Obesity

Obesity: The Skinny

Obesity is one of the leading preventable causes of death in the world; however, over 34% of the American population is obese. In 2004, U.S. Centers for Disease Control and Prevention ranked obesity as the number one health risk facing America. Complications due to obesity result in 400,000 deaths a year in the Unites States alone. Obesity not only impacts lifestyle, but can also lead to low self esteem, depression, social isolation, and a variety of health complications. Obesity is a subject that is very near to my heart. I have several family members who suffer from obesity. It shouldn't be a struggle for American's to go through everyday life. However, I don't believe that obese individuals should be given special privileges or treated differently than the average person. All Americans struggle with stress, temptation, and an increasing amount of easily available poor food choices. It is hard to maintain a healthy life, healthy weight and good exercise habits. It is a daily battle for some; for others, they have simply given up.

Obesity and weight gain typically occur due to excessive calorie intake. A combination of eating unhealthy, highly processed and fatty foods, mixed with poor exercise habits are the major culprits of American obesity. However, some cases of obesity are linked to hormonal imbalance or genetics. For instance, genetic determinations such as the way a body expends energy, hormones that affect the way calories are processed, and other organ systems in the body can all affect appetite. For these reasons, today's doctors address a number of considerations when working with obese patients. Those considerations are increasingly going beyond calorie counting and exercise.

Heart disease, hypertension, sleep apnea, diabetes, metabolic syndrome, polycystic ovary syndrome, certain cancers and osteoarthritis are all increased in individuals whose body mass index is above 30. The most commonly used definition for obesity was created in 1997 by the World Health Organization. It is based on body mass index or BMI. BMI is found when you take an individual's mass or weight, and divide it by their height squared. A BMI between 18.5-24.9 is considered normal, whereas a BMI of 25-29.9 is considered overweight. The BMI chart goes on from there; individual's ranging from 30-34.9 are listed as obese. Any BMI ranging between 35-39.9 is considered clinically obese. If an individual's BMI is over 40 they are considered morbidly obese. Some nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25, while China uses a BMI of greater than 28. Of course, the BMI scale has its exceptions; a high BMI may not only be the result of increased body fat, but the result of increased lean muscle as well. An athletic individual will tend to have a higher BMI than a person living a sedentary lifestyle, due to a higher concentration of lean muscle mass. Aside from the BMI chart, obesity is generally defined as an excessive amount of body fat in relation to lean body mass. In numeric terms, obesity refers to a body weight that is at least 30% over the ideal weight for a specified height.

The obesity rate has increased more than 10% in the last 20 years. An even more startling statistic is that the obesity rate is 30% in children ages 2 to 19. This number has jumped 11% in the last 20 years. Obese children and adolescents are more likely to become obese as adults. For example, one study found that approximately 80% of children who were overweight at ages 10 to 15 years were obese adults by the age of 25. Another study found that 25% of obese adults were overweight as children. The latter study also found that if a child is overweight before 8 years of age, obesity in adulthood is likely to be more severe.

In the United States 1 in 7 children are obese, yet little is known about their health related quality of life. At The Children's Hospital and Health Center in San Diego, California, doctors performed a study on the quality of life in children suffering from obesity. The obese children were compared to children of the same age group who had been diagnosed with cancer. 106 children between the ages of 5 and 18 were studied between January and June of 2002. The children participating in the study had a Body Mass Index of 35 or greater. Child self-reporting and parental reporting using a pediatric quality of life scale ranging 0-100 was used in the study. The quality of life scale was administered by an interviewer for children ages 5 to 7 years old.
The children were tested in four areas; physical functioning, emotional functioning, social functioning, and school functioning. Higher scores indicate better health related quality of life. A total scale score and a psychosocial health summary score are calculated to provide a summary of the child's health related quality of life. The scores were then compared with the previous scores of healthy children, and children diagnosed as having cancer. The results of the study were shocking. When comparing healthy children to obese children, the obese children had significantly lower health related quality of life in all aspects of the study. The average score being 67 for the obese children; whereas, the healthy children scored an average of 83. Obese children were more likely to have an impaired sense of wellness when compared to children who were actually healthy. The doctors called this a "confidence interval." When comparing the "confidence intervals," the obese children had the exact same number as the children diagnosed with having cancer. Anxiety or depression was preexisting or subsequently diagnosed in 14 of the children, which is somewhat higher than the national childhood average.
During the month prior to the study, obese children missed an average of 4.2 days of school; whereas, healthy children only missed 0.7 days on average. Obesity is one of the most stigmatizing and least socially acceptable conditions in childhood. Furthermore, obese children were four times more likely to report impaired school function than healthy children. This is consistent with a study in Thailand, which reported that overweight children in grades 7 through 9 were twice as likely to have low grades in math and language as healthy children. Doctors, parents, and teachers need to be informed of the risk for impaired health related quality of life among obese children. If American children don't know the true state of their health, how will they ever be inspired to make a change? It is sad to think that parents are subjecting their children to ridicule and shame. Growing up is hard enough without having low self- esteem, being bullied, missing school and having serious health issues.

While most people would agree that being overweight is hazardous to your health, others claim that being overweight is actually healthier than being thin. This is called the obesity paradox. The obesity paradox is a phenomenon in the medical world. The most well studied paradox is cardiovascular disease surgery survival among obese patients as opposed to a person of normal weight. Three other related paradoxes deal with pre-obesity, the "fat but fit" theory, and "healthy" obesity. A clinical study was performed by the American College of Cardiology between January 1994 and December 1999. The purpose of the study was to find out the impact of body mass index on the short- and long-term outcomes after percutaneous coronary intervention, or PCI. The study was performed on 9,633 patients who were put into three different groups depending on their BMI. Obese patients were significantly younger and had consistently worse baseline clinical characteristics than normal or overweight patients. The obese patients also had higher incidences of hypertension, diabetes, hypercholesterolemia and smoking history. Despite all these facts, normal BMI patients had a higher incidence of major in-hospital complications, including cardiac death. After one year, overall mortality rates were significantly higher for normal BMI patients compared with overweight or obese patients. Pre-obesity presents another paradox. Prior to obesity, individuals who are characterized as overweight are in fact associated with decreased mortality risk compared with normal weight individuals. Another paradox occurs when fitness is taken into account; the mortality risk associated with obesity is then offset. The final paradox under consideration is the occurrence of obese individuals who are otherwise healthy. Consequently, a large segment of the overweight and obese population is not at increased risk for premature death. It appears that low cardio respiratory fitness and inactivity are a greater health threat than obesity. These studies suggest that more emphasis should be placed on increasing physical activity and cardio respiratory fitness as the main strategy for reducing mortality risk in the broad population of overweight and obese adults.

There is a fine line between being healthy and being under weight. The number on the scale isn't the only factor when determining healthy weight. As mentioned before, athletes tend to weigh more while looking thin. Some might argue that they are too thin, yet their weight may fall between 25-30 on the BMI chart. It is all about how you nourish your body, the amount of exercise you get and overall health of your body. Scales and charts can be misleading, I do believe however, that individuals of a healthy weight and BMI live better lives, are happier, more successful and more disciplined than obese individuals.

The question is, what can we, as American's do about the rising epidemic of obesity? I think that one major area of opportunity is through children. As afore mentioned, 80% of overweight adolescents become obese adults. Where is America going wrong with our children? One area of study and controversy are the breakfast and lunch programs in America's public schools.
New research funded by the U.S. Department of Agriculture finds that children who eat school lunches that are part of the federal government's National School Lunch Program are more likely to become overweight. The same research study found, however, that children who eat both the breakfast and lunch sponsored by the federal government are less heavy than children who don't participate in either, and than children who eat only the provided lunch.

The U.S. Department of Agriculture oversees the federal lunch and breakfast programs. Through the USDA, federal government reimburses schools for a portion of school lunch costs and also donates surplus agricultural food items. While the USDA does require that the meals meet certain nutritional standards, schools choose the specific foods and menus. Schools also can serve individual food items a la carte, which fall outside the scope of the federal guidelines and allow students to choose additional foods. Typically these foods are junk food and provide little or no nutrition to the child. For their study, the researchers analyzed data on more than 13,500 elementary school students. Students were interviewed in kindergarten, first and third grades, and then again in later grades. The study was performed by Daniel Millimet, whose research expertise is the economics of children, specifically topics related to schooling and health.

First, it is very difficult to plan healthy but inviting school lunches at a low price, second, given the tight budgets faced by many school districts, funding from the sales of a la carte lunch items receives high priority. That said, it's comforting to know that the U.S. Department of Agriculture, which oversees the federal school nutrition programs, takes the issue very seriously. The USDA sponsors not only my research, but that of others as well, to investigate the issues and possible solutions. (Millimet)

We need to take a more active role in what our children are eating during the day. New guidelines are becoming prevalent in some schools. These guidelines state that children are no longer allowed to bring bagged lunches and snacks to school. This is one area of control we do have over our children. How can we make sure our kids are being properly nourished if we can't even send them to school with a healthy lunch? These a la carte items that Millimet mentioned are most commonly junk foods that are high in sugar and fat. Our government needs to put more of an emphasis on schools making healthy choices not only available, but required for our children.

Judging from the results of the study, the food being served in school lunches may not maintain a healthy weight in children. The food in school breakfasts appears to be healthier, however. Technically, what is going on is that the federal government establishes nutrition guidelines for lunches and breakfasts if schools wish to receive federal funding, but there's evidence that school lunches are less in compliance with these guidelines than breakfasts. The other possible issue is that these days schools try to make money from a la carte items at lunch. And it's possible that even if the school lunch is healthy, kids buying lunch are more likely to tack on extra items that are not healthy. ( Millimet)

The National Student Lunch Program supplies meals to about 30 million children in 100,000 public and nonprofit private schools, according to the USDA. The School Breakfast Program gives cash assistance to more than 80,000 schools for about 10 million children. Through this study, it is clear that new restrictions and nutritional definitions need to be implemented in our school system.

Huge leaps and bounds have been made in the battle of obesity. Restaurants are now required to provide nutritional information. Although flawed, American schools are making an effort to provide healthier options for children. Federal funding has been provided to study the effect of obesity in families and children, and the health ramifications caused by obesity. With all the awareness of the dangers of obesity, why do Americans still continue to struggle? We need to come together and face these problems. Let's start with our children; they are, after all, the future of the great country we live in.

Works Cited:

Blair, S.N. "Obesity Paradoxes." Journal of Sports Sciences (2011): 1-10.

Cynthia L. Ogden, Ph.D., and Margaret D. Carroll, M.S.P.H. "Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976–1980 Through 2007–2008." June 2010. CDC. 14 April 2011 <http://www.cdc.gov/NCHS/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf>.

Gruberg MD, Lois. "The impact of obesity on the short-term andlong-term outcomes after percutaneous coronary intervention: the obesity paradox?" American College of Cardiology (2002): 578-584.

Millimet, Daniel L., Rusty Tchernis and Muna Husain. "School Nutrition Programs and the Incidence of Childhood Obesity." The Journal of Human Resources (2010): 640-654.

Schwimmer MD, Jeffrey B. Schwimmer, MA Tasha M. Burwinkle and PhD James W. Varni. "Health-Related Quality of Life of Severely Obese Children and Adolescents." Journal of the America Medical Association (2003): 813-819.

Serdula MK, Ivery D, Coates RJ, Freedman DS. Williamson DF. Byers T. "Do obese children become obese adults?" 1993. Prev Med . 14 April 2011 <http://www.cdc.gov/obesity/childhood/references.html>.