Title: Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008
Topic: Prevention/Vascular
Date Posted: 1/22/2010
Author(s): Ogden CL, Carroll MD, Curtin MM, Flegal KM.
Citation: JAMA 2010;303:242-249.
Clinical Trial: No
Study Question: What is the prevalence of high body mass index (BMI) among children and adolescents in the United States?
Methods: Using data from the National Health and Nutrition Examination Survey, 2007-2008, BMI was estimated for 3,281 children (ages 2-19 years) and 719 infants and toddlers (ages birth to 2 years). Prevalence of high weight for recumbent length (≥95th percentile, based on Centers for Disease Control and Prevention growth charts) for infants and toddlers was calculated for five time periods from 1999 to 2008. Prevalence of high BMI was calculated for children (over the age of 2) and adolescents with high BMI defined as three groups: BMI ≥97th percentile, BMI ≥95th percentile, and BMI ≥85th percentile for age. Trends over time were examined by age, sex, and race/ethnicity.
Results: The prevalence of high BMI in 2007-2008 was 9.5% (95% confidence interval [CI], 7.3%-11.7%) for infants and toddlers. For children over the age of 2 and adolescents, the prevalence of those at or above the 97th percentile for BMI was 11.9% (95% CI, 9.8%-13.9%), 16.9% (95% CI, 14.1%-9.6%) for BMI ≥95th percentile, and 31.7% (95% CI, 29.2%-34.1%) for BMI ≥85th percentile. No significant trends over time were observed between 1999-2000 and 2007-2008, with the exception of boys, ages 6-19 years, with BMIs ≥97th percentile (odds ratio [OR], 1.52; 95% CI, 1.17-2.01) and for non-Hispanic white boys ages 6-19 years (OR, 1.87; 95% CI, 1.22-2.94).
Conclusions: The authors concluded that no significant linear trends were observed for high BMI over the past 11 years, with the exception of boys in the highest BMI category.
Perspective: These data suggest a leveling off of the prevalence of overweight and obese children in the United States. However, given the numbers of children with high BMI, aggressive prevention of obesity among US children is still warranted. Elizabeth A. Jackson, M.D., F.A.C.C.
Title: Two Self-Management Interventions to Improve Hypertension Control: A Randomized Trial
Topic: Prevention/Vascular
Date Posted: 1/22/2010
Author(s): Bosworth HB, Olsen MK, Grubber JM, et al.
Citation: Ann Intern Med 2009;151:687-695.
Clinical Trial: yes
Study Question: What is the effectiveness of blood pressure (BP) self-management, or a tailored, nurse-administered health behavior intervention, or both, in the improvement of BP?
Methods: The authors reported the results of a 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, to either usual care, versus home BP monitoring thrice weekly, versus a tailored behavioral telephone intervention, versus behavioral intervention plus BP monitoring. Primary outcome was BP control at 6-month intervals over 24 months.
Results: Of 636 hypertensive patients, 475 (75%) completed the 24-month follow-up. The proportion of patients with controlled BP beyond that seen with usual care was 4.3% (95% confidence interval [CI], -4.5% to 12.9%) in the behavioral intervention group, 7.6% (95% CI, -1.9% to 17.0%) in the home BP monitoring group, and 11.0% (95% CI, 1.9% to 19.8%) in the combined intervention group. Relative to the usual care group, the change in systolic BP was 0.6 mm Hg (95% CI, -2.2 to 3.4 mm Hg) for the behavioral group, -0.6 mm Hg (95% CI, -3.6 to 2.3 mm Hg) for the BP monitoring group, and -3.9 mm Hg (95% CI, -6.9 to -0.9 mm Hg) for the combined intervention group. Similar findings occurred for diastolic BP.
Conclusions: The authors concluded that combined home BP monitoring and tailored behavioral telephone intervention improved BP control, both systolic and diastolic BP at 24 months, compared with usual care.
Perspective: This important study examines the relative effectiveness of simple home BP monitoring, versus continual behavioral 'coaching' regarding exercise, diet, weight, and other healthy lifestyle interventions. This study showed a trend toward improvement in BP with each intervention, but suggests that the only significant improvement came with using both home BP monitoring and the behavioral intervention. We know that home BP measurement is essential to accurately measuring BP (avoiding the very prevalent problem of white coat hypertension), as well as monitoring response to therapy. This study suggests that there are added benefits to combining behavioral intervention with this. Programs based on this type of intervention could have great health and cost benefits, if we could design a health care system with the capacity to efficiently provide this type of support. James B. Froehlich, M.D., F.A.C.C.