Posts Tagged ‘Childhood Obesity’

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

China’s Childhood Obesity Rate Soars

October 15th, 2012

In 1986, China had no obesity epidemic in infants and preschool children. But by 2006, obesity prevalence had reached 4.1% in boys and 2.7% in girls, a 280% increase.  The study had a couple of interesting findings. First, prevalence among boys was increasing much faster than among girls, contrary to studies from the West and even Japan. Second, they observed an increase mainly among pre-school children but among infants. They note that exclusive breast-feeding for infants below six months has declined from 53.5% in 1995 to 32.8% in 2005. However, there was no difference between the obesity and control groups. Finally, family history of obesity was identified as a significant risk factor. PubMed:Secular trends in prevalence of obesity in infants and preschool children in China

Weight of the Nation – TV Food Advertising

May 4th, 2012

Ask almost anyone to name a culprit in the increase in childhood obesity and it won’t be long before marketing of foods on television to children is fingered.

Television viewing has raised three concerns: sedentary behavior during TV watching, food consumption during TV viewing, and exposure to advertisements, especially for foods high in fat, salt and sugar.

In 2010, the World Health Organization published 12 recommendations on the marketing of food and non-alcoholic beverages to children. The United Kingdom was the first country to develop scheduling restrictions of food advertisements to children.

Adams and colleagues studied exposure by children under 16 to food advertising 6 months before and 6 months after the scheduling restrictions went into effect. They found that the scheduling restrictions were widely adhered to but that the restrictions failed to reduce significantly exposure to such ads. “Indeed, they appear to have had a perverse effect of increasing exposure of all viewers to HFSS (high fat, salt, sugar) food advertising. PubMed: Effect of Restrictions on Television food advertising


Weight of the Nation: Childhood Obesity – Is Anything Working?

May 4th, 2012

The Surgeon’s General ground-breaking Call to Action on overweight and obesity came out in 2001. Surgeon General: Call to Action: Obesity Since then, millions of dollars have been spent by governmental and non-governmental organizations on steps to prevent obesity, primarily in children. How’s it going? Well, in spite of the best of intentions of hundreds of people, not well.

A paper just out by Dr. Jeffrey Mechanick , a highly respected researcher in the field, and colleagues, looked at three anti-obesity policies: increasing physical activity in children, taxing sugar-sweetened beverages and funding for walking and biking trails. They found, “While numerous studies have established their efficacy when implemented on a local or communal (small-) scale, there is little published evidence demonstrating statistical correlation between BMI (body mass index) and implementation of these policies, or any combination, thereof, on a statewide (large-) scale.” They conclude, “American culture, policy-making, and the obesity epidemic constitute a recursive, complex adaptive system. We have proposed that an emergent property of this system is that implementation of anti-obesity policies may not be reducing the obesity growth rates as early as expected, if at all. This somewhat counter-intuitive finding is, on the surface, discouraging, but with deeper deliberation, offers redirection for an anti-obesity campaign. Since the obesity epidemic remains uncontrolled with vast downstream adverse effects, it is imperative to gain a thorough understanding of this complex system. The focus should be broadened to improve consumer dietary patterns and physical activity. There should be greater supply-side regulation of food content, as well as interventions targeting obesogenic inflammatory mechanisms. PubMed:Lack of Correlation between anti-obesity poliicy and obesity growth rates

This one paper is not alone. The Cochrane Reviews are distinguished for their rigorous study of important health topics. A Cochrane Review was published in 2011 evaluating all randomized clinical trials (RCTs) of interventions for preventing obesity in children. The review included an 55 studies. The majority of studies targeted children aged 6-12 years. The meta-analysis included 27,946 children. According to the authors, overall, the programs were effective, but not all were, reflecting a high degree of heterogeneity. Children in the intervention group had a standard mean difference in adiposity  (measured as BMI or zBMI) of –0.15 kg/m2 The authors urged that the findings be taken cautiously because of the unexplained heterogeneity and the likelihood that studies with negative outcomes were not published. Cochrane Review: Preventing Obesity in Children

A near-universal policy goal is increasing physical activity of children in school. Yet, even here, the evidence is poor to weak.

Cawley and colleagues examined the impact of state physical activity requirements on youth physical activity and overweight, using data from the Youth Risk Behavior Surveillance System for 1991, 2001, and 2003. They found that high school students with a binding physical education (PE) requirement report an average of 31 additional minutes per week spent physically active in PE classes. Their results indicate that additional PE time raises the number of days per week that girls having exercised vigorously or have engaged in strength-building activity. They found “no evidence” that PE lowers BMI or the probability that a student is overweight. They conclude that “there is not yet the scientific basis to declare raising PE requirements an anti-obesity initiative for either boys or girls. PubMed: Cawley: The Impact of state physical education requirements

A 2011 paper found that adequate PE time was inversely related to recess, and vice versa, suggesting that schools are substituting one form of physical activity for another, rather than providing the recommended amount of both recess and PE.  PubMed: Slater: The Impact of State Laws and District Policies


Child Labor Laws Responsible for Childhood Obesity?

January 28th, 2012

Well, here’s a new one. Senator Charles Grassley (R-Iowa) is suggesting that child labor laws are responsible for the rise in childhood obesity. Grassley was criticizing a Department of Labor regulation that children could only work on farms owned by their parents when he decided to open up this novel line. Political Animal – Leave child-labor laws alone

New View on the Origins of Our Obesity Predicament

December 24th, 2011

As readers know, there is a certain disconnect about when the obesity    epidemic began. Personally, I am quite persuaded that the historical record for the increase in human weight and height (the two parts of the BMI formula) goes back at least 350 years. (See, The Techno-physiological Revolution). On the other hand, something seemed to happened in the United States around the 1970s to send the rates skyward. There are no end of theories, all of which have some plausibility. So now comes Melinda Sothern, a well-respected and highly published obesity researcher, with a new look at mothers in the 1950’s. (Ouch! That’s a little close to home.) Her thoughts in this article do meet up with current research on genetic and, especially, epigenetic factors influencing the development of obesity. 

Many knowledgeable researchers have avoided going into this territory, not because of the science but because of the fear of being blamed for blaming mothers. This is not an inconsequential factor as parents may defer medical care for fear of being blamed for their child’s weight problems. (See the Cleveland obese boy incident.)

Sothern’s experiences and scientific credibility gives impetus to seriously consider her thoughts on the origin of our current predicament, given in this article in The Republic, ’50s women may have triggered obesity epidemic | The Republic

Is Foster Care Good for Obese Children?

December 6th, 2011

Dr. David Ludwig, the Harvard pediatric endocrinologist who wants the government to take obese children away from their families like the boy in Cleveland according to an analysis  which, in my opinion, is deeply flawed, should read the Government Accountability Office study of five states. This study, recently presented to Congress, shows that children in foster care receive very high doses of anti-psychotic medications. Foster Kids Given Psychiatric Drugs At Higher Rates : Shots – Health Blog : NPR#more

Many of these medications are known to increase body weight. Weight gain profiles of new anti-psychotics: public… [Obes Rev. 2003] – PubMed – NCBI  On the other hand,  Dr. Ludwig’s assumes that foster care will be good for the obese child, presumably by reducing their body weight. Unfortunately, there is absolutely no – zero – nada- evidence that foster care can produce sustained, significant weight loss in the children seized from their homes. Dr. Ludwig should look at the study that found that weight of children actually increased in foster care. Obesity in looked after children: is f… [Child Care Health Dev. 2008] – PubMed – NCBI

Are Pediatricians Doing Their Job?

December 6th, 2011

Amid continuing furor over the removal of the 8 year old boy in Cleveland from his family, come two reports. The first, a study just published in the Archives of Pediatrics and Adolescent Health showing that only a quarter of parents were told by their pediatricians that their child was overweight. Interestingly, more parents who were minority and low income were told than other groups of parents. Arch Pediatr Adolesc Med — Abstract: Parental Recall of Doctor Communication of Weight Status: National Trends From 1999 Through 2008, December 5, 2011, Perrin et al. 0 (2011): archpediatrics.2011.1135v1

Another report has addressed a recurring question in the Cleveland case which is ‘how widespread is the removal of overweight/obese children to foster care?’ There does not appear to a clear picture but there is a picture of the frequency in Great Britain, including the case of a child as young as three. Council ‘put child, 5, into care for being obese’ – Telegraph