Primary Care Physicians' Perceptions of the Effects of Being Overweight on All-cause Mortality.
Primary Care Physicians' Perceptions of the Effects of Being Overweight on All-cause Mortality.
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DOI：
10.1097/ede.0000000000001590
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发表时间：
2023-05-01
期刊：
影响因子：
5.4
通讯作者：
Mathur, Vandana S. S.
中科院分区：
文献类型：
--
作者：
Mathur, Maya B. B.;Mathur, Vandana S. S.
鉴于目前的证据，临床指南1认为肥胖（体重指数 [BMI]≥ 30）而非超重（BMI 25-29.9）是全因死亡的危险因素。两项针对普通人群的重要荟萃分析2、3估计了不同BMI类别与全因死亡率之间的关联；这些荟萃分析报告了超重类别的相反方向的适度关联。另一项荟萃分析表明，在老年人中，超重与死亡率适度降低有关。 4 尽管这些荟萃分析具有重要的方法学局限性，但 5 项具有更强设计的单独研究通常也发现了无效或适度的关联。鉴于初级保健医生 (PCP) 经常就 BMI 向患者提供建议，我们评估了 PCP 对超重与死亡率关联的方向和强度的看法。利用 Centiment，我们在美国招募了 192 名 PCP，他们至少 20% 的时间花在直接门诊护理上。参与者以随机顺序阅读两个临床小插图，均描述了一名具有典型年龄临床特征的 60 岁女性患者（eAppendix；http://links.lww.com/EDE/C7）。这些插图仅在患者的 BMI 方面有所不同，BMI 为 28（超重但不肥胖）或 23（正常体重）；我们告诉参与者这是唯一的区别。在每个小插曲之后，参与者估计了患者在未来 20 年（即 80 岁时）因任何原因死亡的风险。作为主播，我们告诉参与者，美国 60 岁女性 20 年平均死亡风险为 29%。每个参与者的超重与死亡率关联的“小插图引发”风险比（RR）是他们对超重小插图与正常体重小插图的估计之比。然后，我们直接询问参与者，与所有其他因素无关，超重（而非肥胖）与正常体重相比是否会降低、增加或不会影响患者未来 20 年的死亡风险。回答“增加风险”或“降低风险”的参与者然后分别通过超重增加或降低风险的次数进行数值估计。我们提供了具体的例子（例如，1.05 意味着风险增加 5%）。这些估计代表参与者直接估计的 RR。对于回答“不影响风险”的参与者，我们指定 RR= 1。为了减少需求特征，参与者在研究开始时并未被告知他们将提供小插图引发的估计和直接估计。斯坦福大学 IRB 批准了这项研究，我们在 R（版本 4.2.0）中进行了分析。 e表1； http://链接。 lww。 com/EDE/C7 显示参与者
Given current evidence, clinical guidelines1 consider obesity (body mass index [BMI]≥ 30), but not overweight (BMI 25–29.9), to be a risk factor for all-cause mortality. Two prominent meta-analyses in general populations2, 3 have estimated associations of different BMI categories with all-cause mortality; these meta-analyses reported modest associations in opposite directions for the overweight category. Another metaanalysis suggested that in older adults, being overweight is associated with modestly reduced mortality. 4 Although these meta-analyses had important methodologic limitations, 5 individual studies with stronger designs have also generally found null or modest associations. Given that primary care physicians (PCPs) frequently advise patients on BMI, we assessed PCPs’ perceptions of the direction and strength of the overweight-mortality association.Using Centiment, we recruited 192 PCPs in the United States who spent at least 20% of their time in direct outpatient care. Participants read two clinical vignettes in randomized order, both describing a 60-year-old female patient with age-typical clinical characteristics (eAppendix; http://links. lww. com/EDE/C7). The vignettes differed only regarding the patient’s BMI, which was either 28 (overweight but not obese) or 23 (normal weight); we informed participants that this was the only difference. After each vignette, participants estimated the patient’s risk of dying from any cause in the next 20 years (ie, by age 80). As an anchor, we informed participants that the average 20-year mortality risk for 60-year-old women in the US is 29%. Each participant’s “vignette-elicited” risk ratio (RR) for the overweight-mortality association was the ratio of their estimate for the overweight vignette versus the normal weight vignette. We then directly asked participants whether being overweight (not obese) versus normal weight decreases, increases, or does not affect a patient’s risk of dying in the next 20 years, independent of all other factors. Participants who responded “increases risk” or “decreases risk” then numerically estimated by how many times being overweight increases or decreases risk, respectively. We provided concrete examples (eg, 1.05 means 5% increased risk). These estimates represent participants’ directly estimated RR. For participants who responded “does not affect risk,” we assigned RR= 1. To reduce demand characteristics, participants were not informed at the beginning of the study that they would be providing both vignette-elicited and direct estimates. The Stanford University IRB approved this research, and we conducted analyses in R (version 4.2. 0). eTable 1; http://links. lww. com/EDE/C7 shows participant