What Exactly Do the Trends Mean?

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Abstract
Lthough the adverse public health and economic conse- quences of obesity have been reported for some time, little success has been achieved in controlling the progressive increase in population prevalence and severity of obesity. The obesity epidemic in children is especially sobering. More than 17% of children are obese, and these rates have increased with each new survey. A consequence of childhood obesity has been the premature onset of diseases associated with obesity. The chronic disorders of hypertension, type 2 diabe- tes mellitus, and sleep apnea, which had been considered conditions of middle to late adulthood, now appear in childhood. When the cardiovascular morbidity associated with these conditions is considered, the health impact of childhood-onset hypertension or diabetes mellitus is likely to be enormous. Article p 1488 The extent to which childhood obesity could contribute to an increase in the prevalence of hypertension was studied in a report in this issue of Circulation. Din-Dzietham et al1 conducted a study in which they examined the secular trend in the prevalence of high blood pressure (BP) among children and adolescents to determine if the rise in childhood obesity contributes to an increase in the prevalence of high BP. Data were drawn from serial health surveys conducted by the National Center for Health Statistics between 1963 and 2002 on a representative sample of the noninstitutionalized civilian US population. Data on children between the ages of 8 to 17 years, which included measurement of BP, were the focus of their analysis. The investigators applied the current BP criteria for hypertension and prehypertension in childhood2 to the data from the participants in each of the 6 survey periods between 1963 and 2002 to determine the prevalence of high BP in each survey period. The representations of non- Hispanic white, non-Hispanic black, and Mexican-American children were sufficient to compare rates and trends across the 3 race/ethnic groups. Childhood obesity markedly in- creased, from 7% in 1976-1980 to 11% in the 1988- 1994 examination period, followed by a further increase to 17% in the 1999-2002 examination period. The prevalence of high BP increased between the 1988-1994 and the 1999-2002 examination periods, and the increase appeared to be attributable to the increase in obesity. The analysis by Din-Dzietham and colleagues also demonstrates racial dis- parities in that the recent unfavorable trends in both obesity and high BP have a substantially greater effect on non- Hispanic blacks and Mexican-Americans. The most pertinent aspect of the report by Din-Dzietham et al1 is the current upward trend in the prevalence of high BP among children that is concurrent with an increase in child- hood obesity. The present report is consistent with a recent report by Munter et al,3 who examined BP level as a continuous variable in adolescents from the same 2 recent National Health Surveys (1988-1994 and 1999-2002). Munter et al found a significant population increase in both systolic and diastolic BP, and they verified that the BP increase was most striking among minority groups.3 They also demonstrated that the population increase in BP among adolescents was largely, although not entirely, a result of the increase in body mass index. These reports provide evidence for the concept that secular trends in childhood obesity are setting the stage for increasing and premature cardiovascular