January 17, 2012, Los Angeles Times, Shari Roan

After a 30-year, record-shattering rise, U.S. obesity rates appear to be stabilizing.

New statistics cited in two papers report only a slight uptick since 2005 — leaving public health experts tentatively optimistic that they may be gaining some ground in their efforts to slim down the nation.

Many obesity specialists say the new data, from the Centers for Disease Control and Prevention, are a sign that efforts to address the obesity problem — such as placing nutritional information on food packaging and revising school lunch menus — are beginning to have an effect in a country where two-thirds of adults and one-third of children and teens are overweight or obese.

“A good first step is to stop the increase, so I think this is very positive news,” said James O. Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver. “It may suggest our efforts are starting to make a difference. The bad news is we still have obesity rates that are just astronomical.”

Historically, there was little change in Americans’ sizes from 1960 through 1980. But obesity rates soared through the end of the century, for reasons that are still debated.

The new studies reflect 2009-10 data, the most recent available, from the government’s National Health and Nutrition Examination Survey, which examined 6,000 adults and 4,111 children, measuring their body mass index, among other items. Though a number of organizations measure obesity rates, the survey’s data are considered among the most accurate.

The statistics showed that more than 35% of U.S. adults (78 million people) are obese, defined as having a body mass index of 30 or greater. That is similar to the 2005-06 rate. Calculated as weight in kilograms divided by height in meters squared, the BMI is not a perfect measure of fatness but is still viewed as the gold standard in assessing population-wide trends.

via Obesity rates in U.S. appear to be finally leveling off – latimes.com.

December 4, 2011, 

All stakeholders must collaborate in the prevention of obesity.

THE World Health Organization (WHO) has highlighted that obesity has reached epidemic proportions globally, with at least 2.6 million people dying each year as a result of being overweight or obese.

Once considered a problem only in high-income countries, the incidence of overweight and obesity are now dramatically on the rise in low- and middle-income countries. It is an ever increasing problem, and worldwide, obesity has more than doubled since 1980.

In 2008, it was estimated that 1.5 billion adults were overweight. Of these, over 200 million men and nearly 300 million women were obese.

Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. All efforts must therefore be made to reduce the extent of the problem and prevent the disease.

The WHO has emphasised that governments, international partners, civil society, non-governmental organisations and the private sector all have vital roles to play in contributing to obesity prevention.

READ MORE AT Obesity is preventable.

Associated Press/The Washington Post, November 29, 2011

The case of an 8-year-old third-grader weighing more than 200 pounds has renewed a debate on whether parents should lose custody if a child is severely obese.

Roughly 2 million U.S. children are extremely obese — weighing significantly more than what’s considered healthy.

A Cleveland Heights boy was taken from his family and was placed in foster care in October after county case workers said his mother wasn’t doing enough to control his weight. The boy, at his weight, is considered at risk for developing such diseases as diabetes and high blood pressure. Government growth charts say most boys his age weigh about 60 pounds.

Cuyahoga County removed the boy because case workers considered the mother’s inability to get his weight down a form of medical neglect. The county’s Children and Family Services agency said Monday it stood by its custody move, which was approved by a judge.

“We have worked very hard with this family for 20 months before it got to this point,” agency Administrator Patricia Rideout said.

Rideout said the issue has created a buzz among agency staff members and she has heard it was a popular Internet item. She said she was following state law in withholding the boy’s name in his best interest.

There’s no easy answer when it comes to determining who’s to blame in such obesity cases, said Dr. Naim Alkhouri, who works with overweight children and their families at Cleveland Clinic Children’s Hospital and leads its pediatric metabolic clinic.

“It’s not only the parents or the child,” he said. “Obesity is an epidemic in the United States. As a society we’re all responsible.”

It’s not enough to just encourage some children to eat healthier and exercise, he said, because there’s also “a big psychological component.”

“When it comes to involving the authorities, I don’t think we have clear guidelines,” he said. “Starting the debate is a good thing. We need more guidance on how to react to the issue.”
Read the rest of the article via 200-pound 8-year-old in Ohio highlights question: Should parents of obese kids lose custody? – The Washington Post.

October 26, New York Times, Gina Kolata

For years, studies of obesity have found that soon after fat people lost weight, their metabolism slowed and they experienced hormonal changes that increased their appetites. Scientists hypothesized that these biological changes could explain why most obese dieters quickly gained back much of what they had so painfully lost.
But now a group of Australian researchers have taken those investigations a step further to see if the changes persist over a longer time frame. They recruited healthy people who were either overweight or obese and put them on a highly restricted diet that led them to lose at least 10 percent of their body weight. They then kept them on a diet to maintain that weight loss. A year later, the researchers found that the participants’ metabolism and hormone levels had not returned to the levels before the study started.

The study, being published Thursday in The New England Journal of Medicine, is small and far from perfect, but confirms their convictions about why it is so hard to lose weight and keep it off, say obesity researchers who were not involved the study.

They cautioned that the study had only 50 subjects, and 16 of them quit or did not lose the required 10 percent of body weight. And while the hormones studied have a logical connection with weight gain, the researchers did not show that the hormones were causing the subjects to gain back their weight.

Nonetheless, said Dr. Rudolph Leibel, an obesity researcher at Columbia, while it is no surprise that hormone levels changed shortly after the participants lost weight, “what is impressive is that these changes don’t go away.”

Dr. Stephen Bloom, an obesity researcher at Hammersmith Hospital in London, said the study needed to be repeated under more rigorous conditions, but added, “It is showing something I believe in deeply — it is very hard to lose weight.” And the reason, he said, is that “your hormones work against you.”

In the study, Joseph Proietto and his colleagues at the University of Melbourne recruited people who weighed an average of 209 pounds. At the start of the study, his team measured the participants’ hormone levels and assessed their hunger and appetites after they ate a boiled egg, toast, margarine, orange juice and crackers for breakfast. The dieters then spent 10 weeks on a very low calorie regimen of 500 to 550 calories a day intended to makes them lose 10 percent of their body weight. In fact, their weight loss averaged 14 percent, or 29 pounds. As expected, their hormone levels changed in a way that increased their appetites, and indeed they were hungrier than when they started the study.

They were then given diets intended to maintain their weight loss. A year after the subjects had lost the weight, the researchers repeated their measurements. The subjects were gaining the weight back despite the maintenance diet — on average, gaining back half of what they had lost — and the hormone levels offered a possible explanation.

One hormone, leptin, which tells the brain how much body fat is present, fell by two-thirds immediately after the subjects lost weight. When leptin falls, appetite increases and metabolism slows. A year after the weight loss diet, leptin levels were still one-third lower than they were at the start of the study, and leptin levels increased as subjects regained their weight.

Other hormones that stimulate hunger, in particular ghrelin, whose levels increased, and peptide YY, whose levels decreased, were also changed a year later in a way that made the subjects’ appetites stronger than at the start of the study.

The results show, once again, Dr. Leibel said, that losing weight “is not a neutral event,” and that it is no accident that more than 90 percent of people who lose a lot of weight gain it back. “You are putting your body into a circumstance it will resist,” he said. “You are, in a sense, more metabolically normal when you are at a higher body weight.”

A solution might be to restore hormones to normal levels by giving drugs after dieters lose weight. But it is also possible, said Dr. Jules Hirsch of Rockefeller University, that researchers just do not know enough about obesity to prescribe solutions.

One thing is clear, he said: “A vast effort to persuade the public to change its habits just hasn’t prevented or cured obesity.
”

“We need more knowledge,” Dr. Hirsch said. “Condemning the public for their uncontrollable hedonism and the food industry for its inequities just doesn’t seem to be turning the tide.”

Study Shows Why It’s Hard to Keep Weight Off – NYTimes.com.

September 12, 2011, New York Times, Jane E. Brody

If you have gained a lot of unwanted pounds at any time during the last 30-odd years, you may be relieved to know that you are probably not to blame. At least not entirely.

Many environmental forces, from economic interests of the food and beverage industries to the way our cities and towns are built, have conspired to subvert the body’s natural ability to match calories in with calories out.

And the solution to the nation’s most pressing health problem — the ever-rising epidemic of overweight and obesity at all ages — lies in the answer to this question: Why did this happen in the first place?

That is the conclusion of an impressive team of experts who spent the last two years examining obesity-promoting forces globally. They recently published their findings online in a series of reports in The Lancet.

But as has happened with smoking, it will take many years, a slew of different tactics and the political will to overcome powerful lobbying by culpable industries to turn the problem around and begin to bring the prevalence of overweight and obesity back to the levels of the 1970s.

What Changed?

When I was growing up in the 1940s and ’50s, I had to walk or bike many blocks to buy an ice cream cone. There were no vending machines dispensing candy and soda, and no fast-food emporiums or shopping malls with food courts. Nor were we constantly bombarded with televised commercials for prepared foods and drinks laden with calories of fats and sugars.

Yes, we kids had our milk and cookies after school, but then we went out to run around and play until dark. Television watching (through my father’s business, my family acquired an early TV with a seven-inch screen) was mostly a weekend family affair, not a nightly ritual with constant noshing.

Most meals were prepared and eaten at home, even when both parents worked (as mine did). Eating out was a special event. “Convenience” foods were canned fruits and vegetables, not frozen lasagna or Tater Tots. A typical breakfast was hot or cold cereal sweetened with raisins or fresh fruit, not a Pop-Tart, jelly doughnut or 500-calorie bagel with 200 calories of cream cheese.

Before a mass exodus to the suburbs left hordes of Americans totally car-dependent, most people lived in cities and towns where feet served as a main means of transportation.

Since 1900, the energy requirements for daily life have decreased substantially with the advent of labor-saving devices and automobiles, yet American weights remained stable until the 1970s. Dr. Boyd A. Swinburn, an obesity researcher at Deakin University in Melbourne, Australia, and his co-authors in one Lancet paper call that decade the “tipping point.”

As more women entered the work force, the food industry, noting a growing new market, mass-produced convenience foods with palate appeal. The foods were rich in sugar, salt and fat, substances that humans are evolutionarily programmed to crave.

“Women were spending a lot less time on food preparation, but the industry figured out ways to make food more readily available for everybody,” Steven L. Gortmaker, a sociologist at the Harvard School of Public Health, said in an interview. “The industry made it easier for people to consume more calories throughout the day.”

As Dr. Swinburn and his co-authors wrote, “The 1970s saw a striking rise in the quantity of refined carbohydrates and fats in the U.S. food supply, which was paralleled by a sharp increase in the available calories and the onset of the obesity epidemic. Energy intake rose because of environmental push factors, i.e., increasingly available, cheap, tasty, highly promoted obesogenic foods.”

During a morning run in Ohio some years ago, I passed five fast-food and family restaurants in one long block, including one that advertised a “Texas-size breakfast” of three scrambled eggs, two fried potato cakes, a buttered croissant and a choice of three sausage links, three ounces of ham or four strips of bacon — enough to produce a Texas-size heart attack, and for $1.99. Americans are not known for resisting such temptations, especially if money is tight.

The Lancet authors reported that to bring the weights of Americans back to 1978 levels, steep reductions in caloric intake are needed: about 240 calories a day less for the average person and double that amount for obese adults, whose body mass index is 35 or higher.

‘Systems Approach’ Needed

Several coordinated, complementary policies are needed to turn the epidemic around, Dr. Gortmaker and his co-authors wrote in one report. He pointed out that four interventions worked together to drive smoking rates down to 20 percent from 40 percent.

First, tobacco advertising was banned from television. Then tobacco taxes were increased, the nicotine patch became available and smoking was banned in more and more public places.

Just as the decline in smoking did not happen overnight, a reduction in the rates of overweight and obesity will take a while, Dr. Gortmaker said. He emphasized the importance of taking action immediately, before the increase in life expectancy that Americans have enjoyed is reversed by obesity-caused diseases.

He and his co-authors listed three of the most cost-saving and health-saving measures: a 10 percent tax on unhealthy foods and drinks (like sugar-sweetened beverages, a proposal defeated in New York State by industry pressure); more obvious nutrition labeling of packaged foods, like a red, yellow or green traffic light on package fronts; and reduced advertising of “junk foods and beverages to children.”

READ MORE via Attacking the Obesity Epidemic by First Figuring Out Its Cause – NYTimes.com.

August 26, 2011, Shari Roan, Los Angeles Times

Weight loss is a complex thing. In fact, the old rule that cutting out or burning 500 calories a day will result in a steady, 1-pound-per-week weight loss doesn’t reflect real people, researchers say.

A new mathematical model from researchers at the National Institutes of Health instead shows that for the typical overweight adult, every 10-calorie-per-day reduction will result in the loss of about 1 pound over three years. Half that loss will occur in the first year. For example, cutting 250 calories a day from one’s diet will lead to a 25-pound weight loss over three years. This is a more realistic model than the traditional rule-of-thumb, the authors said.

The new model provides a more realistic assessment and uses data relating to how energy expenditures change over time. Moreover, people are different. Heavier people will lose weight more rapidly than their less-obese counterparts but will take longer to achieve a stable weight.

The study demonstrates how the average 20-pound increase in the average adult’s body weight occurred over the last 30 years in the United States. That weight gain amounts to only an extra 10 calories a day. But equally small reductions in calories won’t lead to the same weight loss, the authors point out. In fact it takes an average of 220 extra calories a day to maintain people at their higher weight.

That’s why a dedicated, long-term change is needed to reverse the obesity pandemic. For adults with a body mass index of more than 35, which is obese, it would take permanent calorie reductions of more than 500 calories a day to return them to the average body weight seen in the United States in 1978. This would take about three years for moderately obese people and longer for severely obese people.

The research is part of a special issue of the Lancet published Thursday on the global obesity pandemic. In other studies, researchers show how obesity affects people around the world. In developing nations, obesity tends to appear first in middle-aged adults, especially women. In high-income countries, both sexes and all ages tend to be affected by obesity. However, obesity is more prevalent in poorer people.

But, the authors wrote: “No country can act as a public health exemplar for reduction of obesity and type 2 diabetes.”

via Reversing the obesity epidemic will take time – latimes.com.

July 18, 2011, China Realtime Report

Obesity rates in China have surged over the years, leading some to think China is starting to look a lot more like the U.S these days.

A deeper look says otherwise.

According to a recent study published in the American Journal of Health Behavior, the difference between obese people in China and those in the U.S. is striking, suggesting that assumptions about obesity patterns in the West can’t be applied to China’s increasingly overweight population.

Researchers of the study, “Correlates of Overweight Status in Chinese Youth: an East-West Paradox,” zoned in on China’s adolescent population, looking at the relationship between such factors as sleep, diet, exercise and income on obesity among young people.

What they found: Chinese children raised in families with higher incomes and advanced education levels are more likely to become obese.

Findings of the study contrast distinctly with the obese populations of the U.S. and even Europe, where children and adults have waistline sizes that correlate to the degree of their poverty. Overweight American youth tend to be from neighborhoods where fresh produce is less available, from families with lower educational backgrounds and less knowledge of general nutrition.

Chinese boys are also more likely than girls to become overweight, according to the study, whereas in the U.S., boys and girls are equally likely to develop weight problems.

Further differentiating the two cultures of obesity, researchers found that younger children, children who reported having high levels of physical activity, and youth who reported eating lots of vegetables and little fast food or sweets were actually more likely to be obese than the rest of the youth population.

How is it possible that these young vegetable-eaters are getting fat? One explanation, according to the study, is China’s rapidly expanding economy. With disposable incomes growing, families can now afford to eat a lot more food and buy certain foods that just years ago were less available and less affordable. So while these children may be eating their veggies, they’re packing in an excess of other fatty foods to go with them.

Meat consumption has been on the rise, contributing to obesity, according to a separate 2008 University of North Carolina study on China’s changing nutrition habits (pdf).

By 2005, meat comprised 27% of the Chinese diet, up from 6% in 1965, according to the most recent figures from the Food and Agriculture Organization of the United Nations.

Many Chinese families have also made unhealthy lifestyle changes, such as opting for more deep-fried, stir-fried and junk food, the study said.

Conducted by researchers at the Keck School of Medicine of the University of Southern California, the study surveyed 9,000-plus middle school and high school students from families across income brackets in seven densely populated cities in China.

Excessively plump figures have become increasingly prevalent in China, with around 25% of the country’s adult population qualifying as either overweight or obese, according to the University of North Carolina study. Two-thirds of U.S. adults are overweight or obese.

In clinical terms, overweight people are those with a body mass index of 25 to 29.9, while anyone with a BMI over 30 is defined as obese.

China’s Ministry of Health does not track obesity levels in China.

Obesity is a major risk factor for heart disease and type 2 diabetes. China is now home to the world’s largest diabetic population, with 23 million diagnosed, up 40% from 2001, according to London-based research group GfK HealthCare. The U.S. is home to 20 million diabetics.

via Study: China Getting Fatter, But Not Like U.S. – China Real Time Report – WSJ.

Reuters, Bill Berkrot, Novemner 23, 2010

More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go on unabated, according to analysis of a new report released on Tuesday by health insurer UnitedHealth Group Inc.

Diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion — up from an estimated $194 billion this year, according to the report titled “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead.”

The average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for the non-diabetic public, according to new data in the report drawn from 10 million UnitedHealthcare members.

The average annual cost nearly doubles to $20,700 for a person with complications related to diabetes, the report said. Complications related to diabetes can include heart and kidney disease, nerve damage, blindness and circulatory problems that can lead to wounds that will not heal and limb amputations.

Diabetes, which is reaching epidemic proportions and is one of the fastest-growing diseases in the United States, currently affects about 26 million Americans.

Another 67 million Americans are estimated to have prediabetes, which may not have any obvious symptoms. More than 60 million Americans are unaware that they have the condition, according to UnitedHealth.

People with prediabetes have higher than normal blood sugar levels, but not yet high enough to be diagnosed as diabetes. Prediabetics often have other risk factors, such as overweight, high blood pressure and high cholesterol.

The 52-page UnitedHealth report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.

The authors of the report contend the skyrocketing cost forecasts are not inevitable, however, if the crisis is tackled aggressively, including early intervention to prevent prediabetes from becoming diabetes.

“Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early on and prevent this devastating disease before it’s too late,” Deneen Vojta, senior vice president of the UnitedHealth Center for Health Reform & Modernization, said in a statement.

“What is now needed is concerted, national, multi-stakeholder action,” Simon Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in a statement.

“Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models.” Stevens added.

If solutions for tackling the epidemic offered in the report were adopted broadly and scaled nationally it could lead to cost savings of up to $250 billion over the next 10 years, according to the UnitedHealth analysis.

via Half of Americans facing diabetes by 2020: report | Reuters.

The Times of India, November 23, 2010

Nearly 25 per cent of overweight and 16 percent of normal weight women of reproductive-age misperceive their body weight, says a new study.

The research from University of Texas Medical Branch suggests that this misperception affects women’s weight-related behaviours making many vulnerable to cardiovascular and other obesity-related diseases.

The researchers also found that overweight women who perceive themselves as normal weight were significantly less likely to report weight-related behaviours, such as dieting.

“As obesity numbers climb, many women identify overweight as normal, not based on the scale but on how they view themselves,” said corresponding author Mahbubur Rahman, assistant professor Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women’s Health.

Self-perception of body weight is the degree of concordance between perceived and measured weight.

The study analyzed more than 2,200 women 18-25 years old based on survey questions pertaining to sociodemographic variables, height, weight, weight perceptions and weight-related behaviors.

Women with Body Mass Index (BMI) below 25 were considered normal weight and those with BMIs of 25 or more were considered overweight. Overall, 52 per cent of the study participants were considered overweight or obese.

Weight-related behaviours assessed included using diet pills, powder or liquids, laxatives or diuretics; induced vomiting; skipping meals; dieting/eating less or differently; smoking more cigarettes; and not eating carbohydrates.

Respondents were also asked about the number of days over the last week that they exercised for at least 30 minutes continuously.

Overweight misperceivers had significantly lower odds of participating in healthy or unhealthy weight-related behaviours. Normal weight misperceivers were more than twice as likely to diet, skip meals and smoke more cigarettes; the respective odds were nearly four and five times higher with regard to using diet pills, powder, liquids and diuretics.

“Weight misperception is a threat to the success of obesity prevention programs. Overweight individuals who do not recognize that they are overweight are far less likely to eat healthfully and exercise. These patients are at risk for cardiovascular disease, type 2 diabetes and other serious problems,” said lead author Abbey Berenson, of the Center for Interdisciplinary Research in Women’s Health.

The researchers recommend that clinicians calculate patients” BMI at each visit as part of their vital signs, routinely screen for misperceptions of body weight and inquire about unhealthy weight-related behaviours so that they can counsel patients appropriately.

“This is especially important for reproductive-age women because they are more likely to be obese than similarly aged men, often because they’ve had at least one child and have not lost pregnancy weight and find that their schedules make it difficult to exercise and eat healthfully,” added Berenson.

The study is published in the journal Obstetrics and Gynecology .

via Most overweight women think they’re slim – The Times of India.

Reuters, Lynne Peeples, November 19, 2010

The obesity epidemic has taken hold in many developing countries, new research finds, with the burden weighing almost entirely on the nations’ wealthy.

Meanwhile, poor people within the same borders still can’t put on enough pounds.

The findings contrast the pattern in developed nations, such as the U.S., where obesity tends to have a heavier impact on the poor.

“There’s a lot of discussion on how the problems of obesity and overweight are now spreading to poor and developing countries,” lead researcher SV Subramanian of the Harvard School of Public Health, in Boston, told Reuters Health.

But the data to back up this assertion have been lacking, and the question of who is most affected within those countries is almost never asked, he added.

In the new study, Subramanian and his colleagues looked for trends in the weights of more than half a million women across 54 developing countries between 1994 and 2008.

Overall, they found that about a quarter of the women were overweight, with the rate varying widely between countries — from three out of every four women in Egypt to just 6 percent in Ethiopia.

More importantly, said Subramanian, was what his team found when they looked within each country: As levels of income and education rose, so did individuals’ weight.

People ranked in the top quarter of the population based on wealth, for example, had more than double the risk of being overweight compared to individuals in the bottom quarter, report the researchers in the American Journal of Clinical Nutrition.

Meanwhile, a substantial portion of the population — often more than the number overweight or obese — still suffered from being underweight.

“On the one hand, you have populations where there is a need to increase calorie intake, and on the other, you have the rich folks who are over-consuming,” noted Subramanian.

An explanation for this paired pattern is not completely clear. Food is cheap and convenient for well-to-do populations, he explained. Their neighborhoods typically house a lot of restaurants where people can easily consume a lot without expending energy to cook.

He also noted that cultural phenomena may be driving some of these patterns. A marriage-aged girl may be expected to look healthy as opposed to anorexic.

“I think the fact that these two problems are happening in distinctly separate groups offers a very unique opportunity to actually do something,” Subramanian said. “The challenge is finding the balance.”

For the overweight, he suggested that interventions through education and the media might do the trick. Some evidence suggests that such campaigns may be responsible for eventually inverting the relationship of wealth and weight in rich countries.

But simply providing more calories may not be the answer for the poor, noting that Egypt’s government subsidized a lot of trans fats and subsequently saw increases in obesity within poor populations. They also saw continued problems with underweight among those still too poor to buy the cheap food.

“We should have a more comprehensive policy that focuses incentives on the right compositions of nutrients,” he added. “That way we can solve the problem of underweight, while also controlling the problem of overweight.”

SOURCE: American Journal of Clinical Nutrition, online November 10, 2010.

via Obesity weighs on the wealthy in poor countries | Reuters.