Posts Tagged ‘diabetes’

Childhood Obesity-Related Hospitalizations Increasing

December 4th, 2012

In 2009, there were about 38,000 hospital stays with a diagnosis of obesity for children ages 1 to 17 years in the United States, comprising 2.1 percent of all hospitalizations among this age group. From 2000 to 2009, the rate of hospitalizations with obesity more than doubled (from 2.4 to 5.4 stays per 10,000 children). In contrast, the rate of hospital stays without any mention of obesity remained relatively stable. Hospitalizations with a diagnosis of obesity have a longer average length of stay and higher mean costs per stay. This new report from AHRQ repots a sizable growth in the costs of obesity. In 2000, the average cost of an obesity-related hospital stay was 20 percent higher than a stay with no mention of obesity ($7,200 versus $6,000). But, in 2009, the average cost of an obesity-related hospital stay was 24 percent higher than a stay without obesity ($9,900 versus $8,000). From 2000 to 2009, the rate of stays with obesity on the record more than doubled among children age 5—9 years (up 124 percent), 10—14 years (up 114 percent), and 15—17 years (up 139 percent). During this same period, the rate of stays with obesity increased in all four regions, more than doubling in the Midwest, Northeast, and West.

For both obesity-related and non-obesity related hospitalizations for children there was a marked drop in coverage by private insurance and an increase in coverage by Medicaid from 2000 to 2009.

The principal diagnoses, for which obesity was the secondary diagnosis, were mood disorders, asthma, appendicitis, pneumonia, skin infections, biliary tract disease, diabetes mellitus, epilepsy, attention-deficit, conduct, and disruptive behavior disorders. Report is based on H-CUP databases, sponsored by AHRQ. See AHRQ: Hospitalizations and Obesity Children SB 138

Obesity, diabetes to thwart cardiovascular improvements

May 3rd, 2012

Huffman and colleagues looked at the American Health Association’s Strategic Impact Goals target of a 20% relative improvement in overall cardiovascular health. They looked at 35,000 cardiovascular disease-free adults in the NHANES surveys from 1999 to 2008. They found that the prevalence of smoking, hypercholesterolemia and hypertension declined, whereas the prevalence of obesity and dysglycemia increased through 2008. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes could increase to affect 43% and 77% of US men and 42% and 53% of US women. Overall, population level cardiovascular health is projected to improve only 6% overall, far below the AHA 20% target. PubMed: Cardiovascular Health Behaviors Changes and Projections

 

Obesity adding to Preterm Births

May 3rd, 2012

What does the US have in common with Kenya, Turkey, Thailand, East Timor and Honduras?  Answer: high rates – around 12% –  of preterm births, according to a new study from the World Health Organization. Most European countries and Canada have rates around 7% to9%. The report notes, “Underlying maternal conditions (e.g. renal, disease, hypertension, obesity and diabetes) increase the risk of maternal complications (e.g., pre-eclampsia) and medically-indicated preterm birth. The worldwide epidemic of obesity and diabetes is, thus, likely to become an increasingly important contributor to global preterm birth. In one region in the United Kingdom, 17% of all babies born to diabetic mother were preterm, more than double the rate in the general population.

WHO: Born Too Soon, Global Action Report on Preterm Birth

 

American Heart Assn. Sees Tidal Wave of Cardiovascular Disease coming from Obesity Epidemic

December 16th, 2011

The American Heart Association has published an update on the burden of cardiovascular disease and stroke. They warn that the recent drop in death rates is likely to be reversed by the continuing increases in the rates of diabetes and obesity. Dr. Donald Lloyd-Jones told MedPageToday  that rising death rates in cardiovascular death in young adults is particularly troubling, “Because if they’re getting disease at this young of an age then they’re just the leading edge – the canaries in the coal mine, if you will – that suggests that we have a whole tidal wave of cardiovascular disease that is coming as a result of the obesity epidemic.” Medical News: Diabetes, Obesity Overshadow Lower CV Death Rate – in Cardiovascular, Prevention from MedPage Today 

Here are the facts:

The estimated prevalence of overweight and obesity in US adults (>20 years of age) is 149 300 000, which represents 67.3% of this group in 2008. Fully 33.7% of US adults are obese (body mass index >30 kg/m2). Men and women of all race/ethnic groups in the population are affected by the epidemic of overweight and obesity.

● Among children 2 to 19 years of age, 31.9% are overweight and obese (which represents 23 500 000 children), and 16.3% are obese (12 000 000 children). Mexican American boys and girls and African American girls are disproportionately affected. Over the past 3 decades, the prevalence of obesity in children 6 to 11 years of age has increased from <4% to more than 20%.

● Obesity (body mass index >30 kg/m2) is associated with marked excess mortality in the US population. Even more notable is the excess morbidity associated with overweight and obesity in terms of risk factor development and incidence of diabetes mellitus, CVD end points (including coronary heart disease, stroke, and heart failure), and numerous other health conditions, including asthma, cancer, degenerative joint disease, and many others.

● The prevalence of diabetes mellitus is increasing dramatically over time, in parallel with the increases in prevalence of overweight and obesity.

● On the basis of NHANES 2003–2006 data, the age adjusted prevalence of metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance, is 34% (35.1% among men and 32.6% among women).

● The proportion of youth (<18 years of age) who report engaging in no regular physical activity is high, and the proportion increases with age. In 2007, among adolescents in grades 9 through 12, 29.9% of girls and 17.0% of boys reported that they had not engaged in 60 minutes of moderate-to-vigorous physical activity, defined as any activity that increased heart rate or breathing rate, even once in the previous 7 days, despite recommendations that children engage in such activity >5 days per week.

● Thirty-six percent of adults reported engaging in no vigorous activity (activity that causes heavy sweating and a large increase in breathing or heart rate).

● Data from NHANES indicate that between 1971 and 2004, average total energy consumption among US adults increased by 22% in women (from 1542 to 1886 kcal/d) and by 10% in men (from 2450 to 2693 kcal/d;

● The increases in calories consumed during this time period are attributable primarily to greater average carbohydrate intake, in particular, of starches, refined grains, and sugars. Other specific changes related to increased caloric intake in the United States include larger portion sizes, greater food quantity and calories per meal, and increased consumption of sugar-sweetened beverages, snacks, commercially prepared (especially fast food) meals, and higher energy-density foods.

For the full report, see Heart Disease and Stroke Statistics—2011 Update1. About 1. About These Statistics2. American Heart Association’s 2020 Impact Goals3. Cardiovascular Diseases4. Subclinical Atherosclerosis5. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris6.

What’s New in Ubeki-beki-beki-stan-stan-stan or the serious picture of global obesity

November 6th, 2011

Americans tend to think that obesity is a home-grown phenomenon, a reflection of our consumer-oriented society. Yet, obesity is a global phenomenon and not only in other Western industrialized countries. In fact, obesity is occurring throughout the world at a rapid pace and in a lot of countries you might not expect. Here’s a sample of some recent studies.

Obesity prevalence in male school children in Saudi Arabia was found to be 9.7% and 14.2% for overweight, approaching levels in developed countries. It was noted in the study that mothers of obese and overweight children had less education and worked more. The children also missed breakfast more, had frequent consumption of fast food and low daily consumption of fruits, vegetables and dairy products.  Overweight and Obesity and their Association with Dietary Habits, and Sociodemographic Characteristics Among Male Primary School Children in Al-Hassa, Kingdom of Saudi Arabia

We have previously looked at increases of obesity in China. Now, there is a review article of the epidemics of obesity, diabetes and the metabolic syndrome The emerging epidemic of obesity, diabetes… [Cardiol Res Pract. 2012] – PubMed – NCBI Here’s a number of staggering proportions: the number of overweight or obese Chinese: 401 Million, a prevalence of 29.9%.

Greenland sees changes in physical activity among the native Inuit people who are experiencing rapid social transition. Compared to traditional hunters and fishermen, women in the latest stage of change engage in less domestic physical activity; men in less occupational physical activity.

See http://www.ncbi.nlm.nih.gov/pubmed/21948977.

 

 

A study from western Iran found the incidence of type 2 diabetes was increased by obesity at all ages and by extreme leanness in childhood. Being obese throughout life doubled type 2 diabetes prevalence in women. And here’s something you don’t find in many studies: prevalence was increased by green tea and opium consumption. Diabetes mellitus and its correlates in an Iranian … [PLoS One. 2011] – PubMed – NCBI

A study of 14,425 subjects in Nepal found that 32% were obese, 28% were overweight, 6.3% were diabetic and 34% had hypertension. Prevalence was higher in the less educated, those working at home and women. Prevalence of hypertension, obesity, diabete… [Int J Hypertens. 2011] – PubMed – NCBI Nepal is one of the low and middle income countries hit with both infectious disease burden as well as rising incidence of non-communicable diseases frequently characterized by obesity. Low health literacy rates complicate strategies to address the challenges. Obesity prevalence in Nepal:… [Int J Environ Res Public Health. 2010] – PubMed – NCBI

An obesity rate of 53.9% is reported in Sudan The state of heart disease in Sudan. [Cardiovasc J Afr. 2011 Jul-Aug] – PubMed – NCBI

If you are wondering about Ubeki-beki-beki-stan-stan-stan, there is news there too. A national survey has found a strong association between obesity and hypertension in Uzbekistan. Epidemiology of obesity and hypertension and… [Eur J Clin Nutr. 2006] – PubMed – NCBI

http://www.ncbi.nlm.nih.gov/pubmed/21948977

Cancer and Obesity Explored

November 3rd, 2011

The Institute of Medicine’s National Cancer Policy Forum this week convened a two-day workshop, “The Role of Obesity in Cancer Survival and Recurrance.” So this is a good opportunity to re-visit the relationship between these two deadly diseases. Susan Gapstur of the American Cancer Society noted the growing list of cancers associated with obesity. For men, these include cancers of the colon, esophagus, kidney, colorectum, pancreas, gallbladder and liver. Women are affected by the same cancers as well as of the endometrium and postmenopausal breast cancer. Evidence is accumulating for an association with non-Hodgkin’s lymphoma, ovarian cancer in women and aggressive prostate in men. Obesity, she pointed out, is not the second (to tobacco) leading risk factor of cancer. Ominously, she pointed out we do not know what the health effects will be for the children now obesity who will obese for a lifetime.

Pamela J. Goodwin of the University of Toronto explored potential mechanisms in the progression to cancer including inflammation, adipokines, hyperinsulinemia, diabetes/diabetes drugs and sex steroids. She pointed to studies showing reductions in cancer risk with intentional weight loss of 20 pounds or more. Intentional weight loss and in… [Int J Obes Relat Metab Disord. 2003] – PubMed – NCBI and reduction in the relative risks of death and of cancer following bariatric surgery. Metabolic surgery and cancer: protective effects of b… [Cancer. 2011] – PubMed – NCBI.  Specifically, she showed the positive effect of intentional weight loss on breast cancer risk   Does intentional weight loss reduce canc… [Diabetes Obes Metab. 2011] – PubMed – NCBI and the impact of physical activity on improvements in insulin in breast cancer survivors Impact of a mixed strength and endurance exerci… [J Clin Oncol. 2008] – PubMed – NCBI.

Bruce Wolfe of the Oregon and Science University and a bariatric surgeon reminded the participants that the Swedish Obesity Study found the reduction in mortality after bariatric surgery was greater for cancer than for cardiovascular events Effects of bariatric surgery on mortality in Sw… [N Engl J Med. 2007] – PubMed – NCBI. In a Utah study, bariatric surgery reduced deaths from cancer by 60% compared to a 48% reduction in cardiovascular events. Long-term mortality after gastric bypass surgery. [N Engl J Med. 2007] – PubMed – NCBI

Rachel Ballard-Barbash of the National Cancer Institute, who has been a leader in exploring the obesity-cancer connection for many years, moved the discussion to look at the co-morbid conditions of obesity and their relationship to cancer mortality, including renal disease, congestive heart failure, cerebrovascular disease, citing A refined comorbidity measurement algorithm fo… [Ann Epidemiol. 2007] – PubMed – NCBI

Patricia Ganz of the UCLA Schools of Medicine picked up the point and explained that about half of all deaths of breast cancer survivors are due to causes other than breast cancer. She recommended prevention of weight gain and/or weight loss in those breast cancer survivors who are obese. 

Thomas Wadden described the non-surgical approaches to weight loss used in the Diabetes Prevention Program and the LOOK Ahead study and the contribution of intensive behavioral counseling to reduction in comorbid conditions associated with obesity

Some of the workshop’s presentations are on-line at Workshop on the Role of Obesity in Cancer Survival and Recurrence – Institute of Medicine. Watch that site for future information on a publication from the workshop.

New Support for Medicare Coverage of Intensive Counseling for Obesity

October 5th, 2011

If the Centers for Medicare and Medicaid Services needed any more support today for including intensive behavioral counseling for obesity as a covered service, it received it today from the U.S. Preventive Services Task Force (USPSTF.)  The USPSTF today released an update of its 2003 recommendation, which was the basis for the Medicare proposal. The update review of literature clearly supports the value of intensive behavioral counseling. It concludes:

  1. Behaviorally based treatment resulted in 6.6 lb greater weight loss in intervention than control participants after 12-18 months, with more treatment sessions associated with greater loss.

  2. Controls generally lost little or no weight, whereas intervention groups lost an average of 4% of baseline weight.

  3. Weight-loss treatment reduced diabetes incidence in patients with pre-diabetes.

  4. Effects on lipids and blood pressure were mixed and small.

The update is published in the Annals of Internal Medicine. Effectiveness of primary care-relevant treatm… [Ann Intern Med. 2011] – PubMed – NCBI

Will New Study Implicate Obesity in Lowering Life Expectancy?

June 15th, 2011

A new study of life expectancy in the United States will surely raise questions about impact of obesity. The Washington Post reports that a study to be published next Wednesday shows  large variations in changes in life expectancy across the country. Rates of life expectancy are getting worse, it appears in the South and SouthEast where there are the highest rates of obesity and diabetes. Life expectancy in the U.S. varies widely by region and in some places is decreasing – The Washington Post  Check the Washington Post’s interactive map for information on your county. For more in depth information, pull up the USDA Food Environment Atlas and compare it to the life expectancy data. Food Environment Atlas