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Childhood obesity: A call for help in the battle of the bulge

Beech, Bettina M. DrPH, MPH

Journal of the American Academy of PAs: January 2013 - Volume 26 - Issue 1 - p 10–11
COMMENTARY
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Bettina M. Beech, DrPH, MPH, is a professor in the Department of Social Sciences and Health Policy, with secondary appointments in the Departments of Pediatrics and Internal Medicine, at Wake Forest School of Medicine. She is also the co-director of the Maya Angelou Center for Health Equity.

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To view the references and link to the Pediatrics guidelines, please see the online version of this article at http://www.jaapa.com

Unless you have recently taken a long vacation to some remote part of the world, the obesity epidemic is not headline news to you. In fact, you may even be familiar with the often quoted statistics that more than 30% of adults and 17% of adolescents in the United States are overweight or obese.1,2 No doubt you are aware that even higher obesity prevalence rates exist among racial/ethnic minorities, with Hispanic males and African American females overrepresented among overweight adults.1 Quite likely, it goes without saying that numerous comorbidities such as cancer, cardiovascular disease, and type 2 diabetes are strongly associated with obesity.3 Of course, you are aware that obesity costs now exceed $190 billion annually and represent 21% of US health care costs.4 You have heard it all before, right? So what is new?

Despite the figures presented above, the enormity and fullrange impact of obesity are typically less well-known. For example, many hospitals are replacing wall-mounted toilets with floor-mounted commodes to provide additional support for obese patients. The Federal Transit Administration plans to test public buses for the impact of heavier riders on steering and brake systems. Airlines now have to provide seat-belt extenders on all flights. The National Highway and Transportation Safety Administration (NHTSA) has proposed new requirements for car seat manufacturers to produce safety seats that accommodate the growing number of overweight and obese toddlers; finding safe car seats would be a challenge for nearly 300,000 children 1 to 6 years of age because of their age and weight.5

As of February 2012, the Pentagon has deemed childhood obesity to be a threat to our national security. A recent national report “Ready, Willing and Unable to Serve” documents that approximately 15,000 potential military recruits fail their entrance physicals annually because of their weight status and that 27% of young adults are unqualified for military service because of their weight.6 More than 100 retired generals and admirals signed onto this report and a campaign entitled: Mission: Readiness. A second report from Mission: Readiness questions the quality of food in schools. This report provides three main recommendations to Congress: 1) remove junk food and high-calorie beverages from schools; 2) increase funding for the school lunch program; and 3) support the development, testing, and deployment of proven public health interventions.7

So what does all of this have to do with PAs? In a word, plenty! Several articles and editorials have encouraged PAs to “Join the Battle Against Obesity.”8-11 PAs are in a strong position to address the obesity epidemic in the context of patient care, advocacy, and community involvement. Weight gain prevention and treatment counseling delivered by health care providers can have a powerful positive impact on behavior change, yet there is a dearth of clinical intervention studies.

In 2007, an expert committee conducted an extensive review of the obesity prevention and treatment literature and developed a set of recommendations.12 Prevention recommendations include approaches to patient counseling for healthy eating and physical activity. Avenues to address assessment include methods to screen patients for current medical conditions and future risks, as well as methods to evaluate diet and physical activity behaviors. Last, treatment recommendations include a four-stage model of obesity care. These guidelines provide a “treatment roadmap” for patient care, particularly in the context of the significant social and environmental influences on the development and maintenance of obesity.

PAs can also advocate for local, state, and federal policies that support healthy eating, physical activity, and healthy environments. Organizations such as the National Initiative for Children's Healthcare Quality (NICHQ) have launched efforts to mobilize health care professionals to combat the obesity epidemic through supporting the development and implementation of advocacy plans.13 Similarly, NICHQ has developed tools to support partnerships between communitybased organizations and health care professionals (http://nichq.org/advocacy/obesity_resources). The “Community-Based Organizations and Healthcare Professional Partnership Guidebook” provides valuable and practical information regarding forming and maintaining effective partnerships to create healthy communities and tools for community assessments. These tools can be invaluable for PAs interested in making a positive difference in their areas.

The obesity problem is not new, but the prevalence rates remain unacceptably high and the impact of this public health epidemic is being felt in multiple arenas. The ultimate control of overweight and obesity among youth will require multiple interventions society-wide in order to provide cumulative and synergistic effects that can reduce the current trends. PAs can play a critical role in finding solutions to this global problem. JAAPA

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REFERENCES

1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235-241.
2. Ogden CL, Carroll MD, Kit BL, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief. 2012(82).
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5. Trifiletti LB, Shields W, Bashai D, et al. Tipping the scales: obese children and child safety seats. Pediatrics. 2006;117(4):1197-1202.
6. Too Fat to Fight: Retired Military Leaders Want Junk Food Out of America's Schools. A Report by Mission: Readiness. Military Leaders for Kids. http://cdn.missionreadiness.org/MR_Too_Fat_to_Fight-1.pdf. Accessed December 20, 2012.
7. Ready, Willing, and Unable to Serve. A Report by Mission: Readiness. Military Leaders for Kids. http://cdn.missionreadiness.org/MR-Ready-Willing-Unable.pdf. Accessed December 20, 2012.
8. Curtis LG. Join the battle against obesity. JAAPA. 2004;17(4):9-11.
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10. Hines SE. Words into action-promoting successful weight loss in overweight patients. JAAPA. 2004;17(4):19-28.
11. Wright C. A US epidemic: childhood obesity. J Physician Asst Educ. 2010;21(2)39-41.
12. Barlow S and the Expert Committee. Expert committee recommendation in the prevention, assessment, and treatment of child and adolescent overweight and obesity. Pediatrics. 2007;120:S164.
13. National Initiative for Children's Healthcare Quality (NICHQ). Community-based organizations and health care professional partnership guide: Reversing the trend of childhood obesity. Robert Wood Johnson Foundation. http://www.nichq.org/advocacy/obesity_resources/CMAF_Guide%20for%20CBOs%20to%20work%20with%20HCPs.pdf. Accessed December 20, 2012.
© 2013 American Academy of Physician Assistants.