Solutions to child obesity

To make it easier for children to eat healthfully and move more, local governments in towns and cities across the country need to help create a better environment, a new report says.

Children and their families should have access to grocery stores that offer plenty of healthful food such as fruits and vegetables, and schools shouldn't be surrounded by fast-food restaurants. Children should be able to ride their bikes or walk safely to school, and they should have safe places to play afterward, says the report out today from the Institute of Medicine (IOM) and National Research Council.

The healthy choice should be the easy choice, says family physician Eduardo Sanchez, chairman of the expert committee that prepared the report and vice president and chief medical officer of Blue Cross Blue Shield of Texas.

"That statement captures the essence of this particular challenge. Too often the easiest thing to do is the least healthy, and that goes for kids."

The environment influences the decisions people make, and local regulations can make a difference in the fight against childhood obesity, he says.

About a third of the nation's children ages 2 to 19 — or about 23 million kids — are overweight or obese. That puts them at higher risk for type 2 diabetes, high cholesterol, sleep apnea and other health problems.

Some cities and towns in the USA already have made changes that make living healthfully easier. Other community officials need to figure out their areas' biggest problems and work on those first, the report's authors say.

Among their suggestions are several dealing with access to healthful food in underserved areas. They urge communities to offer financial incentives to the owners of corner markets and convenience stores in poor areas so they can carry more affordable healthful foods such as fruits and vegetables, and fat-free and low-fat dairy.

They also suggest offering tax credits, grants, loans and other economic incentives to attract new, bigger supermarkets and grocery stores to underserved communities to increase their access to healthful foods.

Several studies show that some people, especially in poorer communities, don't have easy access to a major grocery store, so they have to rely on small stores, convenience markets and hybrid gas stations where there is a smaller selection of healthful food items at higher prices.

"I believe (benefits from) the relative costs involved far outweigh the cost of doing nothing," Sanchez says. "Obesity in children leads to some diseases, and the cost of their medical care will go up fairly quickly."

Many of the strategies have other benefits. For instance, the report urges better community policing, which may increase safety, and better grocery stores could create more jobs, he says. "These are worthwhile investments because the gain is more than the upfront expense."

Similar ideas for changing the environment were discussed this summer at the Weight of the Nation meeting in Washington, D.C., which was sponsored by the Centers for Disease Control and Prevention and others.

Gut Checks Carry More Weight

When big-bellied patients come through the door of George Griffing's medical office in Brentwood, Mo., he pulls out a measuring stick.

Griffing, a professor of internal medicine at Saint Louis University School of Medicine, has those patients lie flat on their backs on an exam table. Then he measures the height of their bulging midsection from table top to tummy top.

"I'd like to use a ruler, but with a lot of patients I have to use a yardstick," he says. "What we're really looking for is how much fat is in the abdomen and the liver. It's simple and accurate and reveals a lot of information."

Medical experts have long suspected that people with excess deep-belly fat are at an increased risk for cardiovascular disease and Type 2 diabetes, and ongoing research bolsters that belief.

Griffing believes that measuring abdominal height is more efficient and accurate at predicting the risks of diabetes and cardiovascular disease than more commonly used methods such as calculating body mass indexes or waist-to-hip ratios, or measuring the circumferences of patients' waists. Those all factor in subcutaneous fat on arms, legs and hips, which is not as bad for you as fat in the gut, Griffing says. Griffing says most studies have found that abdominal heights that measure more than 10 inches in women and more than 12 inches in men triple the chance of cardiovascular disease.

The American Diabetes Association and the American Heart Association endorse using the midsection measuring technique. On its Web site, the American Diabetes Association calls it a simple, cheap and noninvasive tool but added that more research is needed.

Obesity medicine becomes a specialty

It’s a disturbing sign of the times that doctors soon will be able to earn certification in obesity management.

USA Today reports that the Obesity Society, the American Diabetes Association, the American Academy of Pediatrics and other groups are combining to create the certification. Doctors will be required to pass tests relating to nutrition, exercise and psychology. In announcing the partnership and certification development, the society cited the 66 percent of adults and 32 percent of youth who are overweight or obese.

Some will no doubt criticize the move as a way for doctors to get more money out of consumers and insurance companies. And yet there’s no way to avoid the reality that the growing obesity epidemic among adults and children contributes to rising health care costs. The severely overweight and obese are susceptible to and suffer from more ailments. Unfortunately, Oklahoma’s a case study.

A recent national report found that Oklahoma has the sixth-highest rate of obese adults. The news wasn’t quite so bad for the 10- to 17-year-old group, which ranked 33rd. State health officials have warned that those statistics are partly why the state has such a high incidence of diabetes and heart disease.

Some patients may indeed benefit from the advice and expertise of an obesity specialist. Others would do well to follow the age-old advice of eating better and exercising more.

Weight gain during menopause tied to brain changes

Healthy women who put on weight between the premenopausal and postmenopausal years risk losing nerve cells in the brain, research suggests.

Gaining weight is a "highly modifiable" risk factor that may be targeted to prevent or slow the progression of potentially harmful age-related changes in the brain, the University of Pittsburgh-based study team suggests in the June issue of Psychosomatic Medicine.

Dr. Isabella Soreca and colleagues analyzed brain imaging data obtained from 48 healthy older women who were tracked over a 20-year period as part of the longitudinal epidemiological Pittsburgh Healthy Women Study.

They report in the journal Psychosomatic Medicine that an increase in body weight during the transition to menopause and beyond was "uniquely associated" with a lower volume of gray matter (the portion of the brain containing nerve cell bodies).

Soreca and colleagues say this finding is "particularly noteworthy" given that these were healthy older women who entered menopause naturally and had no history of cardiovascular disease or psychiatric disease and none were obese in mid-life or later on.

"Women may be particularly motivated to maintain a healthy weight in the postmenopausal years, should it be confirmed that weight gain causes alteration in brain function that is important to quality of life," Soreca and colleagues conclude.

Childhood obesity linked to steep rise in hospitalizations

Hospitalizations for children diagnosed with obesity almost doubled between 1999 and 2005, a new national study reports. Costs have almost doubled too, even though federal figures measuring the prevalence of childhood obesity appeared stable over the same period of time.
A research team led by Dr. Leonardo Trasande of Mount Sinai School of Medicine tracked the increase in hospitalizations of children and adolescents from 2 to 19 years old by analyzing records from the Nationwide Inpatient Sample, the largest database for US hospitalizations. The researchers included obesity as a primary diagnosis as well as obesity when it was secondary to another medical condition, such as asthma, diabetes, or a mental illness.
Hospital stays for these children climbed from 21,743 in 1999 to 42,429 in 2005 while costs in constant dollars rose from $126 million to $238 million. The most common conditions the children had along with obesity were psychiatric disorders, pregnancy-related conditions, asthma, and diabetes. The increase in obesity diagnoses could not be explained by increases in the other conditions, which decreased or stayed the same, except for diabetes.
The obesity diagnoses measured in the study were judgment calls made by physicians that were also reviewed by hospital payers, the authors said. That can make the diagnoses different from other definitions of obesity, such as the one used by the US Centers for Disease Control and Prevention, they said. The study findings may represent trends in obesity diagnoses rather than an increase in obesity-related medical problems serious enough to require hospitalization, they cautioned.
"Even if increased recognition has contributed to these trends, our analysis suggests that obesity has a much more immediate impact on the health of children, especially adolescents, than previously understood," they wrote.
The study also found differences in the obesity diagnoses depending on whether the child had public or private insurance. Private insurers paid most of the bills for obesity when it was the primary diagnosis while Medicaid was more often the payer for obesity as a secondary diagnosis.
"Just as growth in the elderly population has contributed to increases in health care costs, increasing obesity appears to be driving increases in Medicaid spending," the study authors write.
That is a worrying development, Dr. Caroline Apovian, director of nutrition and weight management at Boston Medical Center and associate professor of medicine and pediatrics at Boston University School of Medicine, said in a statement. She was not involved in the study, which was posted online in the journal Health Affairs today.
"This is a very disturbing trend and is heralding an increase in healthcare costs for childhood obesity," she said. "Most obese adolescents become obese adults. Many obese children also become obese adults. We can be assured of obesity causing an increase in healthcare dollars for the next generation based on this news."
The authors and Apovian urge more support for prevention programs. In Congress, legislation to revamp the nation's healthcare system includes some of the measures Apovian favors, as a story in today's Globe explains.
"We need not only an increase in exercise facilities, parks, safe neighborhoods, sidewalks, more bike paths and more gym classes in schools but also an increase in subsidies for fruit and vegetable farming and distribution as well as high taxes for sugar-sweetened beverages and nonessential junk foods," Apovian said.