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J Cachexia Sarcopenia Muscle. 2019 Jan 17. doi: 10.1002/jcsm.12378. [Epub ahead of print]

Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta-analysis.

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Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
Division of Cardiology and Metabolism; Department of Cardiology (CVK), Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Charité-Universitätsmedizin Berlin, Berlin, Germany.
Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.
Center for Stroke Research Berlin (CSB) Charité Universitätsmedizin Berlin, Berlin, Germany.


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.


Body weight; Epidemiologic methods; Health policy; Obesity paradigm; Outcome; Risk factor; Weight change

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