Childhood Obesity is the Ultimate Health Disparity

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Childhood Obesityis the Ultimate Health
Disparity
Robert Murray MD Center for Healthy Weight
Nutrition Columbus Childrens Hospital The Ohio
State University
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So, How are we doing with Obesity?
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Obesity Trends Among U.S. AdultsBRFSS, 1991,
1996, 2004
(BMI ?30, or about 30 lbs overweight for 54
person)
1996
2004
No Data lt10 1014
1519 2024 25
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Prevalence of Obesityin the U.S. (1999-2004)

• Obese 32.2
• Overweight 66.3
• Kids
• 33.6 at risk
• 17.1 overweight

All ages Both sexes All ethnic groups All
socioeconomic levels
JAMA 2006 2951549
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Ogden, JAMA 20062951549
Adult Population 20 yrs and older
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Adult Women 20 years and older
Ogden, JAMA 20062951549
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Overweight in Americayoung adults 20-39 yrs
Ogden et al JAMA 20062951549
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The Trend of Childhood Obesity
4 fold increase over 40 years
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a tsunami of risk
First, adults with moderate obesity Then
extreme obesity then young adults then
teens then school aged then pre-school
toddlers and now -- diabetes metabolic
syndrome First, in adults then teens
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Overweight American Childrenpercent gt 95 ile
Ogden et al, JAMA 2006 2951549
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Medical Consequences of Obesity

• Psychosocial
• Cardiovascular
• Lipidemia
• Diabetes mellitus
• Hypertension
• Respiratory
• Cardiac

• Medical
• Polycystic ovary disease
• Gall bladder disease
• Osteoarthritis
• Cancer
• Steatohepatitis
• Mortality

Diseases that begin in childhood amplify
morbidity and costs
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Overweight in Adolescence-- Mortality in Middle
Age

• Nurses Health Study II (n 102,400)
• Followed 22-49 yr olds 1989 2001
• Non-smokers BMI at 18 yrs by recall

Adiposity in adolescence is associated with
premature death in younger and middle-aged U.S.
women
Van Dam, Ann Intern Med 2006 14591
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The Relationship between BMI and Medical
Complications
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Risks for Metabolic SyndromeAfrican American
Children

• obesity high blood glucose abdominal girth
• hypertension high triglycerides
• Screened 385 for BMI and 90 for metabolic syn
• MS in 3-6th grade in urban Chicago?
• Total with risk factors for MS 5.6
• In gt 95th BMI group 13.8
• 57 1 risk factor
• 33.3 2 risk factors
• 13.8 gt 3 risk factors

Used 110 mg/dL value for fasting glucose
Braunschweig, Am J Clin Nutr 2005 81970
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Co-morbidites Extreme Obesity

• 75 have gt 1 related medical comorbidity
• 7 times the normal risk of diabetes
• 6 times the risk of hypertension
• 4 times the risk of arthritis
• 3 times the risk of asthma
• 4 times the risk of only fair to poor health
• 2 times the risk of all-cause mortality

Hensrud, Mayo Clin Proc 200681s5
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Health care Costs Extreme Obesity

• Obesity associated with more cost than any other
  medical condition
• 5-7 of total medical expenditures
• 75 million direct 139 billion total costs
• 36-39 higher health care costs
• Extreme obesity
• 81 higher costs
• accounts for 11billion in direct costs
• Among employed in U.S., the 3 with extreme
  obesity account for 21 of costs

Hensrud, Mayo Clin Proc 200681s5
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Obesity Psychological Issues

• Victimization/ bullying
• Sense of alienation
• Depression
• Behavioral problems
• Lifelong low quality of life
• Low self-esteem

A cycle of food, depression and inactivity
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Adolescents with Extreme ObesityMental Health

• N 33 for by-pass surgery
• PedsQL and Beck Depression Inventory
• Results
• 52 minimally depressed (self report)
• 33 clinically depressed
• 45 clinically depressed (maternal report)
• 21 were being treated
• Depression spanned all domains of BDI
• Physical, emotional, social, school,
  psychosocial, and total

Zeller, Pediatrics 2006 1171159
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Bias and Discrimination among Healthcare
Providers

• Physicians and medical students
• 1/3 view negatively
• feelings of discomfort, reluctance and dislike
  when treating
• poor hygiene, noncompliance, hostility, lazy
• lack of self control
• weak willed, unsuccessful, unintellegent
• Nurses
• patient non-compliance accounts for inability to
  lose weight
• ¼ stated that caring for obese patient repulsed
  them
• Registered Dietitians and their students
• one study showed an ambivalent attitude toward
  obesity
• another showed negative attitudes

Puhl and Brownell, Obes Res 2001 9788
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The Second Wave Diabetes Metabolic Syndrome
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Prevalence of Diabetes in U.S. 1990 to 2001
21 million people/ 7 of the population 1 in 3
children born in 2000 face T2DM
Narayan, JAMA 2003 2901884
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In New York City Diabetes is a Serious Threat

• 800,000 cases in NYC
• 550,000 diagnosed
• 250,000 undiagnosed
• Poverty rate 20.3
• National rate 12.7
• Growing Hispanic and Asian populations
• High African-American population

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Life-years lost to Diabetes

• If diagnosed at age 40 years
• White male 11 yrs female 13.5 yrs
• Hispanic male 11.5 yrs female 12.4 yrs
• Black male 13 yrs female 17 yrs
• If diagnosed at age 10 years
• White male 16.5 yrs female 18 yrs
• Hispanic male 19 yrs female 16 yrs
• Black male 22 yrs female 23 yrs

National Health Interview Survey -- Narayan, JAMA
2003 2901884