U.S. Adult Obesity Rates on the Rise

The number of states with an obesity prevalence of 30 percent or more has tripled in two years to nine states in 2009, according to a CDC Vital Signs report. In 2000, no state had an obesity prevalence of 30 percent or more. The report, “State-Specific Obesity Prevalence Among Adults – United States, 2009,” also finds no state met the nation’s Healthy People 2010 goal to lower obesity prevalence to 15 percent.

The data show a 1.1 percentage point increase—an additional 2.4 million people—in the self-reported prevalence of obesity between 2007 and 2009 among adults aged 18 and over. The report also notes the medical costs associated with obesity are high. In 2008 dollars, medical costs associated with obesity were estimated at $147 billion. People who are obese had medical costs that were $1,429 higher than those of normal weight, the report said.

“Obesity continues to be a major public health problem,” said CDC Director Thomas Frieden, M.D., M.P.H. “We need intensive, comprehensive and ongoing efforts to address obesity. If we don’t more people will get sick and die from obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of death.”

The August Vital Signs report is based on new data from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS contains state-level public health data and provides a way for states to monitor progress toward Healthy People goals. To assess obesity prevalence, approximately 400,000 phone survey respondents were asked to provide their height and weight, which was used to calculate their body mass index (BMI). An adult is considered obese if he or she has a BMI of 30 or above. For example, a 5-foot-4 woman who weighs 174 pounds or more, or a 5-foot-10 man who weighs 209 pounds or more has a BMI of 30, and so is considered obese.

The BRFSS obesity data are underestimates of true obesity prevalence. Research has found that both men and women often say they are taller than they actually are and women often say they weigh less than they do in telephone surveys. As a result, according to William Dietz, M.D., Ph.D., director of CDC’s Division of Nutrition, Physical Activity and Obesity, the overall BRFSS obesity prevalence estimate of 26.7 percent is 7.2 percentage points lower than the national 2007-2008 estimate of 33.9 percent (nearly 73 million people) from the National Health and Nutrition Examination Survey, for which individuals’ height and weight were measured rather than self-reported.

The BRFSS data highlight how obesity affects some populations more than others. The highest prevalence was found among non-Hispanic blacks overall, whose rate was 36.8 percent, and non-Hispanic black women, whose rate was 41.9 percent. The rate for Hispanics was 30.7 percent. The rate among all non-high school graduates was 32.9 percent. Obesity prevalence was also higher in some regions than others. The South had an obesity prevalence of 28.4 percent while the Midwest had a prevalence of 28.2 percent.

“Obesity is a complex problem that requires both personal and community action,” said Dr. Dietz. “People in all communities should be able to make healthy choices, but in order to make those choices there must be healthy choices to make. We need to change our communities into places where healthy eating and active living are the easiest path.”

90% of U.S. Adults Get Too Much Salt

Less than 10 percent of U.S. adults limit their daily sodium intake to recommended levels, according to a new report, “Sodium Intake in Adults – United States, 2005-2006,” published today in Morbidity and Mortality Weekly Report. The report also finds that most sodium in the American diet comes from processed grains such as pizza and cookies, and meats, including poultry and luncheon meats.

According to the report, U.S. adults consume an average of 3,466 milligrams (mg) of sodium per day, more than twice the current recommended limit for most Americans. Grains provide 36.9 percent of this total, followed by dishes containing meat, poultry, and fish (27.9 percent). These two categories combined account for almost two-thirds of the daily sodium intake for Americans.

An estimated 77 percent of dietary sodium comes from processed and restaurant foods. Many of these foods, such as breads and cookies, may not even taste salty. “Sodium has become so pervasive in our food supply that it’s difficult for the vast majority of Americans to stay within recommended limits,” said Janelle Peralez Gunn, public health analyst with CDC’s Division for Heart Disease and Stroke Prevention and lead author of the report. “Public health professionals, together with food manufacturers, retailers and health care providers, must take action now to help support people’s efforts to reduce their sodium consumption.”

The 2005 Dietary Guidelines for Americans recommends that people consume less than 2,300 mg of sodium per day. Specific groups, including persons with high blood pressure, all middle-aged and older adults and all blacks, should limit intake to 1500 mg per day. These specific groups comprise nearly 70 percent of the U.S. adult population. This study found that only 9.6 percent of all participants met their applicable dietary recommendation, including 5.5 percent of the group limited to 1,500 mg per day and 18.8 percent of the 2,300 mg per day group.

The report examined data for 2005–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of adults and children in the United States. Researchers used information from 24-hour dietary recall and the USDA National Nutrient Database to estimate the daily sodium intake and sources of sodium intake for U.S. adults.

The findings add to a growing body of observational research studies on Americans’ excessive sodium consumption. Overconsumption of sodium can have negative health effects, including increasing average levels of blood pressure. One in three U.S. adults has high blood pressure, and an estimated 90 percent of U.S. adults will develop the disease in their lifetime. Blood pressure is a major risk factor for heart disease and stroke, the first and third leading causes of death among adults in the United States.

Source: CDC, June 24, 2010

Twenty Percent of American Teens Have Abnormal Lipid Levels

Twenty percent of young people aged 12-19 years in the United States have at least one abnormal lipid level, according to a study from the Centers for Disease Control and Prevention.  Abnormal lipid levels are major risk factors for heart disease, the leading cause of death among adults in the United States.

The report, “Prevalence of Abnormal Lipid Levels among Youths —United States, 1999–2006,” was published today in CDC’s Morbidity and Mortality Weekly Report (MMWR).

The report examined data for 1999–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of about 6,000 participants every year.  Researchers analyzed measurements of low-density lipoprotein, or “bad,” cholesterol (LDL-C); high-density lipoprotein, or “good,” cholesterol (HDL-C); and triglycerides.

The researchers found that young people who were overweight or obese were more likely to have one or more abnormal lipid levels compared to normal weight youth.  Fourteen percent of normal weight, 22 percent of overweight, and 43 percent of obese youth had one or more abnormal lipid levels.

The study also found that 32 percent of these young people would be candidates for lipid screening based on American Academy of Pediatrics (AAP) guidelines.  The AAP recommends lipid screening for young people with a family history of high blood cholesterol or premature cardiovascular disease, or the presence of at least one major risk factor for heart disease, such as smoking, high blood pressure, diabetes, or overweight/obesity.

Reviewing health indicators for 3,125 youths, researchers found that differences in lipid levels were associated with sex, age, and race/ethnicity. Specifically:

  • More boys (24 percent) than girls (16 percent) had at least one abnormal lipid level.
  • Fourteen- and 15-year-olds (9 percent) and 18- and 19-year-olds (10 percent) were more likely to have low HDL cholesterol levels than 12- and 13-year-olds (5 percent).
  • Non-Hispanic white youths were more likely to have low levels of HDL cholesterol (8 percent) and high triglycerides (12 percent), compared to non-Hispanic black youths (5 percent and 4 percent, respectively).

Typically, heart disease develops in adulthood. But its risk factors, such as abnormal lipid levels and overweight/obesity often emerge during childhood and adolescence.

“Overweight and obese young people are at far greater risk of having abnormal lipid levels than are youths with normal weights,” said Ashleigh May, Ph.D.,  Epidemic Intelligence Service Officer in CDC’s Division for Heart Disease and Stroke Prevention, and lead author of the report.  “The current epidemic of childhood obesity makes this a matter of significant and urgent concern.”

In the past three decades, obesity among American youths has increased from 5 percent to more than 17 percent.  In light of this, the study’s authors suggested that clinicians should be aware of guidelines for lipid screening and treatment among youths.

Source: Centers for Disease Control (Jan. 21, 2010)

Tuberculosis (TB) Drug Doses Too Low for Today’s Obese Populations, Says Study

The typical dose of a medication considered pivotal in treating tuberculosis effectively is much too low to account for modern-day physiques, UT Southwestern Medical Center researchers said.

The finding, reported online and in the August edition of Antimicrobial Agents and Chemotherapy, is particularly important for those living in societies plagued by obesity, said Dr. Tawanda Gumbo, associate professor of internal medicine at UT Southwestern and the study’s lead author.

“What really drives the variability of this particular drug is patient weight and gender, so in our simulations we took that into account,” Dr. Gumbo said. “What we found is that we’re really using doses for very skinny people – 105 to 110 pounds. I haven’t met many adults who are at that weight.”

About one-third of the world’s population is infected with Mycobacterium tuberculosis, the bacterium that causes TB, and as many as 2 million people die from the disease each year. TB, which is the leading cause of death among people infected with HIV/AIDS, kills more people than any other disease caused by a single infectious agent, according to the National Institutes of Health. Treatment usually lasts six to 12 months and includes a combination of antibiotics such as Pyrazinamide, the drug examined in this study.

Because treatment typically includes multiple drugs, introducing new ones to existing regimens has made it harder to identify which, if any, of the drugs are working at the current dosage levels. Researchers also have struggled to identify the needed dosage as well as exactly where in the body these drugs work to combat the bacterium.

The new model developed at UT Southwestern uses cultured cells to gauge the effectiveness and proper dosage of anti-tuberculosis drugs.

“With this model, we can directly test molecules that have the potential to shorten therapy and go straight to coming up with the doses that you would use in patients,” Dr. Gumbo said. “What that means is that if you have a molecule that could cure TB in one month in this model, it stands a good chance that it would do the same in patients.”

For this study, the researchers gave patients Pyrazinamide – an older drug generally used in combination with other drugs – daily for one month. The researchers then used the data collected to calculate how much bacteria the drug killed before resistance emerged. They opted to focus on Pyrazinamide because physicians once used it alone to treat the disease, so there are many studies documenting precisely how the drug behaves in patients – something that is unclear for some newer drugs.

When the UT Southwestern researchers began testing Pyrazinamide in the lab, they found that the concentration of the drug declined at a rate that matches the rate seen in patients.

“In patients, unlike in test tubes, it’s not a constant concentration. A patient given multiple drugs degrades each of them at different rates,” he said. “Using this model, we can actually copy this concentration profile of the drugs to human-like exposures.”

Dr. Gumbo said his team’s finding that the doses traditionally given to tuberculosis patients are much too low suggests that different doses are probably needed in different countries. “Most of the patients we see here in Dallas are not 110 pounds unless they have some other severe disease,” he added.

The next step, Dr. Gumbo said, is to continue researching drug combinations in order to devise the optimum treatment regimen for tuberculosis patients.

“We’ve rationally and scientifically come up with a dose that depends not just on the kinetics or the concentration time profile of patients, but also how the bug itself responds to that particular drug,” he said. “So, instead of using the average patient or a mean patient, we can now project how a drug combination will fare in actual patients. With this model, researchers can use these simulations to determine the duration of therapy, which could shorten from years to months.”

Source: Antimicrobial Agents and Chemotherapy, August, 2009.

Blacks Have Highest Obesity Rate, Says CDC

Blacks had 51 percent higher prevalence of obesity, and Hispanics had 21 percent higher obesity prevalence compared with whites, according to researchers with the Centers for Disease Control and Prevention.

Greater prevalences of obesity for blacks and whites were found in the South and Midwest than in the West and Northeast. Hispanics in the Northeast had lower obesity prevalence than Hispanics in the Midwest, South or West. The study, in CDC′s Morbidity and Mortality Weekly Report, examined data from 2006-2008.

“This study highlights that in the United States, blacks and Hispanics are disproportionately affected by obesity,” said Dr. William H. Dietz, Director of CDC′s Division of Nutrition, Physical Activity, and Obesity, “If we have any hope of stemming the rise in obesity, we must intensify our efforts to create an environment for healthy living in these communities.”

The study uses data from the Behavioral Risk Factor Surveillance System (BRFSS), of the Centers for Disease Control and Prevention. BRFSS is an ongoing, state-based, random-digit–dialed telephone survey of the U.S. civilian, noninstitutionalized population aged 18 years and older.

The study found that in 40 states, obesity prevalence among blacks was 30 percent or more. In five of those states, Alabama, Maine, Mississippi, Ohio, and Oregon, obesity prevalence among blacks was 40 percent or greater.

For blacks, the prevalence of obesity ranged from 23 percent to 45.1 percent among all states and the District of Columbia; among Hispanics in 50 states and DC, the prevalence of obesity ranged from 21 percent to 36.7 percent, with 11 states having an obesity prevalence of 30 percent or higher. Among whites in 50 states and the District of Columbia, the prevalence of obesity ranged from 9 percent to 30.2 percent, with only West Virginia having a prevalence of 30 percent or more.

“We know that racial and ethnic differences in obesity prevalence are likely due to both individual behaviors, as well as differences in the physical and social environment,” said Liping Pan, M.D., M.P.H., lead author and epidemiologist. “We need a combination of policy and environmental changes that can create opportunities for healthier living.”

For this study analysis, CDC analyzed the 2006−2008 BRFSS data.

Source: CDC, July 16, 2009

Scientists Finding Anti-Obesity Drugs With Fewer Side Effects

Fen-phen was once regarded as a miracle weight-loss drug, but when it induced heart valve lesions and mother life-threatening side effects, it was taken off the market. UT Southwestern Medical Center scientists are exploring Fen-phen’s behavior in the brain so that safer anti-obesity drugs with less side effects can be developed.

In a recent study, the researchers define a circuit in the brain that explains the ways fenfluramine, a component of Fen-phen, suppresses appetite.

“Our findings provide evidence that the neural circuit we’ve proposed is sufficient for the neurotransmitter serotonin to regulate food intake and body weight, ” said Dr. Joel Elmquist, professor of internal medicine and pharmacology at UT Southwestern and senior author of the study. “Fen-phen works directly on this pathway. Unfortunately, that drug also adversely affects peripheral tissue such as the heart.”

Mice were engineered for the current study, in which the expression of a serotonin receptor called 5-hydroxytryptamine 2C was blocked throughout the entire body. Previously, this produced obese mice resistant to the anorexic actions of fenfluramine. When activated by serotonin, however, this receptor is also known to suppress appetite. Using this mouse model, the authors engineered another set of mice in which the same serotonin receptor was blocked everywhere in the body except within a group of brain cells called pro-opiomelanocortin, or POMC, neurons. The POMC neurons, which are found in the hypothalamus, are also known to play an important role in suppressing appetite and inducing weight loss.

The scientists noted that the animals with no serotonin 2c receptors expectedly developed obesity as well as other metabolism disorders such as increased food intake, hyperactivity and leptin insensitivity. They also were prone to spontaneous seizures, said Dr. Elmquist. The mice in which the serotonin receptor was fre-expressed and functioning only in the POMC neurons stayed slim and responded to fenfluramine.

“The POMC-specific reactivation of the receptor only in POMC neurons normalizes the abnormal metabolism in these mice,” Dr. Elmquist said. “The animals don’t eat excessively. Their hyperactivity is also gone.”

Previous work from the UT Southwestern group led to the hypothesis that Fen-phen worked by activating the serotonin 2c receptor in the POMC neurons in the hypothalamus. The current work provides genetic proof supporting this model.

“Conventional wisdom is that fenfluramine increases serotonin release that then activates serotonin receptors in the brain to regulate food intake and body weight, but unfortunately, this drug also causes lesions in heart valves,” he said. “If you could develop a drug that would travel to both the brain and the peripheral tissues, and then give a blocker to protect the heart, it’s possible that you could prevent the harmful side effects and still aid weight loss. Admittedly, that’s a bit farfetched, but this mouse model could be used to test that theory.”

The team’s next step is to determine whether they’ve identified the sole circuit required to suppress appetite and induce weight loss.

Source: Neuron,

Americans Consume Twice Daily Recommendations of Salt

Most Americans consume more than double the amount of their daily recommended level of sodium. A new study by the Centers for Disease Control and Prevention shows that more than 2 out of 3 adults are in population groups that should consume no more than 1,500 milligrams (mg) per day of sodium. During 2005-2006 the estimated average intake of sodium for persons in the United States age 2 years and older was 3,436 mg per day.

A diet high in sodium increases the risk of having higher blood pressure, a major cause for heart disease and stroke. These diseases are the first and third leading causes of death in the United States.

“It’s important for people to eat less salt. People who adopt a heart healthy eating pattern that includes a diet low in sodium and rich in potassium and calcium can improve their blood pressure,” said Darwin R. Labarthe, M.D., Ph.D., director of the CDC’s Division for Heart Disease and Stroke Prevention. “Reducing sodium intake can prevent or delay increases in blood pressure for everyone.’’

“People need to know their recommended daily sodium limit and take action to reduce sodium intake,” Labarthe said. Most of the sodium we eat comes from packaged, processed and restaurant foods. CDC along with other HHS agencies, including the Food and Drug Administration, will be working with major food manufacturers and chain restaurants to reduce sodium levels in the food supply.

The study in CDC’s Morbidity and Mortality Weekly Report used data from the National Health and Nutrition Examination Survey, a survey designed to assess the health and nutritional status of adults and children in the United States.

This study is the first to use national data to show that 69.2 percent of the adult population belongs to a specific group that should aim to consume no more than 1,500 mg of sodium per day. This group includes persons with high blood pressure, blacks, or middle-aged and older adults (more than 40 years old). The 2005 Dietary Guidelines for Americans recommend that adults in general should consume less than 2,300 mg (approximately one teaspoon of salt) of sodium per day.

The dietary guidelines, by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, provide advice for people 2 years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.

Nationwide, 16 million men and women have heart disease and 5.8 million are estimated to have had a stroke. People who reduce their sodium consumption benefit from improved blood pressure and reduce their risk for developing other serious health problems. Choosing foods like fresh fruits and vegetables, when eating out, asking that foods be prepared without added salt, and reading the nutrition label of foods before purchasing can improve health for all adults.

Source: CDC, March 26, 2009

The Importance of Nutrition for Your Health

We as patients often assume that a prescription for health involves taking medicines. The drugs that FDA approves are essential for treating disease, but perhaps the most important prescription to prevent many diseases is the food we eat.

Our food not only needs to be safe to protect our health – but also nutritious, in order to promote our health. The FDA’s core mission is to do both, and the Center for Food Safety and Applied Nutrition and other components of FDA, like our Division of Personalized Nutrition and Medicine at NCTR, are hard at work in researching and developing new frontiers in the field of nutrition.

Proper nutrition is an old concept so why do we still have problems with our diet? The answer is complex. But – just like prescriptions for medicine – nutrition must become more personalized because people are different. When I was growing up I could not understand why my brother could eat so much more than I did, and yet he was so much thinner. He obviously metabolized food differently. Because of advancements in science, technology and medicine, we now know that our genes and how they function make us all unique, and we need to factor that understanding into recognizing that our nutritional needs are unique.

In the past, public health recommendations looked like a “one size fits all” approach to nutrition, breaking food down into groups that every school child could easily identify—and we made very good, but very broad recommendations about what we should eat—like fruits and vegetables.

But today we are breaking new frontiers in nutrition and eating behavior. One example is we are beginning to understand the benefits of nutrition at the genetic level. For example, we have identified 50 genes associated with how the human body processes meat and the changes in genes metabolizing starch.

In the future, we will understand your individual needs for such things as vitamins. And if you know your genetic make up and how your body metabolizes different food groups, you will be able to learn how specific nutritional choices you make will affect your health.

As researchers unravel the science, FDA will speed the pathway and apply cutting-edge discoveries in nutrition as quickly as possible, whether it’s in the field of dietary supplements, micronutrients, or our approach to the food label we put on the items you purchase. I hope you will visit the website for FDA’s Center for Food Safety and Applied Nutrition on a regular basis, as well as the USDA web site: MyPyramid.gov, to get the latest on how food can be your prescription for health.

Andrew C. von Eschenbach, M.D.
Commissioner of Food and Drugs

BMP-7 Protein Produces “Good” Fat that Helps Fight Obesity

Researchers have found that a bone growth protein, known as BMP-7, also aids the growth of brown (or “good”) fat that helps fight obesity.

“Obesity is occurring at epidemic rates in the U.S. and worldwide and that impacts the risk and prognosis of many diseases,” said Yu-Hua Tseng, Ph.D. an Assistant Investigator in the Joslin Section on Obesity and Hormone Action and lead author of the paper published in the August 21 issue of Nature. “We hope this study can be translated into applications to help treat or prevent obesity.”

Dr. Teng cited obesity as a major risk factor for type 2 diabetes, and its close relationship to the metabolic syndrome, a group of medical problems associated with insulin resistance that can increase the risk of atherosclerosis.

Dr. Teng states that there are 2 main types of fat cells, white and brown. In laboratory studies of mouse cells, she and her colleagues found that a bone-producing protein called BMP-7 drives precursor cells giving rise to mature brown fat cells.

“White fat cells are the ‘conventional’ form of fat designed to store energy. By contrast, the main role of brown fat is to burn calories by generating heat. Brown fat cells largely disappear by adulthood in humans, but their precursors still remain in the body,” Tseng explained.

An earlier (2005) Joslin study by Dr. Teng and colleagues discovered genes that control the creation of the precursor cells of brown fat. A later (2007) Joslin study by C. Ronald Kahn, M.D., head of the Joslin Section on Obesity and Hormone Action and also a co-author of the current Nature study, found clusters of brown fat cells dispersed between bundles of muscle fibers in an obesity-resistant strain of mice.

The study identified BMP-7 as the protein capable of inducing the formation and function of brown fat cells.Delivery of BMP-7 into mice using adenovirus as a vector resulted in an increase in the development of brown fat tissue. In one of the experiments, the mice that developed brown fat tissue gained less weight than those that did not. In another experiment, mice that received injections of progenitor cells—similar to stem cells—that had been pre-treated with BMP-7 also developed additional brown fat tissue.

The purpose of the study was to determine what controls the development of fat depots, a central question in adipocyte biology. BMPs are a family of proteins known to regulate organ formation during embryonic development. Dr. Teng and associates suggested that different members of BMPs determine brown versus white fat cell fate. Scientists hope that improved knowledge of fat development will lead to new drugs or therapeutic approaches to fight obesity.

“Diet and exercise are still the best approaches for weight reduction in the general population,” Tseng said. “However, for people who are genetically predisposed to obesity, these approaches may have very little effect.” As we learn more about the controls of brown fat development, medical interventions to increase energy expenditure by brown fat inducing agents, such as BMP-7, may provide hope to these individuals in losing weight and preventing the metabolic disorders associated with obesity,” she said.

Source: Nature, August 21, 2008

Health Benefits of Dark Chocolate

Flavonoids in dark chocolate are a naturally occurring antioxidant similar to those found in teas, red wine, and some fruits and vegetables. These flavonoids are thought to have a beneficial effect on the cardiovascular system, and one recent study showed that 6 grams of dark chocolate a day (about one square) lowered systolic and diastolic blood pressure by 2 points each.

The study also claims that dark chocolate may lower low-density lipoprotein (LDL) cholesterol levels by about 5 points. Not a major effect to be sure, but pushing the “bad” cholesterol downwards. Flavonoids also benefit how the lining of the blood vessels function.

“We think a lot of bad things that happen to the cardiovascular system are because the lining of the vessels cracks and becomes inflamed, setting the stage for plaques to form and rupture,” says Robert Sheeler, M.D., a family physician at Mayo Clinic.

Don’t forget, chocolate contains calories and fat, so these findings are not an invitation to go on chocolate binge. Dr. Sheeler says just one square a day (about 30 calories) will provide the health benefits described. He recommends chocolate that contains at least 60% cocoa; milk chocolate by contrast has only 15-25% cocoa, while dark chocolate can contain as much as 80%+ cocoa.

Source: Women’s HealthSource, Mayo Clinic , August, 2008