Prevalence Of Obesity In USA - Chicago Style

Prevalence of Obesity in USA

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Obesity 1

Table of Contents

Introduction ..................................................................................................................................... 2

Discussion ....................................................................................................................................... 2

Identification ............................................................................................................................... 2

Sequelae ...................................................................................................................................... 4

Risk Factors ................................................................................................................................. 5

Physical Activity...................................................................................................................... 6

Conclusion ...................................................................................................................................... 7

Obesity 2

Prevalence of Obesity in USA

Introduction

Obesity has emerged as the most pressing nutritional problem facing the developed

world. This trend has occurred over a relatively short period of time; in the United States, it

appears to have begun in the last quarter of the 20th century

. The epidemic in children followed

shortly thereafter. The most recent data (1999–2000) from national surveys in the United States

suggest that almost two thirds of the adult population is overweight, and almost one third is

obese. In children, current estimates (1999–2000) put the prevalence of overweight at 15%, a

threefold increase over the past 30 years

. Although this epidemic has spared no subgroup of the

population and has been documented in individuals of all ages and racial/ethnic and

socioeconomic subgroups, the problem is greatest in minority populations and among persons

living in poverty. Obesity is a global public health problem, affecting virtually every region of

the world with the exception of sub-Saharan Africa

Discussion

Identification

The World Health Organization (2000) defines obesity as a condition of abnormal or

excess accumulation of adipose tissue (body fat) to an extent that an individual's health may be

impaired. Because the precise measurement of adipose tissue requires invasive laboratory

Must, A. and Strauss, R. S. Risks and consequences of childhood and adolescent obesity. International Journal of

Obesity and Related Metabolic Disorders vol. 23 no. (Suppl. 2) (1999) pp. S2–S11.

Ogden, C. L., Flegal, K. M., Carroll, M. D., and Johnson, C. L. Prevalence and trends in overweight among U.S.

children and adolescents 1999–2000. Journal of the American Medical Association vol. 288 (2002) pp. 1728–1732.

Latnerm, J. D. and Stunkard, A. J. Getting worse: The stigmatization of obese children. Obesity Research vol. 11

no. (3) (2003) pp. 452–456.

Obesity 3

measures, in the population context, a simpler measure on which to base an obesity definition is

required. Although imperfect, the Body Mass Index (BMI), defined as weight in kilograms

divided by height in meters squared, has been adopted by consensus in the United States by the

National Institutes of Health (1998) and the Centers; for Disease Control and Prevention (CDC)

and internationally by WHO (2000). Consensus definitions of overweight and obesity have been

set at 25 (overweight) and 30 (obesity), with severity classes of obesity defined as follows:

overweight, 25.0 to 29.9; Class I obesity, 30.0 to 34.9; Class II obesity, 35.0 to 39.9; and Class

III obesity, 40.0+. The WHO (2000) terminology differs slightly, but the cutoff points are the

same.

In growing children, in whom weight and height are both changing (and at different

rates), the definition of obesity is inherently more complicated. Although no universally agreed

on standard exists for assessing overweight and obesity in children and adolescents, there is a

growing consensus that BMI should be adopted as an indirect measure of adiposity for children

and adolescents, as well

. Because BMI varies substantially by age and gender during childhood

and adolescence, the specific BMI cutoffs used to classify obesity must

be gender- and age-

specific and must be referenced against a standard. In the United States, the standard used is the

CDC Revised Growth Reference

. Internationally, several standards

, including one based on a

pooled international sample

, are also in use.

Barlow, S. E. and Dietz, W. H. Obesity evaluation and treatment: Expert committee recommendations. Pediatrics

vol. 102 (1998) pp. 222–228.

Ibid 3

Cole, T. J., Freeman, J. V., and Preece, M. A. Body mass index reference curves for the U.K., 1990. Archives of

Disease in Childhood vol. 73 (1995) pp. 25–29.

Latnerm, J. D. and Stunkard, A. J. Getting worse: The stigmatization of obese children. Obesity Research vol. 11

no. (3) (2003) pp. 452–456.

Cole, T. J., Bellizzi, M. C., Flegal, K. M., and Dietz, W. H. Establishing a standard definition for child overweight

and obesity worldwide: International survey. British Medical Journal vol. 320 (2000) pp. 1240–1243.

Obesity 4

Several periods in development have been proposed as critical periods in the

development of persistent obesity and its comorbid consequences. These include the prenatal

period (when intrauterine exposures may influence adiposity), early childhood, and adolescence.

Some evidence suggests that breast-feeding may protect against later obesity. Likelihood of

persistence in adulthood of obesity from childhood is related both to age at onset and severity.

Sequelae

Childhood obesity has a number of immediate, intermediate, and long-term health

consequences

. These include classic cardiovascular risk factors, such as high blood pressure,

abnormal blood lipid levels, and impaired glucose tolerance. Respiratory conditions include

sleep-disordered breathing. In addition, early menarche and menstrual abnormalities are linked to

overweight. Of particular concern is the emergence of type 2 diabetes, once considered an adult-

onset disease, as a disease of childhood. The psychological impact may represent one of the most

damaging effects of obesity given that stigmatization and social isolation may result in lower

self-esteem and depression. In a recently replicated classic study, children were asked to rank

order a series of drawings of children with various handicaps (crutches, wheelchair, missing a

hand, facial disfigurement, obesity) based on which child they would “like best”

. The obese

child was ranked last irrespective of the ranking child's sex, race, socioeconomic status, living

environment, and own disability. In another study, ratings of quality of life for children with

obesity were similar to those of children undergoing chemotherapy for cancer

Must, A. and Strauss, R. S. Risks and consequences of childhood and adolescent obesity. International Journal of

Obesity and Related Metabolic Disorders vol. 23 no. (Suppl. 2) (1999) pp. S2–S11.

Ibid 6.

Schwimmer, J. B., Burwinkle, T. M., and Varni, J. W. Health-related quality of life of severely obese children and

adolescents. Journal of the American Medical Association vol. 289 no. (14) (2003) pp. 1813–1819.

Obesity 5

Although obesity in adulthood that has been present from childhood may carry an

additional burden due to increased severity, much adult obesity arises through adult weight gain.

The health consequences of obesity present in adulthood are enormous, both in magnitude and

impact on quality of life. In developing its clinical guidelines, the NIH report identified an

extensive list of health conditions for which obesity increased risk. These include hypertension,

type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea

and respiratory problems, many cancers, and depression. The number of deaths per year in the

United States attributable to obesity has been estimated at about 300,000.

Risk Factors

In all persons, child or adult, obesity arises due to energy imbalance: When energy intake

exceeds energy expenditure, most of the excess calories are stored as adipose tissue. To give rise

to obesity, energy imbalance must occur over a long period of time and likely reflects a

combination of factors. Individual behaviors, environmental factors, and heredity, singly and in

combination, contribute to the development of obesity. The rapidity with which the obesity

epidemic emerged rules out simple genetic explanations. The current environment in the United

States has been characterized as obesogenic, meaning that it promotes high energy intakes and

low energy expenditures—the energy imbalance that gives rise to weight gain. Modern

industrialized societies provide abundant, relatively inexpensive food; modern life is organized

to reduce energy expenditure at work and at home, through technology and urbanization. For a

species that evolved to store fat in times of plenty in order to survive in leaner times, many

individuals are genetically susceptible to gain weight in the current environment.

Obesity 6

Excessive energy intake is a primary risk factor for the development of childhood and

adult obesity, although the specific aspects of intake responsible are controversial. Dietary

factors, such as diet composition, energy density, fat intake, fruit and vegetable consumption,

snacks, sugar-rich foods, and soft drinks, have all been identified in association with obesity.

Increased consumption of fruits and vegetables can help reduce the intake of dietary fat and

calories because they are naturally low in fat and energy density compared with other foods.

Despite current recommendations that individuals over the age of 2 years consume 2 to 4

servings of fruits and 3 to 5 servings of vegetables daily, children and adolescents eat an average

of only 3.6 servings of fruits and vegetables per day, and fried potatoes account for a large

proportion of those servings. A number of other dietary variables, including soft drinks,

snacking, portion sizes, and infant feeding have also been linked to childhood obesity. Studies

suggest that the increased consumption of sugar-sweetened soft drinks, snack foods (which are

often high in fat or/and sugar), and large-sized portions of foods have contributed to the increase

in energy intakes.

Physical Activity

Reduced physical activity may be the most important factor in explaining the increase of

obesity over the past two decades. Physical activity among U.S. youth is in decline, with nearly

half of young people aged 12 to 21 reporting that they do not engage in vigorous physical

activity regularly and one fourth reporting no vigorous physical activity. Whereas leisure time

physical activity has increased in men and remained constant in women over the past four

decades in the United States, activity associated with work and home life has declined over the

same period. Sedentary behavior and “inactivity,” such as watching television and playing

Obesity 7

video/computer games, also are contributory factors. Gortmaker et al. (1996) reported an

adjusted-odds ratio (OR) for obesity of 8.3 for adolescents who watched TV more than 5 hours

per day compared with those who watched 0 to 2 hours. Compelling evidence comes from

intervention studies, which show that reducing TV viewing time can help prevent childhood

obesity. Adults in a trial of maintenance following weight loss sustained their losses best when

physical activity was high and television viewing was low

. TV watching may promote obesity

by reducing physical activity, lowering metabolic rate, and increasing energy intake. The latter

may occur due to the fact that TV viewing may be associated with snacking and may moderate

eating habits generally through greater exposure to advertising of foods high in added sugars and

fat or by conveying mixed messages about lifestyle and health in the content of advertisements.

TV viewing is a major source of inactivity among Americans. Screen time, a summary measure

of time spent viewing television and videos and engaged in computer-based activity, represents

the largest proportion of nonsleep, nonschool time for youth.

Conclusion

Obesity has emerged as the major nutritional problem facing the pediatric and adult

populations worldwide. The etiology of obesity is multifactorial and includes individual risk

factors, genetic influences, and environmental effectors. The severity of the problem, in terms of

immediate and long-term health consequences to physical and psychological health, suggests it is

a problem that will dominate the public health agenda in the 21st century.

Van Baak, M. A., van Mil, E., Astrup, A. V., Finer, N., Van Gaal, L. F., Hilsted, J., and et al. Leisure-time activity

is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity

Reduction and Maintenance (STORM trial). American Journal of Clinical Nutrition vol. 78 (2003) pp. 209–214.

Obesity 8

End Notes

1. Barlow, S. E. and Dietz, W. H. Obesity evaluation and treatment: Expert committee

recommendations. Pediatrics vol. 102 (1998) pp. 222–228.

2. Cole, T. J., Bellizzi, M. C., Flegal, K. M., and Dietz, W. H. Establishing a standard

definition for child overweight and obesity worldwide: International survey. British

Medical Journal vol. 320 (2000) pp. 1240–1243.

3. Cole, T. J., Freeman, J. V., and Preece, M. A. Body mass index reference curves for

the U.K., 1990. Archives of Disease in Childhood vol. 73 (1995) pp. 25–29.

4. Flegal, K. M., Carroll, M. D., Ogden, C. L., and Johnson, C. L. Prevalence and trends

in obesity among U.S. adults, 1999–2000. Journal of the American Medical

Association vol. 288 (2002) pp. 1723–1727.

5. Gortmaker, S. L., Must, A., Sobol, A. M., Peterson, K., Colditz, G. A., and Dietz, W.

H. Television viewing as a cause of increasing obesity among children in the United

States, 1986–1990. Archives of Pediatric and Adolescent Medicine vol. 150 (1996)

pp. 356–362.

6. Latnerm, J. D. and Stunkard, A. J. Getting worse: The stigmatization of obese

children. Obesity Research vol. 11 no. (3) (2003) pp. 452–456.

7. Must, A. and Strauss, R. S. Risks and consequences of childhood and adolescent

obesity. International Journal of Obesity and Related Metabolic Disorders vol. 23 no.

(Suppl. 2) (1999) pp. 2–11.

8. National Institutes of Health. Clinical guidelines on the identification, evaluation, and

treatment of overweight and obesity in adults. Bethesda, MD: Department of Health

Obesity 9

and Human Services, National Institutes of Health, National Heart, Lung, and Blood

Institute. (1998).

9. Ogden, C. L., Flegal, K. M., Carroll, M. D., and Johnson, C. L. Prevalence and trends

in overweight among U.S. children and adolescents 1999–2000. Journal of the

American Medical Association vol. 288 (2002) pp. 1728–1732.

10. Schwimmer, J. B., Burwinkle, T. M., and Varni, J. W. Health-related quality of life of

severely obese children and adolescents. Journal of the American Medical

Association vol. 289 no. (14) (2003) pp. 1813–1819.

11. Van Baak, M. A., van Mil, E., Astrup, A. V., Finer, N., Van Gaal, L. F., Hilsted, J.,

and et al. Leisure-time activity is an important determinant of long-term weight

maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and

Maintenance (STORM trial). American Journal of Clinical Nutrition vol. 78 (2003)

pp. 209–214.

12. World Health Organization. Obesity: Preventing and managing the global epidemic:

Report of a WHO consultation (WHO Technical Report Series, No. 894). Geneva:

Author. (2000).

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