Did obesity conference leave something out?

The CDC held its first “Weight of the Nation” conference in July. It issued the report “Recommended Community Strategies and Measurements weightofnationto Prevent Obesity in the United States,” along with a companion implementation guide. The report recommends 24 environmental and policy strategies to prevent obesity. They include affordable health food and beverages and promoting physical activity. Preventing child trauma wasn’t on the list, even though child trauma and obesity are linked.

Research by David Williamson, a CDC researcher who used data from the Adverse Childhood Experience Study to look at the connection between child trauma and obesity, shows a link between child abuse — physical, sexual and emotional — and obesity in at least 8 percent of the obese population. With 70 million obese and morbidly obese Americans, that’s five million people.

Researchers know that obesity is complex issue: there’s no one answer to solve it. The CDC has a great Web site about obesity. But nowhere does it mention the link between childhood trauma and obesity. And nowhere in the “Recommended Strategies” does it say that one of the many approaches communities can take to prevent obesity is to prevent child abuse. As a journalist, I’m curious about this and want to find out why.

And during this time of grappling with rising health-care costs, obesity is a matter of economics, too. A study also issued at the conference showed that the health cost of obesity in the United States is as high as $147 billion annually. Dr. William Dietz, director of CDC’s Division of Nutrition, Physical Activity and Obesity, noted that obesity can lead to diabetes, heart disease and some cancers. That’s why people who are obese spend nearly $1,500 more each year on health care than those who aren’t obese. And the number is in an upward trend: the study noted that the proportion of all annual medical costs that are due to obesity increased from 6.5 percent in 1998 to 9.1 percent in 2006.

Update: I asked Dr. David Brown, an epidemiologist at the Centers for Disease Control and Prevention and lead author on recent ACE Study research that links child trauma with premature mortality, why it’s taking so long for the CDC to integrate the ACE Study research with its other programs. He gave the following answer:

The classic CDC model is that a program develops, and eventually, there’s enough interest to include it in the states’ BRFSS (Behavioral Risk Factor Surveillance System) to gather some population-based data. This is used as evidence to educate policy makers. “It’s a step-wise process,” says Brown, “building evidence that motivates people to do something with the research.”

In the late 1980s, the CDC started gathering national data on the prevalence of high blood cholesterol and high blood pressure. “Once we began getting data on a national level, and started some clinical trials, then things started to move,” says Brown. In the mid- to late 1990s, state-based programs in heart disease and stroke emerged. In 2000 – 2005, all the states founded programs. But one of the huge studies that led to the current awareness and prevention programs of heart disease started 60 years ago, with the Framingham Heart Study — in 1948.

“That’s a long process,” says Brown. “That’s kind of where this [link between child trauma and adult chronic disease] is at as well.”

The report, “Recommended Community Strategies and Measurements to Prevent Obesity in the United States,” along with a companion implementation guide, appears in CDC’s MMWR Recommendations and Reports. A companion implementation guide is also available on the CDC Web site.
“It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation”, said CDC Director Thomas Frieden, M.D., M.P.H. “These new recommendations and their proposed measurements are a powerful and practical tool to help state and local governments, school districts, and local partners take necessary action.”
The Common Community Measures for Obesity Prevention Project was guided by a systematic process that included expert opinion and a review of the published scientific literature, resulting in the adoption of 24 recommended environmental and policy level strategies to prevent obesity.
The strategies promote the availability of affordable healthy food and beverages, support healthy food and beverage choices, encourage breastfeeding, encourage physical activity or limit sedentary activity, support safe communities that support physical activity, and encourage communities to organize for change.

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