Tuesday, June 10, 2008

Health Care and Childhood Obesity

According to an article online with the WashingtonPost.com that was published mid-May, there is an epidemic of obesity that is compromising the lives of millions of American children, with burgeoning problems that reveal how much more vulnerable young bodies are to the toxic effects of fat. Doctors are seeing confirmation of this daily: boys and girls in elementary school suffering from high blood pressure, high cholesterol and painful joint conditions; a soaring incidence of type 2 diabetes, once a rarity in pediatricians' offices; even a spike in child gallstones, also once a singularly adult affliction. Minority youth are most severely affected, because so many are pushing the scales into the most dangerous territory. As reported in the study, with one in three children in this country overweight or worse, the future health and productivity of an entire generation -- and a nation -- could be in jeopardy.

The trouble is a quarter-century of unprecedented growth in girth. Although the rest of the nation is much heavier, too, among those ages 6 to 19 the rate of obesity has not just doubled, as with their parents and grandparents, but has more than tripled. Because studies indicate that many will never overcome their overweight -- up to 80% of obese teens become obese adults -- experts fear an exponential increase in heart disease, strokes, cancer and other health problems as the children move into their 20s and beyond. The evidence as reported in the Washington Post article suggests that these conditions could occur decades sooner and could greatly diminish the quality of their lives. Many could find themselves disabled in what otherwise would be their most productive years. The cumulative effect could be the country's first generation destined to have a shorter life span than its predecessor. A 2005 analysis by a team of scientists forecast a two- to five-year drop in life expectancy unless aggressive action manages to reverse obesity rates. Since then, children have only gotten fatter.

The epidemic is expected to add billions of dollars to the U.S. health-care bill. Treating a child with obesity is three times more costly than treating the average child, according to a study by Thomson Reuters. The research company pegged the country's overall expense of care for overweight youth at $14 billion annually. A substantial portion is for hospital services, since those patients go more frequently to the emergency room and are two to three times more likely to be admitted. Wow!! That is a huge amount of money to handle a problem that should not be happening if Americans would pay attention to their diet. Yet, we have become a land of Fatties!

It's a wonder that the nation doesn't collapse in on itself with all that extra weight. Plus, fat kids make fatter adults. Ultimately, the economic calculations will climb higher. As reported, no one has yet looked ahead 30 years to project this group's long-term disability and lost earnings, but based on research on the current workforce, which has shown tens of millions of workdays missed annually, indirect costs will also be enormous. The article goes on to say that the cycle of obesity and disease seems to begin before birth--women who are overweight are more likely to give birth to bigger babies, who are more likely to become obese. Patterns of eating and activity, often set during early childhood, are influenced by government and education policies, cultural factors and environmental changes. Income and ethnicity are implicated, though these days virtually every community has a problem.

As many as 90% of overweight children have at least one of a half-dozen avoidable risk factors for heart disease. Even with the most modest increase in future adolescent obesity, a recent study said the United States will face more than 100,000 additional cases of coronary heart disease by 2035. The internal damage does not always take medical testing to diagnose. It is visible as a child laboriously climbs a flight of stairs or tries to sit at a classroom desk, much less rise out of it. Additionally, the emotional distress of these ailments, combined with the social stigma of being fat, makes overweight children prone to psychiatric and behavioral troubles. One analysis found that obese youth were seven times more likely to be depressed. Only within this decade, as studies started to corroborate what doctors were seeing firsthand, has child obesity been recognized as a critical public health concern. The news release in the Washington Post is a very telling situation of the current health of today's children.

There are several consequences related to childhood obesity as reported by the Center for Disease Control (CDC). Overweight children and adolescents may experience immediate health consequences and may be at risk for weight-related health problems in adulthood. Some consequences of childhood and adolescent overweight are psychosocial. Obese children and adolescents are targets of early and systematic social discrimination. The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood. Also, overweight children and teens have been found to have risk factors for cardiovascular disease (CVD), including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. Additionally, less common health conditions associated with increased weight include asthma, hepatic steatosis, sleep apnea and Type 2 diabetes.

Roughly 16% of kids are obese according to an article in May, 2008 in the Wall Street Journal. That’s bad, but it’s nothing new. Yet in what passes for good news on the fat front, the proportion of overweight American kids has been holding steady since 1999. The HSC Foundation has reported that national statistics show approximately one in five African American and Latino children are obese. Traditional fitness and weight loss programs have been undermined in low-income minority communities because of a need to focus on basic survival issues. Less recess at school, the lack of safe and well-equipped recreation centers, and few to no grocery stores in some communities have made keeping adequately fit a greater challenge.

What are the contributing factors to this national explosion in obesity among children? The CDC reports that at the individual level, childhood overweight is the result of an imbalance between the calories a child consumes as food and beverages and the calories a child uses to support normal growth and development, metabolism, and physical activity. In other words, overweight results when a child consumes more calories than the child uses. The imbalance between calories consumed and calories used can result from the influences and interactions of a number of factors, including genetic, behavioral, and environmental factors. It is the interactions among these factors – rather than any single factor – that is thought to cause overweight.

The CDC says that a genetic susceptibility may need to exist in conjunction with contributing environmental and behavioral factors (such as a high-calorie food supply and minimal physical activity) to have a significant effect on weight. Genetic factors alone can play a role in specific cases of overweight. However, the rapid rise in the rates of overweight and obesity in the general population in recent years cannot be attributed solely to genetic factors. The genetic characteristics of the human population have not changed in the last three decades, but the prevalence of overweight has tripled among school-aged children during that time. Because the factors that contribute to childhood overweight interact with each other, it is not possible to specify one behavior as the “cause” of overweight. However, certain behaviors can be identified as potentially contributing to an energy imbalance and, consequently, to overweight:

--Energy intake: Evidence is limited on specific foods or dietary patterns that contribute to excessive energy intake in children and teens. However, large portion sizes for food and beverages, eating meals away from home, frequent snacking on energy-dense foods and consuming beverages with added sugar are often hypothesized as contributing to excess energy intake of children and teens.
--Physical activity: Participating in physical activity is important for children and teens as it may have beneficial effects not only on body weight, but also on blood pressure and bone strength; and children may be spending less time engaged in physical activity during school.
--Sedentary behavior: Children spend a considerable amount of time with media. There is more involvement now with computers, TV, and other media.
--Environmental factors: Home, child care, school, and community environments can influence children’s behaviors related to food intake and physical activity.

The authoritative Robert Wood Johnson Foundation argues that childhood obesity is one of the most urgent and serious health threats confronting our nation. The epidemic afflicts and endangers members of every race and ethnic group, as well as all income levels and in every region of the country. Dr. Dean Ornish recently wrote in Newsweek that childhood obesity is almost completely preventable. We don't have to wait for a new drug or technology; we just have to put into practice what we already know. Clearly, genes have changed little, if at all, in the past 40 years. What's changed is our diet and lifestyle. If we caused it, we can reverse it. The Brookings Institute agrees. Given the causes and consequences of childhood obesity, the challenge is to rally the nation’s policymakers, families, schools and healthcare providers to contain and reverse this ominous epidemic.

Until next time. Let me know what you think.

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