Measuring Progress in Obesity Prevention Workshop Report (2012) / Chapter Skim
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4 Looking Across Domains
4 Looking Across Domains
Pages 39-56
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From page 39... ...
It has developed new tools for obesity researchers: (1) a Measures Registry -- a searchable online registry of diet and physical activity measures at the individual and environmental levels; and (2)
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Robert Malina, professor emeritus in the Department of Kinesiology and Health Education at the University of Texas, Austin, and research professor in the Department of Kinesiology at Tarleton State University, described research related to growth and BMI. Roland Sturm, senior economist at RAND and professor of policy analysis at the RAND Pardee Graduate School, discussed economic perspectives on nutrition, physical activity, and obesity interventions.
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Information in the registry is based on literature searches, a best-practice review, lists of recommended measures prepared by experts in the areas covered, and a tailored abstraction tool. The registry allows users to search and browse for measures, search for specific details related to those measures, link to other measures and other studies that have been conducted using a particular measure, and find measures that are in development and have not yet been published.
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BODY MASS INDEX Presenter: Robert Malina BMI is the most frequently used measure of individuals' weight status. Malina described its use and a number of related issues.
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growth charts because the gain in weight across surveys was viewed as undesirable from a public health perspective, Malina explained, even though that survey was the first to reveal the obesity epidemic. In most countries, people use the International Obesity Task Force (IOTF)
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Workshop participants suggested that the best target for intervention might be even earlier if data indicating that very young children who are overweight or obese have significantly increased odds of being so as adults and experiencing the health problems that often come with excess weight. Greater variation in weight trajectory is evident as children enter adolescence, Malina explained, because of the differential timing of growth spurts.
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. This mixed longitudinal study of boys in Belgium revealed that those who attained their peak height velocity at earlier ages had higher BMIs than those who did so later, and that this difference lasted at least until age 30.
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Cole, M Sempe, et al., 1991, "Body mass index variations: Centiles from birth to 87 years," European Journal of Clinical Nutrition 45:13-21.
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Lopez-Jimenez. "Accuracy of Body Mass Index in Diagnosing Obesity in the Adult General Population." International Journal of Obesity 32, no.
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Because it is affected by growth and pubertal maturation, by aging, and by ethnicity it must be interpreted carefully. Research is needed to monitor BMI rates longitudinally, in Malina's view, "so we can find out how the BMI changes and what factors affect individual change." For example, little is known about how sensitive BMI is to physical activity, particularly in youngsters, but BMI could be an important tool for tracking the role of physical activity in preventing unhealthy weight gain.
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In the United States, more than in most other countries, the belief in consumer sovereignty has a strong influence and affects how institutions work. Long-standing federal guidelines, for example, require agencies to identify market failures (i.e., situations where market forces by themselves cannot achieve desirable outcomes)
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Cost-effective means "good value for the resources compared to alternative interventions or policies," he said, reiterating his belief that cost savings are unlikely to exist for many obesity interventions. Turning next to the sorts of evidence he believes would be useful in developing an approach to obesity prevention, Sturm described a review of behavioral physical activity interventions.
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In other words, the most positive results came from the weakest studies. At present, Sturm noted, no single study provides sufficient information to support cost-effectiveness analysis for many of the most common policy suggestions, such as food taxes, advertising bans, or fast-food bans.
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One suggested that the logical implication of his view is that if there is no clear evidence that reducing obesity rates saves money, there must not be a problem, asking "Why don't we all just be fat and not worry about it? " Others shared this concern, noting, for example, that the diseases
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2009. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults.
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2003. Does early physical activity predict body fat change throughout childhood?
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1999. Longitudinal change in the heights of men and women: Consequential effects on body mass index.
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