Obesity and Kids: A Growing Problem, a Family Affair

This issue of Staying Well focuses on a major threat facing families in this country: our nation's childhood obesity epidemic and what families can do to combat it.

Growing Trends

Over the last 30 years, obesity rates have doubled for adults and tripled for kids.^[1,2] Two thirds of all adults in this country are either overweight or obese.^[2] Not even toddlers are escaping the problem. The 2007-2008 National Health and Nutrition Examination Survey (NHANES) data revealed that nearly one third of all US children over the age of 2 years are overweight or obese.^[3]

Although cherub-cheeked babies are cute and chubby toddlers adorable, obese kids are more likely to become obese adults.^[2] In fact, being overweight before the age of 8 years foreshadows extreme obesity as an adult.^[4]

Racially stratified obesity trends also are concerning. Obesity prevalence is higher among black and Mexican American children than in white children.^[5] Similar racial disparity trends are seen in adults, with adult obesity being 50% more likely in blacks and 20% more likely in Hispanics than in whites.^[6]

The prevalence of childhood obesity also shows substantial state-based geographic variation. As someone who hails from Georgia, this is particularly concerning to me. Kids living in the Southern states (Georgia, Kentucky, Tennessee, and West Virginia) are twice as likely to be obese than kids living in Oregon, the only state showing significant improvement in childhood obesity rates from 2003 to 2007.^[7] Obesity prevalence in adults shows similar geographic trends. Likewise, the highest rates of obesity for both children and adults are in the South, whereas the lowest rates are seen out West.^[7]

Body mass index (BMI): Find out where you stand

Physical Toll

Obesity takes a physical toll on adults and kids. Kids are now suffering from diseases that were once only seen in adults, including high blood pressure, high cholesterol levels, type 2 diabetes mellitus, sleep apnea, and weight-related orthopaedic problems.^[8] A study looking at heart disease risk factors in adolescents and kids demonstrates real consequences of excess weight. In this study, 70% of obese children already had at least 1 heart disease risk factor. Nearly 40% were at even greater risk with 2 cardiovascular risk factors.^[9]

Fiscal Responsibility

The financial cost of carrying extra pounds is significant. Obesity-related medical spending has doubled over the last decade, from over $78 billion in 1998 to $147 billion in 2008. Medical costs due to obesity now represent nearly 10% of total medical spending.^[10]

These differentials in additional costs on an individual basis were highlighted in The New York Times. The price tag for healthcare for a normal-weight individual is on average about $3400 per year. For obese patients, tack on an extra $1429 annually in healthcare expenditures.^[11]

Data presented in March 2010 at the Nutrition, Physical Activity, and Metabolism and Cardiovascular Disease Epidemiology and Prevention joint conference in San Francisco, California, link increased soft drink consumption to $300-$500 million in increased health costs due to heart disease.

Our society can no longer sustain this cycle of increasing pounds with its attendant increasing price tag. Putting a stop to the obesity epidemic is mandatory if we want to get a handle on lowering healthcare costs.

Sodas, Snacks, and Supersizing

Food advertisements and presentations tempt us to eat more than we need, with disregard to satiety -- let alone to nutritional content. Supersized meals and portion distortion increase caloric intake. Snacking also plays a major role. A recent study in Health Affairs looked at snacking trends and found that most kids take in 3 snacks a day, which amounts to almost one third of their daily caloric intake.^[12] Granted, it is great that many food manufacturers are now packaging snacks in convenient 100-calorie servings. Still, the calories add up even when nutritional content is lacking.

Healthy snacks, such as apple slices and carrots, can enhance nutrition. Unfortunately, that's not what most kids eat for snacks. Most kids snack on desserts, candy, chips, sweetened beverages, and other junk food.

Snacking presents another dilemma, which is that we no longer eat to satisfy hunger. We now eat constantly. With the extra calories come extra pounds and additional health risks.

Some health policy experts have proposed a so-called "sin tax^[13]" on sugary soda, postulating that an additional tax of 1 cent per ounce would reduce consumption by 10%. Dr. Kiyah Duffey and colleagues, in the Archives of Internal Medicine, correlated dietary habits of more than 5000 young adults with the price of pizzas and sodas and found that as the price went up, consumption went down. On the basis of their study, they postulated that a 18% tax on "sin foods" may help direct people to more healthy choices.^[14] An analysis by the Rand Corporation^[15] argued that in order to be effective deterrents, these taxes must be large enough to have some punch. A small-tax sales tax would not be effective, whereas a large excise tax could be effective.

I'm personally opposed to a sin tax on soda, and not just because I'm from Atlanta, home of Coca-Cola. One of my objections is the idea of singling out a particular product when so many are to blame. I also worry that such a tax would have a disproportionate impact on minorities and low-income families. What we really need is education about healthy choices, along with greater access to healthy alternatives.

Epigenetic Effects May Strike Early, and Foreshadow Obesity

New research suggests that obese tendencies do not start at birth. They may start even earlier, in the womb. Epigenetic effects can influence hypothalamic and pancreatic programming for weight regulation. For example, moms gaining too much weight during pregnancy and smoking during pregnancy have been linked to increased weight in infancy and early childhood, so have not being breast-fed long enough and getting inadequate sleep during infancy.^[3]

However, blaming it all on mom and dad and genes is a cop-out. Although genetics and epigenetic effects may increase the obesity tendency, a recent study in the Archives of Pediatrics & Adolescent Medicine showed that exercise is the great leveler. This Swedish study of more than 750 teens found that an hour a day of moderate-to-vigorous exercise could minimize weight even for kids with a variant in the FTO gene, which has been associated with obesity. That's why daily exercise has to be a part of any solution to this problem.^[16]

Vital Signs: Include Physical Activity, Diet, Exercise, and Sleep

Details of the new US National Physical Activity Plan, released in early May 2010, had input from many esteemed organizations, including the US Centers for Disease Control and Prevention, the American Medical Association, the American Heart Association, the American Cancer Society, the American Academy of Pediatrics, and the YMCA.^[17,18] First Lady Michelle Obama has launched her own Let's Move initiative to solve the problem of childhood obesity.^[19] Evidence suggests that many obese patients are not counseled about their weight by their physicians.^[20] The American Medical Association, in collaboration with the US Department of Health & Human Services with support from the Robert Wood Johnson Foundation, has created an online primer assessment and management tool.^[21] The entire March 2010 edition of Health Affairs is totally devoted to childhood obesity. Everyone is talking about it. It's time to do something!

Children take cues from parents, and adopting healthy behaviors and habits is no exception. Parents must set good examples for our children and start early. It makes a difference. Young children who eat regular family meals, have only limited television time, and get adequate sleep are less likely to be obese.^[22]

Sleep is also important for adults. Lack of sleep is linked to more belly fat and weight gain,^[23,24] possibly because sleep plays a role in regulating the hunger hormones ghrelin and leptin. This sleep-weight gain connection was highlighted by Anahad O'Connor in The New York Times.^[24] He refers to a small study published in the American Journal of Clinical Nutrition showing that when sleep deprived, young men consumed 500 more calories than after sleeping a good 8 hours.^[25]

Conclusion

Let's beat obesity. Make asking patients about physical activity, diet, sleep, and exercise part of the vital signs that you check on every patient, just like checking blood pressure and pulse. Doctors and other healthcare professionals must also set good examples for our patients and practice what we preach.