By Julie Stelting RN CDE
The current trend in obesity rates in the USA will continue to have a significant impact on the health of our youth and adult populations, and challenge our workforce and healthcare resources.
What is the Problem?
Obesity has been proven to increase the risk of chronic diseases like cardiovascular disease, diabetes, fatty liver disease, cancer, and contributes to many other health complications.
It has been predicted that America’s increasing healthcare cost will drive our government into ruins. The CDC reports American’s annually spend 147 billion dollars on obesity related healthcare.[4] Forty-two percent (42%) of America’s healthcare costs are paid for through Medicare and Medicaid. Under current healthcare policy, those costs will continue to increase. [5] [6]
How Big is the Problem?
According to the Organization for Economic Co-operation and Development (OECD), the USA is leading all other counties in overall population for clients over 15 years of age. The overweight and obesity rates were at 70.1% in 2014, increased from 23.3% in 1990. 10
The OECD committee defines obesity as a BMI over 30, and overweight is classified as a BMI of 25-30, based on professional health examination records.[1] Center for Disease (CDC) reports 30% of Americans over the age of 20 years old are classified as obese plus an additional 30% of adults are “overweight”.10
National Survey of Children’s Health Data
Data from our National Survey of Children’s Health reports 32% of our school age children are overweight.[2] The National Survey defines a child as overweight when their BMI is above the 85th percentile for both height and weight for their age.11 It also reports our children’s overall excellent health status has declined from 87.5% in 2003 to 85.3% in 2007.11
Indiana ranks 29 out of 50 states with a school age childhood obesity rate of 30%.11 Tendencies toward obesity may start at a very early age. The CDC reported in 2011-2014 that 17% of pre-school age children (or 12.7 million young people) where classified as obese.
- 8.9% of children ages 2-4 years old were classified through healthcare records as obese
- 17.5% of 6-11 year old’s were classified as obese
- 20.5% of 12-19 year old’s were obese 12
Center For Disease Control Data
CDC data for obesity is based on children above the 95th percentile on growth charts.[3] CDC’s Adult overweight, including obesity, was 70.7% (2013-2014) and 17.2% of youth ages 2-18 years were obese (this statistic does not include youth who are overweight). Trends in the United States, are showing continued increase in both adults and youth since 1999.
Barriers and Limitations
- Parents may be in denial of children being identified as obese and at risk for diseases
- Cost of treatment (medications) may be prohibitive to families
- Sedentary lifestyles are considered normal for our children
- Parents do not want their children labeled as sick or abnormal
- Being identified with a chronic disease can affect health insurance rates
- Some medical professionals refuse to diagnose children at risk for obesity [5]
The American Diabetes Association Supports Early Lifestyle Interventions
The American Diabetes Association (ADA) admits that these children are at a substantial risk for complications from type 2 diabetes being undetected due to a prolonged asymptomatic period. The ADA suggests that all overweight[7] children with a family history of diabetes, or having signs of insulin resistance, or belonging to a high-risk ethnic group, medical providers begin routine blood testing at age 10 and with testing to be repeated every two years.
The ADA defines overweight in children to be greater than the 85% for weight to height or having a weight greater than 120% above the 50% for height. 16 The ADA proposes that early lifestyle interventions may have long-term beneficial effects. They propose that primary care providers have an obligation to encourage lifestyle modifications of managed weight control and increased physical activities along with regular follow-up assessments. Dieting is not recommended for these children. Behavior modification programs should encourage more fresh fruits and vegetables with reduced high fat foods and sugary drinks. 16
Public Health Approach Targeting Schools
The ADA proposes a public health approach which targets school and community based programs. Schools should promote healthy food choices and increased physical activities. 16 Unfortunately, public school’s resources are scarce. Many schools profit from vending machine sales of candy and soft drinks. School cafeterias also profit from the sale of commercially packaged “junk foods”.
Falling house values directly affect the property taxes that support our local schools. Also, non-funded nationally mandated programs like the “no child left behind” have placed dramatic demands on school budgets. As a greater emphasis is placed on academic achievement, many schools are considering cutting their physical education classes, particularly in the elementary and middle schools. Health officials need to attend school board meetings and voice concerns over the need for funds to be allocated into these programs for the health of our children.
More Research Needed For Children
More research needs to be done. First, there needs to be a nationwide consensus on the definition of childhood obesity. Body Mass Index (BMI) is easy to calculate but it has real limitations. BMI does not take into account the body build (frame size), the distribution of body fat, the maturity level, and other health factors. Many professional football players have a very high BMI but most of them are in good health.
It has been proposed to include waist circumference with student health screenings of height and weight. A waist circumference over 39.3″ (100 cm) places adults at increased risk for insulin resistance and heart disease. Research needs to be done to enable nurses to predict children who are at increased risk of health complications based on waist circumference measurements.
Primary care providers need to be influenced to monitor for risk factors for diabetes in overweight children. The American Diabetes Association reports the rate of type 2 diabetes being diagnosed in children ranges from 8% to 45%.16 The ADA suspects that many children being diagnosed with type 1 diabetes actually have type 2. Although the medications can be similar, the overall management of the disease can be very different. It is important to accurately diagnose and report this disease. Primary care providers also need to provide proper weight management programs for obese children. Nurses can play a primary role in encouraging these families to make permanent lifestyle modifications.
Trends Must Be Reversed
We must reverse the trend of increasing obesity in the USA. The CDC is lobbying law makers to encourage walking to school. The CDC is also proposing a new “3¢ soda tax” to be placed on each can of soda.[8] In America each year 100,000 deaths are associated with obesity. We are all affected by this issue. Often times, nurse have failed to recognize the influence of political, social, economic, and cultural factors that affect the services they provide.[9] As professional nurses, we are in a unique position to be recognized for what nurses can contribute to the care of our obese population. We must stand up and speak boldly to our policy makers.
[1] OECD Data Overweight or Obesity Population (2014) Data, Health at a glance 2015, www.data.oecd.org/healthrisk/overweight-or0obese-population.htm Retrieved April 22, 2017
[2]OECD statistics health data (2007). Health Status (Fertility, Infant Mortality, Life Expectancy, Obesity) download: Health at a glance 2007: Focus on Quality of Care – OECD © 2007 – ISBN 9789264027329 Retrieved July 27,2009 from http://www.oecd.org/dataoecd/32/21/38785100.htm
[2] CDC Overweight &Obesity , Data & Statistics, Childhood Obesity Facts, Prevalence of Childhood Obesity in the United States 2011-2014 www.cdc.gov/obesity/data/childhood.html Retrieved April 22, 2017
[3] Ogden, Cynthia L, Carroll, Margaret D, Fryar, Cheryl D, Flegal, Katherine M. CDC National Center for Health Statistics, Prevalence of Obesity Among Adults and Youth: United States, 2011-2014 NCHS Data Brief No. 219, November 2015 www.cdc.gov/nchs/data/databriefs/db219.htm Retrieved April 22, 2017
[4] ABC News (2009, July 27) Obesity epidemic is a weighty matter. Center for Disease Control annual conference (as cited in ABC World News July 27, 2009.) Retrieved July 27,2009 from abcnews.go.com/video/player Index?id=8187849
[5] Bartlett, Rebecca. (2009, July) S485 Professional Growth and Empowerment. Module 5Mini lecture. Politics and policy in nursing. presented through IUPUC School of Nursing
Indiana’s News Center Fort Wayne, Indiana (2009, July 24) Preschool obesity rate stable at 1 in 7. Retrieved July 25,2009 from www.indiananewscenter.com/news/health/?feed=bim&id=51581162
[6] Obama’08. (2008) Obama’08 background questions and answers on health care plan. Retrieved July 27,2009 from http://brackobama.com/pdf/obama08_healthcareFAQ.pdf
[7] American Diabetes Association (2000, March 3) Type 2 Diabetes in Children and Adolescents. Diabetes Care, 2000; 23:3, 381-389. Retrieved July 27,2009 from http://care.diabetesjournals.org/content/23/3/381.full.pdf
[8] ABC News (2009, July 27) Obesity epidemic is a weighty matter. Center for Disease Control annual conference (as cited in ABC World News July 27, 2009.) Retrieved July 27,2009 from abcnews.go.com/video/playerIndex?id=8187849
[9] Smith-Campbell, B., (2000) Access to Healthcare: Effects of Public Funding on the Uninsured. Journal of Nursing Scholarship. 2000; 32:3, 295-300