisse von Metaanalysen demonstrieren, dass Maßnahmen zur Lebensstilmodifikation (Aktivitätsaufbau, Ernährungsumstellung, Gewichtsreduktion) bei Hochrisikopersonen die Wahrscheinlichkeit für eine Diabetesmanifestation um circa 45% verringern können. Adipositas ist unbestritten der bedeutsamste, beeinflussbare Promotor des Typ-2-Diabetes. Die Mehrheit der übergewichtigen Risikopersonen schafft es jedoch nicht, die zur Prävention des Typ-2-Diabetes empfohlene Gewichtsreduktion von mindestens 5% des Ausgangsgewichts langfristig zu erreichen. Diese Studie untersucht Prädiktoren sowie metabolische Effekte einer erfolgreichen Gewichtsreduktion bei Hochrisikopersonen für Typ-2-Diabetes. Studiendesign und Methodik: Die im Rahmen der Arbeit verwendeten Daten rekurrieren aus der prospektiven, randomisierten und kontrollierten PRAEDIAS-Studie, innerhalb derer 182 Personen (Alter 56.3 ±10.1 Jahre, 43% Frauen, BMI 31.5 ±5.3 kg/m²) mit erhöhtem Diabetesrisiko (gestörte Glukosetoleranz und/oder erhöhte Nüchternglukose) untersucht worden sind. Die Probanden wurden randomisiert dem kognitiv-verhaltenstherapeutisch orientierten Schulungs- und Behandlungsprogramm PRAEDIAS oder einer Kontrollgruppe mit schriftlichen Informationen zugeteilt. Zu den Messzeitpunkten (Baseline; 2-Monats, 6-Monats und 1-Jahres Follow-up) wurden, neben soziodemographischen Charakteristika, der Verlauf des Körpergewichts, des Glukosestoffwechsels, der Lipide, des Blutdrucks sowie von zahlreichen verhaltensbezogenen (Gewichtsmanagement, Bewegung, Ernährung) und psychologischen (Essverhalten, Wohlbefinden, Depressivität, Ängstlichkeit) Variablen erhoben. Als das entscheidende Prüfkriterium für die Wirksamkeit des Programms wurde die erreichte Gewichtsreduktion zum Follow-up Zeitpunkt nach einem Jahr gewählt. Die inferenzstatistischen Überprüfungen wurden mittels t-Test vorgenommen. Bei den Korrelations- und Prädiktoranalysen wurde zunächst univariat überprüft, welche Parameter mit Übergewicht und einer Gewichtsabnahme assoziiert sind (je nach Datenqualität Pearson- oder Spearman-Koeffizienten). Multivariate Vorhersagen wurden mittels schrittweiser multipler, linearer Regression vorgenommen. Ergebnisse: Die Stichprobe war gekennzeichnet durch die typischen Merkmale eines Metabolischen Syndroms: (abdominelle) Adipositas, prädiabetische Glukosewerte, Dyslipidämie und Hypertonie. Ein höherer Body Mass Index (BMI) war in multivariaten Modellen mit einer ausgeprägten Insulinresistenz, einem leicht störbaren Essverhalten, einem niedrigen Bildungslevel sowie einem jüngeren Lebensalter assoziiert. 43% der Gesamtvarianz des Körpergewichts konnten mithilfe dieser Variablen aufgeklärt werden. Durch die Teilnahme an PRAEDIAS gelang den Risikopersonen im Vergleich zur Kontrollgruppe eine erfolgreiche Modifikation ihres Lebensstils: eine langfristige Gewichtsreduktion von durchschnittlich 4%, eine Steigerung des Bewegungspensums auf über 150 Minuten pro Woche sowie ein kognitiv kontrollierteres und weniger störbares Essverhalten. Zudem konnte ein positiver Einfluss auf das psychische Befinden und zentrale kardiovaskuläre Risikofaktoren festgestellt werden. Insbesondere das Erreichen des Gewichtsziels (5%) hatte einen signifikant positiven Effekt auf den Glukosestoffwechsel, die Insulinresistenz und den Lipidstatus. Als Erfolgsprädiktoren für eine langfristige Gewichtsreduktion konnten eine Reihe von psychologischen Faktoren identifiziert werden. In multivariaten Regressionsanalysen moderierten niedrige Depressionswerte und Erfahrungen mit Gewichtsabnahmen vor Interventionsbeginn das Ausmaß der Gewichtsreduktion. Während des Prozesses der Gewichtsreduktion spielten insbesondere eine hohe initiale Gewichtsabnahme, ehrgeizige und flexible Zielanpassungsstrategien, ein kognitiv stärker kontrolliertes Essverhalten sowie ein positives psychisches Befinden zum Follow-up eine wichtige erfolgsfördernde Rolle. Diese sechs Prädiktorvariablen erklärten 52% der Gesamtvarianz der Gewichtsreduktion. Diskussion: Kognitiv-behaviorale, lebensstilorientierte Gruppenprogramme zur Prävention des Typ-2-Diabetes sind effektiv und umsetzbar. Eine erfolgreiche Gewichtsabnahme ist bei Risikopersonen für Typ-2-Diabetes mit signifikanten metabolischen Benefits bei tendenziell verbessertem psychischem Wohlbefinden assoziiert. Insgesamt sollte den Ergebnissen der vorliegenden Arbeit zufolge psychologischen Faktoren bei primärpräventiven Maßnahmen zur Diabetesprävention mittels Lebensstilmodifikation vermehrt Aufmerksamkeit geschenkt werden. Dies gilt sowohl bei der Identifikation von Risikopersonen als auch bei der Auswahl und Umsetzung von geeigneten Maßnahmen zur Therapie des Hauptrisikofaktors Adipositas.
... However, alternative measures are rarely included in most surveys. Moreover, subjective information on weight and height tend to underestimate BMI when compared to objective measurements [50] . Hence, we might have underestimated the number of preobese and obese people. ...
Background/aims:
To project the numbers of pre-obese (BMI 25-29.99 kg/m²) and obese (BMI > 30 kg/m²) men and women aged 50+ in Germany until 2030 and to compare our estimates with actual figures from four European countries and the USA. Estimates are based on six scenarios encompassing improvements as well as worsenings of current trends.
Methods:
We used pooled data from 1999 to 2009 of the German Microcensus (n = 1,472,547). Using multinomial logistic regression models we estimated age-specific probabilities of pre-obesity and obesity and applied them to the 12th population projection of the Federal Statistical Office.
Results:
We project overall increases in absolute numbers of pre-obesity ranging between 14.2 and 18.2 million. However, the prevalence of pre-obesity is likely to decrease slightly. In contrast, absolute and relative numbers of obesity are projected to increase, ranging between 7.2 and 15.8 million. The international comparison revealed that pre-obesity prevalences will remain among the highest in Germany, while obesity is projected to fall below current levels of the UK or the USA.
Conclusion:
Pre-obesity and, particularly, obesity are likely to become a more prominent health issue in Germany in the near future which could have large repercussions for the public health system.
... Age, gender, weight, and height of all respondents were assessed. The BMI was then calculated based on the self-report data [20] . Work-related variables included experience in years, profession, and field of profession. ...
Objective:
The health care setting has been reported to be one main source of weight stigma repeatedly; however, studies comparing different professions have been lacking.
Methods:
682 health care professionals (HCP) of a large German university hospital were asked to fill out a questionnaire on stigmatizing attitudes, perceived causes of obesity, and work-related impact of obesity. Stigmatizing attitudes were assessed on the Fat Phobia Scale (FPS) based on a vignette describing a female obese patient.
Results:
Only 25% graded current health care of obese patients to be 'good' or 'very good'. 63% of all HCPs 'somewhat' or 'strongly' agreed that it was often difficult to get the resources needed in order to care for obese patients. The mean FPS score was comparable to that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes compared to physicians and therapists. Higher age, higher BMI, and ascribing personal responsibility for obesity to the individual were associated with a higher level of stigmatizing attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians attributed obesity to the individual.
Conclusions:
In summary, by making complex models on the causes of obesity known among health care professionals, stigmatizing attitudes might be reduced. Ongoing further education for health care professionals ought to be part of anti-stigma campaigns in the medical field.
... Diese Häufigkeiten sind geringer als die aktuellen Prävalenzra− ten (40,7 % bzw. 18,1 %) [1,13], was vermutlich auf einen Selbst− berichtsbias bei der Einschätzung des Körpergewichts zurück− zuführen ist [18]. ...
Although obesity prevention is increasingly being implemented, attitudes towards obesity prevention in the population are largely unclear. In a representative population-based survey, n = 1,000 individuals were interviewed about their agreement with specific preventive measures and level of problem identification, using computer-assisted telephone interviewing. The results show substantial agreement with obesity prevention, especially with obesity prevention in children and with information-based prevention. There was less agreement with legal measures. Support of prevention was low in men, young people, and in those with low income. Information deficits regarding the definition, prevalence, and chronicity of obesity were identified. Based on strong overall agreement with obesity prevention, addressing specific information deficits could enhance understanding of obesity and help sustainable implementation of preventive measures.
... Subjective and objective BMI-data showed in a German study significant differences. [35] Specifically women underestimated their BMI more than men. Second, as our sample comes from the German population we have a relatively low number of obese individuals, especially in terms of number with severe obesity, compared to prevalence of obesity trends in countries such as the US. ...
Objective:
A number of studies have revealed that the number of completed suicides decreases with increasing body mass index (BMI). However, only few studies have evaluated the association between suicidal behavior, suicide attempts, and the various BMI categories. The aim of this study was to determine whether obesity is positively associated with increased suicide attempts and suicidal behavior with consideration of gender differences.
Methods:
In a representative German population-based sample (N = 2436), interviews were conducted in 2011 to examine the prevalence of suicide attempts and suicidal behavior in participants in the different BMI categories. Logistic regression analyses were conducted for suicidal behavior and suicide attempts to examine the association between obesity status and suicidality, controlling for confounding variables. Suicidal behavior was assessed by the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a four-item self-report measure of suicidal thoughts and past attempts. BMI was calculated from participants' self-reported height and weight.
Results:
Analyses revealed that extremely obese participants (BMI ≥ 40.0) had a prevalence rate of suicidal behavior of 33% for female respondents and 13% for male respondents and rates for suicide attempts of 27% for female and 13% for male respondents. No significant gender differences could be found for any of the weight categories. Furthermore, adjusted odd ratios (AOR) showed a significant difference in suicidal behavior in class I obesity (OR, 3.02 [1.50-6.08] and class III obesity (OR, 21.22 [6.51-69.20]. AORs for suicide attempts showed significantly greater odds for class I obesity (OR, 3.49 [1.76-6.90] and class III obesity (OR, 12.43 [3.87-39.86] compared to the normal weight group.
Conclusion:
These results support a positive relationship between suicidal behavior, suicide attempts, and obesity. However contrary to previous findings, no gender differences were found. The findings support the introduction of routine screening for suicidal behavior in extreme obese individuals.
... Previous studies report that both adults and adolescents tend to over-report their own height and underestimate their weight, with the consequence of an understated BMI [6][7][8][9][10][11]. The same has been found for adolescent self-reports in the KiGGS population [12]. ...
The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children's weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of the validity of BMI derived from parent-reported data. A subsample of children aged 2-17 years (n = 9,187) was taken from the 2003-2006 cross-sectional German KiGGS study. Parent-reported and measured height and weight were collected and BMI was calculated. Besides descriptive analysis, linear regression models with BMI difference and logistic regression models with weight status misclassification as dependent variables were calculated. Height differences varied by gender and were generally small. Weight and BMI were under-reported in all age groups, the under-reporting getting stronger with increasing age. Overall, the proportion for overweight and obesity based on parental and measured reports differed slightly. In the youngest age group, the proportion of overweight children was overestimated, while it was underestimated for older children and adolescents. Main predictors of the difference between parent reported and measured values were age, gender, weight status and parents' perception of the child's weight. In summary, the exclusive use of uncorrected parental reports for assessment of prevalence rates of weight status is not recommended.
... There are inconsistent opinions as to how accurate self-report data are. Several studies have shown that self-reported previous and current weights are valid measures of actual weight [53,54]; however, others have demonstrated an underreporting of current body weight [55]. Overall, there seems to be a trend of underestimating weight and overestimating height [56]. ...
The goal of the present study was to examine the association between attention-deficit/hyperactivity disorder (ADHD) and obesity in a representative community based sample of the German population.
Participants were 1,633 German residents (53.6% female) aged 18-64 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered for diagnosis of adult ADHD. In addition, binge eating and purging behaviors as well as depression and anxiety were assessed using self-rating instruments.
The estimated prevalence of ADHD in obese participants was 9.7% compared to 3.8% in overweight and 4.3% in under-/normal-weight participants. The prevalence of obesity was 22.1% among adults with ADHD and 10.2% among persons without ADHD. Adult ADHD was significantly associated with a greater likelihood of being obese but not overweight even after adjusting for sociodemographic characteristics. Results were similar when adjusting for depression and anxiety symptoms and for purging behaviors. Odds ratios decreased after adjusting for binge eating; however, the results were still significant which shows that the relationship between obesity and ADHD in adulthood is not fully explained by binge eating.
Overall, the results indicate that adult ADHD is associated with obesity in a community-based sample of the adult German population.
... There are inconsistent opinions as to how accurate self-report data are. Several studies have shown that self-reported previous and current weights are valid measures of actual weight [53,54]; however, others have demonstrated an underreporting of current body weight [55]. Overall, there seems to be a trend of underestimating weight and overestimating height [56]. ...
Little research on the prevalence and correlates of adult ADHD has been conducted outside the United States. The aim of the present study was to estimate the prevalence and correlates of adult ADHD in a large representative sample of the German population aged 18-64 years (n = 1,655). Two self-rating screening instruments to assess childhood and adult ADHD symptomatology were used to estimate the prevalence of ADHD. A 4-item screening tool was used to assess probable cases of current depression and anxiety (Patient Health Questionnaire). The estimated crude prevalence rate of current ADHD was 4.7%. Adult ADHD was significantly associated with lower age, low educational level, unemployment, marital status (never married and divorced), and rural residency. No association was found with gender. Adult ADHD was strongly associated with positive screening results for depression and anxiety. ADHD is a common disorder of adulthood, is associated with significant social impairment and psychiatric co-morbidity, and should receive further research attention.
... In other studies, only between 17 and 66% of mothers of obese children perceived them as overweight [19][20][21][22]. Glaesmer and Brähler [23] found that the prevalence of overweight and obesity is underestimated in adults. Furthermore, childhood obesity is not perceived as being clinically important by the patients and their families. ...
The objective of this study was to investigate differences in weight perception and self-concept of obese and lean children, and to examine parents' awareness of overweight in themselves and their children. A total of 59 obese patients aged 7-17 years and 49 of their parents from a pediatric obesity out-patient clinic participated and were compared with 96 normal-weight patients and 81 of their parents from a pediatric pulmonary disease out-patient clinic.
Children's and parents' self-perception of weight, desire for weight change and weight concerns, children's belief that their desired weight can be achieved, and parents' perception of their child's weight status were assessed using single questionnaire items. Children's self-concept was measured by the Self-Perception Profile for Children. In addition, children drew pictures about themselves and their favorite activity.
Obese patients wished to change their weight more frequently (p < 0.001) and had more weight concerns (p < 0.001). Their self-concept was significantly more negative. Physical activities were more common in their drawings than in those of normal-weight peers. Parents of obese children were more frequently overweight or obese themselves (p < 0.001). 35 of them and 73 parents of normal-weight children perceived their own weight realistically. Of the parents with overweight or obese children, 69.4% perceived their own child as overweight and 28.6% as very overweight, whereas 83% of them were obese.
Children and adolescents as well as their parents recognize overweight as a health problem. In the majority, weight perception matches real body weight. Most parents at least recognize overweight in their children.
... There are inconsistent opinions as to how accurate self-report data are. Several studies have shown that self-reported previous and current weights are valid measures of actual weight (10,15); however, others have demonstrated an underreporting of current body weight (27). Overall, there seems to be a trend of underestimating weight and overestimating height. ...
The objective of this study was to investigate the prevalence of weight loss maintenance in a population-based sample of the German adult population. German adults were recruited based on the random digital-dialing methodology. Using computer-assisted telephone interviewing, weight loss maintenance was assessed, defined as having intentionally lost at least 10% from maximum weight and having maintained it for at least 1 year at the time of the survey. A total of 2,095 noninstitutionalized adults were randomly selected from all parts of Germany and the data of 957 respondents were included into the analysis. Of those who were at least overweight (BMI >or= 25 kg/m(2)) at their maximum weight, 17.7% reported having maintained a current weight loss of >or=10% of their maximum weight for at least 1 year. Among participants who reported a maximum weight in the obese range (BMI >or= 30 kg/m(2)), 29.7% reported successful 1-year weight loss maintenance. Among at least overweight participants, being younger and female, and having a higher maximum BMI were significant predictors of successful 1-year weight loss maintenance. The results suggest that successful weight loss maintenance is not uncommon in the general population, particularly in formerly obese participants. More should be learned about the strategies that successful weight maintainers use to avoid regaining weight.
... Despite the strengths of the study (sample size, representativeness, simultaneous coverage of structural, doctors and patients perspective) a few limitations need to be highlighted: (1) the BMI information for the HYDRA study was calculated from self-reported heights and weights. As individuals may tend to under-report weight while overestimating height, 27 overweight and obesity rates may in fact be slightly higher than estimated in our study. ...
In contrast to the well-documented high prevalence of overweight and obesity in the general population, the prevalence, recognition rates and management by primary care physicians--as the core gatekeeper in the health care system--remains poorly studied.
To examine (1) the point prevalence of overweight (BMI 25.0-29.9 kg/m(2)) and obesity (BMI> or =30 kg/m(2)) in primary care patients, (2) prevalence patterns in patients with high-risk constellations (diabetes, hypertension, cardiovascular disease, etc.), (3) doctors' recognition and interventions, as well as patients' use and perceived effectiveness of weight-loss interventions and (4) factors associated with non-treatment.
Cross-sectional point prevalence study of 45 125 unselected consecutive primary care attendees recruited from a representative nationwide sample of 1912 primary care practices. Measures: (1) standardized clinical appraisal of each patient by the physician (diagnostic status and recognition, severity, comorbidity, current and past interventions). (2) Patient self-report questionnaire: height and weight, illness history, past and current treatments and their perceived effectiveness, health attitudes and behaviors.
(1) In all, 37.9% of all primary care attendees were overweight, 19.4% obese. (2) Rates for overweight and obesity were highest in patients with diabetes (43.6 and 36.7%) and hypertension (46.1 and 31.3%), followed by patients with cardiovascular disorders. Rates of overweight/obesity increased steadily by the number of comorbid conditions. (3) Doctors' recognition of overweight (20-30%) and obesity (50-65%) was low, patients' actual use of weight control interventions even lower (past 12 months: 8-11%, lifetime: 32-39%). Patient success rates were quite limited. (4) Co- and multimorbidity in particular as well as other patient and illness variables were identified as predictors for recognition, but prediction of patients' actual use of weight loss interventions was limited.
Primary care management of overweight and obesity is largely deficient, predominantly due to four interrelated factors: doctors' poor recognition of patients' weight status, doctors' inefficient efforts at intervention, patients' poor acceptance of such interventions and dissatisfaction with existing life-style modification strategies.
... Diese Häufigkeiten sind geringer als die aktuellen Prävalenzra− ten (40,7 % bzw. 18,1 %) [1,13], was vermutlich auf einen Selbst− berichtsbias bei der Einschätzung des Körpergewichts zurück− zuführen ist [18]. ...
Although obesity prevention is increasingly being implemented, attitudes towards obesity prevention in the population are largely unclear. In a representative population-based survey, n = 1,000 individuals were interviewed about their agreement with specific preventive measures and level of problem identification, using computer-assisted telephone interviewing. The results show substantial agreement with obesity prevention, especially with obesity prevention in children and with information-based prevention. There was less agreement with legal measures. Support of prevention was low in men, young people, and in those with low income. Information deficits regarding the definition, prevalence, and chronicity of obesity were identified. Based on strong overall agreement with obesity prevention, addressing specific information deficits could enhance understanding of obesity and help sustainable implementation of preventive measures.
Intuitive eating has been described to represent an adaptive eating behaviour that is characterised by eating in response to physiological hunger and satiety cues, rather than situational and emotional stimuli. The Intuitive Eating Scale-2 (IES-2) has been developed to measure such attitudes and behaviours on four subscales: unconditional permission to eat (UPE), eating for physical rather than emotional reasons (EPR), reliance on internal hunger and satiety cues (RHSC), and body-food choice congruence (B-FCC). The present study aimed at validating the psychometric properties of the German translation of the IES-2 in a large German-speaking sample. A second objective was to assess levels of intuitive eating in participants with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, or binge eating disorder). The proposed factor structure of the IES-2 could be confirmed for the German translation of the questionnaire. The total score and most subscale scores were negatively related to eating disorder symptomatology, problems in appetite and emotional awareness, body dissatisfaction, and self-objectification. Women with eating disorders had significantly lower values on all IES-2 subscale scores and the total score than women without an eating disorder diagnosis. Women with a binge eating disorder (BED) diagnosis had higher scores on the UPE subscale compared to participants with anorexia nervosa (AN) or bulimia nervosa (BN), and those diagnosed with AN had higher scores on the EPR subscale than individuals with BN or BED. We conclude that the German IES-2 constitutes a useful self-report instrument for the assessment of intuitive eating in German-speaking samples. Further studies are warranted to evaluate psychometric properties of the IES-2 in different samples, and to investigate its application in a clinical setting.
Despite current speculations about the health and fitness of children in Germany, there is a lack of representative studies simultaneously describing medical parameters and motor skills while including social factors. The medical part of the IDEFIKS-study (Interdisciplinary Evaluation of Fitness and Health in Kids in the Saarland/Germany) investigated 216 children of the 6th and 9th classes from representative secondary modern intermediate and high schools. According to the current percentiles, 18 % of the children were overweight (OW) or adipose (AD), with a clearly higher proportion among the intermediate schools. A percentage of body fat >30 % was measured in 10 % of the children. While the percentage of children with OW+AD increases among the girls from 6th to 9th classes (14 to 20 %), it decreases among the boys (22 to 15 %). 6 % of the children had blood cholesterol >5 mmol/l (193 mg/dl) with significantly increased LDL/HDL-cholesterol ratio >2.5. The LDL/HDL-cholesterol ratio differed between the group of OW+AD (2.0±0.9) and non-OW+AD (1.7±0.8; p<0.05). An elevated systolic and diastolic blood pressure was measured in 5 % (p<0.001). There was a relationship between the standardized Body-Mass-Index (BMI) and systolic blood pressure (r=0.35; p<0.001) and LDL/HDL-cholesterol ratio (r=0.22; p<0.05). The standardized Body-Mass-Index (BMI) of the children correlated weakly with the BMI of the parents (mother: r=0.19, father: r=0.21; p<0.01, respectively). In conclusion, there is a strong need for gender-specific preventive strategies taking the level of education into account.
Zusammenfassung
Hintergrund: Obwohl die Prävalenz von Adipositas im höheren Lebensalter zunimmt, beschäftigen sich bisher nur wenige Studien mit dem Zusammenhang von sozialer Ungleichheit und Adipositas im höheren Lebensalter.
Methoden: Grundlage ist der deutsche Datensatz des Release1 des “Survey of Health, Ageing and Retirement in Europe (SHARE)” aus dem Jahr 2004. Analysiert werden Befragungsdaten von 2992 Personen im Alter von 50 Jahren und älter. Soziale Ungleichheit wird durch Einkommen, Vermögen und Bildung, Adipositas durch den Body-Mass-Index erfasst.
Ergebnisse: Die logistischen Regressionsanalysen zeigen, dass Personen mit einem niedrigen sozialen Status ein höheres Risiko aufweisen, adipös zu sein. Bildung erweist sich als am stärksten mit Adipositas assoziiert. Zudem zeigen sich keine einheitlichen Geschlechts- und Altersdifferenzen.
Schlussfolgerung: Die Analysen bestätigen den für das mittlere Erwachsenenalter bekannten Zusammenhang zwischen sozialer Ungleichheit und Adipositas auch für das höhere Lebensalter. Für die Weiterentwicklung der Forschung zu sozialen Einflüssen auf Adipositas sind möglichst langfristige prospektive Kohortenstudien zu fordern, die das höhere Lebensalter einschließen.
Daten zum Körpergewicht der Bevölkerung werden aus Kostengründen oftmals nicht objektiv gemessen, sondern durch subjektive Angaben erhoben. Frühere Untersuchungen zur Erhebung des Körpergewichts zeigen, dass sich subjektive Gewichtsangaben von objektiv gemessenen Daten unterscheiden, was auf den fehlenden Bekennermut der Befragten zurückgeführt wird. Verschiedene Methodenstudien deuten darauf hin, dass Interviewer und die Interviewsituation einen Einfluss auf das Antwortverhalten der Befragten bei sensitiven Informationen haben. In diesem Beitrag wird untersucht, ob die Anonymität des Interviews, Merkmale der Interviewer und die Erfahrung der Befragten mit der Umfrage Einfluss auf Antworten bzgl. des Körpergewichts haben. Die Ergebnisse zeigen, dass Verweigerungen der Gewichtsangaben äußerst selten sind und dass die angegebene Höhe des Körpergewichts kaum durch Merkmale der Interviewer beeinflusst wird. Allerdings kann die Hypothese bestätigt werden, dass Personen in Befragungen, in denen ein Interviewer anwesend ist, ein niedrigeres Gewicht angeben als in anonymen Interviews. Dieser Effekt zeigt sich jedoch lediglich für Männer, die bei Anwesenheit eines Interviewers im Durchschnitt ihr Gewicht um etwa 1 kg niedriger ansetzen als bei Abwesenheit eines Interviewers. Weiterhin deutet ein positiver Zusammenhang zwischen der Anzahl an Befragungen einer Person durch das Sozio-oekonomische Panel (SOEP) und der angegebenen Höhe des Körpergewichts auf einen vertrauensbildenden Effekt von Panelbefragungen hin.
PURPOSE: Determination of the influence of tube currents varying during a CT scan on organ doses and on the effective dose as a function of patient constitution. Evaluation of the accuracy of effective dose calculations based on summarizing parameters (effective mAs, dose length product [DLP]) compared to calculations based on slice-specific tube currents. MATERIALS AND METHODS: Investigation of the CT datasets of 806 patients acquired from the skull base to the proximal thigh with respect to the body mass index (BMI). The effective dose was calculated by means of slice-specific as well as region-specific conversion factors. RESULTS: Dose optimization by means of variable tube current resulted in a reduction of the gonad dose in patients with BMI ≤ 20 … 21 kg/m 2 and of the effective dose in patients with BMI ≤ 26 kg/m 2 . Effective dose values calculated with the DLP for 90 % of the patients are within an interval of ± 20 % of the values calculated using slice-specific tube currents. CONCLUSION: If tube current optimization during the CT scan was applied, for the scan region under investigation, at a BMI already below the German mean value, an increased effective dose was observed. Calculations of the effective dose on the basis of summarizing values such as DLP or effective mAs are of sufficient accuracy.
Essstörungen im Kindes- und Jugendalter werden immer häufiger und eine frühzeitige Erkennung ist von großer Bedeutung. Neben den „klassischen” Essstörungen besteht eine Anzahl von Essproblemen im Kindesalter, die sich durch vermeidende oder restriktive Nahrungsaufnahme kennzeichnen und zurzeit nicht im DSM-IV Klassifikationssystem aufgeführt werden. Ziel der Untersuchung war es, das Vorkommen dieser Essprobleme in einer allgemeinen, schulbasierten Stichprobe in der Schweiz zu untersuchen und die psychometrischen Kennwerte eines kurzen Screeningfragebogens zur Erfassung vermeidend oder restriktiver Nahrungsaufnahme im Selbstbericht zu ermitteln. Es beantworteten 730 Kinder im Alter von 8 – 13 Jahren den Eating Disturbances in Childhood–Questionnaire (EDCh-Q). 29.8 % der Kinder gaben an, vermeidendes oder restriktives Essverhalten aufzuzeigen. Der EDCh-Q zeigte insgesamt gute Itemcharakteristika. Die vierfaktorielle Struktur konnte bestätigt werden, allerdings mit geringen internen Konsistenzen der Subskalen. Untergewichtige Kinder gaben häufiger an, Symptome einer Nahrungsvermeidung mit emotionaler Störung aufzuzeigen. Vermeidendes oder restriktives Essverhalten ist nicht unüblich bei Kindern im Schulalter. Der EDCh-Q ist ein diagnostisch orientierter Screeningfragebogen zur Identifizierung dieser Essprobleme in der mittleren Kindheit. Weitere Forschung ist wünschenswert zur Validierung des EDCh-Q in allgemeinen und klinischen Stichproben.
Despite current speculations about the health and fitness of children in Germany, there is a lack of representative studies simultaneously describing medical parameters and motor skills while including social factors. The medical part of the IDEFIKS-study (Interdisciplinary Evaluation of Fitness and Health in Kids in the Saarland/Germany) investigated 216 children of the 6th and 9th classes from representative secondary modern intermediate and high schools. According to the current percentiles, 18 % of the children were overweight (OW) or adipose (AD), with a clearly higher proportion among the intermediate schools. A percentage of body fat >30 % was measured in 10 % of the children. While the percentage of children with OW+AD increases among the girls from 6th to 9th classes (14 to 20 %), it decreases among the boys (22 to 15 %). 6 % of the children had blood cholesterol >5 mmol/l (193 mg/dl) with significantly increased LDL/HDL-cholesterol ratio >2.5. The LDL/HDLcholesterol ratio differed between the group of OW+AD (2.0±0.9) and non-OW+AD (1.7±0.8; p<0.05). An elevated systolic and diastolic blood pressure was measured in 5 % (p<0.001). There was a relationship between the standardized Body-Mass-Index (BMI) and systolic blood pressure (r=0.35; p<0.001) and LDL/HDL-cholesterol ratio (r=0.22; p<0.05). The standardized Body-Mass-Index (BMI) of the children correlated weakly with the BMI of the parents (mother: r=0.19, father: r=0.21; p<0.01, respectively). In conclusion, there is a strong need for gender-specific preventive strategies taking the level of education into account.
The magnitude and the development of the prevalence of overweight and obesity in Germany during the past 20 years are analysed in this contribution. Using body mass index (BMI) data of the National Examination Surveys (1984–1992), the German National Health Interview and Examination Survey 1998 as well as the Telephone Health Survey 2003, all representative of the adult non-institutionalised population, the occurrence of overweight and obesity is studied. To improve the comparability with measurement values, the Telephone Health Survey data which were based on self-reporting were adjusted. All data were weighted to improve the representativeness for the time of assessment. Although the proportion of persons with a BMI between 25 and 30 did not change essentially during the last 20 years, the proportion of obese individuals (BMI ≥30) increased considerably. At present, about 70% of men and 50% of women in Germany are overweight or obese. In conclusion, the prevalence of overweight and obesity in Germany continues to increase.
The decision to measure or to ask about data concerning height and weight in order to calculate body mass index (BMI) has an influence on the economy and validity of the measurements. Although self-reported information is less expensive, this information may possibly have a bias on the determined prevalences of different weight groups. Using representative data from the KiGGS study with a comparison of directly measured and self-reported BMI data, Kurth and Ellert (2010) developed two correction formulas for prevalences resulting from self-reported information. The aim of the study was to examine the practicability of the proposed correction formulas on our own data concerning self-reported BMI data of 11- to 13-year-old girls (n=1,271) and to assess the plausibility of the corrected measurements. As a result, the prevalences of our own data changed in the expected direction both for underweight and for overweight. Both formulas were found to be practicable, the consideration of the subjective weight status (formula 2) resulted in a greater change in prevalences compared to the first correction formula.
Aus der Literatur ist bekannt, dass die Adipositas mit einer erhöhten Morbidität und Mortalität einhergeht. Es gibt keine einstimmige Meinung über die Adipositas als unabhängigen Risikofaktor bei chirurgischen Patienten. Der Datenpool von Patienten, die im Zeitraum vom 23.02.1999 bis 31.12.2000 operiert wurden, wurde mit der Fragestellung ausgewertet, ob die Adipositas einen unabhängigen Risikofaktor für die Entwicklung der perioperativen Komplikationen darstellt. Dafür wurde eine Patientengruppe mit erhöhtem BMI von grösser oder gleich 30,0 kg/m2 gewählt und mit einer normalgewichtigen Kontrollgruppe (BMI 20-24,9 kg/m2) verglichen. Die Daten wurden mit Hilfe des Anästhesie-Informations-Management-Systems (AIMS) NarkoData (IMESO GmbH, Hüttenberg) erfasst. Die Matched pairs-Technik wurde angewandt, um den Einfluss der perioperativen Risikofaktoren auf die Zielparameter auszuschließen. Als Matching-Kriterien wurden ASA-Klassifikation, erhöhtes chirurgisches Risiko, Dringlichkeit der Operation, Alter und Geschlecht gewählt. Zu jedem Patienten mit einem BMI grösser/gleich 30 kg/m2 wurde nur ein Kontrollfall zugelassen. Zielparameter waren die Krankenhaus-Mortalität, ein verlängerter stationärer Aufenthalt, die Notwendigkeit einer Intensivbehandlung und intraoperative kardiovaskuläre Ereignisse. Ein logistisches Regressionsmodell wurde für alle Matching-Kriterien und Zielparameter entwickelt. Die vorliegende Arbeit bestätigt, dass ein erhöhter BMI allein ohne begleitende Erkrankungen keinen eigenständigen Risikofaktor für nicht-herzchirurgische Patienten darstellt. Das Regressionsmodell fand nur zwei Variablen, die mit einem erhöhten Mortalitätsrisiko, einem verlängerten stationären Aufenthalt, der Aufnahme auf einer Intensivstation und intraoperativen kardiovaskulären Zwischenfällen assoziiert waren: ASA-Klassifikation und eine Risikooperation. Aus der Literatur ist bekannt, dass die Adipositas mit einer erhöhten Morbidität und Mortalität einhergeht. Es gibt keine einstimmige Meinung über die Adipositas als unabhängigen Risikofaktor bei chirurgischen Patienten. Der Datenpool von Patienten, die im Zeitraum vom 23.02.1999 bis 31.12.2000 operiert wurden, wurde mit der Fragestellung ausgewertet, ob die Adipositas einen unabhängigen Risikofaktor für die Entwicklung der perioperativen Komplikationen darstellt. Dafür wurde eine Patientengruppe mit erhöhtem BMI von grösser/gleich 30,0 kg/m2 gewählt und mit einer normalgewichtigen Kontrollgruppe (BMI 20-24,9 kg/m2) verglichen. Die Daten wurden mit Hilfe des Anästhesie-Informations-Management-Systems (AIMS) NarkoData (IMESO GmbH, Hüttenberg) erfasst. Die Matched pairs-Technik wurde angewandt, um den Einfluss der perioperativen Risikofaktoren auf die Zielparameter auszuschließen. Als Matching-Kriterien wurden ASA-Klassifikation, erhöhtes chirurgisches Risiko, Dringlichkeit der Operation, Alter und Geschlecht gewählt. Zu jedem Patienten mit einem BMI grösser oder gleich 30 kg/m2 wurde nur ein Kontrollfall zugelassen. Zielparameter waren die Krankenhaus-Mortalität, ein verlängerter stationärer Aufenthalt, die Notwendigkeit einer Intensivbehandlung und intraoperative kardiovaskuläre Ereignisse. Ein logistisches Regressionsmodell wurde für alle Matching-Kriterien und Zielparameter entwickelt. Die vorliegende Arbeit bestätigt, dass ein erhöhter BMI allein ohne begleitende Erkrankungen keinen eigenständigen Risikofaktor für nicht-herzchirurgische Patienten darstellt. Das Regressionsmodell fand nur zwei Variablen, die mit einem erhöhten Mortalitätsrisiko, einem verlängerten stationären Aufenthalt, der Aufnahme auf einer Intensivstation und intraoperativen kardiovaskulären Zwischenfällen assoziiert waren: ASA-Klassifikation und eine Risikooperation. Increased body mass index (BMI) is a well acknowledged risk factor for morbidity and mortality. However, there is no common consensus that obesity is an independent surgical risk factor. The retrospective study was designed to assess the attributable effects of increased BMI on outcome in patients undergoing non-cardiac surgery. The study is based on data sets of patients operated upon between 23.02.1999 to 31.12.2000. Data acquisition was performed with an online computerized anesthesia record keeping system, NarkoData (IMESO GmbH, Hüttenberg). Cases were defined as patients with increased BMI greater than or equal 30 kg/m². Control patients were matched if they had a BMI of 20-24,9 kg/m². The matched pairs technik was employed so that the influence of the risk factors on the outcome measurs were excluded. Matching criteria included: ASA physical status, high risk surgery, urgency of surgery, age and gender. Only one control was matched to each case. Main outcome measures were hospital mortality, prolonged hospital length of stay, admission to the intensive care unit (ICU) and the incidence of intraoperative cardiovascular events. Logistic regression models were developed for matching criteria and outcome measures. Results: our study suggests that increased BMI alone without any preexisting morbidities is not an independent risk factor for patients undergoing non-cardiac surgery. The logistic regression models revealed only 2 variables that were associated with an increased risk of mortality, prolonged length of stay, ICU admission and cardiovascular events: ASA physical status and high risk surgery.
The magnitude and the development of the prevalence of overweight and obesity in Germany during the past 20 years are analysed in this contribution. Using body mass index (BMI) data of the National Examination Surveys (1984-1992), the German National Health Interview and Examination Survey 1998 as well as the Telephone Health Survey 2003, all representative of the adult non-institutionalised population, the occurrence of overweight and obesity is studied. To improve the comparability with measurement values, the Telephone Health Survey data which were based on self-reporting were adjusted. All data were weighted to improve the representativeness for the time of assessment. Although the proportion of persons with a BMI between 25 and 30 did not change essentially during the last 20 years, the proportion of obese individuals (BMI>or=30) increased considerably. At present, about 70% of men and 50% of women in Germany are overweight or obese. In conclusion, the prevalence of overweight and obesity in Germany continues to increase.
The objective of this investigation was to evaluate the usefulness of self-reported measures of height and weight under the hypothesis that they under-estimate the prevalence of obesity. A cross-sectional study was carried out on a random sample of the adult population of the province of León, Spain. The study involved 572 participants (262 men and 310 women). All participants were interviewed and questioned about socio-cultural characteristics plus their weight and height. All respondents were later weighted and measured for height using standard methods. A Quetelet or body mass index (BMI) > or = 30 kg/m2 was used as the index for obesity. Many people were unaware of their weight and/or height. Self-reported BMI could not be calculated in 40 men (15%) and 107 women participants (35%). This occurrence was more frequent in women than in men (chi 2 = 3.98; P < 0.05). The prevalence of obesity, based on measured weight and height, was 1.8 times that from self-reported values in men and 2.5 times that from self-reported values in women. If we consider only the measured values for those individuals who supplied self-reported heights and weights, these prevalences fall to 1.7 and 1.6 times those from self-reported values respectively. In addition, the difference between measured and self-reported height increase with age. All these differences are statistically significant. We believe that the use of self-reported values of weight and height in epidemiological studies should be avoided in an elderly population. These measurements could, however, be used on a younger population.
PLANKEY MICHAEL W, JUNE STEVENS, KATHERINE M FLEGAL, PHILIP F RUST. Prediction equations do not eliminate systematic error in self-reported body mass index.
Epidemiological studies of the risks of obesity often use body mass index (BMI) calculated from self-reported height and weight. The purpose of this study was to examine the pattern of reporting error associated with self-reported values of BMI and to evaluate the extent to which linear regression models predict measured BMI from self-reported data and whether these models could compensate for this reporting error. We examined measured and self-reported weight and height on 5079 adults aged 30 years to 64 years from the second National Health and Nutrition Examination Survey. Measured and self-reported BMI (kg/m2) was calculated, and multiple linear regression techniques were used to predict measured BMI from self-reported BMI. The error in self-reported BMI (self-reported BMI minus measured BMI) was not constant but varied systematically with BMI. The correlation between measured BMI and the error in self-reported BMI was −0.37 for men and −0.38 for women. The pattern of reporting error was only weakly associated with self-reported BMI, with the correlation being 0.05 for men and −0.001 for women. Error in predicted BMI (predicted BMI minus measured BMI) also varied systematically with measured BMI, but less consistently with self-reported BMI. More complex models only slightly improved the ability to predict measured BMI compared with self-reported BMI alone. None of the equations were able to eliminate the systematic reporting error in determining measured BMI values from self-reported data. The characteristic pattern of error associated with self-reported BMI is difficult or impossible to correct by the use of linear regression models.
Although some studies have analysed the accuracy of self-reported weight and height data in survey studies, no attention has been paid to the accuracy of the body mass index (BMI, kg/m2), derived from these data and often considered as a reliable indirect estimate of relative body weight. Based on data from about 3400 participants in a study, questionnaire self-reports of these anthropometric data were compared to measured weight and height. A flat slope syndrome (under-reporting of high values, over-reporting of low ones) was found for weight and BMI for both sexes. A low sensitivity of BMI based on self-reported values were found, especially for the obese sub-population. Reliance upon questionnaire-derived self-reports will lead to considerable underestimation of the prevalence of obesity. Only 55 per cent of obese women and 60 per cent of obese men according to measured values were correctly classified as such. Correction of self-reported data according to regression models describing the relationship between questionnaire self-reports and medical records of body size parameters should be considered for some types of epidemiologic studies such as those using BMI as a categorized variable. The statistical rationale for the models used here is discussed.
Overweight is an important public health problem affecting around 50% of the population of Wales, resulting in increased risk of illness, premature disability and premature death. The aim of this study was to examine critically the accuracy of self-reported data in describing the prevalence of overweight in Wales. A sample of 1622 adults aged 18 to 64 years was taken from the Welsh Heart Health Survey 1985. In that survey weight and height data were collected on a self-completed questionnaire and by clinical measurement. Mean differences between self-reported and measured weight and height were used as indicators of bias, and the accuracy of BMI and the prevalence of overweight based on this data were analysed. Weight was reported without significant bias in men, but women under-reported their weight by an average of 1.1 kg. Height was over-reported by 1.4 cm in men, and 0.7 cm in women, on average. More than two-thirds of subjects reported to within 2.3 kg and 2.5 cm of their actual weight and height. Reporting was more biased in older and overweight groups. The calculation of body mass index resulted in amplification of bias and underestimation of the prevalence of overweight and obesity in the study sample of 4.5% in men and 6.7% in women. The results have important implications for the use of self-reported data for the scientific measurement of the prevalence of overweight, especially in longitudinal studies, and suggest that further research should be conducted into the stability of reporting bias over time.
It is important to establish what the medical view of obesity should be. An important step is the development of a standardised definition of obesity. The World Health Organisation (WHO) has proposed body mass index (BMI) as a simple measure of obesity. Whereas BMI has great clinical utility, it should be remembered that calculation of a raised BMI does not automatically indicate a high degree of adiposity. This is because BMI does not distinguish between weight due to excess fat, and weight due to a large mass of muscle or bone. Gender and age also have to be considered when evaluating BMI measurements. Obesity is related to many disorders, most of which are metabolic in origin. For example, hypertension and the adverse lipid profile associated with obesity increases the risk of coronary heart disease (CHD). There is also a profound association between obesity, particularly intra-abdominal adiposity, and the development of non-insulin dependent diabetes mellitus (NIDDM). Obesity has reached epidemic proportions. This is paralleled by an increasing incidence of NIDDM. There is no doubt that weight gain and obesity are major clinical problems, which need to be prevented and managed more effectively. This is essential, given the role of obesity in many of the chronic health problems affecting westernised societies.
Daten des Gesundheitswesens
- Bundesministerium
- Gesundheit
10 Bundesministerium für Gesundheit. Daten des Gesundheitswesens
1995. Baden Baden: Nomos Verlagsgesellschaft 1997
Richtlinien zur Therapie der Adipositas. Adipositas
- Deutsche Gesellschaft
- Adipositasforschung
Deutsche Gesellschaft für Adipositasforschung. Richtlinien zur Therapie der Adipositas. Adipositas; 1995: 6 ± 10
Das macht auch deutlich, wie schwierig es ist, Menschen zur Prävention oder Gewichtsreduktion zu bewegen, denn vor der relativ geringen Aussicht auf langfristigen Erfolg blockiert möglicherweise eine mangelnde Problemwahrnehmung eine entsprechende Entscheidung
- Diskrepanz Eine Groûe
- Besteht
eine groûe Diskrepanz besteht. Das macht auch deutlich, wie
schwierig es ist, Menschen zur Prävention oder Gewichtsreduktion zu bewegen, denn vor der relativ geringen Aussicht auf langfristigen Erfolg blockiert möglicherweise eine mangelnde Problemwahrnehmung eine entsprechende Entscheidung. Trotz der
in der Untersuchung gezeigten Diskrepanzen zwischen subjektiven und objektiven Daten und den daraus resultierenden
Problemen bei epidemiologischen Untersuchungen bleibt die
Bedeutung der subjektiven Daten auf dem Hintergrund gesundheitspsychologischer Theorien bestehen.
Design und Einwohnermelderegisterstichproben bei mündlichen Bevölkerungsumfragen
- A Koch
Koch A. Design und Einwohnermelderegisterstichproben bei mündlichen Bevölkerungsumfragen. In: Gabler S, Hoffmeyer-Zlotnik JHP
(Hrsg). Stichproben in der Umfragepraxis. Opladen: Westdeutscher
Verlag 1997; 99 ± 116
Körper und Schönheit als soziale Leitbilder
- N Kluge
- G Hippchen
- E Fischinger
Kluge N, Hippchen G, Fischinger E. Körper und Schönheit als soziale
Leitbilder. Frankfurt/Main: Peter Lang ± Europäischer Verlag der Wissenschaften 1999
- Der Bundesgesundheitssurvey
Der Bundesgesundheitssurvey. Gesundheitswesen 1999; 61. Sonderheft 2