Obesity – More and Less

The obesity epidemic is in full swing. Just thirty years ago in the U.S., only 4% of 6 – 11 year olds were overweight; today, 17% or 12.5 million children and adolescents 2 – 19 years are obese. Since 1980 the prevalence of obesity among children and adolescents has almost tripled, and 1 in 7 low-income pre-school children are now classified as obese. More than one-third of U.S. adults (35.7%) are considered obese.(1) See Figure below.(2)

prevalence-obesity

The annual medical costs of obesity in the U.S. are estimated at $147 billion (2008 dollars) and rising. There are both direct and indirect costs associated with obesity. Indirect costs include workplace absenteeism and reduced productivity in the workplace due to health problems.  Further, people who are obese have medical costs that are $1,429 higher annually than people of normal weight.(3)

Measuring obesity

Obesity is defined as having an excessive amount of body fat. While there are a variety of methods to measure the condition, the most common one is Body Mass Index or BMI. This is a comparison of height to weight that excludes muscle mass. Two people of the same height and weight will have the same BMI, even though one may be an athlete with more muscle than fat. Different calculations are used for adults and for children.

Obesity in Children

Weight, age and gender have to be considered for children, in order to classify them. Children’s body composition and fat varies as they age, and it also differs between girls and boys.(4)

 

To help patients calculate their children’s BMI, accurate height and weight measurements are needed before they can use the Child and Teen BMI Calculator.

Children who are obese have higher asthma and asthma-related symptoms than children considered non-obese.(5) Obese children are vulnerable to a number of disease and are at increased risk of (6–12):

  • developing asthma in early childhood
  • breathlessness and cough
  • impaired lung function
  • a reduced response to inhaled corticosteroids
  • exercise-induced bronchoconstriction
  • negative health
  • psychosocial difficulties
  • hypertension, diabetes and cardiovascular disease in middle age (30s and 40s)
  • gastroesophageal reflux disease
  • hyperlipidemia
  • fatty liver
  • insulin resistance
  • obstructive sleep apnea
  • nutritional deficiencies
  • orthopedic complications

Obesity in children is of grave concern since a child who is obese will likely become an obese adult.

Obesity in Adults

In 2010, 20% of U.S. adults were obese.

To calculate the BMI for adults, divide the weight in kilograms by the square of the height in metres,  or divide the weight in pounds (lbs) by height in inches (in) squared and multiply by a conversion factor of 703.

Or:

BMI = [ weight (lb) / height (in)2 ] × 703.

A calculator is available at http://www.cdc.gov/healthyweight/assessing/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.html  

Obesity is inflammation-based and potentially fatal. One of the leading causes of preventable death, it has been linked with hypertension, diabetes mellitus, myocardial infarction, obstructive sleep apnea, orthopaedic disorders, infertility, gastroesophageal reflux, hyperventialation syndromes and urinary stress incontinence. It is also a significant risk factor for cancers of the:

  • colon, prostate and rectum in men
  • breast, cervix, ovaries and endometrium in women.

Losing weight reduces the risk of disease. Weight loss improves asthma symptoms and more importantly, quality of life. Every overweight child and parent must be encouraged to lose excess weight.

Conclusion

There is both good news when considering obesity. Data from the National Health and Nutrition Examination Survey2 showed that, between 2010 and 2012, there was a significant decline in obesity in the 2 – 5 year old age group – from a high of 13.9% to 8.4%. However, the good news was tempered by a disappointing increase in adult rates. For adults over 60, there was a 4.4 percentage increase from 31% to 35.4%. Grade 3 obesity or super obesity was higher in women than men at 8.3% and 4.4% respectively and highest in the 40 -59 age group. Prevalence of obesity in women over the age of 60 rose from 31.5% in 2003-2004 to 38.1% in 2011 – 2012.

There is much to be done to fight the battle of the bulge. Primary prevention should begin with preconception counselling and continue through infancy, childhood, adolescence and adulthood through to the senior years. This is not a disease to be taken lightly.

References

  1. http://www.cdc.gov/obesity/data/childhood.html  Accessed Feb 28, 2014
  2. Ogden CL, Carroll MD et al. Prevalence of Childhood and Adult Obesity in the United States, 2011–2012. JAMA, 2014; 311 (8): 806 DOI: 10.1001/jama.2014.732
  3. http://www.cdc.gov/obesity/data/adult.html  Accessed Feb 28, 2014
  4. Centers for Disease Control and Prevention. Healthy weight: body mass index. 2009. http://www.cdc.gov/healthyweight/assessing/bmi. Accessed Feb 28, 2014.
  5. Wang D1, Qian Z, et al. Gender-specific differences in associations of overweight and obesity with asthma and asthma-related symptoms in 30,056 children: result from 25 districts of Northeastern China. J Asthma. 2014 Feb 18. [Epub ahead of print]
  6. Mannino DM, Mott J, Ferdinands JM, et al. Boys with high body masses have an increased risk of developing asthma: findings from the National Longitudinal Survey of Youth (NLSY). Int J Obes (Lond). 2006;30:6–13.
  7. Bibi H, Shoseyov D et al.  The relationship between asthma and obesity in children: is it real or a case of over diagnosis? J Asthma, 41 (2004), pp. 403–410
  8. Kaplan TA,  Montana E. Exercise-induced bronchospasm in nonasthmatic obese children  Clin Pediatr (Phila), 32 (1993), pp. 220–225
  9. Fedele DA1, Janicke DM, Lim CS, Abu-Hasan M. An examination of comorbid asthma and obesity: assessing differences in physical activity, sleep duration, health-related quality of life and parental distress. J Asthma. 2014 Jan 10. [Epub ahead of print]
  10. Daniels S. The influence of obesity and insulin resistance on the heart and vasculature during childhood. World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease 2010
  11. Koebnick C, et al Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes 2010; DOI: 10.3109/17477166. 2010.491118.
  12. Beuther DA and Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies Am J Respir Crit Care Med, 175 (2007), pp. 661–666