Trust for America's Health and the Robert Wood Johnson Foundation have released The State of Obesity 2018: Better Policies for a Healthier America.(www.tfah.org) The report indicates that obesity continues to be a problem across the United States, with several states showing increases in the prevalence of adult obesity and related conditions such as diabetes.
"New studies documenting national obesity rates and trends from the past year reinforce what we already know," the report stated. "Therefore, addressing the obesity epidemic remains imperative for ensuring the health of the nation."
Along with the latest data trends, the report outlined a number of policies and practices that family physicians and other health care professionals can use to combat obesity at the community level. The report also noted several projects currently underway in the United States to fight the obesity epidemic, many of which show promise in reducing obesity rates in children and adults over time.
"Obesity is a complex and often intractable problem, and America's obesity epidemic continues to have serious health and cost consequences for individuals, their families and our nation," said Trust for America's Health CEO John Auerbach in a news release about the report. "The good news is that there is growing evidence that certain prevention programs can reverse these trends. But we won't see meaningful declines in state and national obesity rates until they are implemented throughout the nation and receive sustained support."
Analysis and Report Highlights
The report analyzed information from surveys that track obesity in the general population. Data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES) were used to measure adult obesity prevalence at the state and national levels, respectively. NHANES and other survey data were used to measure childhood obesity prevalence.
- A report from Trust for America's Health and the Robert Wood Johnson Foundation found that obesity continues to be a significant health problem throughout most of the United States.
- The report provided updated data on obesity-related conditions such as diabetes and hypertension.
- Research cited in the report indicates that some programs may be effective in reducing obesity rates in certain areas and among various segments of the population.
It's important to note a key difference in how NHANES and BRFSS data are obtained. BRFSS relies solely on self-reported data and, given that most people overestimate their height and underestimate their weight, BRFSS is thought to underestimate obesity rates -- perhaps by as much as 10 percent. NHANES, on the other hand, bases its obesity rates on physical exam findings and is therefore considered a more accurate reflection of obesity rates in the United States.
Nationally, 39.6 percent of adults and 18.5 percent of children were considered obese in 2015-2016, the most recent period for which NHANES data were available. These figures represent the highest percentages ever documented.
Adult obesity rates varied widely by region, according to 2017 BRFSS data. States in the Northeast (27.7 percent) and West (26.1 percent) had lower overall obesity rates than those in the South (32.4 percent) and Midwest (32.3 percent).
Between 2016 and 2017, adult obesity prevalence increased in six states (Iowa, Massachusetts, Ohio, Oklahoma, Rhode Island and South Carolina) and remained stable in the other states and the District of Columbia. No state experienced a decrease in obesity rates.
Seven states (Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma and West Virginia) had adult obesity rates of 35 percent or higher, led by West Virginia at 38.1 percent.
In 48 states, the adult obesity prevalence was more than 25 percent. The lowest adult obesity rates were in Colorado (22.6 percent), the District of Columbia (23.0 percent) and Hawaii (23.8 percent).
In addition, more than one-fourth of the nation's counties had self-reported adult obesity rates of 35 percent or higher. Adult obesity rates ranged from 13 percent in Eagle County, Colorado, to 48 percent in Macon County, Alabama.
Effects of Social Determinants
The report noted links between increased obesity rates in adults and certain socioeconomic factors, such as
- Education: BRFSS data for 2016 showed that 22.2 percent of adult college graduates had obesity, compared with 35.5 percent of adults with less than a high school education.
- Rural vs. urban: The same 2016 BRFSS data showed that 28.7 percent of adults living in urban or metropolitan areas had obesity, compared with 34.2 percent of adults living in rural areas.
- Income level: According to NHANES data for 2011-14, 29.7 percent of adults with incomes at 400 percent or more of the federal poverty level had obesity, compared with 42.6 percent of adults with incomes between 100 percent and 400 percent of the federal poverty level.
Many of these socioeconomic factors also affected childhood obesity rates.
NHANES data for 2011-14 indicated that in homes where the head of household was a college graduate, 9.6 percent of children ages 2-19 had obesity, whereas in homes where the head of household was a high school graduate or less, 21.6 percent of children had obesity.
Childhood obesity also varied by household income level, according to the same NHANES data. In low- and middle-income households, child obesity rates ranged between 18.9 percent and 19.9 percent. In higher-income households, 10.9 percent of children had obesity.
AAFP Commission on Health of the Public and Science member Jeffrey Quinlan, M.D., of Alexandria, Va., explained to AAFP News the role these and other factors play in obesity.
"It is a troubling situation that many Americans live in relative food deserts where there is often a lack of fruits, vegetables and other healthy foods, but instead there is easy access to relatively cheap fast food which is often high in fat and calories," Quinlan said. "A disproportionate number of these Americans are economically disadvantaged and minorities.
"This highlights the need for focused intervention in these communities to ensure both community involvement and adequate funding to provide healthier options for these individuals and their families."
Other Health Conditions
The report also provided updated data on several obesity-related health conditions, including
- Diabetes. Diabetes rates increased in five states between 2016 and 2017. West Virginia had the highest adult diabetes rate at 15.2 percent, while Utah had the lowest at 7.1 percent.
- Hypertension. Nine states had adult hypertension rates of 35 percent or higher; West Virginia had the highest at 43.5 percent. At 24.5 percent, Utah had the lowest adult hypertension rate.
- Physical inactivity. Kentucky, at 34.4 percent, had the highest percentage of adults who were physically inactive. Washington (19.2 percent) and Colorado (19.5 percent) had the lowest percentage.
The report's authors offered three guiding principles on obesity prevention:
- Promote policies and scale programs that take a multisector approach. Efforts that involve several types of organizations (e.g., schools, health departments and local businesses) are more likely to achieve positive results than efforts that involve only one sector.
- Adopt and implement policies that make healthy choices easy. Federal, state and local agencies can work together to make good food choices and physical activity less expensive, more convenient and easier to access.
- Invest in programs that level the playing field for all individuals and families. Social and economic factors may make it more difficult for some people to escape the obesity epidemic. It is important to design and fund programs that address these challenges.
The authors also provided 41 specific recommendations to policymakers, the food and restaurant industry, and health care professionals and health systems.
Hope on the Horizon?
For all the troubling data contained in the report, there also were small signs of progress. The report cited research showing positive strides being made toward reducing obesity rates in certain areas and segments of the population:
- Between 2010 and 2014, obesity rates for 2- to 4-year-old children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children declined from 15.9 percent to 14.5 percent. Rates decreased among children in most states and across all racial and ethnic groups.
- CDC data regarding an ongoing project in Texas indicated that a clinically focused, intensive, multisector program may be successful at reducing the weight of children in low-income communities who are overweight or obese.
- Evidence from the Healthy Communities Study showed that children living in areas that promoted physical activity and good eating habits had lower body mass index scores and waist circumferences than children in other areas.
- A 2018 study published in Public Health Reports found that in states that implemented CDC-funded nutrition and physical activity programs from 2000 to 2010, the odds of obesity in adults decreased between 2.4 percent and 3.8 percent.
"Together, these studies demonstrate that states and communities that support multisector collaborations and innovative policy approaches over sustained periods can achieve reductions in obesity and offer models for nationwide adoption," the report stated.
What Family Physicians Can Do
Patients who want to lose weight may have a difficult time navigating the maze of weight loss options available. From specialized diets and tailored exercise plans to bariatric surgery, it can be hard to decide on a proper course of action.
That's where family physicians can help.
"It is important to not be afraid to address overweight and obesity with our patients," said Quinlan. "Identifying that there is a health concern and discussing the implications with our patients is an important first step to making appropriate interventions. Engaging in motivational interviewing techniques can help to assess the patient's readiness to accept the need for intervention and engage in change."
Quinlan emphasized that family physicians should know what types of resources are available in the community so that they can refer patients as needed. FPs also should be prepared to discuss changes in diet and exercise that patients are likely to try and willing to adopt.
"A series of small changes which result in quick successes can be very helpful in motivating a patient to continue to make positive changes in their lives," he said.
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