Obesity and Child Obesity 10-23-12 | Obesity | Preventive Healthcare

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OFFICE OF THE STATE COMPTROLLER Thomas P. DiNapoli, State Comptroller Soaring Health Care Costs Highlight Need To Address Childhood Obesity October 2012 Overview Obesity rates in New York State and the nation have jumped sharply in recent decades. Childhood obesity, in particular, has become much more common – nearly tripling nationwide since 1980. According to the New York State Department of Health (DOH), 17 percent of New Yorkers under the age of 18 – or approximately 735,000 young people –
    OFFICE OF THE STATE COMPTROLLER Thomas P. DiNapoli, State Comptroller Soaring Health Care Costs HighlightNeed To Address Childhood Obesity   October 2012 Overview Obesity rates in New York State and the nation have jumped sharply in recentdecades. Childhood obesity, in particular, has become much more common – nearlytripling nationwide since 1980. According to the New York State Department of Health(DOH), 17 percent of New Yorkers under the age of 18 – or approximately 735,000youngpeople – are obese. An estimated 32 percent, or 1.4 million, are overweight orobese. 1 The sharp rise in obesity places tens of thousands more children at higher riskof serious physical health problems such as diabetes and asthma, as well aspsychological issues including depression.The increased prevalence of obesity is also an important factor in burgeoning healthcare costs for employers, consumers, and taxpayers. Total obesity-related costs inNew York State are estimated at more than $11.8 billion annually. Some $4.3 billion ofsuch expenditures are funded by Medicaid, with roughly half of that cost paid by NewYorkers’ State and local taxes. Another $7.5 billion of obesity-related costs are paid byMedicare, employers’ and workers’ health-insurance premiums, and uninsuredindividuals. 2  Obesity-related expenditures for children are a comparatively small part of the overallpicture. However, childhood and the teen years are the period when many individualsenter a long-term struggle with their weight – as well as the time when health carecosts associated with obesity start to mount. National data show that the percentage ofchildren aged 10 to 17 who are classified as overweight or obese is higher in NewYork than in two-thirds of the 50 states. 3 The increased prevalence of childhoodobesity can be expected to add billions of dollars more to health care costs in theyears ahead, as overweight children and teens become adults. Some of these costsmay be avoidable, given the right mix of public policies and personal choicesthroughout society.New York State has taken some initial steps to address the obesity epidemic.Examples include legislation enacted in 2007 that requires reporting of weight statusfor school students outside New York City. 4 Such reporting is one important steptoward measuring trends among overweight and obese children. The State also  2revised its Women, Infants and Children (WIC) nutrition program in 2009 to promotethe consumption of skim or low-fat milk rather than whole milk, and to increaseconsumption of vegetables year-round. The State Education Department (SED) hasissued regulations restricting the sale of candy and soda in schools. However, auditsby the Office of the State Comptroller (OSC) have found that school districts oftenfailed to comply with these rules, as well as other regulations intended to ensureregular physical activity.The magnitude of the obesity challenge demands a more comprehensive, moresustained, and vigorous response. Specifics of such an initiative should be identifiedby DOH, which bears primary responsibility for promoting public health in the State.New York is in the midst of a broad restructuring of its Medicaid policy. This “Medicaidredesign” is defined as pursuing three major goals: improving quality of care,addressing root causes of poor health, and controlling costs. 5 The obesity epidemicrepresents a significant threat to the State’s efforts to improve health outcomes andcontrol health care costs. At the same time, the redesign of Medicaid offers a clearopportunity to address the obesity epidemic more comprehensively, as increasedresearch by academics and health care professionals identifies the most effectivesolutions to the problem.DOH has proposed a new initiative, to be funded with federal dollars, to provideintensive behavioral counseling for an estimated 5.0 percent of Medicaid beneficiarieswho are obese. If the federal government approves the plan, it would represent theState’s most ambitious effort yet to reduce obesity, but would still leave much of theproblem unaddressed. DOH has declared that obesity and overweight status maysoon overtake tobacco consumption as America’s leading preventable cause of death.To date, the State’s response to the growing threat of obesity is not proportionate toDOH’s own assessment of the problem. If New York fails to act more aggressively andeffectively, the costs of obesity – both human and fiscal – will continue to rise in theyears ahead. Rising Prevalence of Childhood Obesity According to the Centers for Disease Control and Prevention (CDC), a component ofthe U.S. Department of Health and Human Services, the terms “overweight” and“obese” refer to ranges of weight that are greater than what is generally consideredhealthy for a certain height. A calculation known as the body mass index (BMI), basedon the ratio of a person’s weight to height, generates a figure that typically correlatesto the amount of body fat, and determines whether the person is classified asoverweight or obese. 6 Even children as young as six months of age may beconsidered obese. Nationally and in New York, childhood obesity has now reachedepidemic proportions. 7  During the 1980s and 1990s, nationwide obesity prevalence among children and teenstripled, from around 5.0 percent to approximately 15 percent. According to CDC,therate of increase has slowed nationally over the last decade, and may be leveling off. 8    3DOH reports a similar jump in childhood obesity rates in New York. The Departmentestimates that 17 percent of students in pre-kindergarten through high school wereobese during the two school years from 2008 to 2010, while another 15 percent wereoverweight. (“Obese” indicates BMI at or above the 95 th percentile for a student’s agegroup, while “overweight” refers to those above the85 th percentile.) Generally, children who are African-American or Hispanic are more likely than non-Hispanic whites to suffer from obesity, although suchvariations are also associated with income andeducation. Low-income children and adolescents areproportionally more likely to be obese than theirhigher-income counterparts, although low-incomeyouth represent a minority ofall obese children andadolescents in absolute terms. 9  A separate measure of obesity rates at the county level emerges from amendments toState Education Law, enacted in 2007, which require student health certificates toinclude body mass index and weight status information for pupils in kindergarten andgrades 2, 4, 7 and 10. Such information is based on a physical examination (usuallyperformed by the student’s personal physician) and sent by schools to DOH.Based on the DOH weight status data by county outside New York City, a median of20 percent of students in 7 th and 10 th grades were classified as obese inschool years2008-09 and 2009-10 (districts are on a biennial reporting cycle). 10 Includingoverweight as well as obese students, the median reaches 36 percent; in sevencounties that proportion rose to more than 40 percent of enrollment. Figure 1 illustratesDOH’s county-level data on the proportion of students in 7 th and 10 th grades who werereported as either overweight or obese in the 2008-09 and 2009-10 school years;Appendix A presents such estimates numerically as well as data on obesity only. (Datafor some students – roughly one in three, in the typical county – were not reported toDOH for reasons including confidentiality restrictions in smaller schools, lack ofdocumentation from health care providers or other factors. Appendix A includes thepercentage of students in each county for whom data were reported; suchpercentages vary and should be considered along with the proportion of studentsreported as overweight or obese.) New York City schools collect data separately. As ofthe 2010-11 school year, an estimated 20.7percent of elementary and middle schoolstudents in the City were considered obese. 11   An estimated 17 percent of New York students were obese during the 2008 to 2010 school years.   4 Figure 1: Student Weight Status By CountyPercentage of 7th- and 10th-Grade Students Reported as Overweight or Obese Source: School district data for 2008-09 and 2009-10 school years reported to New York StateDepartment of Health Forty-one states have adult obesity rates higher than New York’s, according to CDCdata analyzedby the Trust for America’s Health (TfAH) and the Robert Wood JohnsonFoundation. 12 Yet when it comes to childhood obesity, New York’s position is mixed.The 32.9 percent of children aged 10 to 17 who are overweight or obese is 17 th  highest among the 50 states, TfAH’s analysis found. Meanwhile, among high-schoolstudents, New York ranks 30 th in the nation. Figure 2 illustrates estimates of theproportion of overweight and obese children aged 10 to 17 in each state; Appendix Bprovides state-by-state comparisons for both high-school students and for childrenaged 10 to 17. 0% 10% 20% 30% 40% 50% 60% OneidaOswegoJeffersonSt.LawrenceSullivanCattaraugusDutchessOnondagaSenecaClintonFranklinChemungTiogaWyomingCayugaMadisonNiagaraGreeneLewisUlsterBroomeChautauquaOntarioColumbiaAlbanyYatesRensselaerSuffolkWarrenSchenectadyMonroeChenangoWashingtonErieSteubenOrleansHerkimerNassauOtsegoTompkinsCortlandGeneseeSchoharieWestchesterWayneAlleganySchuylerDelawarePutnamLivingston  
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