# Presentation: 892262

## Obesity: A National Health Issue

**William H. Dietz, MD, PhD**
**Director **
**Division of Nutrition and Physical Activity**
**Centers for Disease Control and Prevention **
**24 September 2005**

## Obesity Trends* Among U.S. Adults1991, 1996, 2004

**2004**

**Obesity Trends* Among U.S. Adults****1991, 1996, 2004**

- No Data

- <10%

- 10%-14%

- 15%-19%

- 20%-24%

-  25%

## Changes in the Prevalence of Severe Obesity (BMI >40)

**Notes:**
Severe obesity (BMI > 40 or approximately 100 lbs overweight) increasing more rapidly than obesity. African American women particularly affected –15% have BMI > 40. Treatment of choice for BMI >40 is gastric bypass surgery.

## Relation of BMI Levels to Fat Mass Index in 9-14 yo Boys and Girls (Pearson correlation coefficients adjusted for race and age)

**BMI for Age**
**	****	****<50th %tile****	**** 50-84****th**** %tile****	****       **_**>**_**85****th**** %tile**
**Boys 9-11y****	****      0.45   ****	****       0.43****	****	****0.95**
**Boys 12-14 y****	****      0.45****	****       0.53****	****	****0.85**
**Girls 9-11y****	****      0.56****	****       0.77****	****	****0.93**
**Girls 12-14y****	****      0.58****	****       0.36****	****	****0.96**
**Freedman et al. Int J Obesity 2005;12:1-8.**

## Prevalence of Overweight* Among U.S. Children and Adolescents

**Gender- and age-specific BMI *_*>*_* the 95th percentile*

**1963-70**
**NHES II & III**

**1971-74**
**NHANES I**

**1976-80**
**NHANES II**

**1988-94**
**NHANES III**

**1999-2000**
**NHANES **

## Overweight Prevalence by Race/Ethnicity for Adolescent Boys

**Overweight Prevalence by Race/Ethnicity for Adolescent Boys**
**Aged 12 - 19 Years**

**Percentage**

**Source: *****JAMA, 2004;291:2847***

## Overweight Prevalence by Race/Ethnicity for Adolescent Girls

**Overweight Prevalence by Race/Ethnicity for Adolescent Girls**
**Aged 12 - 19 Years**

**Source: *****JAMA, *****Oct. 9, 2002, Vol. 288, No. 14:1731**

**Percentage**

## BMI and Distribution of Morbid Obesity

- <date/time>

**BMI and Distribution of Morbid Obesity**

**	****	****	****BMI @99%tile*****	****	**_**>**_** BMI 40******	****      % > 99%tile**
**Males**
**	****16yo****	****	****33.9****	****	****     1.6%****	****	****8.1%**
**	****17yo****	****	****34.4****	****	****     0.3%****	****	****6.4%**
**	****18yo****	****	****35.0****	****	****     0.1%****	****	****3.6%**
**	****19yo****	****	****36.0****	****	****     3.1%****	****	****3.5%**
**Females**
**	****16yo****	****	****39.1****	****	****     1.6%****	****	****1.6%**
**	****17yo****	****	****40.8****	****	****     2.3%****	****	****2.0%****	**
**	****18yo****	****	****42.9****	****	****     1.7%****	****	****0.7%**
**	****19yo****	****	****45.4****	****	****     3.3%****	****	****0.7%**
***CDC growth charts        **NHANES 1999-2002**

## Prevalence of Risk factors by BMI Percentile (Bogalusa Data)

**Prevalence of Risk factors by BMI Percentile (Bogalusa Data)**

## Consequences of Childhood and Adolescent Obesity

- Growth
- Psychosocial
- Hyperlipidemia
- Hepatic steatosis
- Abnormal glucose metabolism
- Asthma
- Persistence into adulthood

- Hypertension
- Sleep apnea
- Pseudotumor
- PCOD
- Cholelithiasis
- Orthopedic

**Common**

**Uncommon**

## Prevalence of the Metabolic Syndrome and Abnormalities by BMI Status

- 				Overall	    Normal 	At Risk		Overweight 			  	    (<85%)	(85-94%)	(_**>**_95%)
- 		     		_%_	    _%_		_%_		_%_
**Metabolic Syndrome****	****4.4****	****    0.01****	****	****4.6****	****	****35+**
**High triglycerides****	****23****	****    18****	****	****34*****	****	****52+**
**Low HDL****	****	****23****	****    18****	****	****32*****	****	****50+ ****	**
**High Fasting Glucose****	****1.4****	****    0.7****	****	****4****	****	****3****	**
**High Blood Pressure****	****5****	****    3****	****	****9****	****	****11+**
**	****	****	****	****	****	****	****	****	****	**
***p-value <.05 for at risk vs. normal adolescents**
**+p-value <.05 for overweight vs. normal adolescents**

**Notes:**
This is a break down of the prevalence of the metabolic syndrome and each of the criteria.
We have this divided among the overall sample, those individuals with a normal range BMI, those with an at risk BMI and those with a BMI in the overweight range
For example, 23% of the overall group had elevated TGs, while only 17% of those in a normal range BMI had elevated TGs, 34% of those with At-risk BMI and 52% of those subjects with an overweight BMI had hi TGs.
I hope you can appreciate that the clustering of the pathologic markers of the metabolic syndrome is most evident in the overweight individuals. 
Now we will look at them more closely...........

## Consequences of Childhood and Adolescent Obesity

- Growth
- Psychosocial
- Hyperlipidemia
- Hepatic steatosis
- Abnormal glucose metabolism
- Asthma
- Persistence into adulthood

- Hypertension
- Sleep apnea
- Pseudotumor
- PCOD
- Cholelithiasis
- Orthopedic

**Common**

**Uncommon**

## Impact of Childhood Overweight (BMI > 95th  percentile) on Adult Obesity (BMI > 30)

-  4.9 BMI unit difference in severity
-  Onset _<_ 8y more severely obese as adults
-    ( BMI = 41.7 vs 34.0)
-  CVD risk factors reflect adult BMI
-  25% obese adults were overweight children

- Freedman et al, Pediatrics 2001; 108: 712

## Consequences of Childhood and Adolescent Obesity

- Growth
- Psychosocial
- Hyperlipidemia
- Hepatic steatosis
- Abnormal glucose metabolism
- Asthma
- Persistence into adulthood

- Hypertension
- Sleep apnea
- Pseudotumor
- PCOD
- Cholelithiasis
- Orthopedic

**Common**

**Uncommon**

## Duration of Diabetes and Nephropathy  (Pima Indians)

- The duration of diabetes, rather than the age at diagnosis, is predictive of nephropathy (Krakoff. Diabetes Care 2003;26:76)

- Cumulative Incidence
- Nephropathy (%)

- 15 - 24 Y

- 35 - 44 Y

- 25 - 34 Y

- Duration (years)

## Childhood BMI and Adult Mortality: 32 y Follow-up of 	227,000 Norwegian Adolescents Measured in 1963-75

- Mortality
- per
- 1000 PY

- Childhood BMI-for-Age Percentile

- Boys

- Girls

**A Engeland, Am J Epidemiol 2003;157:517**

## Distribution of BMI among 17- to 19-year-olds 	

- 15

- 20

- 25

- 30

- 35

- 40

- 45

- 50

- 0.00

- 0.04

- 0.08

- BMI

- 15

- 20

- 25

- 30

- 35

- 40

- 45

- 50

- 0.00

- 0.04

- 0.08

**Distribution of BMI among 17- to 19-year-olds ****	**

- US (1999-2002)
- 14%, BMI ≥30

- Norway (1963-75)
-  1% had a BMI ≥ 30

## Costs of Obesity

- <date/time>

**Costs of Obesity**

**Costs of illness**
**Costs of absence from work**
**Costs of reduced productivity**
**Costs of injuries**
**Costs of disability**

## Percent of All Excess Health Care Expenditures

**Associated with Obesity**

- Source: R. Sturm, personal communication.

## Cost for Weight plus Additional Risk Factors

- BMI

- Only

- BMI +1

- Risk

- BMI +2

- Risks

- BMI +3

- Risks

- BMI +4

- Risks

- BMI +5

- Risks

- BMI +6

- or more

- $0

- $1,000

- $2,000

- $3,000

- $4,000

- $5,000

- $6,000

- $7,000

**BMI<25**

**BMI 25-30**

**BMI 30-35**

**BMI>35**

- * Average annual paid healthcare costs (including pharmacy) from 1997 to 2000; N=222,933.

**Notes:**
The higher the weight (by BMI ranges), the greater the costs.  
 A BMI of 30 represents the first major jump HSM and drug costs.
The group with BMI <18.5 is likely a collection of naturally low weight or eating disorders or other diseases.  

## Costs of Obesity

- <date/time>

**Costs of Obesity**

**Costs of illness**
**Costs of absence from work**
**Costs of reduced productivity**
**Costs of injuries**
**Costs of disability**

## Therapeutic Approaches to the Treatment of Obesity

- Behavioral
- dietary alteration
- increase activity
- decrease inactivity
- Aggressive dietary therapy
- Pharmacologic
- Surgical