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Confused about data source for figure 1

Posted by markhoofnagle on 06 Mar 2013 at 04:31 GMT

I am confused about the data source for figure 1. In the paper, the authors cite the WHO BMI database (<a href="http://apps.who.int/bmi/i...">here</a>) but couldn't get the data on BMI from these databases to correlate with what appears to be shown in figure one. For instance, the USA appears at greater than 40% in figure 1 for obesity, but based on the WHO data the most recent data shows 33.9%, similarly values for other country codes I can make out are off, including Mexico, Kuwait, New Zealand etc. In the paper and in the figure the authors cite an obesity rate of 34%, but the WHO database has it at 26.5.

Is there a more updated version of this database that they have available? Or is there a problem with how the x-axis is being displayed in the figure?

No competing interests declared.

RE: Confused about data source for figure 1

sanjaybasu replied to markhoofnagle on 06 Mar 2013 at 14:44 GMT

We use an older version of the database - the version available at the time of this study - than what is now listed on the WHO website. The historical figures can be obtained on the World Bank's WDI database.

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RE: RE: Confused about data source for figure 1

sanjaybasu replied to sanjaybasu on 06 Mar 2013 at 14:52 GMT

i just checked with WHO and the data we used from the 2012 database [which has estimates for 2010] has been archived here:
https://apps.who.int/info...

as you can see, their estimate for US adults was 44.21754 for men and 48.28424 for women, and so on...

you should of course use the most updated estimates, which they have put on the BMI database

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RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 06 Mar 2013 at 16:39 GMT

Ok, I looked through that database as well. It doesn't actually appear different from my source. For the country profile of the US the database uses NHANES data

"Health, United States, 2008 with Special Feature on the Health of Young Adults (NHANES Data) (IBRef: 102915a1)"

They quote the US obesity prevalance for those 20+ years in age at 33.4, both sexes. As there are a great many surveys contained within the database, it's difficult to tell which specific survey gave you such inflated figures. Obesity rates of 48% for the US are prima facie absurd and in conflict with CDC and NHANES data which suggest our highest rate is 35.7% to date. The only survey I saw that had a BMI of 48 for women was of the subset of women from 2004 between the ages of 40-59, and of the populations 20-100 yrs with average of both sexes of "45" is from several subset measurements of individual ethnic populations, specifically, non-hispanic blacks. Obesity rates in the high 40s for the US can only have come from a subset, most likely a survey of non-hispanic blacks.

So I'm concerned these were not data that apply to the entire United States. When you examine the specific sourcing you see these are subpopulation surveys by CDC of specific ethnic groups, but this information is not apparent in the presentation in the WHO database. The actual country-wide data from all years is far lower.

Similarly, for New Zealand, you cite an increase in obesity rate from 23-34% over the last decade. How did you determine this? There are cluster surveys with obesity rates that high, such as for Manukau County, and that is in the WHO database, but the national data for both sexes from 2007 has a rate of 26.5%, from 2004 it was 22.5%, unless I'm mistaken. See survey code 102907a1 within the New Zealand data set, for instance for 2007.

What were the exact survey codes for the data you used?

Take a look at the global database on body mass index http://apps.who.int/bmi/i... and you see that none of the values for Figure 1 appear correct, and your assertion that in New Zealand obesity has increased from 23-34% is not supported by the national figures. Nor can I make these correlate to the appropriate national survey samples within the WHO database. Is it possible that regional and ethnic subset data were used to represent national obesity prevalence?

No competing interests declared.

RE: RE: RE: RE: Confused about data source for figure 1

sanjaybasu replied to markhoofnagle on 06 Mar 2013 at 17:17 GMT

I see your concern. let me ask the WHO folks and repeat the analysis with the latest national data

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RE: RE: RE: RE: Confused about data source for figure 1

sanjaybasu replied to markhoofnagle on 06 Mar 2013 at 17:19 GMT

however the link you sent doesn't seem to work at the moment - will try to get the original data

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RE: RE: RE: RE: RE: Confused about data source for figure 1

sanjaybasu replied to sanjaybasu on 06 Mar 2013 at 17:55 GMT

I've updated the analysis w/ the latest WHO data from the BMI database, using their data on overall country obesity rates. I will post the new figure link shortly. I've also updated the primary tables and the results are actually strengthened. I will post a link to those updates in short duration.

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RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

sanjaybasu replied to sanjaybasu on 06 Mar 2013 at 19:01 GMT

Here is an updated analysis using the latest WHO data, showing consistent results:
http://sbasu.wikispaces.c...

No competing interests declared.

RE: RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 06 Mar 2013 at 19:06 GMT

There is a permissions problem with the file.

Are you planning any correction to the original figure? I think, if anything, there will just be a systematic shift in the data for figure 1, and it doesn't have a major bearing on the main results of the paper, but you may want to correct your statements about New Zealand before the Kiwis become upset over their obesity being exaggerated....

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RE: RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 06 Mar 2013 at 21:56 GMT

Ok, I'm having problems correlating the diabetes data as well. While I'm not able to find the 2011 data set, since the IDF has updated since November, some of the differences are too large to be explained by a 1 year difference. While the USA appears correct at about 11% here are some of the discrepancies I've found:

1. Many discrepancies of both obesity and diabetes rate, for instance GBR, presented obesity/diabetes rate approximately 24/4, based on my search should be 22.7%/7.39
2. New Zealand, discussed in the intro and on the graph, quoted as 34%/5% (declined from 8) thus showing divergence is actually 26%/10.9% showing a continued concurrent increase, NOT a divergence.
3. I can not find obesity data on Sri Lanka in the WHO datasets past 2003 (2% for men, 6% for women in contrast to the paper which states the obesity rate is 0.1%!
4. Countries like Jamaica (JAM) last have data reported from 1996, and should not be compared with modern diabetes data
5. Outliers like Micronesia (FSM) >70% obese! Actual data 42.6% with diabetes prevalence 31.8, not 6% as indicated on graph.

Pretty much every single country I have looked at has had vastly different obesity and diabetes prevelence. You need to send me some raw data sets, and I can show you what I've assembled from these databases because I am decidedly not finding the diabetes/obesity convergence in general, nor in the specific cases you describe.

This seems to undermine the central argument that there is a obesity/diabetes divergence that necessitates additional factors such as sugar availability to explain.

No competing interests declared.

RE: RE: RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

sanjaybasu replied to markhoofnagle on 06 Mar 2013 at 23:13 GMT

Please see the updated file linked above, where we have addressed the most recent databases. We don't have provenance to distribute to third parties but you can obtain this from the IDF. There are some notable errors in your quoted numbers above but these are addressed in the update; the regression results remain robust despite updates to the DM and obesity data for the most recent years.

No competing interests declared.

RE: RE: RE: RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 07 Mar 2013 at 01:58 GMT

I think I may have figured out where we are diverging. When gathering data for your analysis, were you using the Global Infobase "estimates"? Or were you using the actual survey data from these countries? The two tend not to agree and the estimates seem to run high, for instance, in the 40s for the US, > 70 for micronesia, 35 for Mexico etc. That makes all the disagreements disappear from the obesity data, albeit not from the diabetes data. So I apologize if this generated confusion, it was not clear you were using the estimates rather than actual survey data from the methods.

However, I wonder, is it wise to use these estimates rather than actual survey data from the US such as that gathered by CDC? After all, when survey data is provided for each of these countries, it clearly contradicts the estimates, which I assume were calculated in 2005 if the citation is to be believed. Some of the countries appear to diverge by as much as 30%. I'm not able to find the methodology by which these estimates were calculated as the citation does not appear to exist in pubmed.

No competing interests declared.

RE: RE: RE: RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 07 Mar 2013 at 02:56 GMT

Two more things:

I found the 4th edition IDF atlas http://www.idf.org/node/2... and now figure 1 now makes a great deal more sense. It might have been clearer if in citation 6, the edition of the Atlas were noted. Also I feel the source of the obesity data is now clear, and from what I can tell, appears to be 7-year-old estimates of future obesity rates for 2010, not actual measured rates of obesity, which do suffer from infrequent updates. That these data don't correlate with actual measured survey data makes me question their use for such a representation, for many of the countries for such estimates, it's been decades since obesity rates were measured (eg Jamaica). They also are problematic as they are way outside of what seems plausible, or what have been measured by reliable public health agencies such as the CDC, but at least now I can reconstruct the data set It should be noted that in the newer diabetes data set, however, New Zealand is no longer showing a decrease, or divergence between obesity and diabetes, as the comparative prevalence is now back to 9%. And Sri Lanka is now much lower at 7%, is it possible the 2010 values were an aberration?

Second, the link you provided with the updated data has a permissions issue and remains inaccessible. I appreciate that this must have taken additional effort to provide more analysis, I'd like to be able to see it. I'm still hoping to create an identical reconstruction with the 4th edition atlas, as well as the newer diabetes data.

No competing interests declared.

RE: RE: RE: RE: RE: RE: Confused about data source for figure 1

markhoofnagle replied to sanjaybasu on 06 Mar 2013 at 19:03 GMT

Remove the comma that appears with the hyperlink and it will work.

No competing interests declared.