A Demographic Profile of Obesity in the Adult and Veteran US Populations in 2008

Obesity is increasing in the US population and seems to be disproportionately burdening disadvantaged groups. Veterans using the Veterans Healthcare System (VHS) tend to be more disadvantaged socioeconomically than the general population and in poorer health. It is important to understand how the veteran population differs from or is similar to the general population and whether the VHS is able to mediate obesity risk among veterans. This research assesses the sociodemographic, behavioral, and health risk factors for obesity in the US adult and veteran populations in 2008. We use data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to empirically assess predictors of obesity risk. We find that women have lower odds of obesity than men once controls for sociodemographic, behavioral, and health conditions are included in our models. We also observe a veteran obesity disadvantage in the full adult sample when conducting bivariate tests, but no significant association with the odds of obesity in the logistic regression models among veterans and non-veterans. Gender specific models indicate that male veterans have increased odds of obesity compared to non-veterans, but no difference in obesity risks among veterans and non-veterans are noted for women, controlling for all variables. Further, we find no significant differences in the odds of obesity of veterans using VHS for all, some, or none of their health care needs; further no significant gender differences in obesity risk were observed among VHS usages and non-users. Based on the strong, positive association between the number of chronic health conditions and the odds of obesity, we suggest that health policy should focus efforts on weight management counseling for obese patients that have obesity related co-morbidities, and more targeted attention to male veterans would help to address the high level of obesity in this vulnerable population group.     

Trends in health of older adults in the United States: Past,present, future

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.     

Mortality attributable to obesity among middle-aged adults in the united states

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992–2004). Although class II/III obesity (BMI _ 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI _ 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.     

The Implications of Change in Population Size,Distribution, and Composition on the Number of Overweight and Obese Adults and the Direct and Indirect Cost Associated with Overweight and Obese Adults in Texas Through 2040

Changes in population characteristics are associated with changes in the prevalence of physical and related health conditions with alternative types of population change leading to change in the prevalence of certain conditions. Examination of the effects of future demographic change on such conditions is, in turn, critical for understanding the future need for various types of health-related facilities and services. This article provides an example of how future demographic changes are likely to impact overweight and obese status in Texas, a rapidly growing and diversifying state. Specifically it uses population decomposition techniques to examine the relative impacts of population growth, aging and changes in the racial/ethnic composition of the population on increases in the prevalence and related costs of overweight and obesity in Texas, an important input for the formulation of statewide health policies. The number of overweight adults in Texas is projected to increase from 5.5 million in 2000 to 16.0 million in 2040, and the number of obese adults to increase from 3.5 million in 2000 to 14.6 million in 2040. The largest projected increases occur among Hispanics and other minority populations and for all race/ethnicity groups the increases are largest among those who are 65 years of age and older. Decomposition analysis indicates that of the projected increase of 10.5 million overweight adults from 2000 to 2040, 54.0% is attributable to population increase, 15.0% to change in age distribution, and 31.0% to change in racial/ethnic composition. Of the projected increase in the number of obese adults, 61.6% is due to population change and 38.4% to change in racial/ethnic composition. The annual costs associated with overweight and obesity prevalence are expected to increase from $10.5 billion in 2000 to $10.5 billion in 2000 to 40.3 billion in 2040. The results suggest that services to address these conditions will need to be widely dispersed across the state with particular concentrations of the elderly, Hispanics, and Other minority populations.     

Obesity and breastfeeding: The strength of association

Obesity and attendant co-morbidities are an emergent problem in public health. Much attention has focused on prevention, especially during the perinatal period. Breastfeeding is considered a possible protective factor for obesity in childhood, influencing gene–neuroendocrine–environment–lifestyle interaction. Therefore, breastfeeding and its longer duration are probably associated with lower development of childhood obesity. Through human milk, but not formula, the child assumes greater bioactive factors contributing to immunological, endocrine, development, neural and psychological benefits. Contrarily, other studies did not confirm a critical role of breast milk. Confounding factors, especially maternal pre-pregnancy overweight, may influence breastfeeding effects. This review summarises what is known about the possible relationship between breastfeeding and prevention of obesity development.ConclusionBreastfeeding appears to represent a protective factor for obesity in childhood, although evidence is still controversial and underlying mechanisms unclear. Further research is needed to improve knowledge on overweight/obesity and breastfeeding.     

The effects of race,ethnicity, and age on obesity

About 30% of Americans are obese, which is roughly a 100% increase from 25 years ago. This study examines the effects of changes in the racial/ethnic composition and age distribution on the prevalence of obesity, identifies the portion of the increase in obesity caused by these changes, and projects the effects of future racial/ethnic and age changes on obesity using National Health and Nutrition Examination Survey data. Results indicate that racial/ethnic composition changes and age distribution changes have accounted for about 10% of the increase in obesity over the last 25 years. However, future racial/ethnic and age changes are not projected to increase obesity substantially.      

Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

BackgroundObesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity.AimConduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity.MethodsA keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence.FindingsTen articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5–9 kg in women with class I obesity, 1 to less than 5 kg for class II obesity and no gestational weight gain for women with class III obesity.ConclusionsGestational weight gain guidelines may need modification for severity of obesity.     

Television Viewing by School-Age Children: Associations with Physical Activity,Snack Food Consumption and Unhealthy Weight

Alarm about the increasing prevalence of childhood obesity has focussed attention on individual lifestyle behaviours that may contribute to unhealthy weight. Television viewing is often a focus of the obesity debate. Not only is it sedentary, it also has the potential to influence other lifestyle behaviours either by displacing physical activities or through the consumption of high energy snack foods while watching TV. The research reported here uses data from 2,143 Australian 6–7 year children to examine the lifestyle behaviours associated with excess weight. These children spent 90 min each day watching television, 100 min each day in physical activity, and 39% consumed high levels of snack foods. Nearly one in five (18%) were overweight or obese. After adjustment for family and child characteristics, more time spent watching television was associated with more snacking and less physical activity. However, television viewing was associated with children’s weight status, but snacking and physical activities were not. These findings confirm the existence from a young age, of a cluster of lifestyle behaviours that are associated with unhealthy weight status.     

What are the experiences of women with obesity receiving antenatal maternity care? A scoping review of qualitative evidence

ProblemObesity is a major public health problem and is rising in prevalence in child-bearing women. The complications of pregnancy in women with obesity are well documented. Pregnant women with obesity require different maternity care considerations to normal weight women. How women respond to the care of health professionals, determines how likely they will be to engage with it, and thus research into the current care experiences of women with obesity is valuable.ObjectiveThe purpose of this scoping review was to examine the evidence of the antenatal maternity care experiences of women with obesity (BMI ≥ 30 kg/m²).MethodA systematic literature search was conducted for English language publications 2008–2018 using Medline, Scopus, PsycINFO and CINAHL. Following critical appraisal, and a search of the reference lists of primary articles, 17 articles resulted for this review. A thematic synthesis process was used to collate the findings.FindingsFour major themes were identified: 1) inconsistent or absent information regarding weight management, 2) the stigma and stereotyping associated with their obesity, 3) medicalisation and depersonalisation of pregnant women with obesity, and 4) a desire for information and need for change.ConclusionThe findings suggested that based on women’s experiences there is a need for improved education and communication for health care professionals when caring for pregnant women with obesity. Some conflicting information from women in the studies highlight the need for further research in the area, and the implementation of individualised care and continuity of care for pregnant women with obesity.     

Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

Disease prevalence,disease incidence,and mortality in the United States and in England

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55–64 and 70–80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factor’s (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55–64 in both countries and a significant part among Americans 70–80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.     

One Size May Not Fit All: How Obesity Among Mexican-Origin Youth Varies by Generation,Gender, and Age

Immigrants’ health (dis)advantages are increasingly recognized as not being uniform, leading to calls for studies investigating whether immigrant health outcomes are dependent on factors that exacerbate health risks. We answer this call, considering an outcome with competing evidence about immigrants’ vulnerability versus risk: childhood obesity. More specifically, we investigate obesity among three generations of Mexican-origin youth relative to one another and to U.S.-born whites. We posit that risk is dependent on the intersection of generational status, gender, and age, which all influence exposure to U.S. society and weight concerns. Analyses of National Health and Nutrition Examination Studies (NHANES) data suggest that accounting for ethnicity and generation alone misses considerable gender and age heterogeneity in childhood obesity among Mexican-origin and white youth. For example, second-generation boys are vulnerable to obesity, but the odds of obesity for first-generation girls are low and on par with those of white girls. Findings also indicate that age moderates ethnic/generational differences in obesity among boys but not among girls. Overall, ethnic/generational patterns of childhood obesity do not conform to a “one size fits all” theory of immigrant health (dis)advantage, leading us to join calls for more research considering how immigrants’ characteristics and contexts differentially shape vulnerability to disease and death.     

Developing a clinical care pathway for obese pregnant women: A quality improvement project

ProblemObesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥30 kg/m², defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted.AimTo plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI ≥ 35 kg/m² at their first antenatal visit.Project settingThe project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia.SubjectsEighty-two women with a BMI ≥ 35 kg/m² were eligible for the alternative care pathway, offered between January and December 2010.InterventionThe alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation.FindingsDespite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening.     

Some roots of preference: Roles,activities and familial values

This paper examines some of the connecting links between modernization in a developing society, particularly urbanization and increased education for women, and preferences for number of children. Using 1973 Taiwan data, preferences for smaller families are found to be consistently related to modern attitudes and behavior in the three domains examined: intrafamilial husband-wife role relationships, extrafamilial activities of the wife, and familial and religious values relating the family to the larger institutional setting. Modernization of these attitudes, behaviors, and values has an impact on reproductive goals independent of their association with structural variables. The wife's outside activities and exposure to modern influences through the mass media are especially important linkages, having a particularly strong mediating effect in the education effect on preferences. Intrafamilial relations appear to be of less importance. Modernization of familial and religious values mediates between urbanization and family size preferences. The measure of preference used is a scale value which has been found in other research to be more predictive of reproductive behavior than the conventional single-valued statement of number of children wanted. As the level of contraceptive use rises in developing societies, family size preferences increasingly become a factor in birth rates, and understanding the sources of change in these preferences takes on added importance. The policy implications of these findings are discussed.     

Trends in Functional and Activity Limitations among Chinese Oldest‐Old, 1998 to 2008

China has the world's largest oldest‐old population, but information on trends in late‐life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.     

Addressing obesity in pregnancy: The design and feasibility of an innovative intervention in NSW,Australia

ObjectiveObesity amongst women of child bearing age is increasing at an unprecedented, rate throughout the Western world. This paper describes the design of an innovative, collaborative, antenatal intervention that aims to assist women to manage their weight during pregnancy and, presents aspects of the programme evaluation.Data sources/study settingThe programme was introduced at two sites, one in South East Sydney and, the other on the Central North Coast of NSW. Data were drawn from both sites and pooled for analysis.Study designThis evaluation used mixed methods drawing on qualitative and quantitative data.Data collection methodsFocus groups were held with staff in the antenatal clinic, who were, responsible for recruiting to the new service. Members of staff were also asked to record BMI for all women offered the service and using a simple questionnaire, record the reasons women gave for declining the new service.Principle findingsThe recruitment rate to the new service was 35% though this result should be treated with caution. Those women with a BMI of >35 were twice as likely to elect to participate in the new service as women with a BMI of less than 35. Focus groups with midwives in the antenatal clinic responsible for recruitment identified three themes impacting on recruitment to the service; ‘finding the words’, ‘acknowledging challenges’ and ‘midwives’ knowledge’.ConclusionsAntenatal clinic midwives were unprepared for talking to women about their weight. Increasing the confidence and skills of staff in offering service innovations to eligible women is a major challenge to be met if new models of care are to be successful in addressing overweight and obesity in pregnancy.     

Migration Selection, Protection, and Acculturation in Health: A Binational Perspective on Older Adults

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the “salmon bias,” emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.