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The benefits of weight reduction in healthy overweight has not been

contribution from the drug-telegram

The benefits of weight reduction in healthy overweight has not been

• There is doubt that a long-term weight loss ever bring a health benefit.
• may have a health disadvantage of repeated weight loss even

"Every third German is too fat," warns the German Obesity Society at its last session .1 "Obesity is a chronic disease to evaluate," and "weight loss reduces overall mortality by more than 20%," says the German obesity guideline. (2)


nutritionists and epidemiologists will not tire of exhorting the population that they must decrease to prevent cancer and cardiovascular diseases. Hardly anyone dares to disagree. There are, surprisingly, not a single prospective controlled intervention study to assess the effects of weight reduction to the morbidity and mortality risks examined healthy would have. There are only data from epidemiological studies. Data collection through questionnaires reduces the significance of many of these studies also report.


Whoever increases in the course of his life and who does not seem to depend strongly on the genetic predisposition. In the rich industrialized countries, nearly all people are overfed at least slightly. Some may increase their metabolic rate and thus the calories and avoid weight gain or limit. (3.4) Other excess calories stored directly as fat. This ability was thousands of years associated with better survival chance about diseases and starvation.


In many studies, the mortality risk was evaluated in overweight (2). Obesity is more likely than normal weight associated with hypertension, diabetes mellitus, hyperlipidemia, gout, coronary heart disease and asthma. Theoretically, therefore, would also increase the risk of dying prematurely. Actually found in some epidemiological studies, a linear function of body weight (5). After two of the longest studies of this relation decreases with age (6,7). People over 50 and those over 65-year-old with body mass index (BMI *) 25-287 and 326 kg / m² thereafter have no increased risk of dying prematurely. After have a very large Dutch study moderately overweight (BMI between 25 and 27) even the lowest mortality risk (8). Higher mortality among leaner men is explained, among other things, that chronic diseases and have particularly smoking at the same weight-reducing mortality and enhancing (so-called interference or confounders). After an American long-term study but also lean healthy women who have never smoked, a higher mortality risk (9) as moderately obese. The interpretation of these data is complicated by that none of the investigations any disruptive factors taken into account sufficiently: so the social class and the distribution of body fat, two factors with significant influence on mortality (10,11) taken too little account.


Even healthy people who are overweight by an increased mortality risk, it does not follow that losing weight reduces the risk. It is noteworthy that thinner patients with diabetes or hypertension have a worse prognosis than thicker ones (12,13). The alleged beneficial effects of weight loss on joint or lung function and quality of life (1) missing supporting documents Healthy. Several studies describe an increased mortality after weight loss. A deficiency of most studies is that they do not distinguish between intentional and unintentional weight loss. Unintentional weight loss may be due to diseases that increase the risk of death.


only three major U.S. studies examining the effects of proposed reduction in weight. End of the 50s were 93 000 40 - to 64-year-old interviewed in obese women and men on the desired weight loss as well as being and disease and then followed up for twelve years (14,15). The third study is retrospective data of 25,000 women between 55 and 69 about their weight behavior since the 18th Age of reason. The follow-up is three years (16). In no study affects weight loss for healthy overweight beneficial effect on mortality. In subgroup analysis, which depend on the extent of the weight lost or the rate of weight loss, show the statistically significant results even all in the opposite direction: the mortality increases with healthy weight loss. The German guideline cited in the obesity reduced total mortality by more than 20% comes from one of these studies (14), but applies only to women with obesity-associated diseases such as diabetes or hypertension. The generalization of this effect in healthy women and men, as in the "evidence-based" is designated guideline made is not admissible.
fail Because so many attempts to reduce the weight permanently, are weight fluctuation (yo-yo effect) frequently. Of the 50,000 nurses in the Nurses' Health study reported 5% on long-term successful weight loss. 55% give other hand, at least one weight loss attempt and subsequent re-increase in body weight over the course of 16 years (17) in prospective studies suggest weight fluctuations between zwei and five kilograms accompanied by an increase in mortality by 25% to 65% (18). These studies do not distinguish between intentional and unintentional weight loss and do not always factor of smoking. The mortality risk could therefore be overestimated. are examined in the Nurses Health Study, the only study in which weight changes after intentional loss, the yo-yo effect an independent risk factor for cholecystectomy (relative risk: 1.83) is. The greater the weight fluctuations, the higher the risk (17). That diet contribute significantly to experimental and restrained eating behavior eating disorders such as bulimia nervosa, the guideline acknowledges (2).


CONCLUSION: For medical Exhortations to healthy obese to lose weight, now in the form of an "evidence based" guidelines, there is no valid data base. The current best evidence leaves no benefit in terms of reduced mortality risk seen with weight loss. Instead there are indications that the mortality risk of these people by reducing the weight increases even. The prevailing social ideal of beauty and health of overweight people is a strong psychological pressure and discriminated against them. Before recommendations can be made secure for healthy obese, the results of randomized intervention studies are to be seen.

Literature:

Source: Medicinal telegram: at 1999, 12: 121-3

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