Obesity's Massive, but Stable

In a given year in the U.S., 1/4th of US men and 2/5ths of US women attempt to lose weight, unfortunately, they often fail to keep the weight off.

Sobering statistics that we see all around us, particularly poignant in my office as a pediatrician. Clearly a multifaceted approach is required, but the most important ingredient is caring, follow-up and follow-through. All of the following modalities are necessary to prevent reversion: dietary counseling for the whole family (ie, even those not overweight), behavioral modification that includes increasing physical activity, avoiding nibbling, food indulgences when stressed, and empty calories (eg, junk food). It is vital to include psychosocial support, the kind that "promotes long-term changes rather than fad diets that offer short-term weight reduction, only to return the individuals to their previous habits after the short-term goal is achieved."

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Flegal et al and Ogden et al write in the January 20, 2010 issue of JAMA; based upon analysis of NHANES,* they "offer a glimmer of hope that in the United States at least, the steady, decades-long increases in overweight and obesity may have slowed or perhaps reached a plateau. But even if these trends can be maintained, 68% of US adults are overweight or obese, and almost 32% of school-aged US children and adolescents are at or above the 85th percentile of BMI for age."

The authors augur for a massive public health campaign that raises awareness about the "effects of overweight and obesity....Such campaigns have been successful in communicating the dangers of smoking, hypertension, and dyslipidemia; educating physicians, other clinicians, and the public has yielded significant returns. Major research initiatives are needed to identify better management and treatment options."

Tempest fugit: "The longer the delay in taking aggressive action, the higher the likelihood that the significant progress achieved in decreasing chronic disease rates during the last 40 years will be negated, possibly even with a decrease in life expectancy."

The U.S. Preventive Services Task Force (USPSTF) has revised its recommendations for the optimal treatment and prevention strategies of obese/overweight (O/O) in children and adolescents: these include, but are not limited to having comprehensive moderate- to high-intensity programs that include dietary, physical activity and behavioral counseling components. While recommended for virtually all age groups, these interventions are specifically defined for children, adolescents and their families as follows: more than 25 hours of contact over a 6-month period of time to include the modalities of counseling for weight loss, prudent diet, physical activity (especially of the aerobic type) and behavioral management techniques that are designed to sustain salutary lifestyles. Also, notwithstanding that long-term follow-up studies are lacking, (we've been plagued with that problem for many years, now!) combination pharmacological agent and behavioral interventions seem to be safe, as well.

Whitlock EP. Pediatrics. 2010;125e396-e418.

U.S. Preventive Services Task Force. Pediatrics. 2010;125:361-367.

References

J. Michael Gaziano, MD, MPH [3]. "Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity [4]." JAMA. 2010;303(3):275-276. Published online Jan. 13, 2010 (doi:10.1001/jama.2009.2025).

1. [5] Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509-538. FULL TEXT [6] | WEB OF SCIENCE [7] | PUBMED [8]

2. [9] Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q.1986;64(3):355-391. FULL TEXT [10] | WEB OF SCIENCE [11] | PUBMED [12]

3. [13] Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008 [published online Jan. 13, 2010]. JAMA. 2010;303(3):235-241. FREE FULL TEXT [14]

4. [15] Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008 [published online January 13, 2010]. JAMA. 2010;303(3):242-249. FREE FULL TEXT [16]

• The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. The economic costs related to O/O (BMI >25) in 2002 dollars are estimated to be as much as $92.6 billion in 2002—9.1 percent of U.S. health expenditures. [Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: How much, and who's paying? Health Affairs Web Exclusive. 2003; W3:219-226.]
• The estimated opportunity cost of lost productivity related to O/O in 1994 dollars among Americans age 17 to 64 is $3.9 billion.