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In the past 25 years, obesity and diabetes mellitus have overtaken cigarette smoking, dyslipidemia, and hypertension as risk factors for coronary heart disease. Data from a Centers for Disease Control and Prevention (CDC) survey of 50 states revealed that, in 2000, the prevalence of obesity among US adults was approximately 20%, a 61% increase from the 1991 prevalence rate. Currently, most adults (> or =56%) are overweight, approximately 1 in 5 is obese, and 7.3% have diabetes. Overweight and obesity increase the risk for hospitalization and death from cardiovascular disease (CVD) and type 2 diabetes at all levels of risk and independently of other risk factors. In particular, abdominal obesity (assessed indirectly by measuring waist circumference) may be associated with clustering of cardiovascular and metabolic risk factors (i.e., hypertriglyceridemia, low high-density lipoprotein [HDL] cholesterol levels, high blood pressure, and elevated levels of fasting glucose) known as the metabolic syndrome. Patients with even minimal abnormalities in any 3 of the 5 risk factors for the metabolic syndrome are at heightened risk for CVD or diabetes. It is estimated that 47 million US adults, 25% of the population, have > or =3 metabolic syndrome components. Abdominal obesity is the most common, followed by low HDL cholesterol levels, high blood pressure, and high levels of triglycerides. The risk for disease increases over time as the number of metabolic syndrome characteristics accumulates; therefore, early intervention is warranted. Given the prevalence and potentially deadly consequences of the metabolic syndrome, it is imperative for physicians to recognize the presence of these risk factors in their patients and to familiarize themselves with the recommended treatment strategies.
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PMID:Multiple risk factors for cardiovascular disease and diabetes mellitus. 1732 May 20

In 2005, more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese. Both Blacks and Hispanics in the state are more likely than whites to be both overweight and obese, whereas Asians are the least likely to be overweight or obese. Nationally, rates of overweight and obesity are even higher. Obesity is a risk factor for multiple serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, stroke, diabetes, muscle and bone disorders and gallbladder disease. In Massachusetts, it is estimated that direct costs for obesity-related medical expenditures came to a total of $1.8 billion (4.7% of total medical expenditures) in 2003. Medical expenditures for obese people are estimated to be 25-27% higher than normal weight people, and 44% higher among people who are very obese. Costs are largely attributed to higher rates of coronary heart disease, hypertension and diabetes, and longer hospital stays. Indirect costs associated with obesity approached $3.9 billion in 1995 reflecting 39.2 million lost workdays, 239 million restricted activity days, 89.5 million hospital bed-days, and 62.6 million physician visits. Causes of obesity include the wide availability of unhealthy foods, increased consumption, changing eating habits, high-calorie beverages, advertising and lack of physical activity. Although a number federal, state and local programs, policies and initiatives aimed at curbing the obesity epidemic have been implemented, more needs to be done. What is the responsibility of government in curbing the obesity epidemic, and how much of the burden should be left up to the individual? These important questions will be discussed at the Massachusetts Health Policy Forum on January 23, 2007. Overweight and obesity continue to climb steadily in the United States among both adults and children, increasing the risk for a host of physical, psychosocial and economic problems. This paper details the issues associated with being overweight or obese, with a focus on Massachusetts. The discussion begins with a general description and definition of this public health epidemic. Next, an examination of factors that contribute to overweight and obesity and associated costs to individuals, families and society is given, followed by a discussion of programs and policy options, both nationally and in the Commonwealth that are aimed at addressing this crisis.
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PMID:Overweight and obesity in Massachusetts: epidemic, hype or policy opportunity? 1732 23

A cross-sectional study was undertaken to determine the prevalence of overweight and obesity among 431 Bengalee schoolgirls aged 6-9 years in Kolkata, India. Anthropometric measurements of height and weight were made on 431 girls. The body mass index (BMI) was computed following the standard equation. Overweight and obesity was defined following the internationally accepted BMI cut-off points. Results revealed that the overall rates of overweight and obesity were 17.63% and 5.10%, respectively. A steady increase in number of overweight individuals was observed from 6 to 9 years. The prevalence of overweight among affluent Bengalee children was higher than those reported from other Asian countries.
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PMID:Overweight and obesity among affluent Bengalee schoolgirls of Lake Town, Kolkata, India. 1735 46

Overweight and obesity increases risks for many diseases, while treating them is expensive. Trends in the prevalence of overweight and obesity over the last two decades indicate the need for urgent interventions. Several different kinds of interventions could modify the obesogenic environment. The aim of this study was to map which policy options will be acceptable and effective in Hungary. Interviews were conducted with 21 stakeholders representing a wide range of viewpoints to evaluate seven core and 13 discretionary policy options under different criteria. The 21 Hungarian participants used 92 appraisal criteria covering a wide range of issues. Efficacy, practical feasibility, social acceptability and societal benefits were widely judged more important than the costs of measures. Significant additional social and health benefits were anticipated from changes in transport and planning policies, but the cost to the public sector was considered high and the implementation difficult. There was broad support for changes in patterns of food consumption and levels of physical activity. There was a consensus that without developing the attitudes of individuals to be more responsible for their health, environmental changes alone would not be enough to reverse the trend of the growing prevalence of obesity.
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PMID:Stakeholder appraisal of policy options for responding to obesity in Hungary. 1737 10

Overweight and obesity are an increasing problem: worldwide, for Germany and for children and adolescents. Until now there have been no representative and age-specific assessments of the prevalence of obesity among children and adolescents in Germany. Thus, the standardised height and weight measurements gathered in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) have, for the first time, provided national, representative data about overweight and obesity in young people. The terms 'overweight' and 'obese' are defined based on percentiles of the body mass index (BMI) of the Kromeyer-Hauschild reference system. Of children and adolescents between the ages of 3 and 17, 15% exceed the 90th BMI percentile of the reference data and are thus overweight, 6.3% exceed the 97th BMI percentile and thus suffer from obesity by this definition. The proportion of overweight rises from 9% of 3-6-year-olds to 15% of 7-10-year-olds and 17% of 14-17-year-olds. The prevalence of obesity is 2.9%, 6.4% and 8.5% for the same age groups respectively. No clear differences between boys and girls or between East and West Germany are detected. Children are at a higher risk of being overweight or obese if they have a lower socioeconomic status, have a migration background, or have mothers who are also overweight.
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PMID:[The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. 1751 58

In a population-based case-control study we assessed the association between obesity and acute ischaemic/non-embolic stroke. A total of 163 patients aged older than 70 years (88 men and 75 women) admitted due to a first-ever-in-a-lifetime acute ischaemic/non-embolic stroke and 166 volunteers (87 men and 79 women) without a history of cardiovascular disease were included. The association of stroke with body mass index (BMI) or waist circumference (WC) was determined by multivariate logistic regression modelling after adjusting for potential confounding factors. Overweight and obesity were more prevalent amongst stroke patients compared to controls. Subjects with a BMI > or = 30 kg/m2 had 2.5-times higher odds to suffer an acute ischaemic/non-embolic stroke compared to subjects within the lowest BMI category of 18.5-20.9 kg/m2. Analysis of interaction showed that in the presence of overweight and/or obesity (classified as a BMI > or = 25 kg/m2 and/or a WC > 102 cm in men and > 88 cm in women) the inverse relationship between HDL cholesterol and ischaemic/non-embolic stroke was negated. Excess weight is associated with an increased risk of acute ischaemic/non-embolic stroke in elderly individuals independently of concurrent metabolic derangements. Moreover, in the presence of obesity, HDL cholesterol loses its protective effect against ischaemic stroke.
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PMID:Excess body weight and risk of first-ever acute ischaemic non-embolic stroke in elderly subjects. 1759 32

This cross-sectional study assessed the prevalence of malnutrition and several metabolic risk factors for cardiovascular disease in 287 apparently healthy older adults from Northwest Mexico. Also, the impact of overweight and obesity on metabolic risk factors was assessed. Nutritional status was determined using serum albumin levels and anthropometry. Vitamin status was also assessed. Metabolic risk factors for cardiovascular disease were evaluated. The prevalence of undernutrition was 15.3%. Also, vitamin E deficiency was common (18%). On the contrary, 44.9% of men and women were in overweight and 24% were obese. A 50.9% of the older adults had hypertension, 52.6% hypercholesterolemia (HC), 38.3% hypertriglyceridemia (HTG), 26.1% impaired fasting glucose and 26.1% impaired glucose tolerance (IGT). HC and low-density-lipoprotein-cholesterol (LDL-C) were significantly more prevalent in women than in men. Mean adjusted values of fasting glucose, high-density-lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C ratio > or = 5, triglycerides (TG) and diastolic blood pressure (DBP) were significantly higher in subjects with body mass index (BMI) > or = 25.0 kg/m(2). Undernutrition, obesity and vitamin E deficiency, as well as several metabolic risk factors for cardiovascular disease coexisted in this studied group. Overweight and obesity were the most prevalent findings. BMI > or = 25 kg/m(2) was the common factor explaining most of the metabolic abnormalities. However, due to the sample size and the design of the study, the results must be seen with caution and cannot be generalized.
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PMID:Prevalence of malnutrition and associated metabolic risk factors for cardiovascular disease in older adults from Northwest Mexico. 1759 34

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.
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PMID:[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. 1765 8

The purpose of this study was to evaluate secular change in the prevalence of overweight and obesity in a rural Zapotec Indian community in southern Mexico between 1968 and 2000. Cross-sectional surveys of children 6-13 years, adolescents 13-17 years, and adults 19 years of age and older resident in a rural community in Oaxaca were conducted in 1968/1971, 1978, and 2000. Individuals present in the 1968, 1978, and 2000 surveys provided a small longitudinal component. Height and weight were measured; the BMI was calculated. International criteria for overweight and obesity were used. Overweight and obesity were virtually absent in school children 6-13 years in 1968 and 1978 and in adolescents in 1978. Small proportions of children (boys, 5%; girls, 8%) and adolescents (boys, 3%; girls, 15%) were overweight in 2000; two children (1%) and no adolescents were obese. Among adults, 7% of males and 19% of females were overweight and <1% of males and 4% of females were obese in 1971/1978, but 46% of males and 47% of females were overweight; and 5% of males and 14% of females were obese in 2000. The trends for children, adolescents, and adults were confirmed in the longitudinal subsamples. In conclusion, overweight and obesity are not presently a major problem in children and adolescents in this rural Zapotec community. Overweight, in particular, and to a lesser extent obesity have increased in prevalence among adults since the late 1970s. The results suggest adulthood as a critical period for onset of overweight and obesity in this sample.
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PMID:Overweight and obesity in a rural Amerindian population in Oaxaca, Southern Mexico, 1968-2000. 1766 49

Overweight and obesity in children present significant public health concerns because of the link with numerous chronic health conditions, especially type 2 diabetes and cardiovascular disease. Perhaps obesity is only the visible pointer of other underlying risk factors for these disease conditions in childhood. Although an imbalance between energy consumed and expended appears to be the simplistic underlying problem for the increased prevalence of obesity, it is a complex condition, with various contributing factors, and may be considered the metabolic factory for various risk factors for cardiovascular disease, both modifiable and nonmodifiable. It has also been recognized that the risk factors emerge quite early in the clinical course of obesity. Physical activity-based lifestyle change appears to be the most variable component of energy expenditure and therefore has been the obvious choice and the target of behavioral interventions to modify body weight in children. This review focuses on the obesity-related nontraditional risk factors for cardiovascular disease in children and the role of lifestyle changes in modulating these risk factors.
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PMID:Obesity-related cardiovascular risk in children and the role of lifestyle changes. 1767 6

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