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Overview Of Childhood Obesity

Obesity Facts

" No (health) problem needs our attention more than the epedemic of obesity in America. In sheer numbers and its toll in death and disability, obesity has reached crisis proportions in the United States "
Dr. C. Everett Koop
former United States Surgeon General

In the United States, obesity has risen at an epidemic rate during the past 20 years. One of the national health objectives for the year 2010 is to reduce the prevalence of obesity among adults to less than 15%. Research indicates that the situation is worsening rather than improving.

U.S. Obesity Trends 1985–2003
BRFSS, 1985, 1991, 1996 and 2003

BMI > 30, or ~ 30 lbs. overweight for 5'4" person

1985	1991
1996	2003

Source: Behavioral Risk Factor Surveillance System, CDC

During the past 20 years there has been a dramatic increase in obesity in the United States. In 1985 only a few states were participating in CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and providing obesity data. In 1991, four states had obesity prevalence rates of 15–19 percent and no states had rates at or above 20 percent. In 2003, 15 states had obesity prevalence rates of 15–19 percent; 31 states had rates of 20–24 percent; and 4 states had rates more than 25 percent.

The data shown in these maps were collected through CDC's Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS as slightly different analytic methods are used.

Prevalence of Overweight Among Children and Adolescents: Ages 6 - 19 Years, For Selected Years 1971 - 2001

Results from the 1999 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that 13% of children, ages 6-11 years, and 14% of adolescents, ages 12-19 years, are overweight. In 2001, in a study conducted by Dr. Sarita Dhuper, Director of Pediatric Cardiology and the Director of the Pediatric Obesity Program at the BUHMC, it was found that in the Brownsville-East New York section of Brooklyn, which is designated a Health Crisis Zone, the incidence of morbid obesity was 2-3 times the incidence nationwide with a coexistent higher adult mortality rate from heart disease and diabetes than the rest of Brooklyn and New York City. During this study it was also found that the prevalence of obesity was also three time higher than the average among African-Americans.

From an examination of dietary history Dr. Sarita Dhuper found out about the enormous quantity of fruit juice and other sweetened beverages consumed in addition to other calories. This has prompted an important emphasis on changing dietary patterns. It was also evident that the population, in this region, maintained a very low level of meaningful and sustained physical activity. This has focused the program on the need for supervised exercise as a means of weight reduction. Finally we have learnt about the denial of patients and more importantly, the denial by families of patients with morbid obesity. Many appointments are missed and when follow-up calls are made, the caseworkers are told by family members that they won’t come because the children are not obese. (Very often the parents are obese too). This shows the critical continuing needs of community education to alert the population to the risks involved.

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Obesity Causes

WHO: "…The fundamental causes of the obesity epidemic are societal, resulting from an environment that promotes sedentary lifestyles and consumption of high-fat, energy-dense diets"

A number of factors are responsible for causing obesity in both children and adults. These include genetic, environmental and behavioral.

Genes

The Thrifty Phenotype Hypothesis

Catch Up Growth

Some individuals have a genetic tendency to gain weight and store fat. This is based on the Thrifty Gene Hypothesis:

Individuals with thrifty metabolic adaptations convert more of their calories into adipose tissue during periods of feasting.

However, not everyone with this tendency will become obese. Moreover, some people who do not have genetic predisposition also become obese. Hence, it is not entirely correct to blame the genes for obesity.

99% of our genetic material has been in place before the advent of agriculture. With the advent of agriculture, diets have changed significantly. with more refined grains and sugar and less protein forming a part of them. Departure from man’s natural way of eating (consuming more meat and fish) and living leads to maladaptive functioning, obesity and disease.

Environment

The environmental factors also strongly influence obesity. This includes lifestyle behavior such as what a person eats and his or her level of physical activity.

Increased availability of calorie dense foods has played a major role in increasing the percentage of obese people in the American society. Americans tend to eat high calorie foods, and put taste and convenience ahead of nutrition. Easy availability of fast foods, which has such high caloric density that by the time one feels full, one has already overeaten. FAST FOOD restaurants are feeding the obesity epidemic by tricking people into eating many more calories than they mean to.

Bite By Bite It All Adds Up

Also, obesity has grown significantlty as a result of the increased time spent in sedentary activities such as watching TV, playing video games etc. Most Americans do not exercise regularly. This leads to an imbalance of the equation :

" More In, Less Out "

Obesity Prevalance Trend For Women (1971 - 2000)	Obesity Prevalance Trend For Men (1971 - 2000)
Obesity Prevalance Trend For (1971 - 2000) For US Adolescents (Aged 12 - 19) Content Source: American Obesity Association

Thus, it is important to promote an environment which encourages consumption of nutritious foods in reasonable portions and regular physical activity. A healthy environment is important for all individuals to prevent and treat obesity and maintain weight loss. Healthy environments can be created at home, school, work and beyond.

Gene-Environment Interaction in the Pathogenesis of Obesity

Although genetics is an important factor in the pathogenesis of obesity, the recent increase in obesity cannot be attributed to genetics alone and must be a result of alterations in environmental influences. However, people with certain genetic backgrounds are particularly predisposed to weight gain and obesity-related diseases, especially when they are exposed to a precipitating lifestyle. A striking example of this is given by the Pima Indians of Arizona. Lifestyle changes have resulted in an epidemic of obesity and diabetes within this population during the last 50 years [1]. Today, the Pimas of Arizona consume a high-fat diet (50% of energy as fat) provided by government surplus commodities rather than their traditional low-fat diet (15% of energy as fat), and they are much more sedentary than when they were farmers. In contrast, Pima Indians who live in the Sierra Madre mountains of Northern Mexico, and consequently who have been isolated from Western influences, eat a traditional Pima diet and are physically active as farmers and sawmill workers. The Pimas of Mexico have a much lower incidence of obesity and diabetes than their genetic kindred in Arizona.

1) Pratley RE. Gene-environment interactions in the pathogenesis of type 2 diabetes mellitus: lessons learned from the Pima Indians. Proc Nutr Soc. 1998;57:175-181.
2) Ravussin E et al. Effects of a traditional lifestyle on obesity in Pima Indians. Diabetes Care 1994; 17:1067-1074.

Developmental Origins of ObesityClinical and Public Health Implications

Cumulative effect of small daily imbalances in energy intake on body fat mass

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Obesity Effects

Health Effects

Obese people are at risk of developing one or more serious medical conditions, which can cause poor health and premature death.

According to a recent study by the RAND organization, obesity is more damaging to health than smoking, high levels of alcohol drinking, and poverty. Obesity affects all major bodily systems - heart, lung, muscle and bones.

Medical Consequences of Obesity

Serious Adverse Health Effects of Obesity On Different Parts of The Body

There is a direct correlation between mortality and Body Mass Index as can be seen from the following graph:

As the BMI increases the Mortality Ratio also increases.

Insulin Resistance is aggravated by obesity and physical inactivity both of which are increasing in the U.S. Most people with insulin resistance have central obesity. Insulin Resistance in its turn causes:

C oronary artery disease
H ypertension
A dult onset DM (2)
O besity
S troke
Also associated with dyslipidemia TG HDL, sleep apnea, PCOS, Gout.

Insulin Resistance: Causes And Associated Conditions

Insulin Resistance is closely associated with metabolic syndrome. The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

The underlying causes of this syndrome are overweight/obesity, physical inactivity and genetic factors.

People with the metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

The metabolic syndrome is diagnosed by the presence of three or more of these factors:

An estimated 47 million U.S. residents have the metabolic syndrome. (NHANES III [1988-94], CDC/NCHS; JAMA. 2002;287:356-359)

Prevalance of Metabolic Syndrome

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