This blog is a forum developed to facilitate discussion on key topics related to obesity and obesity-related diseases. And there are many topics to discuss!
Obesity continues to plague our nation and increasingly is the gateway to chronic illnesses like diabetes and hypertension. Patients, health care providers, employers, labor, government and insurance providers will all continue to be affected by the tremendous burden of this epidemic. As the STOP Obesity Alliance and its Steering Committee members continue our collaboration on efforts to take on this health crisis, we will take advantage of this forum to have an open dialogue with all of you.
Key contributors to Weighing In are STOP Obesity Alliance Steering Committee members, Christine Ferguson, the STOP Obesity Alliance Director and Dr. Richard H. Carmona, the Health and Wellness Chairperson of the Alliance.
The views and opinions expressed in "Weighing In" do not necessarily reflect the views and opinions of the STOP Obesity Alliance or its individual members.
Recently, CDC epidemiologists published an article in the Journal of the American Medical Association to the effect that there was not a significant change over the past 12 years in the nation’s obesity rate of 35.5% for adult men and 35.8% for adult women. Many, but not all, media reports interpreted this as meaning the obesity epidemic was leveling off. But is that really the case? Let’s look behind the headlines.
First, let’s keep in mind that, even if BMI is highly correlated with body fatness, it still misses a lot of groups for whom the BMI is a crude indicator of body fatness or excess adipose tissue.
Second, obesity prevalence should not be judged by making the BMI of 30 the sole criteria. This is better explained if you look at the “etables” accompanying the article. These breakdown the categories by age and gender and graphically plot the changes in BMI from 1988 to 2010. While each graph is slightly different, they basically all show three trends: the population at normal weight is declining, the population with a BMI of 30 is getting even heavier and the BMI level for 90% of each subgroup is progressively increasing. Bottom line: fewer Americans are at a normal weight and the overweight and obese subgroups are gaining weight.
Third, during this period when supposedly the obesity epidemic was leveling off, there were roughly 7 million new cases of obesity. How did this occur? Well, the population increased from about 281 million in 2000 census to 308 million in the 2010 census. That’s an increase of 28 million. About ¾ are adults or 21 million. Multiply that by the 38% prevalence rate and you get the 7 million figure. I would argue this figure is more relevant that the prevalence rate. These are the persons dealing with the health and social issues related to obesity. Further, the increases in the number of cases reflects the strain on the health care system, health care utilization and health care costs. So that figure is much more relevant to policy makers than the prevalence figure.
Fourth, being normal weight may not mean what it used to. Recent evidence indicates that many individuals at normal BMIs can have elevated levels of adipose tissue, meaning that they are at normal weight for height but are carrying extra fat tissue, putting them at risk for the metabolic syndrome.
The Atlantic recently reported on a small study which showed that our dietary intake may be responsible for this phenomenon.
Fifth, the CDC studies only look back over 12 years. When you consider that we are talking about changes in the fundamental parameters of the human body, this is a pretty short period of time. Taking a longer view, say 300 years, one sees a pretty dramatic upward march in both height and weight. This is supported by more recent studies going back to the 1948 Framingham Study.
Sixth, going forward, the “etables” show a very strong increase in BMI for women and men ages 20-39 who are in their child-bearing years. This carries serious implications, especially for women, as obesity is associated with more difficult pregnancies as well as increased risk for obesity in the child.
The percentage of the population with a BMI over 30 is a relevant figure but it is not the whole story. Looking at the trends of obesity in the population indicate the picture is getting worse, not leveling off.
Morgan Downey, Policy Advisor for the STOP Obesity Alliance and Publisher & Editor, The Downey Obesity Report
The National Institute of Health’s (NIH) Obesity Research Task Force released a new Strategic Plan for Obesity Research that was seven years in the making. Both the Task Force and Strategic Plan serve similar purposes of accelerating progress in obesity research, coordinating research activities across the NIH and targeting efforts based on areas of scientific opportunity and challenge. Considering both the increased rate of obesity and improvements in science and technology, the updated Strategic Plan is a much needed step for obesity. But it must be complemented with the funding that will allow for real change to take place in obesity prevention and intervention.
Several troubling trends around obesity have developed since the initial publication of the strategic plan. Increasing prevalence and cost of obesity and weight-related disease (such as diabetes and heart disease), the amount of vitriolic language in the media–particularly the public’s response to articles, and an increasing willingness by employers to consider imposing penalties for employees who do not meet certain weight loss effort criteria all point to an environment ripe for greater understanding of the factors that contribute to obesity.
Obesity is not as simple as unwillingness to diet or exercise, a fact that the revised Strategic Plan recognizes in several of its core themes. Here are the overarching themes guiding NIH’s research:
While the Obesity Research Task Force is taking an innovative direction as it considers the underlying biologic causes and environmental factors contributing to obesity, we must consider these efforts in context: while the NIH spent a combined $971 million on obesity research in FY 2010, compare that to the $1.2 billion spent on diabetes research, $2.5 billion spent on cardiovascular research, or $6.6 billion spent on cancer research. To put this in perspective, that means that for every dollar spent on obesity research, more than two are spent on cardiovascular research and nearly seven are spent on cancer. This is especially striking given that obesity is linked to diabetes, cardiovascular disease, and some cancers as well – the distribution of research funding should address obesity as a precursor to these conditions.
With obesity affecting over a third of all Americans, it is critical not just to have a plan in place, but to support that plan with the research it will take to meet the need.
Anna Stoto, Research Assistant for the STOP Obesity Alliance at The George Washington University, Department of Health Policy
The National Eating Disorders Association and the STOP Obesity Alliance have released recommendations based on a co-sponsored expert panel discussion on how the media communicates about weight and heath. The document outlines the resulting consensus-based recommendations, identifies objectives aimed at improved communications on health and weight and provides background on the panel. To read the full document including the recommendations, click here.
The STOP Obesity Alliance Health & Wellness Chairperson, 17th U.S. Surgeon General Dr. Richard H. Carmona, facilitated a panel discussion for the launch of the Obesity GPS – featuring the Alliance’s Director, Christine Ferguson, the American Medical Group Association’s Julie Sanderson-Austin, and the American Heart Association’s Dr. John Ring.
Morgan Downey, STOP Alliance Policy Advisor, weighs in on where Obamacare, the Affordable Care Act (ACA) is today as it moves closer to the key date, October 1, 2013. What do you need to know? Individual mandate? State exchanges? Essential health benefits?
Scott Kahan, MD, MPH, Director of STOP Obesity Alliance, discusses STOP’s work to explore possibilities for addressing obesity through nonprofit hospitals’ community health benefit work.
Ted Kyle, Chair of the Advocacy Committee for The Obesity Society, discusses the limits on obesity discrimination may be one fortunate result of the recent AMA decision to address obesity as a disease. Employment law experts believe discriminating against obese people at work will become less and less acceptable.
Ted Kyle, Chair of the Advocacy Committee for The Obesity Society, reflects on the most important developments of 2012 for obesity. He credits the George Washington University Department of Health Policy with helping shift focus toward obesity and health and away from weight loss outcomes through dialogue with experts, advocates, and the FDA.