This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Obesity has roughly the same association with chronic health conditions as does twenty years' aging; this greatly exceeds the associations of smoking or problem drinking. Utilization effects mirrors the health effects. Obesity is associated with a 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications, compared with a 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications for current smokers and smaller effects for problem drinkers. Nevertheless, the latter two groups have received more consistent attention in recent decades in clinical practice and public health policy. M a n y b e h a v i o r a l r i s k fa c t o r s , chief among them smoking, heavy drinking, and obesity, are known causes of chronic health conditions. Chronic health conditions, like cancer, diabetes, or heart disease, in turn are primary drivers of health care spending, disability, and death. This paper compares the associations of smoking, problem drinking, and obesity with health care use and chronic conditions. All three risk factors are prevalent, although only obesity has dramatically increased over the past twenty-five years. There is an extensive literature of the association of individual risk factors with selected clinical problems. Overall assessments are rare, however, and no direct comparisons of obesity and other risk factors have been reported. Obesity research is also a newcomer in health services and policy research, in contrast to a long tradition of influential work on tobacco and alcohol, starting
The prevalence of clinically severe obesity is increasing at a much faster rate among adults in the USA than is the prevalence of moderate obesity. This is consistent with the public health idea that the population weight distribution is shifting, which disproportionately increases extreme weight categories. Because comorbidities and resulting service use are much higher among severely obese individuals, the widely published trends for overweight/obesity underestimate the consequences for population health. The aggressive and costly expansion of bariatric surgery in recent years has had no visible effect on containing morbid obesity rates in the USA.
Clinically severe or morbid obesity (BMI over 40 or 50) entails far more serious health consequences than moderate obesity for patients and creates additional challenges for providers. The paper provides time trends for extreme weight categories (BMI>40 and >50) until 2010 using data from the Behavioral Risk Factor Surveillance System. Between 2000 and 2010, the prevalence of a BMI over 40 (type III obesity) calculated from self-reported height and weight increased by 70%, the prevalence of BMI over 50 increased even faster. While rates at every point in time are higher among Hispanics and Blacks, there were no significant differences in trends between them or to Non-Hispanic Whites. The growth rate appears to have slowed down since 2005. Adjusting for self-report biases, we estimate that in 2010 15.5 million adult Americans or 6.6 percent of the population had an actual BMI over 40. The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.
DATAR, ASHLESHA, ROLAND STURM, AND JENNIFER L. MAGNABOSCO. Childhood overweight and academic performance: national study of kindergartners and first-graders. Obes Res. 2004;12:58 -68. Objective: To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade. Research Methods and Procedures:The data analyzed consisted of 11,192 first time kindergartners from the Early Childhood Longitudinal Study, a nationally representative sample of kindergartners in the U.S. in 1998. Multivariate regression techniques were used to estimate the independent association of overweight status with children's math and reading standardized test scores in kindergarten and grade 1. We controlled for socioeconomic status, parent-child interaction, birth weight, physical activity, and television watching. Results: Overweight children had significantly lower math and reading test scores compared with nonoverweight children in kindergarten. Both groups were gaining similarly on math and reading test scores, resulting in significantly lower test scores among overweight children at the end of grade 1. However, these differences, except for boys' math scores at baseline (difference ϭ 1.22 points, p ϭ 0.001), became insignificant after including socioeconomic and behavioral variables, indicating that overweight is a marker but not a causal factor. Race/ethnicity and mother's education were stronger predictors of test score gains or levels than overweight status. Discussion: Significant differences in test scores by overweight status at the beginning of kindergarten and the end of grade 1 can be explained by other individual characteristics, including parental education and the home environment. However, overweight is more easily observable by other students compared with socioeconomic characteristics, and its significant (unadjusted) association with worse academic performance can contribute to the stigma of overweight as early as the first years of elementary school.
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