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Childhood obesity

Childhood obesity continues to rise in the US despite efforts

The prevalence of severe obesity accounted for the sharpest rise from the previous reporting period

The alarming increase in US childhood obesity rates that began nearly 30 years ago continues unabated, with the biggest increases in severe obesity, according to a study led by a Duke Clinical Research Institute scientist. The paper, ‘Prevalence of obesity and severe obesity in US children, 1999-2014’, published in the journal Obesity, analysed data from the National Health and Nutritional Examination Survey, a large, ongoing compilation of health information that has spanned decades.

They found that for 2013-2014, 33.4 percent of children between the ages of 2 through 19 were overweight. Among those, 17.4 percent had obesity, which includes a range from the lower end of the designation criteria to the higher end. These rates were not statistically different than those from the previous reporting period of 2011-2012. Across all categories of obesity, a clear, statistically significant increase continued from 1999 through 2014.

"Despite some other recent reports, we found no indication of a decline in obesity prevalence in the United States in any group of children aged 2 through 19," said lead author, Dr Asheley Skinner, associate professor at Duke, who also worked with colleagues from the University of North Carolina at Chapel Hill and Wake Forest University. "This is particularly true with severe obesity, which remains high, especially among adolescents. Most disheartening is the increase in severe obesity.”

The prevalence of severe obesity accounted for the sharpest rise from the previous reporting period. Among all overweight youngsters in the 2012-14 reporting period, 6.3 percent had a BMI>35. Another 2.4 percent of those had severe obesity. For the previous reporting period, 5.9 percent of youngsters had class II obesity, and 2.1 percent of those were at class III levels.

Prevalence of childhood obesity, 1999-2014 (Credit: Mark Dubowski for Duke Health)

“The 4.5 million children and adolescents with severe obesity will require novel and intensive efforts for long-term obesity improvement. With scarce resources, and increasing costs of comorbid conditions, there is an urgent need for targeted interventions to stem the rise in severe obesity among children, in addition to policies and clinical efforts designed to prevent obesity,” the authors conclude. “Policy efforts are yet to yield substantive changes in obesity prevalence, but few have specifically targeted severe obesity. Unfortunately, many clinical interventions are limited in their success, and limited availability and costs prevent widespread use of those that are effective. Coordinated efforts, through integration of clinical and community systems, and supported by policies addressing population-level and individual needs, are necessary to address a complex, recalcitrant problem.”

Dr Sarah Armstrong, a paediatrician and director of the Duke Healthy Lifestyles Program who was not involved in the study, said the population-wide findings in the study are consistent with what she sees in her clinical practice. While families are more attuned to the health effects of obesity, she said, reversing the problem is as difficult one-on-one as it is nationally.

"Certainly progress has been made in addressing the issue in our country," she said. "But this study highlights that we may need to be more disruptive in our thinking about how we change the environment around children if we really want to see that statistic move on a national scale."

Skinner said the study has limitations, relying on two-year data that provides a snapshot in time across a wide population. But she said the NHANES database is a broader source than those used in studies that found declines in obesity rates among smaller or segmented populations.

"We don't want the findings to cause people to become frustrated and disheartened," she added. "This is really a population health problem that will require changes across the board - food policy, access to health care, school curriculums that include physical education, community and local resources in parks and sidewalks. A lot of things put together can work."

To access this paper, please click here

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