Document Sample

                                                                        Sharifa Abou-Mediene, MD; Farid Shamo, MD

                                          INTRODUCTION                                   well as the parameter used in most pub-
                                                                                         lished information on body size. It is
                                               Childhood obesity is a growing            calculated as weight in kilograms (kg)
                                          problem in developed and developing            divided by the square of height in me-
                                          countries and a pressing public health         ters (m 2 ) (BMI           weight [kg]/
                                          concern. In the United States, obesity         height[m2]). To estimate BMI using
                                          has gained prominence on the public            pounds (lbs) and inches (in), divide
                                          health agenda because it is now one of         weight in pounds by the square of
                                          the most common health problems fac-           height in inches. Then multiply the re-
                                          ing children. It is a problem because it       sulting number by 704.5 (BMI
                                          is a known risk factor for many diseases,      weight [lbs]/height[in2]      704.5). An
                                          including diabetes, heart disease, stroke,     overweight person has a BMI between
                                          hypertension, hypercholesterolemia,            25 and 29.9; an obese person has a BMI
                                          gallbladder disease, osteoarthritis, sleep     of 30 or greater.3
                                          apnea and breathing problems, and                   As the prevalence of overweight and
                                          some types of cancers.1                        obese adults and children has increased
                                                                                         in the United States, so has related
                                                                                         healthcare costs, both direct and indi-
                                          BACKGROUND                                     rect. The economic costs of obesity are
                                                                                         approximately the same as for diabetes,
                                                                                         1.25 times greater than coronary heart
                                               Nearly two thirds (64.5%) of US           disease, and 2.7 times more expensive
                                          adults are overweight, and one third           than hypertension. 4 According to a
                                          (30.5%) of US adults are obese, accord-        study of national costs attributed to
                                          ing to data from the 1999–2000 Na-             both overweight and obese adults, med-
                                          tional Health and Nutrition examina-           ical expenses accounted for 9.1% of to-
                                          tion Survey (NHANES).2 The preva-              tal US medical expenditures in 1998
                                          lence of overweight and obese adults           and may have reached as high as $78.5
                                          and children has steadily increased over       billion ($92.6 billion in 2002 dollars).5
                                          the years among all ages, racial/ethnic        Being obese or overweight tends to be-
                                          groups, educational levels, smoking lev-       gin in childhood. According to the Cen-
                                          els, and both genders. Being overweight        ters for Disease Control and Prevention,
                                          refers to an excess of body weight com-        about 15.6% of American children be-
                                          pared to normative standards. Obesity is       tween 12 and 19 years old were obese
                                          defined as having an abnormally high            in 2002, up from 6.1% in 1974.6
                                          proportion of body fat. A person can be             Rates of being overweight and/or
                                          overweight without being obese, such as        obese appear to differ among distinct
                                          a bodybuilder or other athlete who has         ethnic groups in America. Obesity is
                                          a large muscle mass. Unfortunately,            higher in women who are members of
                                          most people who are overweight are also        racial and ethnic minority populations
                                          obese.                                         than in non-Hispanic White women.
                                               The most common method for de-            Among men, Mexican Americans have
                                          termining whether someone is over-             a higher prevalence of obesity than non-
                                          weight or obese is by measuring body           Hispanic Whites or Blacks. For non-
   From the Arab Community Center for     mass index. Body mass index (BMI) is           Hispanic men, the prevalence of over-
Economic and Social Services, Dearborn,   the measurement of choice for obesity          weight and obesity among Whites is
Michigan.                                 researchers and health professionals, as       slightly greater than among Blacks.6

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                                                  CARDIOVASCULAR DISEASES                   AND    DIABETES - Abou-Mediene and Shamo

                                                                                                        dren with a BMI greater than the 95th
Table 1. Age and sex distribution of Arab-American children in study
                                                                                                        percentile; they were considered obese;
                                                 Age                                                    12 (17.6%) of boys and 14 (15.5%) of
 Sex           10–11 Years         11–12 Years            12 Years                Total                 the girls were in this category. About
Male            15 (9.5%)          47 (29.7%)             6 (3.8%)            68 (42%)                  half (50%) of the boys were found to
Female          25 (15.8%)         63 (39.9%)             2 (1.3%)            90 (57%)                  be overweight or at risk for becoming
Total           40 (25.3%)        110 (69.6%)             8 (5.1%)           158 (100%)                 overweight, and 40% of the girls were
                                                                                                        found to be overweight or at risk for
                                                                                                        becoming overweight.

    Data for youth from NHANES III              Measurement
showed a similar pattern to that seen               Weight was measured in kilometers                   DISCUSSION
among adults. Mexican-American boys             by having students stand on a pre-tested
tended to have a higher rate of being           scale. Height was measured in meters                        Data for Arab-American children in-
overweight than non-Hispanic Black              using a height measurement scale.                       cluded in this study follow the same
and non-Hispanic White boys. African-           Those considered overweight were de-                    trends of being overweight/obese as seen
American girls tended to have a higher          fined as having a BMI greater than the                   in other ethnic groups in America. The
prevalence of being overweight com-             95th percentile for age and sex, while                  National Longitudinal Survey of Youth,
pared to non-Hispanic White and Mex-            those at risk were defined as having a                   a prospective cohort study conducted
ican-American girls. 7 The National             BMI between the 85th and 95th per-                      from 1986–1998 among children aged
Heart, Lung, and Blood Institute                centiles. The BMI of each student was                   4–12 years, found that the proportion
Growth and Health Study on over-                compared to the CDC growth chart of                     of overweight children was 21.5%
weight children found a higher mean             BMI for each gender.                                    among African Americans, 21.8%
BMI for Black girls aged 9 and 10 years                                                                 among Hispanics, and 12.3% among
compared to White girls of the same                                                                     non-Hispanic Whites.9 Troiano et al10
ages.8 This racial difference in BMI wid-       RESULTS                                                 reported a 10.9% prevalence of those
ened and was even greater at age 19.9                                                                   overweight in the United States (based
    An ethnic group for which no over-              To compare students based on their                  on BMI) above the 95th percentile and
                                                BMI, they were subdivided into three                    22% in the 85th percentile. When we
weight/obesity data have been collected
                                                categories for each gender. The first                    compared our results with the results of
is Arab-American youths. To determine
                                                category was children with a BMI less                   these two studies, the rates of those who
the obesity of Arab-American children
                                                than the 85th percentile. They were                     were overweight were similar.
in an area of southeastern Michigan, a
                                                considered to be of normal weight;
screening survey was conducted in two
                                                51.4% of the boys and 60% of the girls
elementary schools during the Spring of
2003. The screening effort consisted of
                                                fell into this category as shown in                     CONCLUSION
                                                Table 2.
measuring fifth-grade students’ height
                                                    The second group included children                     The increasing overweight trends
and weight then calculating their BMI.
                                                with a BMI between the 85th and 95th                    among youth are affecting Arab-Ameri-
The criteria are based on year 2000
                                                percentiles; they were considered over-                 can children as well as other ethnic mi-
CDC BMI guidelines for age growth
                                                weight. Table 2 shows that 21 (31%) of                  norities. These trends indicate an urgent
charts in the United States.3
                                                boys and 22 (24.5%) of girls fell into                  need to focus on primary prevention for
                                                this category. The third group had chil-                excess body weight. Implementing cul-

                                                Table 2. Body mass index percentile according to gender of Arab-American chil-
Sample                                          dren
   A convenience sample of 158 stu-                                                               BMI Percentile
dents, 90 girls and 68 boys, in two el-
                                                 Sex            85th Percentile           85th Percentile     95th Percentile        Total
ementary schools were screened. Ages
                                                Male                 35 (51.4%)            21 (31%)            12 (17.6%)          68 (42%)
ranged between 10 and 13 years, with
                                                Female               54 (60%)              22 (24.5%)          14 (5.5%)           90 (57%)
110 (69.6%) of the students between 11          Total                89 (56%)              43 (27.5%)          26 (16.5%)         158 (100%)
and 12 years of age (see Table 1).

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CARDIOVASCULAR DISEASES              AND       DIABETES - Abou-Mediene and Shamo

turally competent treatment and pre-              REFERENCES                                           6. Eberhardt MS, Ingram DD, Makuc DM, et
                                                   1. National Task Force on the Prevention and           al. Urban and Rural Health Chartbook:
vention strategies as well as other policy
                                                      Treatment of Obesity. Overweight, obesity,          Health. Hyattsville, Md: NCHS; 2001:256.
interventions are needed to lower the                                                                  7. Troiano RP, Flegal KM. Overweight children
                                                      and health risk. Arch Intern Med. 1998;
growing obesity trend by increasing                   158(22):1855–1867.                                  and adolescents: description, epidemiology,
physical activity and encouraging a                2. National Health and Nutrition Examination           and demographics. Pediatrics. 1998;101(3):
healthy diet among the young. The pre-                Survey 1999–2000 (NHANES). Clinical                 497–504.
liminary findings in this study have en-               Guidelines of the Identification, Evaluation,     8. Campaigne BN, Morrison JA, Schumann
                                                      and Treatment of Overweight and Obesity in          BC, et al. Indexes of obesity and comparisons
couraged the ACCESS Research Health                   Adults. Bethesda, Md: National Institute of         with previous national survey data in 9- and
Team to conduct a more thorough study                 Health; June 1998.                                  10-year old Black and White girls: National
of body weight in growing Arab-Amer-               3. Flegal K, Carroll M, Ogden C, Johnson C.
                                                                                                          Heart, Lung, and Blood Institute Growth and
ican children.                                        Prevalence and trends in obesity among US
                                                                                                          Health Study. J Pediatr. 1994;124:675–680.
                                                      Adults, 1999–2000. JAMA. 2002;288:1723–
                                                                                                       9. Kimm S, Barton B, Obarzanek E, et al. Racial
                                                                                                          divergence in adiposity during adolescence:
                                                   4. Wolf AM. What is the economic case for
ACKNOWLEDGMENTS                                       treating obesity? Obes Res. 1998;6(suppl 1):        The NHLBI Growth and Health Study. Pe-
A special thank you to the following who              2S–7S.                                              diatrics. 2001;107(3):E34-E40.
aided in the data collection process: Abdel-       5. Finkelstein EA, Fiebelkorn IC, Wang G. Na-      10. Troiano RP, Flegal KF, Kucznarski RJ, Camp-
wahab Naser, Dr. Karima Bouchieba, Dr.                tional medical spending attributable to over-       bell M, Johnson CL. Overweight prevalence
Wisam Salman, Hiam Hamade, RN, Mona                   weight and obesity: how much and who’s pay-         and trends for children and adolescents. Arch
Farroukh, Clementine Krolczyk, RN.                    ing? Health Aff. 2003;W3:219–226.                   Pediatr Adolesc Med. 1995;149:1085–1091.

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