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Ranks of Severely Obese Quadruple

Researcher says problem has been underestimated

MONDAY, Oct. 13, 2003 (HealthDayNews) -- America's obesity epidemic is sobering enough, with predictions that the extra poundage will bring on serious health problems such as heart trouble and diabetes.

But now, a new analysis finds the ranks of the severely obese -- those who are roughly 100 pounds overweight -- are growing twice as fast as the numbers of Americans who are simply obese.

"This is a much more serious problem than we thought," says Roland Sturm, senior health economist at the Rand Corp. and author of the report in the Oct. 13 issue of the Archives of Internal Medicine.

"People have been talking about the social burden of obesity," Sturm says. "This group [of severely obese] has much higher health-care needs."

"Health-care costs for a moderately obese person are $1,000 more per year than for a normal weight person," he says, citing data from another, as yet unpublished study he led. But for a severely obese person, he says, the costs are $4,000 more per year than for a normal weight person.

For the Archives study, Sturm extracted data from the Behavioral Risk Factor Surveillance System, a telephone survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) between 1986 and 2000. Sturm evaluated information from 1.5 million respondents who reported their height and weight, the basis on which body-mass index (BMI) is computed.

A BMI of under 25 is deemed desirable for optimal health; a BMI of 30 is termed obese. Sturm found that between the years studied, the number of adult Americans with a BMI of 40, considered severely obese, or greater quadrupled from about one in 200 to one in 50. Those with a BMI of 50 or greater, sometimes called super obesity, increased by a factor of five, from one in 2,000 to one in 400.

During the same period, the number of people with a BMI of 30 or more doubled, from one in 10 to one in 5, Sturm found.

A woman 5-foot-4 who weighs 140, for instance, has a BMI of 24. If she weighs 175, her BMI would be 30, termed obese. And if she weighs 250, her BMI would be 43, sometimes termed morbidly obese.

Among the respondents who had a BMI of over 50, 150 or more pounds overweight, the typical man was 5-foot-10 and weighed 373 pounds.

Sturm notes many hospitals and doctors' offices are not equipped to care for these severely obese patients. Standard wheelchairs, for instance, may not be wide enough to accommodate them.

While doctors who tend to consider severe obesity rare and believe the very obese are a fixed portion of the population, his analysis suggests severe obesity is part of the trend of growing obesity, and that it's been underestimated.

The answers to the obesity or the super-obesity epidemic aren't simple, says James Hill, a weight-control researcher and director of the Center for Human Nutrition at the University of Colorado Health Sciences Center.

"We have to prevent weight gain in the first place," he suggests. "We have to prevent that one, two, three pound a year gain." Once people get to the point of severe obesity, he notes, it's difficult to take off enough weight to get down to a healthy BMI again.

Society as a whole, and individuals, should ask themselves an important question, Hill says: "Are we really going to let our kids grow up in an environment that will let them get to that [obese] BMI?"

The problem is "a combination of food availability and lack of exercise, complicated by stress," adds David Freedman, an epidemiologist at the CDC who published a paper last year in the Journal of the American Medical Association with similar findings.

Sadly, he adds, "these same trends are going on in childhood obesity."

Indeed, a study being presented Monday shows that, between 1996 and 2001, 2 million adolescents became obese, and that three out of four of them remained obese as they reached adulthood.

Researchers at the University of North Carolina at Chapel Hill found that problem was particularly acute among black and Hispanic girls, but that the trend was across the board.

"This research highlights the critical nature of the adolescent and young adult period for developing and continuing obesity," Dr. Penny Gordon-Larsen, assistant professor of nutrition at the UNC schools of public health and medicine, said in a statement.

The research was to be presented in Ft. Lauderdale, Fla., at a meeting of the North American Association for the Study of Obesity.

More information

For more information on overweight and obesity, see the U.S. Centers for Disease Control and Prevention and the American Obesity Association.

SOURCES: Roland Sturm, Ph.D., senior health economist, Rand Corp., Santa Monica, Calif.; James Hill, Ph.D., director, Center for Human Nutrition, University of Colorado Health Sciences Center, and co-founder, America on the Move, an exercise motivation program; David Freedman, Ph.D., epidemiologist, division of nutrition and physical activity, U.S. Centers for Disease Control and Prevention, Atlanta; University of North Carolina press release; Oct. 13, 2003, Archives of Internal Medicine
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