Despite still commanding a hefty price tag -- $14 billion a year, to be precise -- some evidence suggests the worst of the childhood obesity crisis may have already passed.
That's according to State of Childhood Obesity: Helping All Children Grow Up Healthy,(media.stateofobesity.org) a new report issued by the Robert Wood Johnson Foundation that found promising developments in some areas, particularly among very young children.
The report shows that although childhood obesity rates remain alarmingly high, they actually have begun to stabilize in recent years and have even decreased slightly in some populations. The report also provides a raft of recommendations for family physicians, policymakers and others with an interest in ensuring that obesity rates continue to decline.
"Childhood obesity is a major risk factor for many of the most important health issues individuals may encounter later in life, including heart disease, hypertension, diabetes, respiratory diseases, and bone and joint problems," said Bellinda Schoof, M.H.A., director of the Academy's Health of the Public and Science Division. "Family physicians can play a critical role in counseling all patients about healthy diets and physical activity."
- A new report from the Robert Wood Johnson Foundation reviewed childhood obesity data from several national surveys.
- The report found that although overall childhood obesity rates remain high, rates have begun to stabilize and even decrease among some populations.
- The report contained a list of recommendations that family physicians, policymakers and others can implement to keep childhood obesity rates on the decline.
Report Background and Highlights
The RWJF report compiled data from the most recent editions of several national surveys that track childhood obesity rates at different ages, including the National Health and Nutrition Examination Survey,(www.cdc.gov) the National Survey of Children's Health,(www.childhealthdata.org) the WIC Participant and Program Characteristics survey(fns-prod.azureedge.net) and the Youth Risk Behavior Surveillance System.(www.cdc.gov) All four surveys defined obesity as having a BMI at or above the 95th percentile for age and sex on the CDC growth charts.(www.cdc.gov) In all, data was collected on children from ages 2-19 years.
Because of considerable evidence(onlinelibrary.wiley.com) that links obesity at an early age to obesity later in life, the report also included the latest findings from the Behavioral Risk Factor Surveillance System,(www.cdc.gov) which tracks adult obesity rates at the state level.
The report revealed several noteworthy findings by age group.
Young children. The national obesity rate among 2- to 4-year-olds who participate in WIC declined significantly, from 15.9% in 2010 to 13.9% in 2016. This marked the second consecutive survey period(jamanetwork.com) in which obesity rates declined in this age group, and the decline was statistically significant across all racial and ethnic groups surveyed.
Virginia had the highest obesity rate among young children who participate in WIC; the lowest obesity rates were observed in three Western states: Colorado, Utah and Wyoming.
Older children and teenagers. According to the NSCH, 15.3% of children and adolescents ages 10-17 had obesity in 2017-2018 compared with 16.1% in 2016. Projected out to the general population, the report estimated that just over 4.8 million American youth were obese.
This year-over-year decline in obesity rates was not statistically significant, and the report's authors said additional data were needed to determine any reliable trends.
Significant differences were seen in obesity rates by race and ethnicity. Rates were significantly higher in black and Hispanic youth (22.2% and 19%, respectively) than in white and Asian youth (11.8% and 7.3%).
Students in grades 9-12. Nationally, 14.8% of American high school students had obesity in 2017. Although obesity rates rose significantly between 1999 and 2017, they did not change significantly from 2015 to 2017.
A higher percentage of male high school students (17.5%) had obesity compared with female students (12.1%).
Of the three racial and ethnic groups analyzed in the YRBSS, black and Hispanic students had the highest obesity rates at 18.2% each. The obesity rate for white students was 12.5%.
Youth ages 2-19. In 2015-2016, the national obesity rate for youth ages 2-19 was 18.5%, up slightly from 17.2% in 2013-2014.
As in other surveys, obesity rates appeared highest in black and Hispanic youth (22% and 25.8%, respectively) and lower in white and Asian youth (14.1% and 11%).
Adults. According to the BRFSS, between 2017 and 2018, the adult obesity rate increased in seven states, decreased in one state, and remained stable in the remaining states and Washington, D.C.
Mississippi and West Virginia shared the highest adult obesity rate at 39.5%. Colorado, at 23%, had the lowest adult obesity rate.
Nationally, black adults were the most likely to have obesity (39.1%), followed by Hispanic adults (33.3%) and non-Hispanic white adults (29.3%).
Obesity and Social Determinants of Health
The RWJF report suggested that several social, economic and environmental factors were at least partly responsible for the wide discrepancies in obesity rates.
Household income was one factor. NSCH data found that the obesity rate was 21.9% among youth living in households below the federal poverty level, compared with 9.4% in households with incomes four or more times greater than the federal poverty level.
Geography also appeared to play a role. According to the NSCH, the four highest youth obesity rates were found in states in the South, led by Mississippi at 25.4%; youth obesity rates also topped 20% in West Virginia, Kentucky and Louisiana. BRFSS data showed those same four states also had the highest adult obesity rates.
In contrast, obesity rates for young children in Western states such as Arizona, Colorado, Idaho, Montana, Nevada and Utah were all below the national average and remained below average into adulthood.
RWJF President and CEO Richard Besser, M.D., said the obesity rates were symptoms of more systemic problems, such as poverty, unstable housing situations and unsafe neighborhoods, all of which can negatively affect personal health.
"Many of these community conditions are a result of discriminatory policies and systems that have been in place for decades," said Besser. "And they continue to contribute to the significant disparities in obesity rates by race, by income and by geography.
"However, we have the power to change these outcomes and make our nation a more equitable society. The more we understand the barriers to good health, the more we can do to address them."
Continuing the Fight Against Childhood Obesity
The report included a series of recommendations regarding various government programs and agencies, many of which dovetail with recent AAFP efforts to reduce obesity. Among other things, the foundation recommended that
- the Trump administration rescind proposed changes to the Supplemental Nutrition Assistance Program that could potentially cause millions of participants to lose eligibility and/or benefits;
- any recommendations proposed by the Department of Agriculture to revise the WIC food packages(www.fns.usda.gov) be scientifically based;
- the federal government maintain nutrition standards for school meals that were in effect prior to the Department of Agriculture's Dec. 12, 2018, final rule(www.federalregister.gov) regarding milk, whole grains and sodium requirements;
- the scientific integrity of the Dietary Guidelines for Americans(health.gov) published by the Department of Agriculture and HHS be maintained and extended to include children younger than age 2 years; and
- adequate resources be provided to the CDC's Division of Nutrition, Physical Activity and Obesity(www.cdc.gov) and the agency's Racial and Ethnic Approaches to Community Health(www.cdc.gov) program.
Resources and Tools From the AAFP
Schoof noted that the AAFP supports the U.S. Preventive Service Task Force clinical preventive service recommendation on screening children and adolescents for obesity. That recommendation calls for clinicians to screen children and adolescents ages 6 years and older for obesity and, for those who screen positive, offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.
Schoof recommended that members visit the Academy's EveryONE Project toolkit webpage, which offers screening tools FPs can use to assess patients for social needs and identify opportunities to connect patients with the proper resources in their neighborhood. She also suggested members become familiar with the AAFP Neighborhood Navigator, an interactive tool that can be used at the point of care to connect patients to resources and programs that can mitigate food insecurity.
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