Roland Sturm

Morbid obesity rates continue to rise rapidly in the United States.

Clinically severe or morbid obesity (body mass index (BMI) >40 or 50 kg m−2) entails far more serious health consequences than moderate obesity for patients, and creates additional challenges for providers. The paper provides time trends for extreme weight categories (BMI >40 and >50 kg m−2) until 2010, using data from the Behavioral Risk Factor Surveillance System. Between 2000 and 2010, the prevalence of a BMI >40 kg m−2 (type III obesity), calculated from self-reported height and weight, increased by 70%, whereas the prevalence of BMI >50 kg m−2 increased even faster. Although the BMI rates at every point in time are higher among Hispanics and Blacks, there were no significant differences in trends between them and non-Hispanic Whites. The growth rate appears to have slowed down since 2005. Adjusting for self-report biases, we estimate that in 2010 15.5 million adult Americans or 6.6% of the population had an actual BMI >40 kg m−2. The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.

Childhood overweight and elementary school outcomes

Objective:To examine the link between childhood overweight status and elementary school outcomes.Design:Prospective study design: multivariate regression models examining the association between changes in overweight status and school outcomes between kindergarten entry and end of third grade, after controlling for various child, family and school characteristics.Subjects:Nationally representative sample of US children who entered kindergarten in 1998, with longitudinal data on body mass index (BMI) and school outcomes at kindergarten entry and end of third grade.Measurements:Wide range of elementary school outcomes collected in each wave including academic achievement (math and reading standardized test scores); teacher reported internalizing and externalizing behavior problems (BP), social skills (self-control, interpersonal skills) and approaches to learning; school absences; and grade repetition. Measurements of height and weight in each wave were used to compute BMI and indicators of overweight status based on CDC growth charts. A rich set of control variables capturing child, family, and school characteristics.Results:Moving from not-overweight to overweight between kindergarten entry and end of third grade was significantly associated (P<0.05) with reductions in test scores, and teacher ratings of social-behavioral outcomes and approaches to learning among girls. However, this link was mostly absent among boys, with two exceptions – boys who became overweight had significantly fewer externalizing BPs (P<0.05), but more absences from school compared to boys who remained normal weight. Being always-overweight was associated with more internalizing BP among girls but fewer externalizing BPs among boys.Conclusion:Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys. Girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully.

School and residential neighborhood food environment and diet among California youth.

BACKGROUND Various hypotheses link neighborhood food environments and diet. Greater exposure to fast-food restaurants and convenience stores is thought to encourage overconsumption; supermarkets and large grocery stores are claimed to encourage healthier diets. For youth, empirical evidence for any particular hypothesis remains limited. PURPOSE This study examines the relationship between school and residential neighborhood food environment and diet among youth in California. METHODS Data from 8226 children (aged 5-11 years) and 5236 adolescents (aged 12-17 years) from the 2005 and 2007 California Health Interview Survey were analyzed in 2011. The dependent variables are daily servings of fruits, vegetables, juice, milk, soda, high-sugar foods, and fast food, which were regressed on measures of food environments. Food environments were measured by counts and density of businesses, distinguishing fast-food restaurants, convenience stores, small food stores, grocery stores, and large supermarkets within a specific distance (varying from 0.1 to 1.5 miles) from a respondents home or school. RESULTS No robust relationship between food environment and consumption is found. A few significant results are sensitive to small modeling changes and more likely to reflect chance than true relationships. CONCLUSIONS This correlational study has measurement and design limitations. Longitudinal studies that can assess links between environmental, dependent, and intervening food purchase and consumption variables are needed. Reporting a full range of studies, methods, and results is important as a premature focus on correlations may lead policy astray.

National estimates of mental health utilization and expenditures for children in 1998

No recent national data on expenditures and utilization are available to provide a benchmark for reform of mental health systems for children and adolescents. The most recent estimates, from 1986, predate the dramatic growth of managed care. This study provides updated national estimates. Treatment expenditures are estimated to be

Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey.

11.68 billion (

Physical Education in Elementary School and Body Mass Index: Evidence from the Early Childhood Longitudinal Study

172 per child). Adolescents have the highest expenditures at

Soda Taxes, Soft Drink Consumption, And Children’s Body Mass Index

293 per child followed by

Disparities in the food environment surrounding US middle and high schools

163 per child aged 6 to 11 and

Zoning For Health? The Year-Old Ban On New Fast-Food Restaurants In South LA

35 per preschoolaged child. Outpatient services account for 57%, inpatient for 33%, and psychotropic medications for 9% of the total. Unlike earlier reports, outpatient care now accounts for the majority of expenditures. This finding replicates the differences between recent managed care data and earlier actuarial databases for privately insured adults and confirms the trend from inpatient toward outpatient care.

Weight Gain Trends Across Sociodemographic Groups in the United States

Abstract Objectives: To analyse the relation between geographical inequalities in income and the prevalence of common chronic medical conditions and mental health disorders, and to compare it with the relation between family income and these health problems. Design: Nationally representative household telephone survey conducted in 1997-8. Setting: 60 metropolitan areas or economic areas of the United States. Participants: 9585 adults who participated in the community tracking study. Main outcome measures: Self report of 17 common chronic medical conditions; current depressive disorder or anxiety disorder assessed by clinical screeners. Results: A strong continuous association was seen between health and education or family income. No relation was found between income inequality and the prevalence of chronic medical problems or depressive disorders and anxiety disorders, either across the whole population or among poorer people. Only self reported overall health, the measure used in previous studies, was significantly correlated with inequality at the population level, but this correlation disappeared after adjustment for individual characteristics. Conclusions: This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health. What is already known on this topic Several studies have found a relation between income inequality and self reported health or mortality What this study adds There is a strong social gradient in health, as measured by the prevalence of chronic medical conditions and specific mental health disorders, by income or education No such association is seen between income inequality and health