Executive Editor:   Publisher & Managing Editor: Contributing Editor: Design/Copy Editor:   CHRISTOPHER PEREZ     KENDALL KIRSCH   JILL SHUMAN   CAROLYN CROWN What do you want to see in Clinical Compass? ASK THE EDITORS   Last Issue - 01.02.07   Next Issue - 01.30.07   www.neuroscienceCME.com
		Subscribe to Clinical Compass™			VOLUME 2, ISSUE 2 - January 16, 2007
		FROM THE CLINICAL KNOWLEDGE CENTER Obesity as a Mental Health Issue Overweight is a particular risk factor for patients with psychiatric disorders, as this population has an increased rate of cardiovascular morbidity and mortality compared to the general population. Healthy Weight Week, taking place the week of January 18-25, 2007, is an annual, national observance that focuses attention on the importance of staying at a healthy weight. This is especially important at a time when more Americans than ever are overweight. During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older - over 60 million people - are obese. This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are considered overweight. These increasing rates raise concern because of their implications for Americans' health. Being overweight or obese increases the risk of many diseases and health conditions, including the following: • Hypertension • Dyslipidemia • Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Osteoarthritis • Sleep apnea and respiratory problems • Some cancers (endometrial, breast, and colon) • Metabolic syndrome (a triad of interrelated metabolic risk factors [obesity, dyslipidemia, and hyperglycemia] that appear to directly promote the development of heart disease and type 2 diabetes) Data suggest that that patients receiving conventional and/or atypical antipsychotics are at risk for developing diabetes; some atypical antipsychotics are also associated with an increased risk of metabolic disturbances. Therefore, clinicians should provide baseline and ongoing monitoring of clinical and laboratory parameters in patients who are being treated for psychiatric disorders with these agents. Overweight Versus Obesity? Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. Definitions for Adults For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat. The standards are the same for men and women. See the table below for definitions of weight categories for a reference adult who is 5'9" tall. Height Weight Range BMI Considered 5'9" 124 lbs or less Below 18.5 Underweight 125 lbs to 168 lbs 18.5 to 24.9 Healthy weight 169 lbs to 202 lbs 25.0 to 29.9 Overweight 203 lbs or more 30 or higher Obese It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat. For more information about calculating BMI, click here: Body Mass Index. Definitions for Children and Teens For children and teens, BMI ranges above a normal weight have different labels (at risk of overweight and overweight). Additionally, BMI ranges for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at various ages. For more information about BMI for children and teens (also called BMI-for-age), click here: BMI for Children and Teens. BMI is just one indicator of potential health risks associated with being overweight or obese. For assessing someone's likelihood of developing overweight- or obesity-related diseases, the National Heart, Lung, and Blood Institute guidelines recommend looking at two other predictors: • The individual's waist circumference (because abdominal fat is a predictor of risk for obesity-related diseases) • Other risk factors the individual has for diseases and conditions associated with obesity (for example, high blood pressure or physical inactivity) National Estimated Cost of Obesity According to the U.S. Centers for Disease Control and Prevention, overweight and obesity and their associated health problems have a significant economic impact on the U.S. health care system. Medical costs associated with overweight and obesity may involve direct and indirect costs. Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs. Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days. Mortality costs are the value of future income lost by premature death. According to a study of national costs attributed to both overweight (BMI 25-29.9) and obesity (BMI greater than 30), medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6 billion in 2002 dollars). Although one of the national health objectives for the year 2010 is to reduce the prevalence of obesity among adults to less than 15%, current data indicate that the situation is worsening rather than improving. To help clinicians identify patients at risk for overweight, the U.S. Centers for Disease Control and Prevention has provided the following fast facts: The Facts about Overweight and Obesity • 61% of adults in the United States were overweight or obese (BMI > 25)* in 1999. • 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years were overweight* in 1999. This prevalence has nearly tripled for adolescents in the past 2 decades. • The increases in overweight and obesity cut across all ages, racial and ethnic groups, and both genders. • 300,000 deaths each year in the United States are associated with obesity. • Overweight and obesity are associated with heart disease, certain types of cancer, type 2 diabetes, stroke, arthritis, breathing problems, and psychological disorders, such as depression. • The economic cost of obesity in the United States was about $117 billion in 2000. Health Disparities • The prevalence of overweight and obesity increases until about age 60, after which it begins to decline. • In women, overweight and obesity are higher among members of racial and ethnic minority populations than in non-Hispanic white women. • In men, Mexican-Americans have a higher prevalence of overweight and obesity than non-Hispanic whites or non-Hispanic blacks. The prevalence of overweight and obesity in non-Hispanic white men is greater than in non-Hispanic black men. • 69% of non-Hispanic black women are overweight or obese compared to 58% of non-Hispanic black men. • 62% of non-Hispanic white men are overweight or obese compared to 47% of non-Hispanic white women. However, when looking at obesity alone (BMI > 30)*, slightly more non-Hispanic white women are obese compared to non-Hispanic white men (23%; 21%). • For all racial and ethnic groups combined, women of lower socioeconomic status (income < 130 percent of poverty threshold) are approximately 50% more likely to be obese than those of higher socioeconomic status. • Mexican-American boys tend to have a higher prevalence of overweight than non-Hispanic black or non-Hispanic white boys. • Non-Hispanic black girls tend to have a higher prevalence of overweight than Mexican-American or non-Hispanic white girls. • Non-Hispanic white adolescents from lower income families experience a greater prevalence of overweight than those from higher income families. Causes of Overweight and Obesity • Overweight and obesity result from an imbalance involving excessive calorie consumption and/or inadequate physical activity. • For each individual, body weight is the result of a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences. • Behavioral and environmental factors are large contributors to overweight and obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment. Physical Activity and Inactivity • It is recommended that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. More may be needed to prevent weight gain, to lose weight, or to maintain weight loss. • Less than 1/3 of adults engage in the recommended amounts of physical activity. • Many people live sedentary lives; in fact, 40% of adults in the United States do not participate in any leisure time physical activity. • 43% of adolescents watch more than 2 hours of television each day. • Physical activity is important in preventing and treating overweight and obesity and is extremely helpful in maintaining weight loss, especially when combined with healthy eating. Do you have feedback for the author? Click here to send us an email. References Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care 2004;27:596-601.
		©2007 CME Outfitters, LLC