Posts Tagged ‘children’

Improvements Seen in Children’s, Teen’s Diets

February 21st, 2013

Looking for good news? Well, you may need a magnifying glass but it appears caloric intake in American children and adolescents is coming down. In a new report from the CDC, among children and adolescents aged 2–19, caloric intakes decreased for most age groups between 1999–2000 and 2009–2010. According to the report, “Trends in the protein, carbohydrate, and fat intakes were inconsistent. Protein intakes, expressed as a percentage of total kilocalories, increased for all boys and for all girls, and carbohydrate intakes, expressed on the same basis, decreased for all boys and for all girls. However, the observed trends for protein and carbohydrate intakes were not found for all racial and ethnic groups. The percentage of kilocalories from protein increased for all sex and racial and ethnic groups except for non-Hispanic black girls. The percentage of kilocalories from carbohydrate decreased for non-Hispanic white boys and girls and for non-Hispanic black boys, but there was no trend for the other sex and racial and ethnic groups. The only trend in fat intakes was a decrease in saturated fat intakes of Mexican-American boys and girls.

The percentage of calories from protein, carbohydrate, and fat were within the ranges recommended for these macronutrients for this age group, but the percentage of calories from saturated fat was above the 10% recommended in the Dietary Guidelines for Americans, 2010. In 2009–2010, on average, U.S. children and adolescents consumed between 11% and 12% of kilocalories from saturated fat.”

 

Obese Children consume fewer calories than normal weight peers

September 18th, 2012

In a new paper, researchers from the University of North Carolina Chapel Hill looked at children aged 1-17 dietary patterns. What they found surprised a lot of people. Turns out that overweigh and obese girls over 7 and boys over 10 actually consumed fewer daily calories than their healthy weight peers. They hypothesized that one explanation may be that increased energy intake in early childhood and is related to the onset of obesity while another mechanism such as energy expenditure may be more influential in maintaining overweight/obesity status through adolescence. In other words, the normal weight adolescents may get more physical activity and would be expected to eat more to compensate for the effects of greater energy expenditure. This is consistent with the recent study regarding the role of the resting metabolic rate on hunger and food intake. See this study at PubMed: Skinner AC, Self_reported energy intake by age in Overweight

 

Updated obesity prevalence figures for children and adolescents

September 18th, 2012

NCHS has also updated the prevalence figures for children and adolescents, from 1963-1965 to 2009-2010. Overall, data from NHANES indicate 16.9% of children and adolescents aged 2-19 are obese. Among preschool children aged 2-5,  obesity increased from 5% to 12% between 1976-1980 and 2009-2010. Among children aged 6-11, the prevalence rate increased from 6.5% to 18% and among adolescents aged 12-19 from 5% to 18.4%.

Source: http://www.cdc.gov/nchs/data/hestat/obesity_child_09_10/obesity_child_09_10.html

 

The Picture of Underweight in America

September 18th, 2012

Regarding adults, they report a significant decrease in underweight from an estimated 4% in the early 1960s to 1.7% in 2007-2010. The decrease was significant among all age groups. While the prevalence of underweight is greater among women than men, a significant decline was observed in both genders. Women age 20-39 saw a decrease in prevalence of underweight went from 3% in 1988-1994 to 1.9% in 2007-2008.

Source: http://www.cdc.gov/nchs/data/hestat/underweight_adult_07_10/underweight_adult_07_10.htm

Regarding children and adolescents aged 2-19, an estimated 3.5% are underweight, down from 5.1% in 1971-1974. Among children aged 2.5, prevalence dropped from 5.8% to 3.4% from 1971-1974 to 2007-2010; among children 6-11, the rate dropped from 5.3% to 3.6%. No significant change was observed among adolescents aged 12-19.

Source: http://www.cdc.gov/nchs/data/hestat/underweight_child_07_10/underweight_child_07_10.htm

An interesting observation on underweight has come from a study by Koh and colleagues. They looked at demographic, BMI and related data from the Boston Health Care for the Homeless Program and compared the data on the homeless to the NHANES data. They found that only 1.6% of the homeless adults were underweight. They found that the homeless population weight distribution was basically the same as the general population. They state, “Although underweight has been traditionally associated with homelessness, this study suggests that obesity may be the new malnutrition of the homeless in the United States. PubMed: Koh: The Hunger_Obesity Paradox: Obesity in the Homeless

 

FDA Approves Once Weekly Drug for Diabetes; Shows Weight Loss

January 28th, 2012

The Food and Drug Administration has approved Amylin Pharmaceutical’s Bydureon for thetreatment of type 2 diabetes. This is the first once-weekly treatment for type 2 diabetes. It is hoped that this feature will lead to higher adherence to the treatment regimen, although as with Byetta, it is injectable. The drug is exenatide, a GLP-1 receptor agonist. Study results showed an improvement in glycemic control.  A1C levels, a measure of blood sugar, decreased an average of 1.6 points.

Many patients with Type 2 diabetes are also overweight or obese. Many drugs for type 2 diabetes actually cause weight gain. The advantage of Bydureon (and its daily administered counterpart, Byetta) is that patients taking Bydureon can achieve weight loss, in addition to improvements in glycemia, blood pressure, and cholesterol in both overweight and obesity subjects with and without type 2 diabetes. Effects of glucagon-like peptide-1 receptor agonists on … [BMJ. 2012] – PubMed – NCBI

A very small study of 12 children and adolescents with extreme obesity also showed significant improvements, suggesting the need for a larger study. Exenatide as a weight-loss therapy i… [Obesity (Silver Spring). 2012] – PubMed – NCBI

More information is available at www.BYDUREON.com.

Nation’s Obesity Strategy a Failure

October 7th, 2011

The Department of Health and Human Services has issued its 10 year review of the nation’s health care goals, set in 2000. For obesity the picture is not pretty. By direct measurement between 1988-94 and 2005-8, adults over 20 with obesity increased by nearly 47.8%. The target for 2010 was 15%. Children and adolescent rates increased by 63.5% from 11% to 18%. The 2010 target was 5%.  The report also not little to no progress on increasing the proportion of adults or adolescents engaged in regular vigorous physical activity.  Finally, the proportion of adults 20 and over at a healthy weight, directly measured, decreased by 26%; in 2008 only 31% of American adults were at a health weight, the Healthy People goal was 60%. The proportion of persons with healthy eating habits showed no change, still below targets.

CDC – National Center for Health Statistics Homepage

It has to be recognized that during this period millions of dollars have been spent in the public and private sector on educating the public on obesity and the message to ‘eat less and exercise more’ (ELEM).  One would think that this dismal outcome would encourage a critical reappraisal of the nation’s anti-obesity strategy. Alas, I wish it were so. I suspect that we will see merely a call to shout ELEM louder.

FTC Proposes Voluntary Food Marketing Guidelines

May 6th, 2011

The Federal Trade Commission released its long-awaited voluntary guidelines for industry regarding how they market foods to children. Interagency Working Group Seeks Input on Proposed Voluntary Principles for Marketing Food to Children  The agency is proposing that there be more good foods and fewer bad foods marketed to children. (ED: No doubt this will be very controversial.)

 A forum for stakeholders will take place on May 24, 2011.  Public comment is being sought. They must be submitted by June 13, 2011. But early reaction was largely negative Junk Food ‘Guidelines’ Won’t Help – NYTimes.com

Is obesity leveling off and what does it matter?

January 23rd, 2010

Ten days ago, the media was touting new reports from the CDC that the obesity epidemic was ‘leveling off’ or  ‘reaching a plateau.’ The news was taken in some quarters with a sense of relief:”Whew, I’m glad that’s over.” Well, don’t get too comfortable. The reports have a lot more to say and overall, this is not a time for complacency.

What the reports actually say.

First, regarding adults, (Prevalence and trends in obesity among US adults, … [JAMA. 2010] – PubMed result), the authors note that the prevalence of obesity is high, exceeding 30% in most age and sex groups except for men 20-39 years old. Strong racial and ethnic differences persist with very high rates among African-American and Hispanic Americans compared to white Americans. Prevalence of severe or morbid obesity, called class 3, (a BMI of 40 or more) was 5.7% overall, with 4.2% for mean and 7.2% for women, including a rate of 14.2% among non-Hispanic black women. What their analyses found was that the earlier rates of increase were on the order of 6 to 7 percentage points. In the this analysis, over the past ten years, the rate of increase is 4.7 percent. Bottom line: rates are still going up.

Second, regarding children, (Prevalence of high body mass index in US children … [JAMA. 2010] – PubMed result) the authors found no statistically significant increases over the last 10 years among girls. Among boys, there is a different picture. Heavy boys between 6 and 19 years of age are getting heavier. Bottom line: the prevalence of obesity has tripled among school-age children and adolescents if you go back to the 1980s. It is high – 17%- and remains high.

So, is the epidemic leveling off? Answer: we don’t know yet. These analyses look at the last ten year trends and they are less than the peak periods of increase. Is this a pause on an upward track or the start of a decline?

Experts I talked with are not too optimistic. First, there is the perennial question of relying on the BMI. A recent paper indicates that more precise tools, like skinfold tests, would have predicted the obesity epidemic by 10-20 years. The timing of the rise in U.S. obesity varies with… [Econ Hum Biol. 2009] – PubMed result. Second, there isn’t a clear explanation of why the rates should be leveling off. We’d like to think people are changing their behavior but the evidence is there is less compliance with recommended dietary and physical activity standards than ever. Adherence to healthy lifestyle habits in US adults… [Am J Med. 2009] – PubMed result  Compliance with the DASH diet among persons with hypertension has slipped. Deteriorating dietary habits among adults with hyp… [Arch Intern Med. 2008] – PubMed result

The recession may be causing people to forgo buying more expensive but healthier foods Recession Weighs on Waistlines – chicagotribune.com. Many clinicians running medical weight management programs I have talked with report their volume is down 20-30%.

Hopefully, this is the beginning of a levelling or downard trend in obesity but we will not know for sure until more information comes in. In the meantime, we should consider that we don’t to be having phenomenal increases in obesity to justify more programs for treatment and prevention. An editorial  by J Michael Graziano on the two reports from CDC, states, “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. Given the risk of obesity-related major health problems, a massive public health campaign to raise awareness about the effects of overweight and obese is necessary..Major research initiatives are needed to identify better management and treatment options. The longer the delay is 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.”  Amen.