Prevalence Of Extreme Obesity Research Articles

Challenges of Super-Super Obese Patient Presenting for Neurosurgery: A Case-Based Review

AbstractWith the rising prevalence of extreme obesity, their perioperative neurosurgical management demands special attention. We report the case of an acromegalic male with a body mass index as high as 64.12 kg/m2 who presented for craniotomy and resection of a pituitary tumor under general anesthesia. Through this report, we introduce the readers to this newer concept of the highest grade of obesity in the context of neurosurgery, explain the perioperative concerns, and reiterate the need for careful drug dosing, ventilation targets, positioning requirements, thorough cardiac and airway evaluation, and preparedness for adverse events. This report also highlights the fact that a well-planned and managed case can still turn out uneventful in the presence of multiple comorbidities like diabetes mellitus, adrenocortical insufficiency, hypothyroidism, and acromegaly. Advances in airway management, regional anesthesia, and perioperative point-of-care ultrasound have made it possible to formulate a safe anesthetic plan tailored to the patient's needs.

COVID-19 impact on overweight and obesity rates in Aotearoa | New Zealand 4-year-old children

BackgroundCOVID-19 has had profound societal impacts. This study estimated overweight, obesity, and extreme obesity rates in 4-year-old children over pre- and post-COVID-19 periods, and investigated differential changes between sex, ethnic and deprivation groups.MethodsA national screening programme of 4-year-old children undertaking B4 School Checks (B4SCs) between 1 January 2010 and 7 March 2023 was analysed. B4SCs include anthropometric measurements enabling sex-specific body mass index-for-age Z-scores (BMI z-scores) to be derived. Children with ≥85th, ≥95th, and ≥99.7th percentile BMI z-scores were classified as overweight, obese, and extremely obese.ResultsThe eligible sample included 656,038 children (48.8% girls). Overall, 210,492 (32.1%) children were overweight, 95,196 (14.5%) obese, and 19,926 (3.0%) extremely obese. While decreasing in the pre-COVID-19 period, annual prevalence estimates for overweight, obese, and extremely obese significantly (all p < 0.001) increased in the year after COVID-restrictions were implemented. However, after three years, overweight and obese prevalence estimates were no different to pre-COVID levels overall or stratified by sex for ethnicity and deprivation groups. Extreme obesity prevalence estimates also decreased but remained higher than pre-COVID levels.ConclusionThe sharp and steep increases in prevalence estimates all dampened relatively quickly. The question remains whether these rates will continue to decrease in time.ImpactCompared to pre-COVID-19 estimates, the prevalence of overweight, obesity and extreme obesity significantly and substantially increased for 4-year-old children in the immediate post-COVID-19 period.These post-COVID-19 prevalence estimates dampened relatively quickly, returning to pre-COVID-19 rates for overweight and obesity after 3 years.Inequities between ethnic and social deprivation groups in overweight and obesity prevalence estimates remained similar between pre- and post-COVID-19 periods.

Increase of Prevalence of Obesity and Metabolic Syndrome in Children and Adolescents in Korea during the COVID-19 Pandemic: A Cross-Sectional Study Using the KNHANES.

(1) Background: The aim of this study was to evaluate the prevalence of obesity and metabolic syndrome since the COVID-19 pandemic outbreak utilizing representative data on youth aged 2-18 years from the Korean National Health and Nutrition Examination Surveys (KNHANES) conducted in 2019-2020. (2) Methods: The survey consists of three parts: health interviews, health examinations, and nutrition surveys. From the 2019 and 2020 surveys, 1371 (2-9 years = 702 and 10-18 years = 669) and 1124 (2-9 years = 543 and 10-18 years = 581) individuals were included in the analysis. (3) Results: The mean body mass index (BMI) increased significantly among youth aged 2-9 years from 16.53 kg/m2 in 2019 to 17.1 kg/m2 in 2020 (p < 0.01). In youth aged 10-18 years, the BMI was found to increase slightly from 21.25 kg/m2 in 2019 to 21.41 kg/m2 in 2020 (p = 0.64). The increasing prevalence of extreme obesity was significant in girls, especially those aged 2-9 years (p < 0.01). However, extreme obesity had increased in 10-18-year-old boys (p = 0.08). The overall prevalence of metabolic syndrome in adolescents increased from 3.79% to 7.79% during the COVID-19 pandemic (p = 0.01). (4) Conclusions: We observed that the prevalence of obesity and metabolic syndrome among children and adolescents has increased after the COVID-19 outbreak. This is believed to be associated with an increase in the rate of early comorbidities in adulthood. The prevention of the progression of pediatric obesity has recently become an urgent public health concern in Korea.

Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome.

Because of the prevalence of extreme obesity in the United States, there has been an increase in prevalence of obesity hypoventilation syndrome (OHS). There is limited information on the characteristics and pattern of positive airway pressure (PAP) adherence in patients with OHS compared with eucapnic patients with obstructive sleep apnea (OSA). This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence.

Differential Outcomes and Clinical Challenges of NAFLD With Extreme Obesity.

Nonalcoholic fatty liver disease (NAFLD) is closely associated with obesity. The prevalence of extreme obesity, defined as body mass index (BMI) of 50 kg/m2 or higher, is rising more rapidly than overall obesity. We aimed to compare the clinical outcomes and performance of noninvasive fibrosis assessment tools in NAFLD with or without extreme obesity. A retrospective analysis was performed in 304 patients with NAFLD with extreme obesity and compared them to patients with NAFLD with BMI of 40 kg/m2 or less, matched for age, gender, race, and liver fibrosis stage. The mean age of the NAFLD with extreme obesity cohort was 55.9 years, BMI 55 kg/m2, and 49.7% had cirrhosis at initial evaluation. Baseline cirrhosis and coronary artery disease were associated with increased risk of death, and dyslipidemia with decreased risk of mortality. Age, insulin use, hypertension, albumin and platelet count were associated with cirrhosis. Fifteen percent of patients had weight‐loss surgery, but this was not associated with survival or risk of cirrhosis. Of the 850 abdominal ultrasound scans performed in 255 patients, 24.1% were deemed suboptimal for hepatocellular carcinoma screening. The mean NAFLD fibrosis score (NFS) in the extreme obesity cohort, versus a propensity‐matched cohort with BMI of 40 kg/m2 or less, was significantly different for both low fibrosis (F0‐F2) (0.222 vs. −1.682, P < 0.0001) and high fibrosis (F3‐F4) (2.216 vs. 0.557, P < 0.001). Conclusion: NAFLD with extreme obesity is associated with increased risk of liver‐related and overall mortality. Accurate noninvasive assessment of liver fibrosis, low rates of weight loss surgery, and high failure rate of ultrasound were identified as clinical challenges in this population.

Use of Small-Area Estimates to Describe County-Level Geographic Variation in Prevalence of Extreme Obesity Among US Adults

The prevalence of extreme obesity continues to increase among adults in the US, yet there is an absence of subnational estimates and geographic description of extreme obesity. This shortcoming prevents a thorough understanding of the geographic distribution of extreme obesity, which in turn limits the ability of public health agencies and policy makers to target areas with a known higher prevalence. To use small-area estimation to create county-level estimates of extreme obesity in the US and apply spatial methods to identify clusters of high and low prevalence. A cross-sectional analysis was conducted using multilevel regression and poststratification with data from the 2012 Behavioral Risk Factor Surveillance System and the US Census Bureau to create prevalence estimates of county-level extreme obesity (body mass index ≥40 [calculated as weight in kilograms divided by height in meters squared]). Data were included on adults (aged ≥18 years) living in the contiguous US. Analysis was performed from June 4 to December 28, 2018. Multilevel logistic regression models estimated the probability of extreme obesity based on individual-level and area-level characteristics. Census counts were multiplied by these probabilities and summed by county to create county-level prevalence estimates. Moran index values were calculated to assess spatial autocorrelation and identify spatial clusters of hot and cold spots. Estimates of moderate obesity were obtained for comparison. Overall, the weighted prevalence of extreme obesity was 4.0% (95% CI, 3.9%-4.1%) and the prevalence of moderate obesity was 23.7% (95% CI, 23.4%-23.9%). County-level prevalence of extreme obesity ranged from 1.3% (95% CI, 1.3%-1.3%) to 15.7% (95% CI, 15.3%-16.0%). The Pearson correlation coefficient comparing model-predicted estimates with direct estimates was 0.81 (P < .001). The Moran index I score was 0.35 (P < .001), indicating spatial clustering. Significant clusters of high and low prevalence were identified. Hot spots indicating clustering of high prevalence of extreme obesity in several regions, including the Mississippi Delta region and the Southeast, were identified, as well as clusters of low prevalence in the Rocky Mountain region and the Northeast. Substantial geographic variation was identified in the prevalence of extreme obesity; there was considerable county-level variation even in states generally known as having high or low prevalence of obesity. The results suggest that extreme obesity prevalence demonstrates spatial dependence and clustering and may support the need for substate analysis and benefit of disaggregation of obesity by group. Findings from this study can inform local and national policies seeking to identify populations most at risk from very high body mass index.

Heterogeneity in sociodemographic characteristics and cardiovascular risk factors at the initiation of a lifestyle intervention for obesity within Germany: an APV multicenter study on 40,942 children and adolescents

ABSTRACTObjective: The objective of this study is to analyze whether sociodemographic characteristics or cardiovascular risk factors differ in children and adolescents at the beginning of a lifestyle intervention (LI) for obesity within Germany.Methods: A total of 40,942 children and adolescents with German residence from the APV-registry were included. Subjects were assigned to the 16 federal states of Germany according to their postal code. Sociodemographic and cardiovascular risk factors at the beginning of a LI for obesity were compared between the federal states. Logistic models were implemented for the prevalence of extreme obesity, hypertension, dyslipidemia, abnormal carbohydrate metabolism, nonalcoholic fatty liver disease (NAFLD), and treatment modality (inpatient vs. outpatient).Results: Age at the beginning of a LI ranged from 11.5 to 13.5 years. Proportion with a migration background was between 5.8% and 49.7%. Within Germany, extreme obesity in children and adolescents initiating a LI strongly differed between 35.6% and 50.8%. Regional differences were also found for obesity-related risk factors: hypertension (39.0–68.1%), dyslipidemia (24.9–44.6%), NAFLD (9.4–20.4%), abnormal carbohydrate metabolism (0.7–6.2%) (all p < 0.0001). Inpatient treatment varied between 11.2% and 88.2%. Overall, no clear regional pattern was observed.Conclusion: Several factors as individual socioeconomic status, personal attitude, treatment accessibility, or regional differences in reimbursement decisions might have contributed to the disparities.

Overweight, Obesity, and Extreme Obesity Among Mississippi Adults, 2001-2010 and 2011-2015.

IntroductionIn 2015, about 1.5 million adults in Mississippi were overweight or obese. Obesity is associated with increased risk for diabetes and cardiovascular problems. We examined trends in the prevalence of overweight, obesity, and extreme obesity from 2001 through 2010 and 2011 through 2015.MethodsWe used data from the Mississippi Behavioral Risk Factor Surveillance System to analyze trends in the prevalence of overweight, obesity, and extreme obesity among adults from 2001 through 2010 and 2011 through 2015. Joinpoint software was used to examine annual percentage change (APC) in the prevalence of each condition overall and by sex and race.ResultsWe observed a significant decrease in overweight prevalence from 2001 to 2010, both overall (APC, −1.3%) and among men (APC, −2.0%), blacks (APC, −1.0%), and whites (APC, −1.5%), but not among women. The overall prevalence of both obesity (APC, 2.9%) and extreme obesity (APC, 3.6%) increased significantly, and these increases occurred across all subgroups for both obesity (men APC, 3.5%; women APC, 2.5%; blacks APC, 1.9%; and whites APC, 3.8%) and extreme obesity (men APC, 6.7%; women APC, 2.5%; blacks APC, 2.2%; and whites APC, 5.0%). From 2011 to 2015, the only significant change was an increase in the prevalence of extreme obesity among whites (APC, 2.6%).ConclusionThe increasing proportion of adult Mississippians in the 2 highest-risk BMI categories warrants urgent community and clinical obesity interventions. Community-tailored and sustained obesity prevention, treatment, and control programs that include diet and physical activity are needed to address the obesity epidemic.

Trends in the prevalence of extreme obesity among Korean children and adolescents from 2001 to 2014.

We assessed nationwide trends in extreme obesity prevalence and its impact on metabolic syndrome in Korean youth. Data from 19,593 youth (10,271 boys) aged 2-19 were obtained from the Korean National Health and Nutrition Examination Surveys (2001-2014). The prevalence of extreme obesity and the odds ratio of metabolic syndrome were calculated. Questionnaires on body weight perceptions and weight control behaviors were administered. The prevalence of extreme obesity increased significantly among boys (p<0.05). The odds ratios of extreme obesity on metabolic syndrome compared with obesity were 3.781 and 1.979 in boys and girls, respectively. Obese teenage girls with appropriate weight perception attempted to lose weight more frequently than obese teenage boys did. Although the prevalence of childhood obesity in Korea was similar since early 2000s, extreme obesity prevalence has increased, especially among teenage boys. Considering greater morbidity risks, preventing progression to extreme obesity is crucial.

Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014.

Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. Survey period. Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.

Ethical considerations in the treatment of childhood obesity

Rates of obesity in children and adolescents appear to be stabilizing, though the prevalence of extreme obesity in this population remains fairly consistent at 4%. Childhood obesity contributes to serious health complications, such as hypertension, orthopedic problems, hormonal imbalances, and adult obesity. Psychological, as well as social issues are also com- mon comorbid conditions to childhood obesity. Families and health care providers have limited options in regard to treating childhood obesity, some of which come with complications and potentially severe consequences. Currently, though there are no standardized recommendations or guidelines for the treatment of childhood obesity, it is routinely suggested that families and medical practitioners attempt to decrease weight through family-based treatment prior to the prescription of medications or bariatric surgery. Family-based treatment options include therapy, psychoeducation, and lifestyle modification for the entire family, rather than solely focused on the overweight child. Using pharmacotherapy to treat childhood obesity has shown to be effec- tive in decreasing body mass index, along with changes in nutrition and activity. Use of these medications for managing obesity comes with undesirable side effects involving gastrointestinal and cardiovascular systems and raises concerns about malnutrition. Although bariatric surgery has increased over the last several years and has shown some success in the treatment of obesity, minor to severe medical complications have surfaced. Low calcium levels, unexpected pregnan- cies, risk of death postoperation, and the development or resurfacing of psychological disorders, such as binge eating disorder and depression, have occurred after bariatric surgery. The health of the child, efficacy of weight loss alternatives, risks and benefits associated with those choices, and the decision-making ability of minors must all be considered when determining the best treatment option for obese children.

Dynamic model predicting overweight, obesity, and extreme obesity prevalence trends

ObjectiveObesity prevalence in the United States (US) appears to be leveling, but the reasons behind the plateau remain unknown. Mechanistic insights can be provided from a mathematical model. The objective of this study is to model known multiple population parameters associated with changes in body mass index (BMI) classes and to establish conditions under which obesity prevalence will plateau.Design and MethodsA differential equation system was developed that predicts population-wide obesity prevalence trends. The model considers both social and non-social influences on weight gain, incorporates other known parameters affecting obesity trends, and allows for country specific population growth.ResultsThe dynamic model predicts that: obesity prevalence is a function of birth rate and the probability of being born in an obesogenic environment; obesity prevalence will plateau independent of current prevention strategies; and the US prevalence of obesity, overweight, and extreme obesity will plateau by about 2030 at 28%, 32%, and 9%, respectively.ConclusionsThe US prevalence of obesity is stabilizing and will plateau, independent of current preventative strategies. This trend has important implications in accurately evaluating the impact of various anti-obesity strategies aimed at reducing obesity prevalence.

Disparities in Obesity and Related Conditions Among Americans with Disabilities

Despite representing nearly 20% of the U.S. population, individuals with disabilities are invisible in obesity surveillance and intervention efforts. The current study (1) compares obesity and extreme obesity prevalence between Americans with and without disabilities and (2) examines the association between BMI category and weight-related chronic disease risk factors in both groups. In 2012, six waves of data from the National Health and Nutrition Examination Survey (NHANES, 1999-2010) were pooled to compare the prevalence of obesity and extreme obesity between adults (aged ≥20 years, N=31,990) with disabilities (n=11,556) versus without disabilities (n= 20,434). Chronic disease risk factors (blood pressure, lipids, C-reactive protein [CRP], glucose) were compared across weight categories, by disability severity, and disability status. Obesity (41.6%) and extreme obesity (9.3%) prevalence among those with disabilities were significantly higher than they were among those without disabilities (29.2% and 3.9%, respectively). Disability severity and disability status negatively affected nearly all chronic disease risk factors. Additionally, there was a disability-by-weight interaction: people with disabilities at all weight categories were significantly more likely to report being told they had hypertension, high cholesterol, or diabetes and to have been prescribed antihypertensive and lipid-lowering medications. The prevalence of obesity (41.6%) and extreme obesity (9.3%) found in individuals with disabilities is high. When compared to obese adults without disabilities, obese adults with disabilities are more likely to have diabetes, high cholesterol, hypertension, and higher CRP. Thus, the study provides convincing evidence of obesity-related health disparities between Americans with and without disabilities.

Dynamic Model Predicting Overweight, Obesity, and Extreme Obesity Prevalence Trends

ObjectiveTo model known multiple population parameters associated with changes in the prevalence of body mass index (BMI) classes (overweight, obese, and extremely obese) and to establish the necessary conditions under which the prevalence of obesity will eventually plateau.MethodsA six differential equation system was developed that predicts population‐wide obesity prevalence trends. The model considers both social and non‐social influences on weight gain, incorporates other known parameters affecting obesity trends, and allows for country specific population growth. Long‐term obesity trends were calculated after input of parameters specific to the US.ResultsThe dynamic model predicts that the prevalence at which obesity plateaus in a population is primarily a function of birth rate and the probability of being born in an obesogenic environment; that obesity prevalence will eventually plateau independent of current prevention strategies if key population‐specific parameters such as birth rate remain constant; and that the US prevalence of obesity, overweight, and extreme obesity will plateau by about 2030 at 28%, 32%, and 9%, respectively.ConclusionsThe US prevalence of obesity is tapering off and will plateau in less than two decades, independent of current preventative strategies. This trend has important implications in accurately evaluating the impact of various anti‐obesity strategies aimed at reducing the national obesity prevalence.

Trends in the Prevalence of Extreme Obesity Among US Preschool-Aged Children Living in Low-Income Families, 1998-2010

Trends in the Prevalence of Extreme Obesity Among US Preschool-Aged Children Living in Low-Income Families, 1998-2010

Impact of mother tongue and gender on overweight, obesity and extreme obesity in 24,989 Viennese children/adolescents (2–16 years)

The present survey aims at determining the prevalence of extreme obesity (defined as a body mass index (BMI) ≥ 99.5th percentile) for the first time in Austria and at investigating the relationship between weight status and mother tongue in a representative Viennese sample of 24,989 children and adolescents (2-16 years) with a percentage of approximately 46 % of migration background.Directly measured anthropometric data on body weight and height were collected and BMI was calculated. Prevalence of overweight, obesity and extreme obesity was determined for every subgroup according to mother tongue using the German national reference criteria by Kromeyer-Hauschild et al.In this sample, 2.1 % of all children and adolescents had to be classified as being extremely obese. More boys (2.3 %) than girls (1.9 %) suffered from extreme obesity (p = 0.048). Total 1.7 % of children and adolescents with German as their native language, 2.5 % of Turkish native speakers and 2.9 % of children and adolescents with another mother tongue were extremely obese (p ≤ 0.001). The highest prevalence of overweight or obesity was found in Turkish-native-speaking children and adolescents (p ≤ 0.001), whereas the lowest one was found in German-native-speaking children and adolescents (p ≤ 0.001).This large study clearly shows that extreme obesity is a common disease and largely neglected. Apparently, another native language than German, as an indicator for a migration background, may be associated with a substantially higher probability for the development of extreme obesity in Vienna, Austria. Thus, effective preventive measures to overcome obesity are urgently needed.

Sleep-disordered Breathing and Asthma Severity

Research Article| April 01 2012 Sleep-disordered Breathing and Asthma Severity AAP Grand Rounds (2012) 27 (4): 39. https://doi.org/10.1542/gr.27-4-39 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Sleep-disordered Breathing and Asthma Severity. AAP Grand Rounds April 2012; 27 (4): 39. https://doi.org/10.1542/gr.27-4-39 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma, sleep apnea syndromes, obesity Source: Ross KR, Storfer-Isser A, Hart MA, et al. Sleep-disordered breathing is associated with asthma severity in children. J Pediatr. In press; doi: https://doi.org/10.1016/j.jpeds.2011.10.008 Researchers from Case Western Reserve University, Cincinnati Children’s Hospital Medical Center, and Harvard Medical School conducted a prospective observational study of children diagnosed with asthma to assess the relationship of their asthma severity with obesity and sleep-disordered breathing (SDB). Patients diagnosed with asthma by a pediatric pulmonologist were eligible for the project and were recruited sequentially from the asthma clinic at a tertiary medical center and followed for one year. At the one-year follow-up each child was classified as having either severe or mild/moderate asthma. Severe asthma was defined based on required clinical treatment (≥2 hospitalizations, ≥3 treatments with systemic corticosteroids, or ≥3 unscheduled doctor or emergency department visits); diagnostic testing (asthma control test [ACT] score ≤14); or pharmacologic therapy (regular use of high-dose inhaled corticosteroids or every-other-day/daily systemic corticosteroids). Based on body mass index (BMI) at baseline, the children were categorized as normal (BMI <85th percentile), overweight (BMI ≥85th and <95th percentile), obese (BMI ≥95th percentile and <99th percentile), or extremely obese (BMI ≥99th percentile). Sixty (55.6%) of the children were obese or extremely obese. SDB was defined as parent-reported snoring “louder than talking” three or more times per week and an average of three or more desaturations per hour of at least 3% during two nights of oximetry monitoring. A total of 108 children were enrolled in the study. Mean age was 9.1±3.4 years (range 4–18 years), 67.6% (73/108) were male, and 45.4% (49/108) were African American. Thirty-two children (29.6%) had SDB. At the one-year follow-up, 29 children (26.9%) were categorized as having severe asthma and the remaining 79 children (73.1%) as having mild/moderate asthma. Children with severe asthma were more likely to be African American and come from lower income households. BMI z-scores were not associated with asthma severity at follow-up and there was no significant difference in the prevalence of extreme obesity between children with severe and mild/moderate asthma. SDB was more likely among children with severe asthma (55.2% vs 20.3%; P<.01; OR=4.85). Even after adjusting for obesity, gender, and race, children with SDB had 3.62-fold greater odds of having severe asthma (P=.02). The authors conclude that among asthmatics who had received a year of management by a pediatric pulmonologist, SDB is a risk factor for having severe asthma. Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. A 2005 study by some of the same authors of this article found an increased prevalence of asthma in obese children and the possibility that some of this relationship may be explained by SDB.1 In the current study, these children were re-evaluated after 12 months of follow-up. Perhaps somewhat surprisingly in this study, while obesity was not associated with the severity... You do not currently have access to this content.

Obesity and trends in life expectancy.

Background. Increasing levels of obesity over recent decades have been expected to lead to an epidemic of diabetes and a subsequent reduction in life expectancy, but instead all-cause and cardiovascular-specific mortality rates have decreased steadily in most developed countries and life expectancy has increased. Methods. This paper suggests several factors that may be masking the effects of obesity on life expectancy. Results. It is possible that health and life expectancy gains could be even greater if it was not for the increasing prevalence of extreme obesity. It is also possible that the principal impact of obesity is on disability-free life expectancy rather than on life expectancy itself. Conclusion. If the principal impact of obesity were through disability-free life expectancy rather than on life expectancy itself, this would have substantial implications for the health of individuals and the future burden on the health care system.

Neighborhoods, obesity, and diabetes--a randomized social experiment.

The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes. From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(1c)). As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], -8.54 to -0.69), 3.38 percentage points (95% CI, -6.39 to -0.36), and 4.31 percentage points (95% CI, -7.82 to -0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant. The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.).

PS2-23: Prevalence of Extreme Obesity in Southern California

Background and Aims: Specific weight goals and treatment options for extremely obese children and adolescents have been suggested. The objective of this study is to provide current estimates of the prevalence of extreme obesity in a large multiethnic youth cohort. Methods: In a cross-sectional study, measured weight and height were extracted from electronic medical records of 710,949 patients aged 2–19 years (87.8 % of eligible patients) who were enrolled in an integrated prepaid health plan between January 1, 2007 and December 31, 2008. Prevalence of extreme obesity was defined as body mass index [BMI]-for-age =1.2 x 95th percentile according to the sex-specific 2000 Centers for Disease Control and Prevention growth charts or BMI =35 kg/m2. Results: Extreme obesity was observed in 7.3% of boys and 5.5% of girls. The prevalence first peaked at about 10 years of age with a bimodal distribution in girls (second peak at 18 years, P for sex × age interaction = 0.036). The prevalence of extreme obesity varied among ethnic/ racial and age groups with highest prevalence in Hispanic boys (up to 11.2%) and Blacks girls (up to 11.9%). In 12–19 year olds, the prevalence of obesity class 3 (BMI 40–49.9 kg/m2) and class 4 (BMI =50 kg/m2) was 1.8% and 0.2%, respectively, with the highest prevalence in Blacks (3.5%) compared to Whites independent of sex (P = 0.001). Conclusion: Extreme obesity in Southern California youth is a serious issue and frequently observed at relatively young age. The shift towards extreme body weights is likely to cause an enormous burden of adverse health outcomes once these youth grow older.