Statement of New York State Nurses Association by Gail DeMarco, RN, MS, before the Assembly and Senate Standing Committees on Children and Families on Childhood Obesity, June 10, 2003, Albany, New York.
Overweight and obesity have reached epidemic proportions in the United States, among both genders and all population groups. The most recent data (1999), estimated that overweight and obesity affects 61% of adults, 13% of children (age 6-11 years) and 14% of adolescents (age 12-19 years). In the past two decades, adult overweight and obesity have doubled, while adolescent overweight and obesity have tripled. Overweight adolescents have a 70% chance of becoming overweight/obese adults, increased to 80% if one parent is also overweight or obese.
The National Institutes of Health (NIH) adopted use of the Body Mass Index (BMI) for defining overweight and obesity. BMI is a measure of weight in relation to height. It is calculated as weight in pounds divided by the square of the height in inches, multiplied by 703. Studies have shown that BMI is significantly correlated with total body fat content for the majority of individuals. Many organizations, including over 50 scientific and medical organizations, support the NIH guidelines that distinguish between overweight and obesity in adults. A BMI of 30 kg/m² or greater characterizes obesity, whereas a BMI between 25 kg/m² and 29.9 kg/m² identifies an adult who is overweight.
Approximately 300,000 deaths in the United States are currently associated with overweight and obesity. This is compared with 400,000 deaths associated with cigarette smoking. Although obesity-associated deaths occur most frequently in adults, important consequences of excess weight as well as antecedents of adult disease occur in overweight children and adolescents. Obesity is associated with an increased risk of coronary heart disease, hypertension, stroke, type 2 diabetes, several types of cancers (endometrial, colon, kidney, gallbladder, and post menopausal breast cancer), and asthma.
Over the past several decades, we have experienced reduced mortality rates from infectious diseases and an increase in life expectancy. Yet, our successes may be offset by the alarming rise in incidence of overweight and obesity, providing a new set of public health challenges. Type 2 diabetes, high blood lipids, hypertension, and asthma as well as early development of orthopedic problems also occurs with increased frequency in overweight youth. Consequences of childhood overweight are not just physical; there are psychosocial effects, specifically discrimination and social stigmatization that can lead to isolation and depression.
Overweight and obesity and their associated health problems have a substantial economic impact, on both direct and indirect costs. Direct costs are those expenses associated with preventative, diagnostic and treatment services. Indirect costs refer to lost wages because of illness or disability as well as future earnings lost due to premature death resulting from overweight or obesity related conditions. In 2000, the total cost of obesity was estimated to be $117 billion ($61 billion direct and $56 billion indirect). Most of the health related costs associated with obesity have been attributed to type 2 diabetes, coronary artery disease, and hypertension.
Overweight and obesity is clearly preventable and given the dramatic increased incidence among all populations, particularly in children and adolescents, action is needed now. What may be less clear are the most effective strategies to address this public health concern. Some employers have taken the initiative and invested in the wellness of their employees. Sixteen years ago, an Omaha company, Union Pacific Railroad (UP) opened an 8,000 square foot gym at their headquarters. They offered everything from treadmills to advice from exercise specialists. Later, contracts were established with other gyms to expand access. In spite of these efforts, from 1995 2001 the percentage of obese UP employees rose from 40% to 52%. UP believes they couldnt insulate their employees from the temptations of the environment the fast food. They also identified resisters. Marketing studies have shown that 10-20% of any group are resisters. They have since doubled their efforts, referring employees to weight reduction programs. Its too soon to determine the success of these additional steps. UPs experience suggests that like many public health concerns, a multifaceted approach would be most effective.
Currently, research suggests that both environmental and behavioral factors are large contributors to overweight and obesity, although more extensive data and experience is needed. There is a need to promote:
The New York State Nurses Association believes the health care community is in a critical position to affect change. Since many interact with the health care system at least annually, health care providers have the opportunity to identify those at risk for becoming overweight. Health care providers are in a pivotal position to provide prevention education and individualized counseling in nutrition and exercise treatment techniques when overweight and obesity are identified. To fully realize medically necessary weight management programs, mechanisms are needed that will partially or fully reimburse for health care monitoring and counseling.
Since there is still a large number of people who do not access the health care system routinely and/or do so only when experiencing a health crisis, partnerships between health care providers, schools and faith-based groups and community organizations must be encouraged and supported.
Although individual choices and actions lie at the foundation of the solution, organizations, industry and government need to work together to promote an environment in which healthy dietary and physical options are readily accessible.
For more information, contact Governmental Affairs at 518.782.9400, ext. 283 or by e-mail.