Richard Kahn, PhD, who was the chief scientific and medical officer of the ADA for nearly 25 years stated at a conference that, "Community-based weight-loss programs have not been shown to be effective at reducing the incidence of diabetes, so implementing a national program would likely be money down the drain."...
He stated that, "Community programs are ineffective at achieving weight loss."
Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a published paper, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.
His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.
(However, a preliminary study presented at the American Diabetes Association meeting last year found that a short-term lifestyle modification program for overweight diabetic patients showed long-term benefits for many of the participants.)
"In sum, to date, we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than two to three years in the great majority of participants and at a low cost," Kahn wrote.
Kahn's remarks preceded those of Kenneth Thorpe, of Emory University, who outlined how the healthcare reform law laid the groundwork for a national, community-based diabetes prevention strategy modeled on the Diabetes Prevention Program.
Kahn said that would be a waste of money. "The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources." He also stated that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?" Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors. "While we wait for the time when lifestyle modification becomes practical, we might be better served by focusing more attention on improving our understanding of the processes that affect energy intake and expenditure and improving the medical management of diabetes," Kahn wrote.
Those medical management strategies include making an early diagnosis and administering "proven treatments that have been shown to reduce complications of diabetes and extend life," he said.
He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
Health Affairs, Jan. 2012
Showing posts with label adolescent obesity. Show all posts
Showing posts with label adolescent obesity. Show all posts
Thursday, January 19, 2012
Friday, October 7, 2011
Hypermobile Flatfoot And Pediatric Obesity: What You Should Know
Given the increasing prevalence of childhood obesity, this author examines the emerging connection with pediatric flatfoot via a thorough review of the current research and discusses the need for further research to support treatment of flatfoot in this population.
Almost daily, you can turn on your TV or open your favorite newspaper and learn about the “national health crisis” that is obesity. There is also a tremendous amount of literature concerning the long-term health pitfalls of morbid obesity and how it can affect the heart, liver, kidney and lymphatic system. Obviously, obesity can also lead to diabetes and a whole host of other health-related issues.
We are also starting to realize that these poor habits begin in our youth and translate to our overall health as adults. This is very apparent if you’ve ever watched The Jamie Oliver Experiment. In this show, the titular young chef travels the United States and tries to revamp cafeterias in public schools to have a menu that is generally healthier, and convince our nation’s youth to modify their lifestyles and help them attain health into adulthood.
As a parent, I am very concerned about my children’s health but does their health translate to their feet as well? Are obese children more prone to a certain foot type? If that is the case, how does that relate to their general health?
A Closer Look At How Researchers Are Identifying Flatfoot In Study Populations
Before starting the discussion of flatfoot studies and their outcomes, I would like to discuss the methodologies of many of these authors with respect to how they determined a flatfoot condition. Many of the studies that I will discuss employed modern methods of determining foot type. We use many of these methods (such as weightbearing radiographic measurements and evaluation of patients in stance and ambulation) in the day-to-day practice of podiatry.
Study authors used these and other more sophisticated methods of determining flatfoot. The other methods included: electronic footprint capture during gait; ultrasonography to measure fat pad thickness; dynamic plantar pressure analysis; and three dimensional laser surface measures. It is important to point out the use of these additional measurement techniques as they lend credence to the outcomes and conclusions of the studies. Without these modalities, one might be tempted to pass off many of the conclusions derived from these studies as “user bias.” However, most of these studies also combined sophisticated measurement techniques with hard data and statistical analysis. This was one the reasons I selected these studies for this review.
Other studies throughout the world’s medical communities have found similar results when studying the relationship with childhood obesity and flatfoot. In doing the research for this article, it became evident that every corner of the world is struggling with this problem of obesity and flatfoot, given the type of research that is occurring with the pediatric population.
What The Research Says About The Effect Of Weight On Pediatric Feet
As we know, infants do not have much of an arch. Even new walkers do not display much of an arch height. Up until approximately the age of 2, when the arch becomes recognizable, it is virtually impossible to assess foot type unless significant pathology is present.
One study attempted to correlate obesity and low arch height in adults.1 The authors found, using footprint-based estimates, that study patients who were obese displayed lower arch heights than their non-obese adult counterparts. Although this study did not focus on the pediatric population, it served as a springboard for others to investigate this topic in obese children as well.
Another study in Australia measured the same basic premise of arch height in obese children.2 The authors found that “obese children had fatter and flatter feet compared to normal weight children.” They did caution, however, that more studies needed to be completed to assess “… the functional and clinical relevance of the increase [sic] … .”2
A similar study out of Spain found similar results when researchers compared the arch height of obese and non-obese children.3 The authors concluded that obese children had lower medial longitudinal arch heights. They did not, however, relate whether lower arch heights were due to a more pronounced fat pad or whether they were due to a more structurally related etiology.
Another study based in Australia also found that obese children had flatter feet.4 Researchers then postulated that this flatter foot morphology could be caused by structural changes in the anatomy of these children’s feet and the morphology can affect function as these children mature into adulthood.
Interestingly, another group of Australian researchers studied the effects of medial midfoot fat pad thickness and how it correlates to plantar pressures in school age children.5 Although the authors did find some correlation between the two factors, they also admitted that this correlation was rather low and more intense study was needed to solidify a more meaningful conclusion.
The last but potentially most telling of the research published in Australia on this topic is a study that took this concept into a more biomechanical realm than the others and examined the kinematics of gait.6 The study patients underwent analyses that measured certain aspects of their gait while they were being filmed walking. What the authors found was that obese children had more “gait asymmetry … a greater stride width … pointing to a slower, more tentative normal speed.” They also found that the obese children were more unstable at a slower walking speed and that they had trouble walking at a faster pace. Additionally, they found that obese children had a more flat-footed and abducted gait at all phases of the gait cycle.
In a study of 835 preschool age children in Austria, the authors found that the most common study group that displayed a flat-footed morphology was the obese male children.7 Researchers went so far to say they observed “a highly significant prevalence of flatfoot” in the overweight child. A study based in Italy found similar results.8 In a study of 243 children between the ages of 8 to 10 years of age, the authors found those who were obese had a higher incidence of moderate and very marked flat-footedness in comparison to their non-obese classmates.
A group in Germany chose a slightly different route to identify the feet of their patients.9 They chose to classify the feet by how they looked and found that overweight children were much more likely to have flat feet or what they called “robust” feet. They did not quantify exactly what “robust” referred to but the description of flat feet was more descriptive of the morphology of the overweight children in any case.
The Taiwanese were so interested in this phenomenon that they generated three separate studies concerning the prevalence of flexible flatfoot in obese school age children. Within these three research articles, researchers evaluated a total of over 4,700 children. This comprises the largest cumulative sample size ever seen with this topic.
The first study was comprised of 1,598 children and its conclusion was that obesity was one of the risk factors of developing this foot type.10 A study concluded one year earlier with a sample size of over 2,000 children showed that male children who were obese were 2.66 times more likely to have a flatfoot morphology than their non-obese classmates.11 The study also noted that female children who were obese were 1.39 times more likely to have this foot morphology than females who were not obese. In addition, researchers noted that obese children of either sex showed this foot morphology between the ages of 7 and 8.
The last of the Taiwanese studies published recently evaluated flatfoot in children between the ages of 5 and 13.12 Researchers found that when combining the children they considered “overweight” and “obese,” there was a very large percentage who had flat feet. Fifty-six percent of children they classified as “obese” had flat feet and 31 percent of those who were “overweight” had flat feet. The one observation with this study that one should note is that the “normal” children had a 27 percent prevalence of obesity. This calls the statistical analysis of the authors’ data into question but we cannot overlook their conclusion.
In Search Of EBM For Flatfoot Treatment In Obese Pediatric Patients
Much of the research shows that to some degree or another, obesity in childhood can lead to flatfoot. Now how do we transfer this knowledge to the care of this pediatric population?
Much of the studies talk about the foot type but few refer to the consequences of this foot type. One journal article that talks about obesity as a potential cause of flatfoot also expresses concern that one should treat this carefully and consider patient adherence and parental involvement in following the treatment plan.13
There are only two papers relating the factors of pediatric obesity, flatfoot and pain. The relationship of the three factors in these articles is not direct but the authors talk of the factors in broader terms as potential explanations for the foot type causing pain. One study discusses pediatric obesity as a potential cause for flatfoot pain via Sever’s disease.14 The other study discusses an increase in symptoms in pediatric patients with rigid flat feet if the patients were in the 95th percentile or higher in weight for their age.15 Once again, there is no literature that offers evidence to suggest a youngster who is obese will eventually become an adult with painful flatfoot.
This is where the vacuum exists. This is our biggest hurdle to overcome to begin the process of justifying the treatment of the pediatric flatfoot. Whether the flatfoot is caused by obesity, connective tissue disorders, severe equinus, compensated metatarsus adductus or the myriad of other potential causes, our next hurdle is to show that left to its own devices, this foot type will cause lasting pain and potential disability if left untreated or supported.
The biggest problem we encounter is how to design a study protocol to test this theory. It is unreasonable to expect that a study protocol would suggest having a treatment group and a control group. In such a hypothetical study, one group would wear orthotics or undergo corrective surgery to reconstruct the foot into a more “neutral” and functional foot type. The other group would just have simple observation. This study would follow the “subjects” over the course of a generation and the results would be calculated regardless of the patient’s lifestyle or job choice. The “subjects” would be followed by a group of practitioners or via a multicenter study over the course of the doctors’ careers and would only be subject to statistical scrutiny as the pediatric patients mature into their adult lives, or beginning in their late teens.
Until a project such as the one described occurs, the evidence basis to justify treatment of flatfoot in obese pediatric patients remains elusive.
Almost daily, you can turn on your TV or open your favorite newspaper and learn about the “national health crisis” that is obesity. There is also a tremendous amount of literature concerning the long-term health pitfalls of morbid obesity and how it can affect the heart, liver, kidney and lymphatic system. Obviously, obesity can also lead to diabetes and a whole host of other health-related issues.
We are also starting to realize that these poor habits begin in our youth and translate to our overall health as adults. This is very apparent if you’ve ever watched The Jamie Oliver Experiment. In this show, the titular young chef travels the United States and tries to revamp cafeterias in public schools to have a menu that is generally healthier, and convince our nation’s youth to modify their lifestyles and help them attain health into adulthood.
As a parent, I am very concerned about my children’s health but does their health translate to their feet as well? Are obese children more prone to a certain foot type? If that is the case, how does that relate to their general health?
A Closer Look At How Researchers Are Identifying Flatfoot In Study Populations
Before starting the discussion of flatfoot studies and their outcomes, I would like to discuss the methodologies of many of these authors with respect to how they determined a flatfoot condition. Many of the studies that I will discuss employed modern methods of determining foot type. We use many of these methods (such as weightbearing radiographic measurements and evaluation of patients in stance and ambulation) in the day-to-day practice of podiatry.
Study authors used these and other more sophisticated methods of determining flatfoot. The other methods included: electronic footprint capture during gait; ultrasonography to measure fat pad thickness; dynamic plantar pressure analysis; and three dimensional laser surface measures. It is important to point out the use of these additional measurement techniques as they lend credence to the outcomes and conclusions of the studies. Without these modalities, one might be tempted to pass off many of the conclusions derived from these studies as “user bias.” However, most of these studies also combined sophisticated measurement techniques with hard data and statistical analysis. This was one the reasons I selected these studies for this review.
Other studies throughout the world’s medical communities have found similar results when studying the relationship with childhood obesity and flatfoot. In doing the research for this article, it became evident that every corner of the world is struggling with this problem of obesity and flatfoot, given the type of research that is occurring with the pediatric population.
What The Research Says About The Effect Of Weight On Pediatric Feet
As we know, infants do not have much of an arch. Even new walkers do not display much of an arch height. Up until approximately the age of 2, when the arch becomes recognizable, it is virtually impossible to assess foot type unless significant pathology is present.
One study attempted to correlate obesity and low arch height in adults.1 The authors found, using footprint-based estimates, that study patients who were obese displayed lower arch heights than their non-obese adult counterparts. Although this study did not focus on the pediatric population, it served as a springboard for others to investigate this topic in obese children as well.
Another study in Australia measured the same basic premise of arch height in obese children.2 The authors found that “obese children had fatter and flatter feet compared to normal weight children.” They did caution, however, that more studies needed to be completed to assess “… the functional and clinical relevance of the increase [sic] … .”2
A similar study out of Spain found similar results when researchers compared the arch height of obese and non-obese children.3 The authors concluded that obese children had lower medial longitudinal arch heights. They did not, however, relate whether lower arch heights were due to a more pronounced fat pad or whether they were due to a more structurally related etiology.
Another study based in Australia also found that obese children had flatter feet.4 Researchers then postulated that this flatter foot morphology could be caused by structural changes in the anatomy of these children’s feet and the morphology can affect function as these children mature into adulthood.
Interestingly, another group of Australian researchers studied the effects of medial midfoot fat pad thickness and how it correlates to plantar pressures in school age children.5 Although the authors did find some correlation between the two factors, they also admitted that this correlation was rather low and more intense study was needed to solidify a more meaningful conclusion.
The last but potentially most telling of the research published in Australia on this topic is a study that took this concept into a more biomechanical realm than the others and examined the kinematics of gait.6 The study patients underwent analyses that measured certain aspects of their gait while they were being filmed walking. What the authors found was that obese children had more “gait asymmetry … a greater stride width … pointing to a slower, more tentative normal speed.” They also found that the obese children were more unstable at a slower walking speed and that they had trouble walking at a faster pace. Additionally, they found that obese children had a more flat-footed and abducted gait at all phases of the gait cycle.
In a study of 835 preschool age children in Austria, the authors found that the most common study group that displayed a flat-footed morphology was the obese male children.7 Researchers went so far to say they observed “a highly significant prevalence of flatfoot” in the overweight child. A study based in Italy found similar results.8 In a study of 243 children between the ages of 8 to 10 years of age, the authors found those who were obese had a higher incidence of moderate and very marked flat-footedness in comparison to their non-obese classmates.
A group in Germany chose a slightly different route to identify the feet of their patients.9 They chose to classify the feet by how they looked and found that overweight children were much more likely to have flat feet or what they called “robust” feet. They did not quantify exactly what “robust” referred to but the description of flat feet was more descriptive of the morphology of the overweight children in any case.
The Taiwanese were so interested in this phenomenon that they generated three separate studies concerning the prevalence of flexible flatfoot in obese school age children. Within these three research articles, researchers evaluated a total of over 4,700 children. This comprises the largest cumulative sample size ever seen with this topic.
The first study was comprised of 1,598 children and its conclusion was that obesity was one of the risk factors of developing this foot type.10 A study concluded one year earlier with a sample size of over 2,000 children showed that male children who were obese were 2.66 times more likely to have a flatfoot morphology than their non-obese classmates.11 The study also noted that female children who were obese were 1.39 times more likely to have this foot morphology than females who were not obese. In addition, researchers noted that obese children of either sex showed this foot morphology between the ages of 7 and 8.
The last of the Taiwanese studies published recently evaluated flatfoot in children between the ages of 5 and 13.12 Researchers found that when combining the children they considered “overweight” and “obese,” there was a very large percentage who had flat feet. Fifty-six percent of children they classified as “obese” had flat feet and 31 percent of those who were “overweight” had flat feet. The one observation with this study that one should note is that the “normal” children had a 27 percent prevalence of obesity. This calls the statistical analysis of the authors’ data into question but we cannot overlook their conclusion.
In Search Of EBM For Flatfoot Treatment In Obese Pediatric Patients
Much of the research shows that to some degree or another, obesity in childhood can lead to flatfoot. Now how do we transfer this knowledge to the care of this pediatric population?
Much of the studies talk about the foot type but few refer to the consequences of this foot type. One journal article that talks about obesity as a potential cause of flatfoot also expresses concern that one should treat this carefully and consider patient adherence and parental involvement in following the treatment plan.13
There are only two papers relating the factors of pediatric obesity, flatfoot and pain. The relationship of the three factors in these articles is not direct but the authors talk of the factors in broader terms as potential explanations for the foot type causing pain. One study discusses pediatric obesity as a potential cause for flatfoot pain via Sever’s disease.14 The other study discusses an increase in symptoms in pediatric patients with rigid flat feet if the patients were in the 95th percentile or higher in weight for their age.15 Once again, there is no literature that offers evidence to suggest a youngster who is obese will eventually become an adult with painful flatfoot.
This is where the vacuum exists. This is our biggest hurdle to overcome to begin the process of justifying the treatment of the pediatric flatfoot. Whether the flatfoot is caused by obesity, connective tissue disorders, severe equinus, compensated metatarsus adductus or the myriad of other potential causes, our next hurdle is to show that left to its own devices, this foot type will cause lasting pain and potential disability if left untreated or supported.
The biggest problem we encounter is how to design a study protocol to test this theory. It is unreasonable to expect that a study protocol would suggest having a treatment group and a control group. In such a hypothetical study, one group would wear orthotics or undergo corrective surgery to reconstruct the foot into a more “neutral” and functional foot type. The other group would just have simple observation. This study would follow the “subjects” over the course of a generation and the results would be calculated regardless of the patient’s lifestyle or job choice. The “subjects” would be followed by a group of practitioners or via a multicenter study over the course of the doctors’ careers and would only be subject to statistical scrutiny as the pediatric patients mature into their adult lives, or beginning in their late teens.
Until a project such as the one described occurs, the evidence basis to justify treatment of flatfoot in obese pediatric patients remains elusive.
Tuesday, August 30, 2011
Obesity Ranking System Predicts Mortality
An obesity classification system that distinguishes between fat and lean tissue and takes into account functional status and the various comorbid conditions that can be associated with obesity may be a more effective mortality prediction tool than standard body mass index (BMI), according to new research....
Raj S. Padwal, MD, from the Department of Medicine, University of Alberta, Edmonton, Canada, explains, "Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility." The new tool, called the Edmonton obesity staging system (EOSS), ranks obese and overweight people according to a 5-point scale based on factors relating to an individual's underlying health status and the presence or absence of underlying health conditions and, therefore, may be a better predictor of mortality.
A "0" on the EOSS scale, for instance, represents "no apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range), physical symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesity," according to the study authors.
A ranking of 2 indicates "the presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis), moderate limitations in activities of daily living and/or well-being," and the highest ranking indicates, "severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being."
In determining efficacy of the tool, researchers with the University of Alberta applied it to data on 8143 people aged 20 years and older in the 1988-1994 and 1999-2004 US National Health and Human Nutrition Examination Surveys (NHANES).
The results indicated that 77.2% of overweight or obese people in the 1988-1994 survey and 90.3% of those in the 1999-2004 survey were classified as stage 1 or 2 in the EOSS, and their risk for death was significantly lower than that of overweight or obese people classified as stage 3.
In the NHANES 1988-1994 data, scores of 2 and 3 each were associated with a higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI], 1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared with scores 0 or 1.
The higher risk was seen even after adjustment for BMI, metabolic syndrome, and hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for women), as well as in a cohort eligible for bariatric surgery.
Measurements of BMI and waist circumference are typically among key factors in the assessment of appropriate treatments for obesity, such as bariatric surgery or anti-obesity therapies.
But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.
In considering the broader range of factors, the EOSS is intended to provide more clinically relevant prognostic information in a manner similar to that of the tumor, node, metastasis system used in the staging of cancer, the authors write.
"The major incremental contribution of this staging system to anthropometric indices and cardiovascular risk equations is the direct measurement of the presence and severity of underlying obesity-related comorbidities, which enables a more comprehensive and individualized assessment of risk," they said.
"Such enhanced risk assessment may enable a greater understanding of obesity-related prognosis and may also assist in determining the urgency of intervention."
The system could be particularly beneficial in prioritizing patients for bariatric surgery according to ranking that reflects a broader assessment of obesity and obesity-related comorbid conditions than simply a BMI ranking, the authors added.
Canadian Medical Association Journal, August 15, 2011 cmaj.110387
Raj S. Padwal, MD, from the Department of Medicine, University of Alberta, Edmonton, Canada, explains, "Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility." The new tool, called the Edmonton obesity staging system (EOSS), ranks obese and overweight people according to a 5-point scale based on factors relating to an individual's underlying health status and the presence or absence of underlying health conditions and, therefore, may be a better predictor of mortality.
A "0" on the EOSS scale, for instance, represents "no apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range), physical symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesity," according to the study authors.
A ranking of 2 indicates "the presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis), moderate limitations in activities of daily living and/or well-being," and the highest ranking indicates, "severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being."
In determining efficacy of the tool, researchers with the University of Alberta applied it to data on 8143 people aged 20 years and older in the 1988-1994 and 1999-2004 US National Health and Human Nutrition Examination Surveys (NHANES).
The results indicated that 77.2% of overweight or obese people in the 1988-1994 survey and 90.3% of those in the 1999-2004 survey were classified as stage 1 or 2 in the EOSS, and their risk for death was significantly lower than that of overweight or obese people classified as stage 3.
In the NHANES 1988-1994 data, scores of 2 and 3 each were associated with a higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI], 1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared with scores 0 or 1.
The higher risk was seen even after adjustment for BMI, metabolic syndrome, and hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for women), as well as in a cohort eligible for bariatric surgery.
Measurements of BMI and waist circumference are typically among key factors in the assessment of appropriate treatments for obesity, such as bariatric surgery or anti-obesity therapies.
But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.
In considering the broader range of factors, the EOSS is intended to provide more clinically relevant prognostic information in a manner similar to that of the tumor, node, metastasis system used in the staging of cancer, the authors write.
"The major incremental contribution of this staging system to anthropometric indices and cardiovascular risk equations is the direct measurement of the presence and severity of underlying obesity-related comorbidities, which enables a more comprehensive and individualized assessment of risk," they said.
"Such enhanced risk assessment may enable a greater understanding of obesity-related prognosis and may also assist in determining the urgency of intervention."
The system could be particularly beneficial in prioritizing patients for bariatric surgery according to ranking that reflects a broader assessment of obesity and obesity-related comorbid conditions than simply a BMI ranking, the authors added.
Canadian Medical Association Journal, August 15, 2011 cmaj.110387
Thursday, April 7, 2011
Diabetes Tied to Poor Impulse Control
Patients with newly diagnosed Type 2 diabetes were significantly more likely to show poor impulse control in psychological testing than healthy people....
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
In the standard Go/NoGo test of impulse control, newly diagnosed diabetics made about 50% more errors of commission than normal controls, regardless of whether they were overweight.
The differences were not attributable to cognitive impairment, the researchers concluded, because diabetic patients performed as well as controls on the Wisconsin Card Sorting Test of executive function.
"Our results showed that middle-aged, newly diagnosed, and medication-free patients with Type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight," Yasuhiko Iwamoto, MD, of Tokyo Women's Medical University in Japan, and colleagues wrote.
They suggested the findings could help explain why diabetic patients find it difficult to make the recommended lifestyle adjustments such as avoiding high-fat foods and maintaining daily exercise.
The researchers explained that decision-making about daily activities relies on brain functions in different cerebral regions, mixing predictions of future rewards and punishments, inhibition of impulsive responses, and executive functions.
Overeating, they explained, occurs when the prospect of immediate reward overwhelms inhibitions that derive from awareness of negative consequences. "In such conditions, rapid reward prediction or impulsive response to environmental stimuli prevails over the preparations by executive function," Iwamoto and colleagues asserted.
Earlier studies had indicated that reward predictions by overweight individuals tend to be higher than those of normal weight people, and their impulse control was generally lower. Consequently, the Japanese researchers sought to test diabetic patients for performance on psychological tests that measure these functions.
The Go/NoGo test for impulse control involved showing participants one of two letters, N or H, with instructions to press a button when they saw the N but not H. Pressing the button in response to H was an error of commission, and failing to press it when shown the N was an error of omission. The test also measured reaction times, including slowed responses that sometimes followed errors.
Prediction of future rewards was evaluated with so-called reversal and extinction tasks.
In the former, participants won points for correctly switching images on a computer screen that randomly replaced each other. The extinction task was structured the same way, except that participants stopped winning points for executing the reversal after nine correct responses; at that point, they received points for not responding to the stimulus.
As on a TV game show, correct responses were signaled with a pleasant chime sound, whereas errors were announced with a buzzer. Participants were also assessed for clinical depression and for standard laboratory measures of glycemia and insulin resistance. A total of 27 newly diagnosed Type 2 diabetic patients and 27 non-diabetic controls participated. All participants in both groups were men, and none of the diabetic patients were taking medications for diabetes. The diabetic group included 16 who were overweight (mean BMI 29.8). There were 11 overweight controls (mean BMI 27.6).
Response inhibition in the Go/NoGo test was significantly decreased in the diabetic patients, the researchers reported. In a combined measure of commission and omission errors, labeled d', diabetic patients had a mean value of 2.55 compared with 3.22 for controls (P=0.001).
The difference was most pronounced for errors of commission, with a mean of 10 for patients versus about 6 for controls (P=0.002).
The researchers found a significant interaction between Go/NoGo performance and glycated hemoglobin levels, with an r2 value of 0.287 for d' versus HbA1c (P=0.024). Scores did not differ significantly by weight, although there was a trend toward reduced impulse control in overweight participants. Diabetes did not affect reaction times, overall or after errors, but weight did affect them, with faster reaction times in overweight participants.
Iwamoto and colleagues also found that diabetes status did not affect scores on the reversal and extinction tests. Overweight participants made about 40% more errors on the extinction test compared with normal-weight individuals (P=0.029) but not on the reversal test.
Achievement scores on the Wisconsin Card Sorting Test were similar in all patient groups stratified by weight and diabetes status.
So-called perseverative errors (involving continuous repetition of a response) appeared more common in normal-weight diabetic participants, but rates of these errors varied widely among individuals and the group difference was not statistically significant.
"Our study included only newly diagnosed patients with Type 2 diabetes, suggesting the possibility that the neuropsychological deficits in response inhibition may contribute to the behavioral problems leading to chronic lifestyle-related diseases, such as Type 2 diabetes," they wrote.
However, they acknowledged that the causal arrow could point in the other direction -- that "metabolic changes with diabetes affect brain functions and cause neuropsychological deficits."
Indeed, the researchers observed, some earlier studies have found that metabolic improvements in diabetic patients lead to improved cognitive performance.
"Further longitudinal studies will be useful to detect progression or improvement of neuropsychological deficits associated with metabolic change," Iwamoto and colleagues wrote.
They also recommended more studies into the potential causal role of impulsivity in development of Type 2 diabetes. If confirmed, psychobehavioral interventions aimed at improving impulse control could be beneficial in preventing or treating the disease
Friday, March 4, 2011
Meal Replacements Don't Help Obese Teens
Dietetic shakes and prepackaged entrees help obese teenagers lose weight loss at first. But "meal replacements" were no better than a standard low-calorie diet for helping young people continue losing weight over the course of a year....
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Monday, February 14, 2011
10 States With the Deadliest Eating Habits
Americans are fat and getting fatter by the year. Recent data reported in medical journal Lancet showed that BMI (Body Mass Index), a recognized measurement of obesity, is higher on average in America than in any other nation.
The obesity problem, however, is international. The report in Lancet states that "In 2008, 9.8 percent of the world's male population were obese, as were 13.8 percent of women. In 1980, these rates were 4.8 percent and 7.9 percent." U.S. eating habits and diets have been exported, many experts say. Nations which before had relatively lean diets which were high in grains and fruits now consume many more soft drinks and hamburgers.
This trend toward poorer diets has caused obesity to be the most written-about health problem in the United States. Fat Americans are more likely to have diabetes, coronary artery disease, strokes and certain forms of cancer. Less well reported are links between obesity and dementia, obesity and postmenopausal estrogen receptors, and obesity and social status. Thin people, apparently, are more likely to be chief executives and billionaires. The problem of obesity is so acute that the number of studies about its causes and solutions grows by the day. The journal Health Affairs reported last year that overall obesity-related health spending reached $147 billion in the U.S., about double what it was a decade earlier.
Like so many other issues where data are collected in the public sector and the information is used to solve problems nationwide, the problems are local. 24/7 Wall St. looked at a number of factors which cause unhealthy diets and resulting obesity. These include income, access to healthy food sources, the ability to pay for healthy food, the concentration of fast food outlets, and the consumption of fruits, vegetables, sugar, fat and soft drinks. The levels of healthy eating defined with these parameters varies wildly from state-to-state. That means there is not likely to be any one set of solutions created and funded at the federal level to solve the problem. Just as education results and their causes are hyper-local, so are the habits that cause unhealthy diets and their results. That makes the problem harder to solve. Congress cannot mandate how many McDonald's can be built within any hundred square mile area, or, if it could, McDonald's would object.
The data on poor eating habits and obesity are abundant and unusually well-researched. Congress funded a nationwide report which was called "Access to Affordable and Nutritious Food -- Measuring and Understanding Food Desserts and Their Consequences." The information contained in this report includes the number of households who do not have access to cars and probably find it difficult to go to grocery stores frequently. The USDA keeps in-depth statistics on concentration of grocery stores. The Census Bureau tracks fast food expenditures per capita. The U.S. Department of Health and Human Services follows consumption of fruits and vegetables. 24/7 made its state rankings based on grocery stores per 1,000 residents, amount spent on fast food per capita, gallons of soft drinks purchased per capita and pounds of sweet snacks purchased per capita. We also took into account information provided about poverty levels, obesity and other factors directly related to unhealthy diets.
It is worth mentioning again how complex and local the obesity and eating habit problem is. This does not mean that the problems are insoluble, but nearly so. The issue of fat Americans is one that almost needs to be addressed house-to-house.
10. New Mexico
Grocery Stores Per 1,000 Residents: 0.26 (23rd)
Amount Spent on Fast Food Per Capita: $737 (8th most)
Gallons of Soft Drinks Purchased Per Capita: 58 (12th least)
Pounds of Sweet Snacks Purchased Per Capita: 111 (13th least)
New Mexico's worst rankings occur in two metrics. It has the 44th-greatest percentage of households without a car that are more than 10 miles from a supermarket or grocery store and the 44th-greatest percentage of population that has low income and is more than 10 miles from a supermarket or grocery store, according to the United States Department of Ag1riculture. These metrics are significant because they suggest a lack of access to affordable and nutritious food. Residents may rely on fast food restaurants and convenience stores instead. New Mexico has the eighth-greatest amount of money spent on fast food per capita among all the states considered.
9. Arizona
Grocery Stores Per 1,000 Residents: 0.17 (47th)
Amount Spent on Fast Food Per Capita: $761 (4th most)
Gallons of Soft Drinks Purchased Per Capita: 60 (21st least)
Pounds of Sweet Snacks Purchased Per Capita: 109 (11th least)
Arizona has the second-fewest grocery stores per person, with only 0.17 for every 1,000 people. This illustrates a major restriction on healthy food access for one of the country's fastest growing states. One of the ways in which residents of Arizona are supplementing their diets is with fast food. Arizonans spent an average of $760.50 each on fast food in 2007, the fourth-greatest amount among the states.
8. Ohio
Grocery Stores Per 1,000 Residents: 0.18 (45th)
Amount Spent on Fast Food Per Capita: $622 (20th least)
Gallons of Soft Drinks Purchased Per Capita: 70 (11th most)
Pounds of Sweet Snacks Purchased Per Capita: 122 (10th most)
Because a large part of Ohio's poor population is located in major urban centers like Cleveland and Cincinnati, the state ranks well in regards to access to grocery stores among the poor. However, the state ranks third-worst in store availability across all income classes at 0.18 locations per 1,000 people, compared to 0.6 in first place North Dakota. Ohio's population has the 11th-greatest consumption of soft drinks, and top-10 highest consumption of both sweet snacks and solid fats. As a result of these poor diets, Ohio has an adult diabetes occurrence of over 10%, which is the 11th-worst rate in the country.
7. South Dakota
Grocery Stores Per 1,000 Residents: 0.5 (4th)
Amount Spent on Fast Food Per Capita: $547 (9th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd least)
Pounds of Sweet Snacks Purchased Per Capita: 122 (8th most)
South Dakota has the fifth-smallest population in the country, and yet, it is the 17th-largest state in terms of geographic area. As a result, many residents have limited access to affordable and nutritious food. In fact, South Dakota has the greatest percentage of households with no car and which are more than 10 miles from a supermarket or grocery store, as well as the greatest percentage of low-income households which are more than 10 miles from a supermarket or grocery store. Only 10.1% of adults in South Dakota consume the U.S. Department of Health and Human Services' recommended two or more fruits and three or more vegetables per day, compared to the national average of 14%. This is the fifth-worst rate in the nation.
6. Nevada
Grocery Stores Per 1,000 Residents: 0.23 (29th)
Amount Spent on Fast Food Per Capita: $939 (most)
Gallons of Soft Drinks Purchased Per Capita: 58 (10th least)
Pounds of Sweet Snacks Purchased Per Capita: 114 (19th least)
Nevada spends the most per capita on fast food -- nearly $940 per person per year. This is roughly 25% more than Texas, the second-worst state, and well more than twice what Vermont residents spend. As might be expected, the state ranks in the bottom 10 for both households with no cars and low-income populations, defined as people with income less than 200 percent of the federal poverty thresholds, and proximity to grocery stores. Nevada's obesity and diabetes rates, are above average.
5. Oklahoma
Grocery Stores Per 1,000 Residents: 0.25 (24th)
Amount Spent on Fast Food Per Capita: $676 (15th most)
Gallons of Soft Drinks Purchased Per Capita: 69.8 (8th most)
Pounds of Sweet Snacks Purchased Per Capita: 103.2 (3rd least)
The rate of household-level food insecurity, including households with food access problems as well as households that experience disruptions in their food intake patterns due to inadequate resources for food, is 15.2% in Oklahoma. The national rate is 13.5%. Oklahoma also has the third-lowest rate of adults who meet the recommended two fruit/three vegetable daily intake, with only 9.3% of adults doing so. Perhaps this is part of the reason Oklahoma's obesity rate is 31.4%, the fifth-worst in the country.
4. Kansas
Grocery Stores Per 1,000 Residents: 0.35 (7th)
Amount Spent on Fast Food Per Capita: $610 (19th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd most)
Pounds of Sweet Snacks Purchased Per Capita: 121 (12th most)
Kansas has some of the easiest access (seventh-best) to stores where cheap and healthy food is available. It is clear, however, that most residents do not take advantage of this, as the state has one of the worst diets in the country. Residents consume the 12th-most sweet snacks per person as well as the 12th-most solid fats -- more than 20 pounds per person. The state ranks 28th in adult diabetes and 31st in obesity -- 28% of the state's adults are considered overweight.
3. Missouri
Grocery Stores Per 1,000 Residents: 0.26 (22nd)
Amount Spent on Fast Food Per Capita: $623 (21st least)
Gallons of Soft Drinks Purchased Per Capita: 65 (18th highest)
Pounds of Sweet Snacks Purchased Per Capita: 121 (17th most)
Missouri does not rank especially poor in any of the metrics considered, however it does rank badly in about almost every one. It has the 11th-lowest rates of adults eating the recommended amount of fruits and vegetables, the eighth-greatest rate of food insecurity, and relatively high rates of soft drink, sweet snack and solid fats consumption. Missouri has the ninth-worst rate of obesity among adults, with 30% having a body mass index greater than 30.
2. Alabama
Grocery Stores Per 1,000 Residents: 0.21 (37th)
Amount Spent on Fast Food Per Capita: $649 (23rd most)
Gallons of Soft Drinks Purchased Per Capita: 77 (4th most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (16th least)
Alabama residents consume 77 gallons of soft drinks per capita per year, the fourth-highest amount in the country. This is roughly 33% more than Oregon, which consumes the least. Soft drinks like cola have more sugar per ounce than nearly any other food we regularly consume, and it is clear that soda has helped contribute to Alabama's poor health outcomes. The state has the seventh-highest obesity rate and, predictably, the second-worst diabetes rate. More than 12% of the state's adult population has the disease.
1. Mississippi
Grocery Stores Per 1,000 Residents: 0.21 (34th)
Amount Spent on Fast Food Per Capita: $588 (17th least)
Gallons of Soft Drinks Purchased Per Capita: 82 (most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (17th least)
Mississippi has the worst eating habits in the country. Only 8.8% of the adult population eats the recommended amount of daily fruits and vegetables, the lowest rate in the country. Residents consumed just under 82 gallons of soft drinks per capita in 2006, the greatest amount reported. Furthermore, the state has the third-highest rate of household-level food insecurity, with 17.1% of households being affected. It is perhaps unsurprising, then, that the state has the highest rates of both adult diabetes (12.8%) and adult obesity (34.4%).
by Charles B. Stockdale, Douglas A. McIntyre and Michael B. Sauter
Wednesday, February 9, 2011
The obesity problem, however, is international. The report in Lancet states that "In 2008, 9.8 percent of the world's male population were obese, as were 13.8 percent of women. In 1980, these rates were 4.8 percent and 7.9 percent." U.S. eating habits and diets have been exported, many experts say. Nations which before had relatively lean diets which were high in grains and fruits now consume many more soft drinks and hamburgers.
This trend toward poorer diets has caused obesity to be the most written-about health problem in the United States. Fat Americans are more likely to have diabetes, coronary artery disease, strokes and certain forms of cancer. Less well reported are links between obesity and dementia, obesity and postmenopausal estrogen receptors, and obesity and social status. Thin people, apparently, are more likely to be chief executives and billionaires. The problem of obesity is so acute that the number of studies about its causes and solutions grows by the day. The journal Health Affairs reported last year that overall obesity-related health spending reached $147 billion in the U.S., about double what it was a decade earlier.
Like so many other issues where data are collected in the public sector and the information is used to solve problems nationwide, the problems are local. 24/7 Wall St. looked at a number of factors which cause unhealthy diets and resulting obesity. These include income, access to healthy food sources, the ability to pay for healthy food, the concentration of fast food outlets, and the consumption of fruits, vegetables, sugar, fat and soft drinks. The levels of healthy eating defined with these parameters varies wildly from state-to-state. That means there is not likely to be any one set of solutions created and funded at the federal level to solve the problem. Just as education results and their causes are hyper-local, so are the habits that cause unhealthy diets and their results. That makes the problem harder to solve. Congress cannot mandate how many McDonald's can be built within any hundred square mile area, or, if it could, McDonald's would object.
The data on poor eating habits and obesity are abundant and unusually well-researched. Congress funded a nationwide report which was called "Access to Affordable and Nutritious Food -- Measuring and Understanding Food Desserts and Their Consequences." The information contained in this report includes the number of households who do not have access to cars and probably find it difficult to go to grocery stores frequently. The USDA keeps in-depth statistics on concentration of grocery stores. The Census Bureau tracks fast food expenditures per capita. The U.S. Department of Health and Human Services follows consumption of fruits and vegetables. 24/7 made its state rankings based on grocery stores per 1,000 residents, amount spent on fast food per capita, gallons of soft drinks purchased per capita and pounds of sweet snacks purchased per capita. We also took into account information provided about poverty levels, obesity and other factors directly related to unhealthy diets.
It is worth mentioning again how complex and local the obesity and eating habit problem is. This does not mean that the problems are insoluble, but nearly so. The issue of fat Americans is one that almost needs to be addressed house-to-house.
10. New Mexico
Grocery Stores Per 1,000 Residents: 0.26 (23rd)
Amount Spent on Fast Food Per Capita: $737 (8th most)
Gallons of Soft Drinks Purchased Per Capita: 58 (12th least)
Pounds of Sweet Snacks Purchased Per Capita: 111 (13th least)
New Mexico's worst rankings occur in two metrics. It has the 44th-greatest percentage of households without a car that are more than 10 miles from a supermarket or grocery store and the 44th-greatest percentage of population that has low income and is more than 10 miles from a supermarket or grocery store, according to the United States Department of Ag1riculture. These metrics are significant because they suggest a lack of access to affordable and nutritious food. Residents may rely on fast food restaurants and convenience stores instead. New Mexico has the eighth-greatest amount of money spent on fast food per capita among all the states considered.
9. Arizona
Grocery Stores Per 1,000 Residents: 0.17 (47th)
Amount Spent on Fast Food Per Capita: $761 (4th most)
Gallons of Soft Drinks Purchased Per Capita: 60 (21st least)
Pounds of Sweet Snacks Purchased Per Capita: 109 (11th least)
Arizona has the second-fewest grocery stores per person, with only 0.17 for every 1,000 people. This illustrates a major restriction on healthy food access for one of the country's fastest growing states. One of the ways in which residents of Arizona are supplementing their diets is with fast food. Arizonans spent an average of $760.50 each on fast food in 2007, the fourth-greatest amount among the states.
8. Ohio
Grocery Stores Per 1,000 Residents: 0.18 (45th)
Amount Spent on Fast Food Per Capita: $622 (20th least)
Gallons of Soft Drinks Purchased Per Capita: 70 (11th most)
Pounds of Sweet Snacks Purchased Per Capita: 122 (10th most)
Because a large part of Ohio's poor population is located in major urban centers like Cleveland and Cincinnati, the state ranks well in regards to access to grocery stores among the poor. However, the state ranks third-worst in store availability across all income classes at 0.18 locations per 1,000 people, compared to 0.6 in first place North Dakota. Ohio's population has the 11th-greatest consumption of soft drinks, and top-10 highest consumption of both sweet snacks and solid fats. As a result of these poor diets, Ohio has an adult diabetes occurrence of over 10%, which is the 11th-worst rate in the country.
7. South Dakota
Grocery Stores Per 1,000 Residents: 0.5 (4th)
Amount Spent on Fast Food Per Capita: $547 (9th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd least)
Pounds of Sweet Snacks Purchased Per Capita: 122 (8th most)
South Dakota has the fifth-smallest population in the country, and yet, it is the 17th-largest state in terms of geographic area. As a result, many residents have limited access to affordable and nutritious food. In fact, South Dakota has the greatest percentage of households with no car and which are more than 10 miles from a supermarket or grocery store, as well as the greatest percentage of low-income households which are more than 10 miles from a supermarket or grocery store. Only 10.1% of adults in South Dakota consume the U.S. Department of Health and Human Services' recommended two or more fruits and three or more vegetables per day, compared to the national average of 14%. This is the fifth-worst rate in the nation.
6. Nevada
Grocery Stores Per 1,000 Residents: 0.23 (29th)
Amount Spent on Fast Food Per Capita: $939 (most)
Gallons of Soft Drinks Purchased Per Capita: 58 (10th least)
Pounds of Sweet Snacks Purchased Per Capita: 114 (19th least)
Nevada spends the most per capita on fast food -- nearly $940 per person per year. This is roughly 25% more than Texas, the second-worst state, and well more than twice what Vermont residents spend. As might be expected, the state ranks in the bottom 10 for both households with no cars and low-income populations, defined as people with income less than 200 percent of the federal poverty thresholds, and proximity to grocery stores. Nevada's obesity and diabetes rates, are above average.
5. Oklahoma
Grocery Stores Per 1,000 Residents: 0.25 (24th)
Amount Spent on Fast Food Per Capita: $676 (15th most)
Gallons of Soft Drinks Purchased Per Capita: 69.8 (8th most)
Pounds of Sweet Snacks Purchased Per Capita: 103.2 (3rd least)
The rate of household-level food insecurity, including households with food access problems as well as households that experience disruptions in their food intake patterns due to inadequate resources for food, is 15.2% in Oklahoma. The national rate is 13.5%. Oklahoma also has the third-lowest rate of adults who meet the recommended two fruit/three vegetable daily intake, with only 9.3% of adults doing so. Perhaps this is part of the reason Oklahoma's obesity rate is 31.4%, the fifth-worst in the country.
4. Kansas
Grocery Stores Per 1,000 Residents: 0.35 (7th)
Amount Spent on Fast Food Per Capita: $610 (19th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd most)
Pounds of Sweet Snacks Purchased Per Capita: 121 (12th most)
Kansas has some of the easiest access (seventh-best) to stores where cheap and healthy food is available. It is clear, however, that most residents do not take advantage of this, as the state has one of the worst diets in the country. Residents consume the 12th-most sweet snacks per person as well as the 12th-most solid fats -- more than 20 pounds per person. The state ranks 28th in adult diabetes and 31st in obesity -- 28% of the state's adults are considered overweight.
3. Missouri
Grocery Stores Per 1,000 Residents: 0.26 (22nd)
Amount Spent on Fast Food Per Capita: $623 (21st least)
Gallons of Soft Drinks Purchased Per Capita: 65 (18th highest)
Pounds of Sweet Snacks Purchased Per Capita: 121 (17th most)
Missouri does not rank especially poor in any of the metrics considered, however it does rank badly in about almost every one. It has the 11th-lowest rates of adults eating the recommended amount of fruits and vegetables, the eighth-greatest rate of food insecurity, and relatively high rates of soft drink, sweet snack and solid fats consumption. Missouri has the ninth-worst rate of obesity among adults, with 30% having a body mass index greater than 30.
2. Alabama
Grocery Stores Per 1,000 Residents: 0.21 (37th)
Amount Spent on Fast Food Per Capita: $649 (23rd most)
Gallons of Soft Drinks Purchased Per Capita: 77 (4th most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (16th least)
Alabama residents consume 77 gallons of soft drinks per capita per year, the fourth-highest amount in the country. This is roughly 33% more than Oregon, which consumes the least. Soft drinks like cola have more sugar per ounce than nearly any other food we regularly consume, and it is clear that soda has helped contribute to Alabama's poor health outcomes. The state has the seventh-highest obesity rate and, predictably, the second-worst diabetes rate. More than 12% of the state's adult population has the disease.
1. Mississippi
Grocery Stores Per 1,000 Residents: 0.21 (34th)
Amount Spent on Fast Food Per Capita: $588 (17th least)
Gallons of Soft Drinks Purchased Per Capita: 82 (most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (17th least)
Mississippi has the worst eating habits in the country. Only 8.8% of the adult population eats the recommended amount of daily fruits and vegetables, the lowest rate in the country. Residents consumed just under 82 gallons of soft drinks per capita in 2006, the greatest amount reported. Furthermore, the state has the third-highest rate of household-level food insecurity, with 17.1% of households being affected. It is perhaps unsurprising, then, that the state has the highest rates of both adult diabetes (12.8%) and adult obesity (34.4%).
by Charles B. Stockdale, Douglas A. McIntyre and Michael B. Sauter
Wednesday, February 9, 2011
Sunday, February 6, 2011
The Growing Problem of Childhood Obesity
With childhood obesity starting at ever-younger ages, it's never too soon to educate kids about a healthy diet. Learn about creating an obesity-fighting diet for your children at home and at school. Childhood obesity is a growing problem. Figuring out how to help your children eat a healthy diet and avoid obesity may be challenging, especially in the face of favorite high-calorie snacks, finger foods, and sugary drinks. But the stakes are high: A recent study of 3,098 children between 3 and 6 years old showed that excess weight causes an increase in heart disease risk factors even in toddlerhood.
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
Monday, January 31, 2011
Causes of Type 2 Diabetes
Causes of Type 2 Diabetes
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Wednesday, December 15, 2010
Obese Adolescents at Greatest Risk of Becoming Severely Obese Adults
Obese adolescents are 16 times more likely to become severely obese by age 30 than their healthy weight or even overweight peers, according to a new study....
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
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