Childhood Obesity is the Ultimate Health Disparity

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

2. So, How are we doing with Obesity?

3. 1991 Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1996 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

4. 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; 295:1549

5. Adult Population 20 yrs and older Ogden, JAMA 2006;295:1549

6. Adult Women 20 years and older Ogden, JAMA 2006;295:1549

7. Overweight in Americayoung adults 20-39 yrs Ogden et al JAMA 2006:295:1549

8. The Trend of Childhood Obesity 4 fold increase over 40 years

9. 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

10. Overweight American Childrenpercent > 95% ile Ogden et al, JAMA 2006; 295:1549

11. 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

12. 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; 145:91

13. The Relationship between BMI and Medical Complications

14. 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 > 95th % 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

15. 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

16. 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

17. 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

18. 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; 117:1159

19. 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

20. The Second Wave Diabetes & Metabolic Syndrome

21. 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; 290:1884

22. 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

23. Life-years lostto 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; 290:1884