increasing childhood and adult obesity

 ​The NY times had a health column highlighting the increases of obesity rates in young kids and adults (see https://www.nytimes.com/2018/03/23/health/obesity-us-adults.html?module=WatchingPortal®ion=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=7&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2018%2F03%2F23%2Fhealth%2Fobesity-us-adults.html&eventName=Watching-article-click .  this was largely based on a recent article in JAMA (see obesity in kids increasing jama2018 in dropbox, or doi:10.1001/jama.2018.3060​). The more complete CDC report: https://www.cdc.gov/nchs/products/databriefs/db288.htm​ 

Details from the JAMA article:

--obesity in youth had plateaued between 2005-6 and 2013-14, though had been increasing in adults

--this current analysis is from the National Health and Nutrition Examination Survey (NHANES) done in adults and kids between 2007-8 and 2015-6; data included 16,875 youth and 27,449 adults

--obesity was defined as: BMI >30 in adults >20yo, and >95th percentile in those 2-20 yo; severe obesity as BMI>40 in adults and >120% of the 95th percentile of BMI for kids

--adjusted models accounted for sex, age, survey cycle, education, race, smoking status.

Results: (see graph below, from the CDC report mentioned above)

--youth (overall): nonsignificant in adjusted model

    --2007-8: obesity prevalence 16.8% (14.2-19.8%)

    --2015-6: obesity prevalence 18.5% (15.8-21.3%)

--kids aged 2-5: p=0.04, values were quadratic [rest of analyses nonsignificant]

    --2007-8: obesity prevalence 10.1% (7.7-12.9%)

    ​--2011-2: obesity prevalence decreased to 8.4% (5.8-11.7%)

    --2015-6: obesity prevalence increased to 13.9% (11.6-16.5%)

--adults: increased overall, p=0.001

    --2007-8: obesity prevalence overall 33.7% (31.5-36.1%)

    --2015-6: obesity prevalence overall 39.6% (36.1-43.1%)

        --for women, dramatic increase: 

                --2007-2008: obesity prevalence 35.4% (33.1-37.8%)

                --2015-16: obesity prevalence increased to 41.1% (37.8-44.5%), p<0.001

        --for men: 

                --2007-2008: obesity prevalence 32.2% (29.3-35.2%)

                --2015-16: obesity prevalence increased to 37.9% (33.1-42.8%), p=0.05

    ​--significant overall linear trend for severe obesity, BMI>40 (p<0.001), with:

        ​--7.7% of all adults: 5.6% of men (trend to increase over time, from 4.2% in 2007-8, with p=0.04) and 9.7% of women (trend to increase, from 7.3% in 2007-8, with p=0.001)

    --also, from the full CDC report: the prevalence of obesity in 2015-6 was higher in black (46.8%) and Hispanic (47.0%) adults, then whites (37.9%), then Asians (12.7%)

        ​--the highest prevalence was 54.8% in black women, followed by Hispanic women at 50.6%

        --and though obesity was pretty similar for different age groups, those 40-59 had the highest rates (42.8% overall, with 40.8% of men and 44.7% of women)

Commentary:

--pretty discouraging: many of us were hopeful with the trend noted in 2013-4 to less obesity in kids.  but alas... (though the numbers of kids in the study who were in the 2-5 range was smaller than other groups, with only n= 853)

--one particular clinical target has been to decrease sugar-sweetened beverages: and the mean kcal/day decreased significantly, and especially for soda (around 140 kcal/day in 1999-2000, and decreasing 67 kcal/d for youth and 58 kcal/d for adults in 2009-2010. a different CDC study found that in 2011-2014: the overall consumption of sugar-sweetened beverages was 143 kcal/day (164 kcal/d in boys and 121 kcal/d in girls). see https://www.cdc.gov/nchs/data/databriefs/db271.pdf . and in kids 2-5yo it was around 60 kcal/day, increasing in 12-19 yo boys to 232 kcal/d and 12-19 yo girls to 162 kcal/d.  [i could not find more recent numbers, though the failure of the NYC initiative to decrease the size of soda bottles was disheartening. see below]. there are striking geographic differences in the US, with the highest consumption of sugar-sweetened beverages in the southeast (though there are no data available for much of the middle of the country). unfortunately, these areas also coincide with populations with decreased health coverage, non-expansion of Medicaid under Obamacare, more extreme poverty, and really poor health outcomes.

--the NY Times noted that there was a 22.7% increase in fast foods and an 8.8% increase in packaged foods from 2012 to 2017.

--we all know that the most important issue is obesity prevention (and, on the other side, how hard it is to lose weight).  this is really difficult to do in our society given the alignment of persuasive/seductive product advertisements, placement of bad foods in shopping aisles at eye level, subliminal messaging on TV/media, the low cost of these non- or minimally-nutritional calorie-dense "foods", and the presence of "food deserts" in some inner cities and rural areas where there is less access to nutritious foods. it is not clear, for example, that advertising the calorie content of foods in restaurants/fast food places has made much of a difference. but is a great stride in the wrong direction​ by the recent proposal by Trump in the NAFTA negotiations to limit the ability of US/Canada/Mexico to have prominent warning labels on non-nutritious foods, at the urging of large US food and soft-drink companies (see https://www.nytimes.com/2018/03/20/world/americas/nafta-food-labels-obesity.html ) . Mexico and Canada had been discussing using strong pictorial warning signs for foods with lots of sugar, salt, and fat, as done in a remarkably successful Chilean program (see http://gmodestmedblogs.blogspot.com/2018/02/junk-food-regulations-in-chile-ag.html ) 

-- though the NY Times article did mention that genetics may be a factor in the increasing degree of obesity (which is no doubt true), a recent study found that those at the highest genetic predisposition to weight gain actually had the most beneficial effect when they adhered to a healthier diet (see http://gmodestmedblogs.blogspot.com/2018/01/dietary-effect-strong-when-high-genetic.html )

so, this issue of increasing obesity is really really serious. multitudes of studies have shown that childhood obesity is associated with adult obesity. and, of course, all of the the social and medical sequelae for both kids and adults.  And attempts to decrease empty calorie consumption has been difficult: the rather limited New York initiative just to decrease the size of sodas was shot down in the courts (both initially and on appeal) because the Board of Health "failed to act within the bounds of its lawfully delegated authority". [What???? seems that the Board of Health has some obligation to protect the public health...] This brings up another major issue in the US in particular (also seen with the trans fat fight to decrease these remarkably atherogenic fats). Our public health system is not empowered either financially or legally to really defend obvious public health threats against the money and power of the vested commercial interests (in the case of sodas, the combined might of coca-cola, pepsi, doctor (!!) pepper/snapple). And sodas are the low-hanging fruit (excuse the inaccurate metaphor) of diet changes. But, as with the deficiencies of the health care system, rather drastic and fundamental changes need to take place to ensure and promote the public good.