Japanese Lifestyle during Childhood Prevents the Future Development of Obesity among Japanese-Americans

Objective

To evaluate whether a Japanese lifestyle during childhood could protect against the future development of obesity-associated metabolic diseases by comparing native Japanese with Japanese-Americans in whom genetic factors are the same.

Methods

Study subjects were 516 native Japanese and 781 Japanese-Americans who underwent medical examinations between 2007 and 2010. Japanese-Americans were divided into 444 first-generation immigrants (JA-1), who were born in Japan, and 337 second- or later-generation descendants (JA-2), who were born in the United States. The JA-2 group was then divided into the kibei subgroup (N = 79), who had moved to Japan before the age of 18 years and later returned to the United States, and the non-kibei subgroup (N = 258), who had never lived in Japan.

Results

The JA-2 group had the highest percentages of obesity, metabolic syndrome, and type 2 diabetes compared with native Japanese and JA-1. Furthermore, among JA-2, the prevalence of obesity and metabolic syndrome in the kibei subgroup was significantly lower than that in the non-kibei subgroup. The prevalence of diabetes in the kibei subgroup also tended to be lower than in the non-kibei subgroup.

Conclusions

The prevalence of obesity and metabolic diseases differed with residence in Japan during childhood among Japanese-Americans. These findings indicate the possibility that Japanese lifestyle during childhood could reduce the future risks for obesity-associated metabolic diseases.     

Prevalence and Covariates of Obesity in Lebanon: Findings from the First Epidemiological Study

Objective: To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population. Research Methods and Procedures: A cross‐sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI. Results: For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age ≥ 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI ≥ 30 kg/m²) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity. Discussion: The results from this national population‐based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.     

California and federal school nutrition policies and obesity among children of Pacific Islander,American Indian/Alaska Native,and Filipino origins: Interrupted time series analysis

BackgroundObesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students.Methods and findingsWe used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (−0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies.ConclusionsThe current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.

Dr. Mika Matsuzaki and co-authors found evidence of favorable associations between state and federal school nutrition policies with overweight/obesity prevalence trends among children of Pacific Islander origin, Filipino, and American Indian/Alaska Native origins in the United States.     

Differences in Overweight and Obesity among Children from Migrant and Native Origin: The Role of Physical Activity,Dietary Intake,and Sleep Duration

A cross-sectional survey was performed to examine to what degree differences in overweight and obesity between native Dutch and migrant primary school children could be explained by differences in physical activity, dietary intake, and sleep duration among these children. Subjects (n=1943) were primary school children around the age of 8–9 years old and their primary caregivers: native Dutch children (n=1546), Turkish children (n=93), Moroccan children (n=66), other non-western children (n=105), and other western children (n=133). Multivariate regressions and logistic regressions were used to examine the relationship between migrant status, child’s behavior, and BMI or prevalence of overweight, including obesity (logistic). Main explanatory variables were physical activity, dietary intake, and sleep duration. We controlled for age, sex, parental educational level, and parental BMI. Although sleep duration, dietary intake of fruit, and dietary intake of energy-dense snacks were associated with BMI, ethnic differences in sleep duration and dietary intake did not have a large impact on ethnic differences in overweight and obesity among children from migrant and native origin. It is suggested that future preventive strategies to reduce overweight and obesity, in general, consider the role of sleep duration. Also, cross-cultural variation in preparation of food among specific migrant groups, focusing on fat, sugar, and salt, deserves more attention. In order to examine which other variables may clarify ethnic differences in overweight and obesity, future research is needed.     

Socioeconomic and seasonal variations in births: A replication

Many studies, but not all, suggest that immigrant health worsens with duration of residence in the United States. Cohort effects may explain the inconsistent findings; not only are cohort effects confounded with duration, but the timing of entry into the United States may also create qualitatively different migration experiences. The present study tests for duration and cohort patterns among Asian immigrants to the United States across six year-of-entry cohorts (pre-1980, 1981–85, 1986–90, 1991–95, 1996–2000, 2001–05). Data come from the Asian American sample (n = 44,002) of the 1994–2009 waves of the National Health Interview Survey. The data show cohort differences for self-rated health, such that more recent cohorts showed improved baseline health compared to older cohorts. After accounting for cohorts, there was no significant change in self-rated health by duration of residence. Older cohorts actually showed improving self-rated health with longer duration. Obesity showed the opposite pattern; there were no differences across cohorts, but duration in the United States correlated with higher obesity. These results imply that immigrant health is not simply an issue of duration and adaptation; instead, they underscore the utility of considering cohorts as broader contexts of migration. Collectively, the results encourage future research that more carefully examines the etiological mechanisms that drive immigrant health.     

Lower Obesity Rate during Residence at High Altitude among a Military Population with Frequent Migration: A Quasi Experimental Model for Investigating Spatial Causation

We sought to evaluate whether residence at high altitude is associated with the development of obesity among those at increased risk of becoming obese. Obesity, a leading global health priority, is often refractory to care. A potentially novel intervention is hypoxia, which has demonstrated positive long-term metabolic effects in rats. Whether or not high altitude residence confers benefit in humans, however, remains unknown. Using a quasi-experimental, retrospective study design, we observed all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 who were stationed in the United States. We compared high altitude (>1.96 kilometers above sea level) duty assignment with low altitude (<0.98 kilometers). The outcome of interest was obesity related ICD-9 codes (278.00-01, V85.3x-V85.54) by Cox regression. We found service members had a lower hazard ratio (HR) of incident obesity diagnosis if stationed at high altitude as compared to low altitude (HR 0.59, 95% confidence interval [CI] 0.54–0.65; p<0.001). Using geographic distribution of obesity prevalence among civilians throughout the U.S. as a covariate (as measured by the Centers for Disease Control and Prevention and the REGARDS study) also predicted obesity onset among service members. In conclusion, high altitude residence predicts lower rates of new obesity diagnoses among overweight service members in the U.S. Army and Air Force. Future studies should assign exposure using randomization, clarify the mechanism(s) of this relationship, and assess the net balance of harms and benefits of high altitude on obesity prevention.     

Global prevalence of overweight and obesity in preschoolers

Twenty-three studies reporting cross-sectional and longitudinal data were conducted in 14 different countries between 1998 and 2008. The number of preschool age children totaled more than 43,837 with one study not reporting a sample size. Studies used both international (i.e., International Obesity Task Force (IOTF), World Health Organization (WHO)) and national reference standards (i.e., United States - Centers for Disease Control and Prevention (CDC), Spain - SRS, Italy - Luciano) to classify children as overweight or obese. Within the same sample the percentage of children classified in these categories often showed a 1.5- to 2-fold difference in the prevalence of overweight/obesity with greatest differences in the between country-specific standards (CDC vs. Luciano). WHO percentages frequently exceeded the IOTF percentages. The prevalence of overweight/obese children escalated with increasing age from 2-5 years in both boys and girls with girls showing higher frequencies in 2/3rds of the 72 sex-paired comparisons. The results indicate a recent high prevalence of overweight and obesity in middle and high income countries, among both well-off and lower income segments of populations, in both rural and urban areas, and among all ethnic and racial groups represented. Because a high proportion of preschool overweight/ obese children will continue to increase their adiposity and are at risk for the early onset of metabolic syndrome, cardiovascular disease, type 2 diabetes, musculoskeletal disorders and behavioral problems, concerted public health efforts are needed to coordinate culturally-appropriate parental and caregiver education, home lifestyle changes, dietary and exercise modifications that will reverse the current trajectory.     

Height and BMI of Italian immigrants to the USA, 1908–1970

We analyze self-reported anthropometric data pertaining to 2140 adults who emigrated to the United States, mainly from southern Italy, between 1908-1928 and 1960-1970. The mean height of immigrant men was 165.5 cm: they were taller than contemporary southern Italian men by 0.5-7.3 cm in different periods. The mean height of the Italian immigrant women born before 1952 was 157.6 cm, less than the national average. At the end of the 1990s, national women average height was 162 cm, 159.5 cm for southern women. There were age-related increases of weight and BMI: overweight was more prevalent in the 40-49 years age category. In the male sample, the mean values of BMI were within the overweight range in all age classes. The prevalence of obesity was higher in the male sample than among US men, whereas it was virtually identical in the women's sample and much higher than the values reported for several European countries for the period 1970-1980.     

The prevalence of obesity in ethnic admixture adults

Objective: To determine whether the prevalence of obesity in ethnic admixture adults varies systematically from the average of the prevalence estimates for the ethnic groups with whom they share a common ethnicity. Methods and Procedures: The sample included 215,000 adults who reported one or more ethnicities, height, weight, and other characteristics through a mailed survey. Results: The highest age‐adjusted prevalence of overweight (BMI ≥ 25) was in Hawaiian/Latino men (88%; n = 41) and black/Latina women (74.5%; n = 79), and highest obesity (BMI ≥ 30) rates were in Hawaiian/Latino men (53.7%; n = 41) and Hawaiian women (39.2%, n = 1,247). The prevalence estimates for most admixed groups were similar to or higher than the average of the prevalences for the ethnic groups with whom they shared common ethnicities. For instance, the prevalence of overweight/obesity in five ethnic admixtures—Asian/white, Hawaiian/white, Hawaiian/Asian, Latina/white, and Hawaiian/Asian/white ethnic admixtures—was significantly higher (P < 0.0001) than the average of the prevalence estimates for their component ethnic groups. Discussion: The identification of individuals who have a high‐risk ethnic admixture is important not only to the personal health and well‐being of such individuals, but could also be important to future efforts in order to control the epidemic of obesity in the United States.     

Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users – A Cross-Sectional Study

Background

Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities.

Materials and Methods

The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable.

Results

The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males.

Conclusion

It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.     

Prevalence and Risk Factors of Overweight and Obesity among Children Aged 6–59 Months in Cameroon: A Multistage,Stratified Cluster Sampling Nationwide Survey

Background

Childhood obesity is one of the most serious public health challenges of the 21st century. The prevalence of overweight and obesity among children (<5 years) in Cameroon, based on weight-for-height index, has doubled between 1991 and 2006. This study aimed to determine the prevalence and risk factors of overweight and obesity among children aged 6 months to 5 years in Cameroon in 2011.

Methods

Four thousand five hundred and eighteen children (2205 boys and 2313 girls) aged between 6 to 59 months were sampled in the 2011 Demographic Health Survey (DHS) database. Body Mass Index (BMI) z-scores based on WHO 2006 reference population was chosen to estimate overweight (BMI z-score > 2) and obesity (BMI for age > 3). Regression analyses were performed to investigate risk factors of overweight/obesity.

Results

The prevalence of overweight and obesity was 8% (1.7% for obesity alone). Boys were more affected by overweight than girls with a prevalence of 9.7% and 6.4% respectively. The highest prevalence of overweight was observed in the Grassfield area (including people living in West and North-West regions) (15.3%). Factors that were independently associated with overweight and obesity included: having overweight mother (adjusted odds ratio (aOR) = 1.51; 95% CI 1.15 to 1.97) and obese mother (aOR = 2.19; 95% CI = 155 to 3.07), compared to having normal weight mother; high birth weight (aOR = 1.69; 95% CI 1.24 to 2.28) compared to normal birth weight; male gender (aOR = 1.56; 95% CI 1.24 to 1.95); low birth rank (aOR = 1.35; 95% CI 1.06 to 1.72); being aged between 13–24 months (aOR = 1.81; 95% CI = 1.21 to 2.66) and 25–36 months (aOR = 2.79; 95% CI 1.93 to 4.13) compared to being aged 45 to 49 months; living in the grassfield area (aOR = 2.65; 95% CI = 1.87 to 3.79) compared to living in Forest area. Muslim appeared as a protective factor (aOR = 0.67; 95% CI 0.46 to 0.95).compared to Christian religion.

Conclusion

This study underlines a high prevalence of early childhood overweight with significant disparities between ecological areas of Cameroon. Risk factors of overweight included high maternal BMI, high birth weight, male gender, low birth rank, aged between 13–36 months, and living in the Grassfield area while being Muslim appeared as a protective factor. Preventive strategies should be strengthened especially in Grassfield areas and should focus on sensitization campaigns to reduce overweight and obesity in mothers and on reinforcement of measures such as surveillance of weight gain during antenatal consultation and clinical follow-up of children with high birth weight. Meanwhile, further studies including nutritional characteristics are of great interest to understand the association with religion, child age and ecological area in this age group, and will help in refining preventive strategies against childhood overweight and obesity in Cameroon.     

Short Sleep Duration and Childhood Obesity: Cross-Sectional Analysis in Peru and Patterns in Four Developing Countries

Background

We aimed to describe the patterns of nutritional status and sleep duration in children from Ethiopia, India, Peru and Vietnam; to assess the association between short sleep duration and overweight and obesity, and if this was similar among boys and girls in Peru.

Methods and Findings

Analysis of the Young Lives Study, younger cohort, third round. In Ethiopia there were 1,999 observations, 2,011, 2,052 and 2,000 in India, Peru and Vietnam, respectively. Analyses included participants with complete data for sleep duration, BMI, sex and age; missing data: 5.9% (Ethiopia), 4.1% (India), 6.0% (Peru) and 4.5% (Vietnam). Exposure was sleep duration per day: short (<10 hours) versus regular (10–11 hours). Outcome was overweight and obesity. Multivariable analyses were conducted using a hierarchical approach to assess the effect of variables at different levels. Overweight/obesity prevalence was 0.5%/0.2% (Ethiopia), 1.3%/0.3% (India), 6.1%/2.8% (Vietnam), and 15.8%/5.4% (Peru). Only Peruvian data was considered to explore the association between short sleep duration and overweight and obesity, with 1,929 children, aged 7.9±0.3 years, 50.3% boys. Short and regular sleep duration was 41.6% and 55.6%, respectively. Multivariable models showed that obesity was 64% more prevalent among children with short sleep duration, an estimate that lost significance after controlling for individual- and family-related variables (PR: 1.15; 95%CI: 0.81–1.64). Gender was an effect modifier of the association between short sleep duration and overweight (p = 0.030) but not obesity (p = 0.533): the prevalence ratio was greater than one across all the models for boys, yet it was less than one for girls.

Conclusions

Childhood overweight and obesity have different profiles across developing settings. In a sample of children living in resource-limited settings in Peru there is no association between short sleep duration and obesity; the crude association was slightly attenuated by children-related variables but strongly diminished by family-related variables.     

Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study

Background

Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population.

Methods and Findings

Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%–5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%–1.9%) among various Indian subpopulations over the period 2014–2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5–10.0%) and 2.5% (95% CI 1.0–2.8%) of incident type 2 diabetes from 2014–2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations.

Conclusion

Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations. Please see later in the article for the Editors'' Summary     

Birthplace, years of residence in the United States, and obesity among Mexican-American adults

Objective: To evaluate the association between birthplace (Mexico or U.S.) and obesity in men and women and to analyze the relationship between duration of U.S. residency and prevalence of obesity in Mexican immigrants. Research Methods and Procedures: We used cross‐sectional data from 7503 adults of Mexican descent residing in Harris County, TX, to evaluate the relationships among BMI, birthplace, and years of residency in the U.S., controlling for demographic characteristics, physical activity level, and acculturation level. Results: U.S.‐born adults had an increased risk (between 34% and 65%) of obesity compared with their Mexican‐born counterparts. After controlling for recognized confounders and risk factors, this association was maintained in the highly acculturated only. Among highly acculturated obese U.S.‐born men, 6% of the cases were attributable to the joint effect of birthplace and acculturation; in women, this proportion was 25%. Among Mexican‐born women, there was an increasing trend in mean BMI with increasing duration of residency in the U.S. Compared with immigrants who had lived in the U.S. for <5 years, Mexican‐born women who had resided in the U.S. for ≥15 years had an adjusted BMI mean difference of 2.12 kg/m² (95% confidence interval, 1.53–2.72). Discussion: Mexican‐born men and women have a lower risk of obesity than their U.S.‐born counterparts, but length of U.S. residency among immigrants, especially in women, is directly associated with risk of obesity. Development of culturally specific interventions to prevent obesity in recent immigrants may have an important public health effect in this population.     

Midlife obesity and dementia: Meta‐analysis and adjusted forecast of dementia prevalence in the united states and china

Objective:

Obesity is a risk factor of dementia. Current forecasts of dementia prevalence fail to take the rising obesity prevalence into account.

Design and Methods:

Embase and Medline were searched for observational studies on the association between overweight (BMI 25‐30 kg/m²) or obesity (BMI > 30 kg/m²) and dementia and pooled the effect sizes by meta‐analysis. The population attributable risk (PAR) was calculated for different time points and adjusted them for confounders. Based on current prevalence rates of dementia and demographic forecasts, patient numbers were calculated and adjusted by the growth rates of PAR.

Results:

Compared to normal weight, midlife obesity increases the risk of dementia later in life (BMI 25‐30: RR = 1.34 [95% CI 1.08, 1.66], BMI > 30: RR = 1.91 [1.4, 2.62]). If obesity is included into forecast models, the prevalence of dementia is estimated to be 7.1 million (6.9, 7.3) and 11.3 million (10.9, 11.7) for the United States in 2030 and 2050, respectively. In China, the estimate is 13.1 million (12.8, 13.3) in 2030 and 26.2 million (25.1, 27.4) in 2050. These figures are 9% and 19% higher for the United States and China, respectively, than forecasts that rely solely on the demographic change.

Conclusion:

The past and ongoing increase in midlife obesity prevalence will contribute significantly to the future prevalence of dementia and public health measures to reduce midlife obesity are simultaneously primary prevention measures to reduce the risk of dementia.     

Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic

We projected future prevalence and BMI distribution based on national survey data (National Health and Nutrition Examination Study) collected between 1970s and 2004. Future obesity-related health-care costs for adults were estimated using projected prevalence, Census population projections, and published national estimates of per capita excess health-care costs of obesity/overweight. The objective was to illustrate potential burden of obesity prevalence and health-care costs of obesity and overweight in the United States that would occur if current trends continue. Overweight and obesity prevalence have increased steadily among all US population groups, but with notable differences between groups in annual increase rates. The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46-0.49), and in women than in men (0.91 vs. 0.65). If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. In children, the prevalence of overweight (BMI >/= 95th percentile, 30%) will nearly double by 2030. Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion US dollars by 2030, accounting for 16-18% of total US health-care costs. We continue to move away from the Healthy People 2010 objectives. Timely, dramatic, and effective development and implementation of corrective programs/policies are needed to avoid the otherwise inevitable health and societal consequences implied by our projections .     

Prevalence of obesity and correlations with lifestyle and dietary factors in Chinese men

Objective: To estimate the age‐adjusted prevalence of general and centralized obesity among Chinese men living in urban Shanghai. Methods and Procedures: A cross‐sectional study was conducted in 61,582 Chinese men aged 40–75. BMI (kg/m²) was used to measure overweight (23 ≤ BMI < 27.4) and obesity (BMI ≥ 27.5) based on the World Health Organization (WHO) recommended criteria for Asians. Waist‐to‐hip ratio (WHR) was used to measure moderate (75th ≤ WHR < 90th percentile) and severe (WHR ≥ 90th percentile) centralized obesity. Results: The average BMI and WHR were 23.7 kg/m² and 0.90, respectively. The prevalence of overweight was 48.6% and obesity was 10.5%. The prevalence of general and centralized obesity was higher in men with high income or who were retired, tea drinkers, or nonusers of ginseng than their counterparts. Men with high education had a higher prevalence of overweight and centralized obesity, but had a lower prevalence of obesity and severe centralized obesity compared to those with less education. Current smokers or alcohol drinkers had a lower prevalence of general obesity but higher prevalence of centralized obesity than nonsmokers or nondrinkers of alcohol. Ex‐smokers and ex‐alcohol drinkers had a higher prevalence of general and centralized obesity compared to nonsmokers and nondrinkers of alcohol. Prevalence of obesity was associated with high energy intake and less daily physical activity. Discussion: The prevalence of obesity among Chinese men in urban Shanghai was lower than that observed in Western countries but higher than that in other Asian countries, and the prevalence of general and centralized obesity differed by demographic, lifestyle, and dietary factors.     

Changes in Prevalence of Overweight and in Body Image among Fijian Women between 1989 and 1998**

Objective: To investigate changes in prevalence of overweight and obesity and in body image among ethnic Fijian women in Fiji during a period of rapid social change and the relationship between changes in body image and BMI. Research Methods and Procedures: The study design was a multiwave cohort study of BMI in a traditional Fijian village over a 9.5‐year period from 1989 to 1998. Cohorts were identified in 1989 (n = 53) and in 1998 (n = 50). Selection criteria included Fijian ethnicity, female gender, age of at least 18 years, and residence in a specific coastal Fijian village in 1989 and 1998, respectively. Assessments consisted of measurement of height and weight, collection of demographic data by written survey, and administration of the Nadroga Language Body Image Questionnaire. Results: The prevalence of overweight and obesity was significantly different between the cohorts, increasing from 60% in 1989 to 84% in 1998 (p = 0.014). In addition, the age‐adjusted mean BMI was significantly higher in 1998 compared with 1989 (p = 0.011). Finally, there were significant between‐cohort differences in multiple measures of body image, which were mostly independent of BMI. Discussion: At 84%, the prevalence of overweight and obesity in this community sample of Fijian women is among the highest in the world. The dramatically increased prevalence over the 9.5‐year period studied corresponds with rapid social change in Fiji and significant shifts in prevailing traditional attitudes toward body shape.