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W H Dietz

Publications and source records attributed to W H Dietz.

At least 19 recordsLinked to original sources
PubMed2002

Body weight and obesity in adults and self-reported abuse in childhood.

BACKGROUND: Little is known about childhood factors and adult obesity. A previous study found a strong association between childhood neglect and obesity in young adults. OBJECTIVE: To estimate associations between self-reported abuse in childhood (sexual, verbal, fear of physical abuse and physical) adult body weight, and risk of obesity. DESIGN: Retrospective cohort study with surveys during 1995-1997. PATIENTS: A total of 13,177 members of California health maintenance organization aged 19-92 y. MEASUREMENTS: Body weight measured during clinical examination, followed by mailed survey to recall experiences during first 18 y of life. Estimates adjusted for adult demographic factors and health practices, and characteristics of the childhood household. RESULTS: Some 66% of participants reported one or more type of abuse. Physical abuse and verbal abuse were most strongly associated with body weight and obesity. Compared with no physical abuse (55%), being 'often hit and injured' (2.5%) had a 4.0 kg (95% confidence interval: 2.4-5.6 kg) higher weight and a 1.4 (1.2-1.6) relative risk (RR) of body mass index (BMI) > or = 30. Compared with no verbal abuse (53%), being 'often verbally abused' (9.5%) had an RR of 1.9 (1.3-2.7) for BMI > or = 40. The abuse associations were not mutually independent, however, because the abuse types strongly co-occurred. Obesity risk increased with number and severity of each type of abuse. The population attributable fraction for 'any mention' of abuse (67%) was 8% (3.4-12.3%) for BMI > or = 30 and 17.3% (-1.0-32.4%) for BMI > or = 40. CONCLUSIONS: Abuse in childhood is associated with adult obesity. If causal, preventing child abuse may modestly decrease adult obesity. Treatment of obese adults abused as children may benefit from identification of mechanisms that lead to maintenance of adult obesity.

Adult↗
PubMed2001

Impact of overweight on the risk of developing common chronic diseases during a 10-year period.

BACKGROUND: Overweight adults are at an increased risk of developing numerous chronic diseases. METHODS: Ten-year follow-up (1986-1996) of middle-aged women in the Nurses' Health Study and men in the Health Professionals Follow-up Study to assess the health risks associated with overweight. RESULTS: The risk of developing diabetes, gallstones, hypertension, heart disease, and stroke increased with severity of overweight among both women and men. Compared with their same-sex peers with a body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) between 18.5 and 24.9, those with BMI of 35.0 or more were approximately 20 times more likely to develop diabetes (relative risk [RR], 17.0; 95% confidence interval [CI], 14.2-20.5 for women; RR, 23.4; 95% CI, 19.4-33.2 for men). Women who were overweight but not obese (ie, BMI between 25.0 and 29.9) were also significantly more likely than their leaner peers to develop gallstones (RR, 1.9), hypertension (RR, 1.7), high cholesterol level (RR, 1.1), and heart disease (RR, 1.4). The results were similar in men. CONCLUSIONS: During 10 years of follow-up, the incidence of diabetes, gallstones, hypertension, heart disease, colon cancer, and stroke (men only) increased with degree of overweight in both men and women. Adults who were overweight but not obese (ie, 25.0 < or = BMI < or = 29.9) were at significantly increased risk of developing numerous health conditions. Moreover, the dose-response relationship between BMI and the risk of developing chronic diseases was evident even among adults in the upper half of the healthy weight range (ie, BMI of 22.0-24.9), suggesting that adults should try to maintain a BMI between 18.5 and 21.9 to minimize their risk of disease.

Body Mass Index↗
PubMed2001

C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988-1994.

OBJECTIVES: To examine the relationship between C-reactive protein (CRP) concentration and body mass index (BMI) in children. STUDY DESIGN: With the use of data from 5305 children aged 6 to 18 years in the Third National Health and Nutrition Examination Survey (1988 to 1994), a cross-sectional health survey, we examined whether CRP concentrations were elevated among overweight children. RESULTS: Among children whose BMI was below the age- and sex-specific 15th percentile, 6.6% of boys and 10.7% of girls had an elevated CRP concentration (>2.1 mg/L) compared with 24.2% of boys and 31.9% of girls whose BMI was > or =95th percentile. After adjustment was done for age, sex, race or ethnicity, poverty income ratio, high-density lipoprotein cholesterol concentration, white blood cell count, and history of chronic bronchitis, the adjusted odds of having an elevated CRP concentration were 2.20 (95% CI 1.30, 3.75) for children with a BMI of 85th to <95th percentile and 4.92 (95% CI 3.39, 7.15) for children with a BMI of > or =95th percentile compared with children who had a BMI of 15th to <85th percentile. The associations did not differ significantly by age, sex, or race or ethnicity. CONCLUSIONS: In a large representative sample of US children, CRP concentration was significantly elevated among children with a BMI > or=85th percentile, thus confirming previous findings of this association in children and extending previous research in adults to children. Excess body weight may be associated with a state of chronic low-grade inflammation in children.

Adolescent↗
PubMed2001

Preventing obesity in children and adolescents.

In this review, we address the natural history of obesity in children, the most promising family- and school-based approaches to the prevention of obesity, and the barriers and opportunities associated with secondary prevention. In childhood, the most important periods of risk appear to be the periods of adiposity rebound and adolescence. Caution regarding the period of adiposity rebound is still warranted, because it is not yet clear that early rebound is attributable to changes in body fat. Families and schools represent the most important foci for preventive efforts in children and adolescents. One productive approach is to proceed from an examination of factors that affect energy balance to the identification of more proximal influences on those factors. This approach may help to narrow the strategies necessary to prevent or treat childhood obesity. For example, television viewing affects both energy intake and energy expenditure, and therefore represents a logical target for interventions. Anticipatory guidance by pediatricians may offer an effective mechanism by which to change parental attitudes and practices regarding television viewing. A similar process is used to emphasize the potential influence of school-based interventions directed at changes in food choices and sedentary behavior.

Adolescent↗
PubMed2001

Nutritional rickets in Georgia.

Opinions expressed in commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees. Commentaries are not peer-reviewed.

Breast Feeding↗
PubMed2001

Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study.

BACKGROUND: Childhood obesity is related to adult levels of lipids, lipoproteins, blood pressure, and insulin and to morbidity from coronary heart disease (CHD). However, the importance of the age at which obesity develops in these associations remains uncertain. OBJECTIVE AND DESIGN: We assessed the longitudinal relationship of childhood body mass index (BMI, kg/m(2)) to adult levels of lipids, insulin, and blood pressure among 2617 participants. All participants were initially examined at ages 2 to 17 years and were reexamined at ages 18 to 37 years; the mean follow-up was 17 years. RESULTS: Of the overweight children (BMI >/=95th percentile), 77% remained obese (>/=30 kg/m(2)) as adults. Childhood overweight was related to adverse risk factor levels among adults, but associations were weak (r ~ 0.1-0.3) and were attributable to the strong persistence of weight status between childhood and adulthood. Although obese adults had adverse levels of lipids, insulin, and blood pressure, levels of these risk factors did not vary with childhood weight status or with the age (</=8 years, 12-17 years, or >/=18 years) of obesity onset. CONCLUSIONS: Additional data are needed to assess the independent relationship of childhood weight status to CHD morbidity. Because normal-weight children who become obese adults have adverse risk factor levels and probably will be at increased risk for adult morbidity, our results emphasize the need for both primary and secondary prevention.

Adolescent↗
PubMed2001

Interventions for weight loss and weight gain prevention among youth: current issues.

The recent increase in the prevalence of paediatric obesity is one of the most pressing public health concerns today because of the immediate and long term health consequences associated with this often intractable disease. Efforts are currently being made to reduce the prevalence of paediatric obesity. Youth weight loss studies have produced significant long term results. Most of these programmes included behaviour modification, diet and exercise. Studies have suggested that lifestyle exercise programmes may produce the best long term results. Effective components of these programmes appear to be parental involvement, reduced intake of foods having high energy density and reductions in physical inactivity. Future weight loss studies need to determine the type, intensity, and duration of exercise that will produce acceptable adherence and consequent long term weight loss, and to ascertain the reinforcing factors that determine youth behaviour choice. Weight gain prevention interventions for youth are clearly in their infancy. This review describes 3 completed and 2 ongoing weight gain prevention trials. One study showed reductions in the prevalence of obesity among junior high school girls, but not among boys. Another study among elementary school students showed significant mean decreases in body mass index in boys and girls following an intervention specifically to reduce time spent viewing television. Whether these studies altered food intake or increased physical activity remains unclear. A combination of weight loss treatment and weight gain prevention strategies employed in parallel is likely to yield the greatest benefits. Development and testing of novel intervention strategies, using innovative behavioural approaches to increase the likelihood that children will adopt healthy dietary, physical activity, and sedentary behaviour patterns, holds great promise to significantly reduce the epidemic of obesity.

Adolescent↗
PubMed2000

Establishing a standard definition for child overweight and obesity worldwide: international survey.

OBJECTIVE: To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. DESIGN: International survey of six large nationally representative cross sectional growth studies. SETTING: Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. SUBJECTS: 97 876 males and 94 851 females from birth to 25 years of age. MAIN OUTCOME MEASURE: Body mass index (weight/height(2)). RESULTS: For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m(2) for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years. CONCLUSIONS: The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.

Adolescent↗
PubMed2000

Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents.

OBJECTIVES: (1) To determine the prevalence of abnormal liver enzymes in overweight and obese adolescents and (2) to determine the relationship of alcohol ingestion and serum antioxidants to the presence of abnormal liver enzymes in overweight and obese adolescents. METHODS: Serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were measured in 2450 children between the ages of 12 and 18 years, enrolled in the National Health and Examination Survey, cycle III (NHANES III). Obesity was defined as a body mass index >95th percentile for age and sex. Overweight was defined as a body mass index >85th percentile for age and sex. Nutritional intake was assessed by 24-hour dietary recall and food frequency questionnaires. Serum antioxidants were measured by high-pressure liquid chromatography. RESULTS: Sixty percent of adolescents with elevated ALT levels were either overweight or obese. Overall, 6% of overweight adolescents had elevated ALT levels (odds ratio: 3.4 [95% CI: 3.5-12.8]). Ten percent of obese adolescents had elevated ALT levels (odds ratio: 6.7 [95% CI: 3.5-12.8]). In addition, approximately 1% of obese adolescents demonstrated ALT levels over twice normal. Approximately 50% of of obsese adolescents who reported modest alcohol ingestion (4 times per month or more) had elevated ALT levels (odds ratio: 10.8, 95% CI: 1.5-77). Other factors associated with elevated ALT levels in overweight and obese adolescents include increased age, elevated glycolated hemoglobin, elevated triglycerides, and decreased levels of serum antioxidants-vitamin E, beta-carotene, and vitamin C. CONCLUSION: Overweight and obesity are the most common findings in adolescents with elevated ALT levels. Even modest alcohol consumption may significantly increase the likelihood of obese adolescents developing obesity-related liver disease.

Adolescent↗
PubMed1999

The spread of the obesity epidemic in the United States, 1991-1998.

CONTEXT: The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases. OBJECTIVE: To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults. DESIGN: Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998. SETTING: States that participated in the Behavioral Risk Factor Surveillance System. MAIN OUTCOME MEASURES: Body mass index calculated from self-reported weight and height. RESULTS: The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases). CONCLUSIONS: Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Adult↗
PubMed1999

The disease burden associated with overweight and obesity.

CONTEXT: Overweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions. OBJECTIVE: To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population. DESIGN AND SETTING: Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994. PARTICIPANTS: A total of 16884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] > or =25 kg/m2) based on National Institutes of Health recommended guidelines. MAIN OUTCOME MEASURES: Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis. RESULTS: Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups. CONCLUSIONS: Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.

Adult↗