Obesity Prevalence Among Low-Income, Preschool-Aged Children—United States, 1998-2008
JAMA. 2010;303(1):28-30.
MMWR. 2009;58:769-773
1 figure, 1 table omitted
Childhood obesity continues to be a leading public health concern that disproportionately affects low-income and minority children.1 Children who are obese in their preschool years are more likely to be obese in adolescence and adulthood2 and to develop diabetes, hypertension, hyperlipidemia, asthma, and sleep apnea.3 One of the Healthy People 2010 objectives (19-3) is to reduce to 5% the proportion of children and adolescents who are obese.4 CDC’s Pediatric Nutrition Surveillance System (PedNSS) is the only source of nationally compiled obesity surveillance data obtained at the state and local level for low-income, preschool-aged children participating in federally funded health and nutrition programs. To describe progress in reducing childhood obesity, CDC examined trends and current prevalence in obesity using PedNSS data submitted by participating states, territories, and Indian tribal organizations during 1998-2008. The findings indicated that obesity prevalence among low-income, preschool-aged children increased steadily from 12.4% in 1998 to 14.5% in 2003, but subsequently remained essentially the same, with a 14.6% prevalence in 2008. Reducing childhood obesity will require effective prevention strategies that focus on environments and policies promoting physical activity and a healthy diet for families, child care centers, and communities.
PedNSS is a state-based surveillance system that monitors the nutritional status of children from birth through age 4 years enrolled in federally funded programs that serve low-income children. For all states except California and North Carolina, data come exclusively from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).* In California, data are exclusively from Medicaid-funded programs. North Carolina submits data from both WIC (95.5%) and non-WIC programs (4.5%).
For the states included in this analysis, 21.0% of children aged 2-4 years are covered by PedNSS. On average, children are seen twice a year by the program; height and weight are measured each time. Data are collected at the clinic level and submitted to CDC for analysis. Federally funded programs submit data on weight, height (measured by trained staff using a standard protocol during clinic visits), age, sex, and the race/ethnicity reported by the child’s parent or caregiver. CDC uses weight, height, and age data to calculate body mass index (BMI) (weight [kg]/ height [m2]). For children aged 2-4 years, obesity is defined as BMI-for-age
95th percentile based on the 2000 CDC sex-specific growth charts.5 CDC performs routine edits to assess data quality. An error flag is applied to height or weight data that are either missing, miscoded, or biologically implausible (e.g., height-for-age z-score <–5.0 or >3.0, body mass index [BMI]-for-age [children aged
CDC randomly selected one record per child per year to estimate obesity prevalence in 1998, 2003, and 2008. To assess the change in obesity prevalence in PedNSS overall and by race/ethnicity, prevalence was estimated using data only from the subset of federally funded programs that participated in 1998, 2003, and 2008 (N = 37). The average annual change in obesity prevalence during 1998-2003 and 2003-2008 was estimated for each PedNSS program. If data for a program were unavailable for a given year but were available for the preceding or subsequent year, CDC substituted the data for the adjacent year and calculated the annual change to account for the shorter or longer period. Chi-square tests for difference in proportions were conducted across each period, and tests were statistically significant (p<0.05) unless otherwise noted in this report.
During 1998-2008, the number of federally funded programs reporting data to PedNSS varied from 43 to 52. In 2008, records on approximately 8 million children were submitted from 43 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and six Indian tribal organizations. The overall prevalence of obesity among low-income, preschool-aged children increased from 12.4% (n = 1,999,970) in 1998 to 14.5% (n = 1,967,625) in 2003 and 14.6% (n = 2,222,410) in 2008. Obesity prevalence increased 0.43 percentage points annually during 1998-2003, but only 0.02 percentage points annually during 2003-2008. Obesity increased across all racial/ethnic groups during 1998-2003, with the exception of Asian/Pacific Islander (A/PI) children. However, during 2003-2008, obesity remained stable among all groups except American Indian/Alaska Native (AI/AN) children. In 2008, prevalence was highest among AI/AN (21.2%) and Hispanic (18.5%) children, and lowest among non-Hispanic white (12.6%), non-Hispanic black (11.8%), and A/PI (12.3%) children.
In 2008, only programs in Colorado and Hawaii had obesity prevalences
10%. The two federally funded programs with prevalence >20% were Indian tribal organizations. Of the 41 PedNSS programs supplying data for 1998-2003, a total of 38 (93%) reported an increase in obesity prevalence. In contrast, of the 44 programs supplying data for 2003-2008, 22 (50%) reported an increase in obesity, whereas 14 (32%) reported no change, and eight (18%) reported a decrease.
Reported by:
AJ Sharma, PhD, LM Grummer-Strawn, PhD, K Dalenius, MPH, D Galuska, PhD, M Anandappa, MS, E Borland, H Mackintosh, MSPH, R Smith, MS, Div of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC.
CDC Editorial Note:
Reduction of obesity among children and adolescents is a national priority in the United States.4 The results presented in this report indicate that among low-income, preschool-aged children participating in federally funded nutrition programs, the prevalence of obesity increased during 1998-2003, but stabilized during 2003-2008. In 2008, the national prevalence of obesity in this group remained highest among low-income Hispanic and AI/AN children and continued to increase among AI/AN children. These results suggest overall progress in stabilizing the prevalence of childhood obesity in a subset of low-income, preschool-aged children. However, these results should be confirmed through additional research using other data sets.Children in preschool age groups are a priority for surveillance because obesity trends in this group can serve as a bellwether for trends in older children and adults.2 PedNSS currently serves as the only source of national obesity prevalence data compiled specifically on low-income, preschool-aged children. Because PedNSS nutritional data are dependent on enrollments in participating federally funded programs, PedNSS results are subject to variations in enrollment in these programs in each state. However, the effect of such variations on PedNSS results is difficult to determine. Conditions within a state that differentially affect the enrollment of children with varying prevalences of obesity could affect state or national results. In addition, changes in the proportion of children from each state might alter the results. For example, California, the largest data contributor to PedNSS, has one of the highest prevalences of obesity. The percentage of the total PedNSS sample provided by California decreased from 20.2% in 1998 to 13.6% in 2008. However, even deletion of all California data would not alter the overall results; an increase from 1998 to 2003 would still be observed, followed by stabilization through 2008. Furthermore, stabilization or declines were observed in half of the individual federally funded programs in PedNSS.
To maintain the consistency of PedNSS data, methods for data collection and recording are set nationally and are uniform across states and participating federal programs. The procedures for collecting height and weight data did not change during 1998-2008, with the exception of an increasing use of digital scales. Given the procedures within the WIC program for regular calibration of scales, this change should not affect rates of obesity. CDC has stringent requirements for data quality and uses standardized procedures for data cleaning; data files that do not meet these standards are rejected, as are records that do not meet standards for acceptable heights and weights.
The reason for the stabilization of overall obesity prevalence among these children during 2003-2008 is not known and likely is complex. One factor might be prevention efforts within state and local WIC programs targeting behaviors related to obesity in children. For example, certain initiatives in WIC
have attempted to raise public awareness, acceptance, and support of breastfeeding, increased the percentage of low-fat or fat-free milk vouchers issued for children aged >2 years,
and reduced television viewing.6 Recommendations such as those from the Institute of Medicine’s Preventing Childhood Obesity report also might have spurred greater attention to obesity prevention for all children.7
The National Health and Nutrition Examination Survey (NHANES) also has found a stabilization of obesity prevalence in U.S. children. NHANES found no significant increase in obesity prevalence during 1999-2006 in children aged 2-19 years.8 This apparent plateau remained even after adjusting for differences in prevalence by age group. Trends in the 2-5 year age group were not analyzed separately because of small sample size. For NHANES 2003-2006, the overall prevalence of obesity (BMI-for-age
The findings in this report are subject to at least three limitations. First, the proportion of children participating in federally funded nutrition programs increased during 1998-2008, as evidenced by the 11% increase in the number of children in these analyses (i.e., from 1,999,970 in 1998 to 2,222,410 in 2008). However, how the addition of these children might have affected the prevalence of obesity is unknown. Second, the percentage of the total PedNSS dataset that is made up of WIC records increased from 76% in 1998 to 85% in 2008. If the prevalence of obesity were lower in WIC than in non-WIC programs, this increase could partially explain the observed trends. However, when the analysis was conducted using only data from WIC, results were not substantially different. Finally, PedNSS data are not representative of all low-income, preschool-aged children in the United States because not all states participate in PedNSS and not all low-income children participate in federally funded programs.
Childhood obesity remains a serious public health problem even among this subset, particularly among AI/AN children. A sustained and effective public health response is necessary across the United States to reduce childhood obesity. Strategies should emphasize improving environments and policies that promote physical activity and a healthy diet.
REFERENCES
8 Available.
*Eligibility criteria for WIC includes a family income 185% of the poverty income threshold, based on U.S. Poverty Income Guidelines, available at http://aspe.os.dhhs.gov/poverty. A person who participates or has family members who participate in certain other benefit programs, such as the Medicaid or Aid to Families with Dependent Children/Temporary Assistance to Needy Families, automatically meets the income-eligibility requirement.
Including the Early and Periodic Screening, Diagnosis, and Treatment Program, other Medicaid-funded child health programs, and Title V Maternal and Child Health Programs. Eligibility criteria includes a family income 200% of the poverty income threshold, based on U.S. Poverty Income Guidelines. The non-WIC records accounted for 24% of records in 1998, 19% in 2003, and 15% in 2008.
Additional information available at http://www.nal.usda.gov/wicworks/spotlight/bfweek_resources.html.
Additional information available at http://www.health.state.ny.us/prevention/nutrition/resources/docs/2003-2006_ewph_community_intervention_projects.pdf.
JAMA article about metabolism shifts.
Extra Calories Cause Weight Gain—But How Much?
Martijn B. Katan, PhD; David S. Ludwig, MD, PhD
JAMA. 2010;303(1):65-66.
How much weight would an individual gain by eating an extra chocolate chip cookie every day for life? One approach to answering this question, frequently used in textbooks1 and scientific articles, is based on the assumption that a pound (454 g) of fat tissue has about 3500 kilocalories (kcal). Thus, a daily 60-kcal cookie would be expected to produce 0.2 kg (0.5 lb) weight gain in a month, 2.7 kg (6 lb) in a year, 27 kg (60 lb) in a decade, and many hundreds of pounds in a lifetime. This of course does not happen. In this article, the physiology of weight gain and loss is reviewed, and the amount of reduction of caloric intake necessary to avoid becoming overweight or obese is estimated.
Weight Change Is Self-limiting
Body weight remains stable as long as the number of calories consumed equals the number expended through physical activities and metabolic processes. When energy intake increases above expenditure, the excess is used to build new tissue, and weight gain results. However, weight gain does not continue indefinitely. Carefully controlled overfeeding experiments show that calorie expenditure increases progressively because of the energetic costs of maintaining the newly created tissue. A person who consumes an extra cookie every day will initially experience weight gain, but over time an increasing proportion of the cookie’s calories will go into repairing, replacing, and carrying the extra body tissue. After a few years of daily cookie eating, weight gain will level off at approximately 2.7 kg (6 lb).2 Thus, a one-time step-up in caloric intake will cause body weight to increase asymptotically to a new, stable level.The converse occurs when an individual reduces food intake. As body size diminishes, so does the amount of fuel needed to maintain and move it, and weight settles at a new steady level. In addition, weight loss produces changes in hormones, the autonomic nervous system, and the intrinsic efficiency of muscle that serve to conserve energy.3 Therefore, additional weight loss can only be achieved by a more severe diet or a more arduous physical activity routine. Most individuals do the opposite: after having achieved some weight loss, they resume their original diet and exercise habits. Consequently, weight gain recurs rapidly.
How Much Are Americans Overeating?
According to the first National Health and Nutrition Examination Survey (NHANES)—a nationally representative study of the US population—women aged 20 to 29 years had a mean body mass index (BMI) of 23 in the early 1970s.4 The fourth NHANES, conducted in 1999 to 2002, found that women aged 50 to 59 years (who would have been in their 20s in the original study), had a mean BMI of 29,4 representing a weight gain of approximately 16 kg (35 lb) in 28 years (Figure, A). How much overeating is needed to gain this amount of weight? Physiologists and physicists have developed mathematical models that accurately predict the effect of a discrete change in energy intake on body weight.2, 5-6 These equations suggest that a young adult woman must increase energy intake by 370 kcal per day to increase BMI from 23 to 29.2 That increase probably occurs gradually. For example, adding 30 mL (1 oz) of sugar-sweetened beverage and walking 1 minute less per day creates a temporary energy surplus of about 13 kcal/d, leading to a weight gain of 0.6 kg (1.4 lb). Repeating changes in diet and physical activity of this magnitude on an annual basis for 28 years would produce the 370 kcal/d “energy gap” and 16-kg (35-lb) weight gain considered above.
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Figure. The Effects of Graded Reductions in Calorie Intake Beginning at Age 25 Years on Body WeightSolid curves demonstrate the predicted effects of a decrease in energy intake initiated at age 25 years on the weight gain that results from progressive changes in diet and physical activity in 2 situations. Panel A represents deviations from the natural course of weight gain (the dashed line) for the average US women interpolated from National Health and Nutrition Examination Survey (NHANES) I to IV data covering a 28-year period.4 Panel B represents the hypothetical case of a man aged 25 years whose body mass index increased from 25 to 35 over 28 years (dashed line). Mathematical models were based on Hall et al.10 To become obese, a much larger cumulative change in lifestyle would be required. The 90th percentile of BMI is 35 for men aged 50 to 59 years.7 To reach this degree of adiposity from a BMI of 25 at age 25 years (Figure, B), an individual would need to increase energy intake, decrease physical activity, or both by 680 kcal per day.2 For obese children, this energy gap is even greater. An adolescent at the 95th percentile of BMI at age 15 to 17 years is approximately 26 kg (58 lb) over ideal body weight.6 Assuming normal weight at age 5 to 7 years, this individual must overconsume 700 to 1000 kcal every day during this period.6 It is difficult to determine with certainty how energy intake has changed since the early 1970s, but some studies suggest a per capita increase of up to 500 kcal/d.8
Preventing Weight Gain
Obesity is difficult to reverse. But what would it take for a lean young adult to stay that way, instead of gaining about 1 or 2 lbs every year? If the effect of excess energy intake on body weight were linear, a small, one-step change in energy balance initiated at age 25 years would be sufficient to prevent overweight by middle age for most individuals.9 However, any single change in diet or physical activity, even if permanent, will elicit compensatory mechanisms that limit long-term effect on body weight. Since the weight gain experienced by a typical American must be caused by repeated changes in diet, physical activity, or both, a small decrease in food intake or increase in physical activity will halt this increase only temporarily (Figure).
Implications
These calculations suggest that small changes in lifestyle would have a minor effect on obesity prevention. Walking an extra mile a day expends, roughly, an additional 60 kcal compared with resting—equal to the energy in a small cookie. Physiological considerations suggest that the apparent energy imbalance for much of the US population is 5- to 10-fold greater, far beyond the ability of most individuals to address on a personal level. Rather, an effective public health approach to obesity prevention will require fundamental changes in the food supply and the social infrastructure. Changes of this nature depend on more stringent regulation of the food industry, agricultural policy informed by public health, and investments by government in the social environment to promote physical activity.
Corresponding Author: Martijn B. Katan, PhD, Institute of Health Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands (katan99@falw.vu.nl).Financial Disclosures: Dr Katan reported receiving royalties from a book about nutrition and health, earning fees for periodically writing a newspaper science section column and for serving as a radio health commentator, and receiving grants from the Netherlands Heart Foundation and the Netherlands Organization for Health Research and Development for research on childhood obesity. Dr Ludwig reported receiving royalties from a book about childhood obesity and grants from foundations and the National Institutes of Health for obesity-related research, mentoring, and patient care.
Funding/Support: Dr Katan is supported by an Academy Professorship from the Royal Netherlands Academy of Sciences. Dr Ludwig is supported in part by career award K24DK082730 from the National Institute of Diabetes and Digestive and Kidney Diseases.
Role of Sponsors: Neither the National Institute of Diabetes and Digestive and Kidney Diseases nor the Royal Netherlands Academy of Sciences had any role in the preparation, review, or approval of the manuscript.
Disclaimer: The content of this commentary is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.
Additonal Contributions: We thank Steven Gortmaker, PhD, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts; Kevin D. Hall, PhD, Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and Boyd Swinburn, MB, ChB, MD, FRACP, World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia, for their critical reading of the manuscript. We also thank Dr Hall for assistance in preparing the figure. None received remuneration for their contributions.
Author Affiliations: Institute of Health Sciences, VU University, Amsterdam, the Netherlands (Dr Katan); and Optimal Weight for Life Program, Department of Medicine, Children’s Hospital, Boston, Massachusetts (Dr Ludwig).
REFERENCES
1. Shils ME, ed, Shile M, ed, Ross AC, ed, Caballero B, ed, Cousins RJ, ed. Modern Nutrition in Health and Disease. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:982.
2. Hall KD, Jordan PN. Modeling weight-loss maintenance to help prevent body weight regain. Am J Clin Nutr. 2008;88(6):1495-1503. FREE FULL TEXT
3. Goldsmith RL, Joanisse DR, Gallagher D; et al. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects [published online November 4, 2009]. Am J Physiol Regul Integr Comp Physiol. doi:10.1152/ajpregu.00053.2009. 2009. FREE FULL TEXT
4. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height, and body mass index, United States 1960-2002. Adv Data. 2004;347(347):1-17. PUBMED
5. Weinsier RL, Bracco D, Schutz Y. Predicted effects of small decreases in energy expenditure on weight gain in adult women. Int J Obes Relat Metab Disord. 1993;17(12):693-700. WEB OF SCIENCE | PUBMED
6. Wang YC, Gortmaker SL, Sobol AM, Kuntz KM. Estimating the energy gap among US children: a counterfactual approach. Pediatrics. 2006;118(6):e1721-e1733. FREE FULL TEXT
7. McDowell MA, Fryar CD, Hirsch R, Ogden CL. Anthropometric reference data for children and adults: US population, 1999-2002. Adv Data. 2005;361(361):1-5. PUBMED
8. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity [published online October 14, 2009]. Am J Clin Nutr. doi:10.3945/ajcn.2009.28595. 2009;90(6):1453-1456. FREE FULL TEXT
9. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science. 2003;299(5608):853-855. FREE FULL TEXT
10. Hall KD, Guo J, Dore M, Chow CC. The progressive increase of food waste in America and its environmental impact. PLoS One. doi:10.1371/journal.pone.0007940. 2009;4(11):e7940. FULL TEXT | PUBMED
Uh-0h. I’m in trouble then. Cause my kids never seem to be IN bed. I’m serious. I say this as I’m drinking caffeine to try and chase away a migraine (aversion therapy, trying to ignore the elephants marching through my skull) and to try and stay awake since my son, my dear loving son, was awake at 2:30 this morning. And didn’t go to sleep until about 4. At least they are both in the 25th percentile for weight..
Of course, I also have read that metabolic syndrome numbers change quite frequently in kids, so I wouldn’t be surprised if this study were to be counterdicted, say, next week.
From Medscape:
By Joene Hendry
NEW YORK (Reuters Health) Jan 11 – Young children who average 8 hours or less of sleep a night may be at higher risk for developing diabetes, report Chinese and American researchers.
This risk may be even greater among obese youngsters, Dr. Zhijie Yu, at the Chinese Academy of Sciences in Shanghai and colleagues note in Archives of Pediatric and Adolescent Medicine.
Moreover, Dr. Yu said in an email to Reuters Health, shorter sleep seemed to influence blood glucose “independently of a large variety of risk factors,” such as age, gender, birth-related influences, early life feeding or later diet, recent illness, physical activity, body mass, and waist girth.
Dr. Yu’s team investigated sleep duration and blood glucose levels in 619 obese and 617 non-obese children who were 3 to 6 years old and free of diabetes.
Parental reports showed a greater percentage of the obese (47%) than the non-obese (37%) kids averaged 8 or fewer hours of sleep nightly. These reports also showed nightly averages of 9 or 10, or 11-plus, hours of sleep less common in obese (37% and 16%) versus non-obese (43% and 20%) kids, respectively.
High fasting glucose levels, defined as 100 mg/dL or greater, were about 1.35-fold and 2.15-fold more likely in the shorter-sleeping non-obese and obese kids, respectively. Overall, 11 children had levels above 126 mg/dL.
Among the children who slept less than 8 hours per night, elevated fasting glucose levels were documented in 23 of the 217 who were non-obese and in 49 of the 291 obese kids. By contrast, among children getting 9 or 10 hours of sleep each night, 21 of the 175 non-obese and 21 of 229 obese kids had high blood sugar.
These findings hint that, similar to adults, adequate sleep may help kids, maintain a healthy body weight and an optimal blood sugar level, Dr. Yu said.
However, Dr. Yu and co-authors emphasize the need for further studies to confirm these findings in both Chinese and other populations of youngsters.
Arch Pediatr Adolesc Med 2010.
Sad, but possibly true. Especially given the rate of childhood obesity.
So here’s the question — or maybe a few. When will we, as a country, redefine obesity to include fewer people? And when will WLS become even more prevalent than it is now?
BTW MSNBC? I take a few issues with your language. Just so you know — not that you care.
Updated to include Medscape article.
From MSNBC.com:
Obesity rates idle as most of us are already fat
Have we simply reached a maximum level of tubbiness?
America’s rapid rise in obesity appears to have leveled off, with new government figures showing no significant increase in a decade.
But there’s little reason to cheer. More than two-thirds of adults and almost a third of children are overweight, and there are no signs of improvement.
Experts say they’re not sure whether the lull in the battle of the bulge can be attributed to more awareness and better diets — or whether society has simply reached a maximum level of tubbiness.
“Maybe in this environment, this is as overweight as we’ll get,” said Gary Foster, director of the Temple University Center for Obesity Research and Education.
Being thin is the exception
Not only are the vast majority of adults — 68 percent — overweight, 34 percent are obese; and 17 percent of children are obese. Even the youngest Americans are affected — 10 percent of babies and toddlers are precariously heavy.
The most recent Centers for Disease Control and Prevention data, from the years 2007 to 2008, were contained in two reports published online Wednesday in the Journal of the American Medical Association.
“The absolute numbers here are staggering,” said Foster. “This isn’t something that should be celebrated.”
The new data are based on health surveys involving height and weight measurements of 5,700 adults and 4,000 children, surveys the CDC does every two years.
“In the most recent decade, we saw a slowing in the increase,” said Carolyn Ogden, the report’s author and a CDC researcher who has tracked obesity for years. “It was better news, but it’s still a serious problem.”
In most age groups, black adults had the highest rates of obesity, followed by Mexican-Americans and whites.
Heaviest boys getting heavier
Among children ages 2 to 19, 32 percent were too heavy — a rate that was mostly unchanged. But disturbingly, most obese kids were extremely obese. And the percentage of extremely obese boys ages 6 to 19 has steadily increased, to 15 percent from about 9 percent in 1999-2000.
Ogden said it was disappointing to see no decline, and troubling that the heaviest boys seem to be getting even heavier. The study didn’t examine the causes, but Ogden cited the usual reasons — soft drinks, video games and inactivity — as possible explanations.
“We shouldn’t be complacent. We still have a problem,” Ogden said.
Dr. William Dietz, an obesity expert with the CDC, cautiously called the results promising. “We’re at the corner; we haven’t turned the corner,” he said.
Turning point?
One factor in the plateau may be the barrage of information about the obesity epidemic — and what to do about it, said Foster.
“There’s an increased availability of healthier options than there was five years ago,” he said.
School- and community-based efforts to emphasize fitness and healthy eating may also have had some effect, although Foster acknowledges that there’s no good data to prove the point.
“I think there’s lot of things you could point to, but the truth is, it’s a confluence of factors,” he said.
One of those factors might be the intersection of genetic predisposition to obesity and an environment that encourages weight gain, Foster said.
“This is about what we can expect,” he said. “For it to go down, we’re going to have to greatly change the environment for the better.”
The obesity epidemic is considered a top White House priority. President Barack Obama has pushed to make obesity prevention part of health care reform. Overhaul measures pending in Congress include encouraging employer-based wellness programs and requiring large restaurant chains to list calories. And Michelle Obama has made childhood obesity and healthy eating habits a pet project.
People like Darrell Pender are paying attention.
Obesity “is constantly in the news,” said Pender, a 42-year-old New York City computer technician who decided to get serious about fighting fat after being diagnosed with diabetes three years ago.
Pender was tempted by a TV ad for obesity surgery, but chose a less drastic option — a nutrition support group that he credits with helping him make healthier food choices. So far, he’s lost 50 pounds over several months. At 350 pounds, he’s still very obese, but his diabetes is under control and he feels healthier.
From Medscape:
Most Americans Overweight, and One-Third Are Obese: NHANES
January 13, 2010 (Hyattsville, Maryland) — Two new studies this week draw attention to the alarming number of individuals in the US considered overweight or obese [1,2]. Based on the latest surveys, more than two-thirds of US adults are overweight or obese, one-third are considered obese, and more than 10% of children and adolescents are also considered too heavy for their age.
The good news, however, is that the increasing obesity trends observed over the past decade appear to be leveling off, according to investigators.
“The levels are still very high, and obesity is a significant health concern,” Dr Cynthia Ogden (Centers for Disease Control, Hyattsville, MD), an investigator on both studies, told heartwire . “On the other hand, we’ve seen a slowing down, if you will, in the rate of increase compared with what it was in the 1980s and 1990s, so that’s a positive thing. But the prevalence remains very high, and significant disparities remain, and we did see an increase within this 10-year period. It’s not as if there were no increase.”
The data, from analyses of the National Health and Nutrition Examination Survey (NHANES), are published online January 13, 2010 in the Journal of the American Medical Association. In an editorial accompanying the studies [3], Dr J Michael Gaziano (Brigham and Women’s Hospital, Boston, MA) argues that the despite the leveling off, the magnitude of the obesity problem threatens to undo gains made in recent years.
“Despite the many advances in preventive medicine and treatment that reduced cardiovascular disease, the new stage of the epidemiologic transition, the age of obesity and inactivity, emerged to threaten the progress made in postponing illness and death to later in adult life spans,” he writes. “The steady gains made in both quality of life and longevity by addressing risk factors such as smoking, hypertension, and dyslipidemia are threatened by the obesity epidemic.”
Two-Thirds of US Adults Obese or Overweight
Speaking with heartwire , Ogden, the first author of the study investigating trends in the prevalence of high body-mass index (BMI) in children and adolescents and an author, along with lead investigator Dr Katherine Flegal (Centers for Disease Control, Hyattsville, MD) of the study in adults, said NHANES provides enough data every two years to examine the natural prevalence of obesity in the US population. The purpose of these studies was to document trends over two-year periods for the past 10 years.
In the first study, they analyzed the prevalence of obesity and overweight in 5555 adult men and women based on height and weight measurements used to calculate BMI. Overweight was defined as a BMI of 25.0 to 29.9 kg/m2 and obesity defined as a BMI >30.0 kg/m2.
In 2007–2008, the overall prevalence of obesity was 33.8%, with more women than men, 35.5% vs 32.2%, considered obese. Combining obesity and overweight, the overall prevalence was 68.0%, this time with more men than women, 72.3% vs 64.1%, considered overweight and/or obese. The prevalence of obesity varied by age group and by racial and ethnic groups.
Prevalence of Obesity and Overweight (%) for Adults >20 Years
| Category | All (n=5555) | Non-Hispanic white (n=2618) | Non-Hispanic black (n=1114) | All Hispanic (n=1566) | Mexican-American (n=945) |
| BMI >30 | 33.8 | 32.4 | 44.1 | 38.7 | 40.4 |
| All men | 32.2 | 31.9 | 37.3 | 34.3 | 35.9 |
| All women | 35.5 | 33.0 | 49.6 | 43.0 | 45.1 |
| BMI >25 | 68.0 | 66.7 | 73.8 | 77.9 | 78.8 |
| All men | 72.3 | 72.6 | 68.5 | 79.3 | 80.0 |
| All women | 64.1 | 61.2 | 78.2 | 76.1 | 76.9 |
Over the 10-year period, however, the prevalence of obesity did not significantly increase for women. There was a significant linear trend for men in the prevalence in 2007–2008 compared with the prevalence in 1999–2000, but the most recent figures were not statistically different when compared with data in 2003–2004 and 2005–2006.
In the second NHANES analysis, 11.9% of children and adolescents aged two to 19 years were considered obese, in this case defined as being at or above the 97th percentile of the BMI-for-age growth charts. Using less stringent definitions, 16.9% and 31.7% of the kids were at or above the 95th and 85th percentile of the BMI-for-age growth charts. Like adults, disparities existed by age and by race and ethnic groups.
“In children, we saw no change over the 10-year period except for in boys six to 19 years of age,” noted Ogden. “Here we saw an increase among the heaviest boys, among a cut point that is usually heavier than what we use to determine obesity. For those kids, the prevalence did increase, so there is a suggestion that the heaviest kids are getting even heavier. There is definitely still a concern.”
Statistics Are Still Staggering
In his editorial, Gaziano writes that while a slowing of the steady upward trend in overweight and obesity is good news, “the statistics are still staggering,” given that most Americans are overweight and one-third are obese.
The results of the survey are sobering, “given the wide variety of deleterious health effects strongly linked to excess weight,” such as coronary heart disease, ischemic stroke, hypertension, dyslipidemia, type 2 diabetes, joint disease, cancer, sleep apnea, asthma, and other chronic conditions. Early obesity, he notes, strongly predicts later cardiovascular disease, and excess weight might help explain the dramatic increase in type 2 diabetes, a major risk factor for cardiovascular disease.
“If left unchecked, overweight and obesity have the potential to rival smoking as a public-health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years,” writes Gaziano.
Unlike smoking, high blood pressure, and dyslipidemia, however, the best approach to treating overweight and obese individuals is still unknown. The current approach involves changes in lifestyle, but as most clinicians are aware, promoting lifestyle changes to encourage weight reduction has been disappointing, according to the editorial. Still, given the risk of obesity-related health concerns, a massive public-health campaign to raise awareness about the dangers is needed, and the longer the delay in doing so increases the likelihood of negating the significant progress achieved in decreasing chronic disease in the past four decades, writes Gaziano.
Filing under the “duh” category for the medical community… I would like to state, though, that my GERD has come back somewhat. I still get heartburn, but never to the degree I once had. I just wanna make it clear, though, despite being told otherwise, it is not because I’ve stretched my pouch out beyond repair or because my stoma is the size of the Grand Canyon. It’s cause I’m special, damnit. I’m a lemon, and don’t you forget about it.
BTW — hello Medscape? You have many typos on your dates today. You should correct that, given, you know, that you are an important resource to us peeps out here in the interwebz.
From Medscape:
Gastric Bypass Relieves GERD Syndromes in Most Obese Patients
By Michelle Rizzo
NEW YORK (Reuters Health) Jan 08 – Gastric bypass alleviates gastroesophageal reflux disease (GERD) in most obese patients and provides “substantial” improvement in heartburn by 6 months after surgery, report researchers from Brazil in the December 10th online issue of the Annals of Surgery.
Obese GERD patients also have an improved quality of life after gastric bypass, and they use fewer proton pump inhibitors, senior author Dr. Fernando Fornari, from the University of Passo Fundo, told Reuters Health.
“GERD is highly prevalent in patients with morbid obesity, contributing to compromise the quality of life of these patients,” Dr. Fornari noted. “In the last 50 years, the conventional surgical treatment for GERD has been a gastric fundoplication.”
However, he added, GERD symptoms often recur after gastric fundoplication in obese patients.
In their study, he and his colleagues followed 86 morbidly obese patients who were evaluated for GERD symptoms before and 6 months after their gastric bypass operations.
Overall, the mean age was 38 years, the mean preoperative body mass index was 45.3, 25 patients were male, and most (n=84) were white Brazilians.
The overall prevalence of GERD was 64% before gastric bypass and 33% at 6 months after the surgery (p < 0.0001).
Forty-seven patients had typical reflux syndrome before surgery, which resolved in 39. Of the 39 patients without preoperative reflux syndrome, 4 developed symptoms postoperatively.
The chief complaint before surgery was heartburn (in 96%); after surgery, it was regurgitation (in 64%).
After gastric bypass, the esophageal mucosa was improved in 27 patients, unchanged in 51 patients, and worse in 8 patients. Postoperatively, the number of patients with extra-esophageal injury was reduced from 16 to 1.
There was also a significant decrease in acid exposure in the overall population, from a median of 5.1% before surgery to 1.1% afterward.
After surgery, 74 patients had a pH below 4 in their gastric pouch. Although there was no difference in typical reflux syndrome symptoms in patients with or without an acid gastric pouch (18% versus 8%), reflux esophagitis was more frequent with an acid gastric pouch (26% versus 0%; p = 0.041).
“Based on our study, we believe that gastric bypass may replace the conventional surgical technique for patients with morbid obesity who suffer from GERD,” Dr. Fornari noted. “In addition, it is well established that gastric bypass increases both quantity and quality of life by treating obesity and its related comorbidities.”
He and his colleagues conclude, “Whether regurgitation post-gastric bypass corresponds to reflux disease or bad eating behavior deserves further studies.”
Ann Surg 2009.
