Childhood Obesity is the Ultimate Health Disparity Robert Murray MD Center for Healthy Weight & Nutrition Columbus Children’s Hospital The Ohio State University

So, How are we doing with Obesity? So, How are we doing with Obesity?

Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2004 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 2004

Prevalence of Obesity in the U.S. ( ) 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; 295:1549

Extreme Obesity BMI > 40 WhiteAfrican- American Hispanic %9.8%3.9% %8.1%4.5% %10.5%4.5% Ogden, JAMA 2006;295:1549 Adult Population 20 yrs and older

Extreme Obesity BMI > 40 WhiteAfrican- American Hispanic %15.0%5.5% %11.9%5.8% %14.7%7.8% Ogden, JAMA 2006;295:1549 Adult Women 20 years and older

young adults yrs Overweight in America young adults yrs BMI 25 BMI 30 BMI All Cauc Af Am Mex Am Ogden et al JAMA 2006:295:1549

The Trend of Childhood Obesity 4 fold increase over 40 years

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… a tsunami of risk

Overweight American Children Overweight American Children percent > 95% ile 2-5 yrs 6-11 yrs yrs White Black Mex Am Ogden et al, JAMA 2006; 295:1549

Medical Consequences of Obesity Psychosocial Cardiovascular –Lipidemia –Diabetes mellitus –Hypertension –Respiratory –Cardiac Psychosocial Cardiovascular –Lipidemia –Diabetes mellitus –Hypertension –Respiratory –Cardiac Medical –Polycystic ovary disease –Gall bladder disease –Osteoarthritis –Cancer –Steatohepatitis Mortality Medical –Polycystic ovary disease –Gall bladder disease –Osteoarthritis –Cancer –Steatohepatitis Mortality Diseases that begin in childhood amplify morbidity – and costs amplify morbidity – and costs

Overweight in Adolescence -- Mortality in Middle Age Nurses Health Study II (n = 102,400) Followed 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; 145:91

The Relationship between BMI and Medical Complications

Risks for Metabolic Syndrome African American Children obesityhigh blood glucoseabdominal girth hypertensionhigh triglycerides Screened: 385 for BMI and 90 for metabolic syn MS in 3-6 th grade in urban Chicago? –Total with risk factors for MS = 5.6% –In > 95 th % BMI group = 13.8% 57% 1 risk factor 33.3% 2 risk factors 13.8% > 3 risk factors * Used 110 mg/dL value for fasting glucose Braunschweig, Am J Clin Nutr 2005: 81:970

Co-morbidites & Extreme Obesity 75% have > 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 2006:81:s5

Health care Costs 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 2006:81:s5

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

Adolescents with Extreme Obesity Mental 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; 117:1159

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; 9:788

The Second Wave Diabetes & Metabolic Syndrome

Prevalence of Diabetes in U.S.– 1990 to million people/ 7% of the population 1 in 3 children born in 2000 face T2DM Narayan, JAMA 2003; 290:1884

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

Life-years lost to Diabetes If diagnosed at age 40 years –White male: 11 yrsfemale: 13.5 yrs –Hispanic male: 11.5 yrsfemale: 12.4 yrs –Black male: 13 yrsfemale: 17 yrs If diagnosed at age 10 years –White male: 16.5 yrsfemale: 18 yrs –Hispanic male: 19 yrsfemale: 16 yrs –Black male: 22 yrsfemale: 23 yrs National Health Interview Survey -- Narayan, JAMA 2003; 290:1884