Obesity rates in China have tripled over the past 10 years

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Obesity rates in China have tripled over the past 10 years

A cluster of high obesity prevalence was identified in the metro area of Beijing, Tianjin, and Hebei

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0477

URLs go live when the embargo lifts

Since 2004, the prevalence of general obesity has tripled and that of abdominal obesity has increased by more than 50 percent. While the prevalence of obesity in China is still much lower than in the United States, evidence suggests that adverse effects of obesity may manifest at lower thresholds in Asian populations. Findings from a brief research report are published in Annals of Internal Medicine.

According to the World Health Organization, the global prevalence of obesity nearly doubled between 1980 and 2008. This increase in obesity prevalence was observed in China, as well, but national estimates of adult obesity in China have not been updated since 2010 and did not include provincial prevalence estimates.

Researchers from the Chinese Center for Disease Control and Prevention used data from the China Chronic Disease and Risk Factor Surveillance (CCDRFS) survey to estimate the national and provincial prevalence of general and abdominal obesity among Chinese adults and by sex. General obesity was defined as having a BMI of 28 kg/m2 or higher and abdominal obesity as having a waist circumference of at least 90 cm for men and 85 cm for women. Based on these criteria, the overall prevalence of general obesity in Chinese adults was 14 percent in men and 14.1 percent in women. The prevalence of abdominal obesity was 31.5 percent in men and 32.4 percent in women. On the province level, geographic heterogeneity was clearly observed across 31 provinces and a cluster of high prevalence of general and abdominal obesity in both sexes was identified in Beijing, Tianjin, and Hebei, which are also known as the Jing-Jin-Ji metropolitan area.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at laevans@acponline.org. To speak with the lead authors, Peng Jia, PhD, please contact jiapengff@hotmail.com, or Limin Wang, MPH, wanglimin@ncncd.chinacdc.cn

2. Over 5 years, CBT appears to provide better value than antidepressants as initial therapy for major depression

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1480

Editorial: http://annals.org/aim/article/doi/10.7326/M19-2623

URLs go live when the embargo lifts

Neither second-generation antidepressants nor cognitive behavior therapy (CBT) provides consistently superior cost-effectiveness relative to the other. Given that many patients seem to prefer psychotherapy over medication, increasing patient access to CBT may be warranted. Findings from a decision analytic model are published in Annals of Internal Medicine.

Per guidelines from the American College of Physicians, adult patients with major depressive disorder should receive either CBT or a second-generation antidepressant. Although 70 percent of patients with depression prefer psychotherapy to pharmacotherapy, fewer than one quarter receive CBT or other types of psychotherapy. This could be because of the cost, which can be more than $100 per session, whereas antidepressant medications cost less than $100 per year. However, studies have been conflicting about which treatment is more cost-effective for initial treatment of depression.

Researchers from the University of Michigan Medical School used relative effectiveness data from a meta-analysis of randomized controlled trials and additional clinical and economic data to inform a decision analytic model to quantify the cost-effectiveness of CBT versus second-generation antidepressants for initial treatment of major depressive disorder. The researchers found that neither treatment was consistently superior from a cost-effectiveness perspective. CBT had a higher initial cost, but over a 5-year period, it was less costly while producing the same or greater improvement. At 1 year, there was approximately 70 percent likelihood that antidepressants were the superior treatment from a cost-effectiveness perspective, whereas at 5 years, there was approximately 75 percent likelihood that CBT was superior. The researchers said that in the absence of clear superiority of either treatment, shared decision making incorporating patients' preferences is critical. Given that patients seem to prefer CBT, efforts to improve access to psychotherapy may be warranted.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Eric L. Ross, MD, please contact Laura Neves at McLean Hospital at 617-855-2110 or pa@mclean.harvard.edu

Also new in this issue:

A Veteran-Centric Model of Care: Crossing the Cultural Divide

Edward P. Manning, MD, PhD

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M19-1264

The Majority Subsidy

Roy C. Ziegelstein, MD, and Deidra C. Crews, MD, ScM

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M19-1923

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