American Association for Clinical Chemistry
Better health through laboratory medicine
Expo Issue 2011: Tackling the Obesity Epidemic

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Expo Issue 2011

Tackling the Obesity Epidemic
Speakers Bring Together Research, Policy, and Praxis

By Bill Malone

Set in 2000, the U.S. Department of Health and Human Services’ Healthy People 2010 goals highlighted overweight and obesity as one of 10 leading health indicators and called for efforts to reduce the proportion of children and adolescents who are overweight or obese. However, the country has made little progress toward that goal. Results from the 2007–2008 NHANES indicate that 17% of children and adolescents age 2–19 are obese, and more than one third of adults. In fact, recent data show that the prevalence of obesity more than doubled among adults and tripled among children and adolescents from 1980–2004.

At this year’s AACC Annual Meeting, plenary speakers, symposia, and other sessions will bring new focus to this public health crisis. A 2010 survey of AACC members found that 31% said they needed more education on metabolic syndrome and obesity, and the Association has designated nutrition as a hot topic for AACC programming. “In the lab, we’re seeing more and more children coming in for glucose tolerance tests and more diagnosed with diabetes at an earlier age. Whether out in the world or in the lab, the effects of obesity are being felt all around us now,” said Elia Mears, MT (ASCP), an independent laboratory consultant and the moderator of today’s full day symposium, Pediatric Obesity: A Growing Epidemic. “I hope this is a reality check for people and builds awareness so that we as laboratorians can be part of the solution.” The symposium starts at 10:30 a.m. in Room B206 of the Georgia World Congress Center.

A Unique Public Health Problem

The focus on obesity at this year’s meeting also is highlighted this morning by the plenary session featuring Jeffrey Koplan, MD, MPH. The director of the Centers for Disease Control and Prevention (CDC) from 1998–2002, Koplan is now the vice president for global health of Emory University and director of the Emory Global Health Institute here in Atlanta. He chaired the National Academy of Science’s Institute of Medicine Committee on Preventing Childhood Obesity for 6 years.

This is an exciting time in the field, with many kinds of interventions, programs, and research taking on the obesity problem, according to Koplan. However, it will take a large and sustained effort by healthcare providers and other stakeholders to turn around the trends, he warned. “We’re at the early stage of a major health challenge, so it’s really too early to say one particular solution is great and everyone needs to do it. This is a problem that took us several decades to get where we are now, and it might take us that long to solve it. I think there are a range of interventions that we can be hopeful about, but the proof of their value is yet to be fully established.”

Like other major public health challenges such as tobacco, addressing obesity will require a range of strategies, Koplan noted. “All these public health issues are unique, and yet they’re all alike,” he said. “For example, the obesity problem involves consumption of items in excess, or the wrong items, and a lack of physical activity, and that’s not dissimilar from some elements of tobacco control or other things that require a mixture of regulations and public policies, along with individual decision making. It’s never as simple as one or the other; it’s always an interplay of the two. A difference with tobacco is that it’s a product in which at any level it’s unhealthy for you, whereas we all need to eat. It’s just what we eat and how much. With tobacco, the manufacturers have been active obstructers of the public’s health, and in the food and beverage industry, there are hopeful signs that companies want to partner and do their part to address nutrition and obesity issues in a responsible way.”

Koplan also emphasized that strategies fighting obesity will have to be localized to fit each community. “How you get people to take in fewer calories or exercise more is culturally specific. Bicycle riding may be the easiest thing to do in Copenhagen, but it may be taking your life in your hands to do so in Atlanta. Finding fresh fish that you can broil and a plethora of fresh vegetables may be a lot easier when you’re higher income on the Upper East Side of Manhattan than when you’re in a poor neighborhood in South Central Los Angeles.”

A Growing Role for the Lab

How will labs make their mark on this national health crisis? Today’s brown bag session, Metabolic Syndrome: an Update on Prevalence, Criteria, and Laboratory Testing, aims to answer this question with insights into how lab testing plays a pivotal role in the definition and diagnosis of metabolic syndrome. The ticketed session is offered twice today, from 7:30–8:30 a.m. and 12:30–1:30 p.m. in the Georgia World Congress Center.

This is the third consecutive year that Ross Molinaro, MT(ASCP), PhD, DABCC, FACB, has presented this session, in part because new tests, epidemiological data, and guidelines make it a field that’s changing quickly. “Several new markers for metabolic syndrome are being evaluated, such as plasminogen activator inhibitor-1 and oxidized low density lipoprotein cholesterol, and certainly the lab’s role in performing state of the art testing while working to determine the clinical utility of new tests in diagnosing metabolic syndrome is huge,” he said. “The statistics are truly astounding. Recent National Health and Nutrition Examination Survey [NHANES] data indicates the prevalence of metabolic syndrome is increasing, so labs will likely be performing more and more of the tests that are involved in diagnosis.” Molinaro is assistant professor of pathology and laboratory medicine, medical director of the core laboratories at Emory University Hospital Midtown in Atlanta, and co-director of the Emory Clinical Translational Research Laboratory.

In addition to new markers, the session will include an update on the global and national prevalence of metabolic syndrome and the evolving criteria for diagnosis. Attendees will also explore patient cases in which the attendees will help determine whether the diagnosis of metabolic syndrome is justified.

Researchers and public policymakers have stepped up efforts since the 2009 publication of a joint statement on the criteria of metabolic syndrome, which they defined as “a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus that occur together more often than by chance alone” (Circulation 2009;120:1640–1645). The American Heart Association, along with the International Diabetes Federation Task Force on Epidemiology and Prevention, the National Heart, Lung, and Blood Institute, the World Heart Federation, the International Atherosclerosis Society, and the International Association for the Study of Obesity agreed that abnormal findings in three out of five criteria should qualify a person as having metabolic syndrome: elevated waist circumference, triglycerides ≥150 mg/dL, high density lipoprotein cholesterol <40 mg/dL in males and <50 mg/dL in females, systolic blood pressure ≥130 and/or diastolic ≥85 mm Hg, and fasting glucose ≥100 mg/dL.

Nevertheless, controversy about metabolic syndrome remains, Molinaro noted. “If you ask some people, they don’t believe that there should even be criteria for it. Their argument is that it’s just several common problems that are lumped into one situation,” he said. “But when you look at the definition of a syndrome, that’s what a syndrome is. It’s a constellation of different clinical factors occurring together.”

A Big Problem for Small Patients

Most distressing to public health officials and the healthcare community has been the rise in obesity among children, a trend that portends not only higher healthcare costs, but also earlier cases of diabetes and other effects of obesity, Mears emphasized. “We’ve got to reach out to these kids, because they’re really our future,” she said. “The number of young people who are developing type 2 diabetes as a result of obesity is on the rise. We know the additional and long term complications awaiting them unless we get it under control.”

The full day symposium on pediatric obesity features speakers from a variety of viewpoints, including public health experts from CDC like Heidi Blanck, PhD, and physicians on the front lines of treating the complications of obesity, such as Miriam Vos, MD, MSPH, of Emory University and Children’s Healthcare of Atlanta.

Stephanie Walsh, MD, of Emory University School of Public Medicine and Children’s Healthcare of Atlanta will offer attendees a view of a new public health campaign focused on children in Georgia. Walsh is medical director of child wellness at Children’s Healthcare of Atlanta and a member of a multi-specialty, evidence-based obesity clinic called Health4Life. This year, Walsh and colleagues from Children’s launched a campaign called Strong4Life that strives to more effectively educate families, physicians, daycare workers, and others about how to teach children healthy eating and exercise habits.

With children now presenting with heart disease, hypertension, diabetes, and liver and kidney disease, something new was needed to try and win a healthier future for children, said Walsh. “Georgia has the second highest childhood obesity rate in the country, and almost 40% of children are overweight or obese. This is a serious health crisis for children in our state,” she said. “These children are getting bigger, and they’re our future. For Georgia, 24 percent of our third graders are obese, and if they are obese, then they have a 50 percent chance of being obese as adults. So we realized that we really need to get to these kids early.”

As pediatricians cope with all the diseases associated with obesity, they will need the support of the lab, Walsh noted. “We used to feel that children didn’t need a lot of lab testing unless there was a family history or something unusual,” she said. “But now we run into so many children with comorbid diseases at early ages that the need for lab evaluation is really important. I hope that attendees will see that we are all on the same team, and that everyone has a part to play in this. From those who figure out what we should and can test for to help us evaluate children, to those that go out and implement public health campaigns. Getting our society healthier and our infrastructure together to support health instead of what it’s become will take everyone working together.”