A review by obesity researcher David Ludwig of Children's Hospital Boston, epidemiologist S. Jay Olshansky of the University of Illinois at Chicago, and colleagues concludes that obesity now reduces average life expectancy by about 4 to 9 months, a conservative estimate. More ominously, the researchers further conclude that if the current epidemic of child and adolescent obesity continues unabated, life expectancy could be shortened by two to five years in the coming decades.
The researchers based their predictions on data on the prevalence of obesity from the National Health and Nutrition Examination Survey and previously published estimates of years-of-life lost from obesity. A reduced life expectancy could have implications for such programs as Social Security and Medicare, they suggest.
Current trends indicate that the prevalence of obesity will continue to rise and affect ever-younger age groups, especially among children, the researchers note. Minority groups are expected to be hardest hit because of their reduced access to health care and especially sharp increases in childhood and adult obesity.
The long-term consequences of the child obesity epidemic have yet to be seen, says Ludwig, who directs the Optimal Weight for Life (OWL) program at Children's Hospital Boston. Obesity is known to increase risk for heart disease and cancer, and the surge in childhood obesity has already triggered an unprecedented rise in type 2 ("adult") diabetes in children.
"The tsunami of childhood obesity has not yet hit the shore -- it takes many years for complications to develop," Ludwig says. "If the clock starts ticking at age 12 or 14, the consequences to public health are potentially disastrous -- imagine heart attack or kidney failure becoming a relatively common condition of young adulthood."
Two thirds of American adults today are obese or overweight, and the proportion of people with extreme obesity has risen especially rapidly, the investigators note. Thus far, medical treatment has had little success in offsetting this trend.
Ludwig attributes much of the obesity epidemic to environmental factors. "If we were to reverse environmental factors back to those of the 1960s, most of the obesity epidemic would disappear," he asserts.
In the past 40 years, fast food, junk food, and soft drinks have become a prominent part of the landscape. Food advertising directed at children has exploded, and portion sizes have ballooned (see attached fact sheet). Schools have become purveyors of fast food and soft drinks through contracts with the food and beverage industry that help fund school programs -- even as they cut physical education classes from their curricula to save money. At the same time, children are becoming more sedentary, spending more time watching TV and using computers.
Moreover, many insurance companies don't cover obesity treatment, or offer only limited coverage. Nationally, reimbursement is as little as 10 percent, Ludwig notes.
"To tackle obesity we will need unambiguous political leadership at all levels of government, to make clear that public health has to come before private profit," he says. "This means a fundamental shift in the social environment that will support healthful eating and an active lifestyle. While the campaign must be led by government, it will require the active participation of primary care physicians, nutritionists, schools, and parents."
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 325 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: http://www.childrenshospital.org.
An Obesity Index
Courtesy: David Ludwig, MD, PhD
1. Proportion of American adults that are overweight: 2/3
2. Proportion that are obese: 1/3
3. Proportion of American children with excessive body weight: 25% to 30%
4. Increase in childhood obesity in the past 25 years: 2.3 to 3.3 fold
5. Estimated increase, in the past 20 years, in the prevalence of childhood diabetes: 10-fold
6. Americans' average daily fat intake, as a percentage of total calories, in 1960: 42%
7. The same percentage in 2000: 33
8. Increase in per capita consumption of soft drinks, 1950s to today: 500%
9. Amount that one additional soft drink per day increases a child's risk for obesity: 60%
10. Percentage of school districts that have contracts with soft-drink companies, allowing them to sell soft drinks on school premises: 50%
11. Proportion of a child's calories that originate from fast food, 1970s: 2%
12. The same proportion today: 10%
13. Percentage of children eating fast food on a given day, according to a national survey: 30%
14. Ratio of the total daily calorie needs of the average 10-year-old to the number of calories in a single "supersize" fast food meal: 1:1
15. Number of food ads viewed by the average child each year: 10,000
16. Percentage of these that advertise fast food, soft drinks, candy, or sugared cereals: 95%
17. Estimated annual amount spent on food advertising aimed at U.S. children: $10 billion
18. Budget for the "Five a Day" program, a federal educational program to increase fruit and vegetable consumption: $1.1 million
19. The entire federal budget for nutrition education, compared with the advertising costs for Altoids mints: 1/5
20. Increase in risk for childhood obesity per hour of daily television viewing: 12%
21. Decrease in risk for childhood obesity per hour of exercise: 10%
22. Average insurance reimbursement rate for childhood obesity treatment: 10%
23. Average charge for coronary-bypass surgery: $60,853
24. Estimated average cost of three one-hour sessions with a dietician at an obesity clinic: $180
25. Annual direct costs of obesity to the American economy in 1995: $100 billion
Obesity Index References:
1, 2 Flegal KM, Carroll MD, Ogden CL, and Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002 Oct 9; 288: 1723-7.
3, 4 Ogden CL, Flegal KM, Carroll MD, and Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002 Oct 9; 288: 1728-32.
5 Ludwig DS, Ebbeling, CB. Type 2 diabetes in children: primary care and public health consideration. JAMA 2001 Sep 26; 286:1427-1430.
6 Stephen AM and Wald NJ. Trends in individual consumption of dietary fat in the United States, 1920-1984. Am J Clin Nutr 1990 Sep; 52: 457-69.
7 Trends in intake of energy and macronutrients--United States, 1971-2000. MMWR Morb Mortal Wkly Rep 2004 Feb. 6; 53: 80-82.
8 Putnam JJ, Allshouse JE. Food consumption, prices, and expenditures, 1970-97. Washington, DC: Food and Consumers Economics Division, Economic Research Service, US Department of Agriculture, 1999.
9 Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001 Feb 17; 357:505-8.
10 School Health Policies and Programs Study 2000, Centers for Disease Control and Prevention.
11,12 Lin B-H, Guthrie J, Frazao E. American children's diets not making the grade. Food Rev May-Aug 2001; 24: 8–17.
13 Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household study. Pediatrics 2004 Jan; 113:112-18.
14 Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public health crisis, common sense cure. Lancet 2002 Aug 10; 360: 473–82.
15-19 Nestle M. Food politics: how the food industry influences nutrition and health. Berkeley: University of California Press, 2002.
20, 21 Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public health crisis, common sense cure. Lancet 2002 Aug 10; 360: 473–82.
22 Tershakovec AM, Watson MH, Wenner WJ, Marx AL. Insurance reimbursement for the treatment of obesity in children. J Pediatr 1999 May; 134:573–78.
23 Healthcare Cost and Utilization Project, U.S. Dept of Health and Human Services, 2001.
24 Ludwig estimate
25 Wolf, AM, Colditz GA. Current estimates of the economic costs of obesity in the United States. Obes Res 1998; 6:97-106.
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