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News and Trends—September 2016

| September 1, 2016

New Report Finds Adult Obesity Rates Decreased in Four States
Obesity Rates Remain High: 25 States have Adult Obesity Rates above 30 Percent
Washington, D.C.— U.S. adult obesity rates decreased in four states (Minnesota, Montana, New York and Ohio), increased in two (Kansas and Kentucky) and remained stable in the rest, between 2014 and 2015, according to The State of Obesity: Better Policies for a Healthier America, a report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). This marks the first time in the past decade that any states have experienced decreases – aside from a decline in Washington, D.C. in 2010.

Despite these modest gains, obesity continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year.

In 2015, Louisiana has the highest adult obesity rate at 36.2 percent and Colorado has the lowest at 20.2 percent. While rates remained steady for most states, they are still high across the board. The 13th annual report found that rates of obesity now exceed 35 percent in four states, are at or above 30 percent in 25 states and are above 20 percent in all states. In 1991, no state had a rate above 20 percent.  The analyses are based on the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS).

The State of Obesity also found that:
•    9 of the 11 states with the highest obesity rates are in the South and 22 of the 25 states with the highest rates of obesity are in the South and Midwest.
•    10 of the 12 states with the highest rates of diabetes are in the South.
•    American Indian/Alaska Natives have an adult obesity rate of 42.3 percent.
•    Adult obesity rates are at or above 40 percent for Blacks in 14 states.
•    Adult obesity rates are at or above 30 percent in: 40 states and Washington, D.C. for Blacks; 29 states for Latinos; and 16 states for Whites.

There is some evidence that the rate of increase has been slowing over the past decade.  For instance, in 2005, 49 states experienced an increase; in 2008, 37 states did; in 2010, 28 states did; in 2011, 16 states did; in 2012, only one state did; and in 2014, only two states did. (Note: the methodology for BRFSS changed in 2011).

In addition, recent national data show that childhood obesity rates have stabilized at 17 percent over the past decade. Rates are declining among 2- to 5-year-olds, stable among 6- to 11-year-olds, and increasing among 12- to 19-year-olds. There are significant racial and ethnic inequities, with rates higher among Latino (21.9 percent) and Black (19.5 percent) children than among White (14.7 percent) children.

“Obesity remains one of the most significant epidemics our country has faced, contributing to millions of preventable illnesses and billions of dollars in avoidable healthcare costs,” said Richard Hamburg, interim president and CEO, TFAH. “These new data suggest that we are making some progress but there’s more yet to do. Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts. Improving nutrition and increasing activity in early childhood, making healthy choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up.”

Some other findings from the report include:
•    The number of high school students who drink one or more soda a day has dropped by nearly 40 percent since 2007, to around one in five (20.4 percent) (note: does not include sport/energy drinks, diet sodas or water with added sugars).
•    The number of high school students who report playing video or computer games three or more hours a day has increased more than 88 percent since 2003 (from 22.1 to 41.7 percent).
•    More than 29 million children live in “food deserts,” and more than 15 million children live in “food-insecure” households with not enough to eat and limited access to healthy food.
•    The federal government has provided more than $90 million via 44 Healthy Food Financing Initiative awards in 29 states since 2011, helping leverage more than $1 billion and create 2,500 jobs.
•    Farm-to-School programs now serve more than 42 percent of schools and 23.6 million children.
•    18 states and Washington, D.C. require a minimum amount of time that elementary students must participate in physical education; 14 states and Washington, D.C. require a minimum amount for middle schoolers; and six states require a minimum amount for high schoolers.

The report also includes a set of priority policy recommendations to accelerate progress in addressing obesity:
•    Invest in Obesity Prevention: Providing adequate funding for the Prevention and Public Health Fund and for the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion/Division of Nutrition, Physical Activity, and Obesity would increase support to state and local health departments.
•    Focus on Early Childhood Policies and Programs: Supporting better health among young children through healthier meals, physical activity, limiting screen time and connecting families to community services through Head Start; prioritizing early childhood education opportunities under the Every Student Succeeds Act (ESSA); and implementing the updated nutrition standards covering the Child and Adult Care Food Program.
•    School-Based Policies and Programs: Continuing implementation of the final “Smart Snacks” rule for improved nutrition for snacks and beverages sold in schools; eliminating in-school marketing of foods that do not meet Smart Snacks nutrition standards; and leveraging opportunities to support health, physical education and activity under ESSA.
•    Community-Based Policies and Programs: Prioritizing health in transportation planning to help communities ensure residents have access to walking, biking, and other forms of active transportation and promoting innovative strategies, such as tax credits, zoning incentives, grants, low-interest loans and public-private partnerships to increase access to healthy, affordable foods.
•    Health, Healthcare and Obesity: Covering the full range of obesity prevention, treatment and management services under all public and private health plans, including nutrition counseling, medications and behavioral health consultation, along with encouraging an uptake in services for all eligible beneficiaries.

“This year’s State of Obesity report is an urgent call to action for government, industry, healthcare, schools, child care and families around the country to join in the effort to provide a brighter, healthier future for our children. It focuses on important lessons and signs of progress, but those efforts must be significantly scaled to see a bigger turn around,” said Risa Lavizzo-Mourey, president and CEO of RWJF. “Together, we can build an inclusive Culture of Health and ensure that all children and families live healthy lives.”

The State of Obesity report (formerly known as F as in Fat), with state rankings and interactive maps, charts and graphs, is available at http://stateofobesity.org. Follow the conversation at #StateofObesity.

2015 STATE-BY-STATE ADULT OBESITY RATES
Based on an analysis of new state-by-state data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance Survey, adult obesity rates by state from highest to lowest were as follows:
Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity.

1.    Louisiana (36.2)
2.    (tie) Alabama (35.6), Mississippi (35.6) and West Virginia (35.6);
5.    Kentucky (34.6);
6.    Arkansas (34.5); 7. Kansas (34.2);
8.    Oklahoma (33.9);
9.    Tennessee (33.8);
10.    (tie) Missouri (32.4) and Texas (32.4);
12.    Iowa (32.1);
13.    South Carolina (31.7);
14.    Nebraska (31.4);
15.    Indiana (31.3);
16.    Michigan (31.2);
17.    North Dakota (31.0);
18.    Illinois (30.8);
19.    (tie) Georgia (30.7) and Wisconsin (30.7);
21.    South Dakota (30.4);
22.    (tie) North Carolina (30.1) and Oregon (30.1);
24.    (tie) Maine (30.0) and Pennsylvania (30.0);
26.    (tie) Alaska (29.8) and Ohio (29.8);
28.    Delaware (29.7);
29.    Virginia (29.2);
30.    Wyoming (29.0);
31.    Maryland (28.9);
32.    New Mexico (28.8);
33.    Idaho (28.6);
34.    Arizona (28.4);
35.    Florida (26.8);
36.    Nevada (26.7);
37.    Washington (26.4);
38.    New Hampshire (26.3);
39.    Minnesota (26.1);
40.    Rhode Island (26.0);
41.    New Jersey (25.6);
42.    Connecticut (25.3);
43.    Vermont (25.1);
44.    New York (25.0);
45.    Utah (24.5);
46.    Massachusetts (24.3);
47.    California (24.2);
48.    Montana (23.6);
49.    Hawaii (22.7);
50.    District of Columbia (22.1);
51.    Colorado (20.2).

About Trust for America’s Health. Trust for America’s Healthis a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. For more information, visit www.healthyamericans.org.
About Robert Wood Johnson Foundation. For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook

News from the Obesity Society

Doctors prescribe diabetes treatment medications 15 times more than obesity drugs, study finds
Clinicians are missing critical opportunity to prevent diabetes with obesity treatments
SILVER SPRING, Maryland—Obesity is a well-established major risk factor for developing diabetes, with almost 90% of people living with type 2 diabetes having obesity or overweight.1 Even with the close tie between obesity and type 2 diabetes, new research shows that healthcare clinicians prescribe 15 times more antidiabetes medications than those for obesity. Although six antiobesity medications are now approved by the Food and Drug Administration (FDA) for treating obesity when combined with a reduced-calorie diet and increased physical activity, this research points out that only 2% of the eligible 46% of the U.S. adult population is receiving these medications. The research is published in the September issue of Obesity, the scientific journal of The Obesity Society.
“Given the close tie between obesity and type 2 diabetes, treating obesity should be an obvious first step for healthcare providers to prevent and treat diabetes,” says Catherine E. Thomas, MS, the lead researcher from Weill Medical College of Cornell University. “By treating obesity, we may be able to decrease the number of patients with type 2 diabetes, among other related diseases and the medications used to treat them.”

Researchers pointed to a number of barriers to obesity treatment including lack of reimbursement for healthcare providers, limited time during office visits, lack of training in counseling, and competing demands, among others.

“A greater urgency in the treatment of obesity – on the part of clinicians and patients – is essential,” continued Thomas. “We’re talking about prolonged and better quality of life for patients.”

To conduct the study, Thomas et al. performed a retrospective analysis of 2012 – 2015 data from the IMS Health National Prescription Audit and Xponent databases to examine prescribing trends for antidiabetes and antiobesity medications. According to the analysis, the number of prescribed antidiabetes medications (excluding insulin) was 15 times the number of prescribed antiobesity medications. Medical specialties prescribing the majority of the antiobesity medications included family medicine/general practitioners, internal medicine clinicians and endocrinologists.

“By comparing the adoption rate of new antiobesity medications to the considerably faster rate for new diabetes medications, this new research provides an important snapshot of the problem,” says Ted Kyle, RPh, MBA, founder of ConscienHealth in a commentary accompanying the research.
“Obesity is a serious disease that is not getting serious treatment,” says Charles Billington, MD, FTOS, past president and spokesperson for The Obesity Society and Director of Medical Weight Management at the University of Minnesota. “We are missing the opportunity among patients with serious obesity-related illness to provide the full range of proven, safe and effective therapies. It’s time to start treating people with obesity as we would others with chronic diseases – with compassion and access to evidence-based care in a clinical setting.”

According to the commentary by Kyle, future research should aim to better quantify the benefit of obesity medications in real clinical settings as measured by patient outcomes. Additionally, a better understanding of the systematic barriers to adoption of obesity pharmacotherapy is necessary.
The study* and its accompanying commentary are published in the September issue of Obesity, the scientific journal of The Obesity Society.

About The Obesity Society. The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org. *Disclosure: The authors of this research were given access to the prescription databases through a partnership with Vivus, Inc.
1. http://www.obesity.org/content/weight-diabetes.

Presidential Proclamation: National Childhood Obesity Awareness Month, 2016  
President Brack Obama Proclaims September 2016 as National Childhood Obesity Awareness Month
WASHINGTON, DC—President Barack Obama released a proclamation declaring september 2016 as National Childhood Obesity Awareness Month. Read the proclamation at https://www.whitehouse.gov/the-press-office/2016/08/31/presidential-proclamation-national-childhood-obesity-awareness-month.

News from the Obesity Action Coalition

OBESITY ACTION COALITION LAUNCHES BIAS-FREE IMAGE GALLERY TO HELP REFOCUS THE PUBLIC PERCEPTION OF OBESITY
Tampa, Florida—The Obesity Action Coalition (OAC) is excited to announce the launch of its brand new FREE stock image gallery. The OAC Image Gallery was created with one simple goal in mind: providing the public with a set of images free of weight bias or stigma.

“Visual depictions of weight bias are far too common in today’s mass media. The OAC Image Gallery aims to reduce and eradicate the negative portrayal of individuals with obesity by providing better imagery showing individuals with obesity in a variety of settings and activities,” said Joe Nadglowski, OAC President and CEO.

Individuals with obesity are often portrayed in a negative light, with photos focused on uncontrolled eating, headless men and women, shots zoomed in on body parts and other common practices perpetuating bias and stigma around this disease.

“We are so excited to launch this gallery with 500 bias-free images. In 2017, we will expand the gallery to more than 4,000 images, making it the largest non-commercial bias-free online stock image gallery,” said James Zervios, OAC Vice President of Marketing and Communications.

Whether you’re a member of the media or a healthcare professional in need of imagery representing individuals with obesity, the OAC encourages you to use these images as a bias-free alternative to help change the way the world sees individuals affected by this disease.

To visit the OAC Image Gallery and learn more about this incredible initiative, please visit www.ObesityAction.org. To view the OAC Image Gallery promotional video, please visit http://bit.ly/2bL1bNW.

About the Obesity Action Coalition. The Obesity Action Coalition (OAC), a more than 52,000 member-strong National non-profit organization, is dedicated to improving the lives of individuals affected by the disease of obesity through education, advocacy and support.

One approach can prevent teen obesity, eating disorders, new guidelines say
New guidelines from the American Academy of Pediatrics tell pediatricians and parents to avoid focusing on teenagers’ weight and shape to prevent both obesity and eating disorders.

A single approach can prevent both obesity and eating disorders in teenagers, according to new guidelines from the American Academy of Pediatrics.

Scientific evidence summarized in the new recommendations shows that physicians and parents can ward off problems at both ends of the weight spectrum by avoiding focusing teens’ attention on weight or dieting, and instead encouraging a healthy, balanced lifestyle.

The guidelines, which were published online Aug. 21 in Pediatrics, were developed in response to growing concern about teenagers’ use of unhealthy methods to lose weight. Teens who use these methods may not fit doctors’ or parents’ image of eating-disorder patients, since most are not excessively thin. However, their quick, substantial weight loss can trigger medical consequences seen in people with anorexia nervosa, such as an unstable heart rate.

“This is a dangerous category of patient because they’re often missed by physicians,” said Neville Golden, MD, professor of pediatrics at the Stanford University School of Medicine and a lead author of the new guidelines. “At some point, these patients may have had a real need to lose weight, but things got out of control.”

Up to 40 percent of patients now admitted to some eating disorder treatment programs fit this easy-to-miss category, said Golden, who is also chief of adolescent medicine at Lucile Packard Children’s Hospital Stanford and a physician with the hospital’s Comprehensive Eating Disorders Program.

Evidence-based strategies. The new recommendations include five evidence-based strategies that pediatricians and parents can use to help teenagers avoid both obesity and eating disorders, and that apply to all teens, not just those with weight problems. Three recommendations focus on behaviors to avoid: Parents and doctors should not encourage dieting; should avoid “weight talk,” such commenting on their own weight or their child’s weight; and should never tease teens about their weight. Two recommendations focus on behaviors to promote: Families should eat regular meals together, and parents should help their children develop a healthy body image by encouraging them to eat a balanced diet and to exercise for fitness, not weight loss.

“Scientific evidence increasingly shows that for teenagers, dieting is bad news,” Golden said. Teens who diet in ninth grade are three times more likely than their peers to be overweight in 12th grade, for instance. And calorie-counting diets can deprive growing teenagers of the energy they need and lead to symptoms of anorexia nervosa, which may even become life-threatening. “It’s not unusual for us to see young people who have rapidly lost a lot of weight but are not healthy; they end up in the hospital attached to a heart monitor with unstable vital signs,” Golden said.
Negative comments about weight can also be detrimental to a teen’s health, Golden said. “Mothers who talk about their own bodies and weights can inadvertently encourage their kids to have body dissatisfaction, which we see in half of teen girls and a quarter of boys,” Golden said. Such dissatisfaction is associated with lower levels of physical activity and with use of vomiting, laxatives and diuretics to control weight.
Visit https://med.stanford.edu/news/all-news/2016/08/new-guidelines-offer-one-approach-to-prevent-teen-obesity-eating-disorders.html for the full press release.

More evidence that ‘healthy obesity’ may be a myth  
The term “healthy obesity” has gained traction over the past 15 years, but scientists have recently questioned its very existence. A study published August 18 in Cell Reports provides further evidence against the notion of a healthy obese state, revealing that white fat tissue samples from obese individuals classified as either metabolically healthy or unhealthy actually show nearly identical, abnormal changes in gene expression in response to insulin stimulation.

“The findings suggest that vigorous health interventions may be necessary for all obese individuals, even those previously considered to be metabolically healthy,” says first author Mikael Rydén of the Karolinska Institutet. “Since obesity is the major driver altering gene expression in fat tissue, we should continue to focus on preventing obesity.”

Obesity has reached epidemic proportions globally, affecting approximately 600 million people worldwide and significantly increasing the risk of heart disease, stroke, cancer, and type 2 diabetes. Since the 1940s, evidence supporting the link between obesity and metabolic and cardiovascular diseases has been steadily growing. But in the 1970s and 80s, experts began to question the extent to which obesity increases the risk for these disorders. Subsequent studies in the late 90s and early 2000s showed that some obese individuals display a relatively healthy metabolic and cardiovascular profile.
Recent estimates suggest that up to 30% of obese individuals are metabolically healthy and therefore may need less vigorous interventions to prevent obesity-related complications. A hallmark of metabolically healthy obesity is high sensitivity to the hormone insulin, which promotes the uptake of blood glucose into cells to be used for energy. However, there are currently no accepted criteria for identifying metabolically healthy obesity, and whether or not such a thing exists is now up for debate.

To read the full press release from ScienceDaily, visit https://www.sciencedaily.com/releases/2016/08/160818131127.htm.
To read the article “The Adipose Transcriptional Response to Insulin Is Determined by Obesity, Not Insulin Sensitivity” published in in Cell Reports, visit http://www.cell.com/cell-reports/abstract/S2211-1247(16)31014-2

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