doi: 10.1161/01.CIR.0000163655.15190.FB
(Circulation. 2005;111:1866-1868.)
© 2005 American Heart Association, Inc.
Editorial |
America’s Children
A Critical Time for Prevention
From the University of Colorado at Denver and Health Sciences Center (R.H.E.), Denver; the Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (S.R.D.); Boston University School of Medicine, Boston, Mass (A.K.J.); and Vanderbilt University Medical Center, Nashville, Tenn (R.M.R.).
Correspondence to Robert H. Eckel, MD, University of Colorado at Denver and Health Sciences Center, PO Box 6511, Mail Stop 8106, Aurora, CO 80045. E-mail robert.eckel{at}uchsc.edu
Key Words: Editorials • obesity • children • cardiovascular diseases • prevention
The rising tide of overweight and obesity in this nation and indeed around the world is apparent to all. From airlines to clothing manufacturers, industry has responded, either by charging larger customers more money for the space they occupy or by providing more accommodating sizes. Even the "final" industry has acquiesced—Goliath Casket, Inc, of Lynn, Ind, now provides several lines of oversize resting places for people weighing up to 700 lb, for whom conventional caskets are much too small. Of course, the tragedy is that these caskets are holding many who die too young.
Obesity has been recognized as a major determinant of atherosclerotic cardiovascular disease since 1998,1 but our efforts to stem the tide in the United States have not been successful. The Centers for Disease Control and Prevention (CDC) have documented an increasing prevalence of this disorder during the period from 1985 to 2003 via the Behavioral Risk Factor Surveillance System,2 with increasing rates of overweight and obesity documented in successive surveys. Most recently, data from the National Center for Health Statistics National Health and Nutrition Examination Survey, which uses actual body measurements,3 showed that although US adult men and women are 
1 in taller than they were in 1960, they are nearly 25 lb heavier on average as well. The average body mass index (BMI) has increased in adults from 25 in 1960 to 28 in 2002. Most troublesome were the data in children. A 10-year-old boy in 1963 weighed on average 74.2 lb. In 2002, he weighed nearly 85 lb. Fifteen-year-old boys were 15 lb heavier in 2002, and 15-year-old girls were 12 pounds heavier. Although children’s heights also increased (except for those of 15-year-old girls), the increase was not proportional; our children are a little taller, but they are much heavier. Finally, overweight and obesity are increasing worldwide, ultimately challenging malnutrition as the No. 1 cause of nutrition-related morbidity and mortality.4
It has been well documented that the behaviors associated with an increased prevalence of risk factors in adults are acquired in childhood, including habits related to dietary intake, physical exercise, and tobacco use.5 In addition, the multiple adverse risk factors associated with poor diet and lack of exercise, including elevated low-density lipoprotein levels, high triglycerides, elevated systolic and diastolic blood pressures, and elevated BMI itself, correlate positively with atherosclerotic lesions in young people.6 The Bogalusa Heart Study also has clearly shown that as the number of these risk factors increases, it is more likely that pathological and imaging evidence of atherosclerotic involvement of the aorta and the coronary arteries will be found.7,8 The clustering of these risk factors that defines the metabolic syndrome is now also being observed in children. That this will have an important impact is supported by the work of Olshansky et al,9 which suggested that we may be seeing a slowing and even a possible reversal of the decades-long, gradual increase in lifespan, and that this may be in part the result of the increase of obesity in the population. Although such a change in trend no doubt has more complex causes, as suggested by Preston,10 there is little question that the overall effects of obesity are detrimental in many ways.
The public is convinced that obesity is an important issue. A recent Wall Street Journal/Harris Interactive healthcare poll found that 77% of US adults and 70% of parents believe that the excessive weight of US children is a major problem.11 Most of the people polled (86%) agreed with the concept that the increasing prevalence of childhood obesity will increase healthcare costs in the future. Although there was a strong sense that personal and parental responsibility cannot be abdicated when it comes to lifestyle health choices, 83% of poll respondents clearly wished that the schools and governments would play a role. A large majority (68%) expressed the belief that the food industry’s advertising to children also contributes significantly to obesity. A lack of physical activity is an additional critical issue, with the states rarely mandating physical education in schools, and even less often, actual physical activity. Even the shape of our communities can contribute, with urban sprawl encroaching on areas that were initially planned to bring adults and children outdoors and provide more opportunities to interact and exercise. Instead, apparently, the lack of "connectedness" in those areas actually forces people to drive to shopping centers, church, and school rather than bike or walk.12
How can this epidemic be stopped? Society as a whole has begun to exert some small pressure. Healthier options are appearing in restaurants, and even the Sunday comics exhort children to shop around the perimeters of supermarkets, where the fresh food is located. For many parents and for children themselves, the nutritional knowledge and the tools to address these issues in their personal lives are not easily available. For this reason, the American Heart Association (AHA) is stepping up its activities designed to help the public. In the coming weeks, the AHA will embark on a new initiative to address this leading health issue of childhood obesity. Although we have been involved in this issue and the overall issue of children’s heart health for some time, this is the first time that we are taking it to the level of creating a movement that is "for kids and by kids."
First, the science base of information must be solid. Obesity is certainly an area in which science is exploding, from the genetic and molecular level to behavioral and population research. A recent National Heart, Lung, and Blood Institute/National Institute of Diabetes and Digestive and Kidney Diseases workshop on the pathophysiology of obesity-associated cardiovascular disease13 took a step toward promoting more creative research agendas in the minds of geneticists and molecular and cellular biochemists, physiologists, and pharmacologists. It is hoped that this will lead to new ideas that can be tested with state-of-the-art technologies in places such as general clinical research centers. As population demographics and basic science define more hypotheses to be tested, the results of such patient-related research can drive new paradigms of prevention and treatment.
In late 2004, the Atherosclerosis, Hypertension and Obesity in Youth Committee of the AHA’s Council on Cardiovascular Disease in the Young published their recommendations on the promotion of cardiovascular health in our schools.14 In this issue of Circulation, readers can find the latest information on the consequences, prevention, and treatment of overweight in children and adolescents.15 The AHA’s Dietary Guidelines and Dietary Guidelines for Children are being revised and will be published within the next 12 months. We also will provide recommendations specifically directed at the promotion of physical activity in schools. From January 18 to 20, 2006, we will hold an Obesity, Lifestyle, and Cardiovascular Disease Symposium in Washington, DC, a site chosen because of its accessibility to policymakers, as well as to investigators, who will address topics ranging from the contribution of genetics, the environment, patterns and trends in portion sizes, factors affecting portion control, and the effects of macronutrients on calorie intake, to behavioral issues in children and adults. We will provide effective tools for healthcare providers, so that they can use the latest behavioral research to guide their patients, young and old, to a leaner, fitter, and longer life.
Next, the AHA will enhance programs that are touching thousands of Americans and their children, such as Choose to Move,16 an Internet-based program that helps individuals add activity to their daily lives and provides helpful nutritional hints, and the nutritional components of Search Your Heart,17 a faith-based program that brings health information to hundreds of churches nationwide. The AHA’s cookbooks, which provide hundreds of delicious and nutritious recipes, will be joined this summer by a new book that will provide concrete advice for people who need to lose weight and then maintain their new, healthy weight and fit lifestyle. The Cardiology Patient Page in this issue of Circulation18 outlines some of that advice and makes it easier for individuals to find their way through the maze of often-conflicting information. We will enhance the educational messages on nutrition and physical activity that we provide to the 4 million elementary and middle-school students who Jump Rope or shoot Hoops for Heart each year. To coincide with the back-to-school period this September, we will launch a campaign targeted toward children that gives them new, hip, healthy information and activities so they can take charge of their own health. We are developing a campaign name, logo, and icon that will help the AHA create a new identity with children and will inspire them to be advocates for their own health. We will keep readers posted in the coming weeks and months as the various elements of this campaign are unveiled. In the meantime, we encourage you to stay informed by registering on the AHA Web site and joining the movement at www.americanheart.org.
As in the past, we will work with partners. We are proud to be publishing an Obesity Sourcebook in conjunction with The Robert Wood Johnson Foundation. The Sourcebook will provide the same level of solid science information to the public, healthcare professionals, and policymakers that the AHA’s yearly statistical update has provided for many years. We will work with our colleagues at the CDC as they gather essential information on trends in American society and present information to decision makers so they can act on it. Another partnership that helps carry the message of the benefit of healthy lifestyles is Everyday Choices, our collaborative program with the American Cancer Society and the American Diabetes Association. This program focuses attention on eating well, exercising, not smoking, and seeing a doctor regularly and how these actions can protect against heart disease and stroke, as well as diabetes and some forms of cancer.
Essential to our success in helping the public with this difficult task is our role in advocating for a healthier environment. We will continue to educate policymakers about the important role that physical activity and better nutrition should play in our schools. We will continue to communicate with the Food and Drug Administration and the Federal Trade Commission about the role of food labeling and the importance of giving the public the information it needs to make reasonable choices about calories, serving size, and components they want to limit or avoid for heart health, such as saturated fats and trans fats.
To create a healthier America, we need to engage a broad range of individuals, from basic and clinical scientists to parents to politicians to healthcare providers. We hope readers will be motivated by the information contained in this issue of Circulation and will join us in working to make all communities healthier places to live. For our part, the AHA pledges to continue to work to make it easier for you to help your patients, your families, your friends, and yourselves become a part of a healthier tomorrow.
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Footnotes |
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The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
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References |
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 Top References |
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- Krauss RM, Winston M, Fletcher BJ, Grundy SM. Obesity: impact on cardiovascular disease. Circulation. 1998; 98: 1472–1476.
[Free Full Text]
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, Prevalence Data, 1995–2003. Available at: http://www.cdc.gov/brfss. Accessed March 18, 2005.
- Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean Body Weight, Height, and Body Mass Index, United States 1960–2002. PHS 2005–1250. Available at: http://www.cdc.gov/nchs/data/ad/ad347.pdf. Accessed March 18, 2005.
- Eckel RH, York DA, Rossner S, Hubbard V, Caterson I, St. Jeor ST, Hayman LL, Mullis RM, Blair SN; American Heart Association. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation. 2004; 110: 2968–2975.
[Free Full Text]
- Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K; American Heart Association. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003; 107: 1562–1566.
[Free Full Text]
- Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking. A preliminary report from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. JAMA. 1990; 264: 3018–3024.[Abstract]
- Newman WP III, Freedman DS, Voors AW, Gard PD, Srinivasan SR, Cresanta JL, Williamson GD, Webber LS, Berenson GS. Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study. N Engl J Med. 1986; 314: 138–144.[Abstract]
- Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998; 338: 1650–1656.
[Abstract/Free Full Text]
- Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwig DS. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005; 352: 1138–1145.
[Abstract/Free Full Text]
- Preston SH. Deadweight? The influence of obesity on longevity. N Engl J Med. 2005; 352: 1135–1137.
[Free Full Text]
- The Wall Street Journal Online/Harris Interactive Health-Care Poll. Available at: http://www.harrisinteractive.com/news/newsletters_wsj.asp. Accessed March 14, 2005.
- Lopez R. Urban sprawl and risk for being overweight or obese. Am J Public Health. 2004; 94: 1574–1579.
[Abstract/Free Full Text]
- Eckel RH, Barouch WW, Ershow AG. Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on the pathophysiology of obesity-associated cardiovascular disease. Circulation. 2002; 105: 2923–2928.
[Free Full Text]
- Hayman LL, Williams CL, Daniels SR, Steinberger J, Paridon J, Dennison BA, McCrindle BW; Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Cardiovascular health promotion in the schools: a statement for health and education professionals and child health advocates from the Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004; 110: 2266–2275.
[Free Full Text]
- Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, Robinson TN, Scott BJ, St. Jeor S, Williams CL. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005; 111: 1999–2012.
[Abstract/Free Full Text]
- American Heart Association. Choose to Move. Available at: www. americanheart.org/choosetomove. Accessed March 18, 2005.
- American Heart Association. Search Your Heart. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3008521. Accessed March 18, 2005.
- Eckel RH. Obesity. Circulation. 2005; 111: e257–e259.
[Free Full Text]
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