The Childhood Obesity Epidemic
Impact on Endothelial Function
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Overweight and obesity have become major public health issues. According to the most recent National Health and Nutrition Survey (NHANES III, 1988 to 1991), 40% of all men and 26% of all women in the United States are overweight, and 20% and 26%, respectively, are obese. Projected adult obesity rates are 30% in 2015 and >40% in 2025.1 Although the public awareness of adult obesity is growing, the magnitude of this problem among children still remains widely unknown. According to the NHANES III database, the percentage of overweight children (>95th percentile) has tripled between the 1960s and the 1990s and today reaches approximately 14% among both boys and girls. The steepness of this increase is twice as high as in the adult population, where the increase of obesity in the same time period was 1.6-fold.
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It is, however, difficult to compare the prevalence of obesity between children and adults because of the lack of generally accepted definitions for children. Although body mass index (BMI) >25 indicates overweight and >30 defines obesity in adults, the diagnosis of overweight in children relies on age-adjusted percentiles. In the context of NHANES III, children are classified as being at risk of overweight when between the 85th and 94th percentiles and are called overweight when ≥95th percentile. In the United States, the term obesity is reserved for clinically diagnosed cases. For the purpose of their study published in the present issue of Circulation, Woo and colleagues2 used the age-adjusted BMI cutoff points suggested by Cole et al3 and defined overweight as a BMI between 21 and 23 and obesity as a BMI >23.
Several environmental factors contribute to the obesity epidemic that is now being observed among children: the sustained excess of energy-dense foods with refined carbohydrates and …