Adult Obesity in Howard County, Maryland: Part 1 Academic Paper

Adult Obesity in Howard County, Maryland

Abstract

Obesity is a health problem that has reached epidemic levels. The rate of obesity has nearly tripled worldwide since 1975 (World Health Organization (WHO), 2020). Studies suggest that approximately 20% of the world population will be obese by 2038 (WHO, 2020). In 2016 alone, over 1.9 billion adults, 18 years and older, were overweight. Of these, over 650 million were obese (WHO, 2020). Obesity is associated with complications such as heart disease, stroke, type 2 diabetes, and certain types of cancer (Centers for Disease Control and Prevention (CDC), 2020). The global economic impact of obesity in 2016 was estimated at 2.0 trillion U.S dollars or 2.8% of the global gross domestic product (Harvard, 2020). Researchers estimate that by 2030, overweight and obesity-related medical costs could rise by $48 billion to $66 billion a year if the current trend continues. This paper discusses the epidemiological and demographic data related to obesity in Howard County, Maryland. It further addresses the health disparity among the residents, the development of a program, and the social justice rationale for the program.

Keywords: Obesity, adult, epidemiology, health disparity, social justice

Overview of the Problem

Obesity is defined as a body mass index (BMI) greater than or equal to 30 (World Health Organization (WHO), 2020). An excess accumulation of fat results from an imbalance between caloric intake and expenditure (Eckdahl, 2019). BMI is defined as weight in kilograms divided by height in meters square (The Centers for Disease Control and Prevention (CDC), 2020). The WHO (2020) states that obesity has nearly tripled since 1975. More than 1.9 billion adults, 18 years and older, were overweight in 2016 alone. Of these, over 650 million were obese (WHO, 2020). Studies have shown that obesity increases the risk of chronic diseases such as stroke, diabetes, hypertension, cholesterol, polycystic ovarian syndrome, coronary heart disease, osteoarthritis, and certain types of cancer (breast, colorectal, kidney, and endometrial) (Maryland Department of Health (MDH), 2020). Overweight and obesity combined account for approximately 5% to 10% of U.S. healthcare spending (Tsai et al., 2011). The Maryland Department of Health and Mental Hygiene (DHMH, 2014) suggests that the state of Maryland could save up to $13,836,000,000 by 2030 if BMI were lowered by 5%.

The prevalence, associated complications, and the economic burden of overweight and obesity suggest a need for further understanding of the problems and measures to prevent them. This paper discusses the epidemiological and demographic data related to obesity in Howard County, Maryland, and further discusses the health disparity among the residents, the development of a program, and the social justice rationale for the program.

Epidemiology

It is estimated that approximately 38% of the world population will be overweight and 20% will be obese by 2028 (WHO, 2020). Adult obesity exceeds 30% in the United States and constitutes a significant public health concern (Kim & Basu, 2016). The Maryland Department of Health (MDH, 2020) reports that 28.3% of adults in Maryland are considered obese. Scarfone (2012) states that nearly 25% of Howard County residents are obese. Likewise, in the 2018 Howard County health assessment survey, 27% of the respondents reported BMI scores in the obese range. Many of the participants reported behaviors that contribute to an unhealthy weight, including lack of exercise and low consumption of fruits and vegetables as the contributing factor; a drop from 14% (who ate fruit and vegetables at least 3 times a day) in 2016 to 9% in 2018 (Howard County Health Department (HCHD), 2020). The group that was most likely to participate in some kind of cardiovascular exercise from 55+ years were those between the ages of 55 and 64 (73%). 42% of the seniors aged 75+ were unable to engage in physical activity due to health (HCHD, 2020).

A literature review shows that obesity and its associated complications increase the risk of morbidity and mortality. In a meta-analysis study of 2.88 million obese individuals, obesity was associated with an increase in mortality rate, with a hazard ratio of 1.18 (95% CI, 1.12–1.25) (Abdelaal et al., 2017). According to Abdelaal et al. (2017), cardiovascular disease (CVD) and cancer account for the greatest mortality risk associated with obesity. Likewise, in a study by Ghanta et al. (2017) on obesity risk-adjusted mortality, mortality was 60% more in obese patients than in normal-weight patients. Research has found that severe obesity can be associated with obesity-hypoventilation Syndrome (OHS), which is defined as a combination of obesity with chronic daytime hypercapnia (arterial carbon dioxide pressure (PaCO2) ≥45 mmHg). Castro-Anon et al. (2015) showed that obese patients with OHS had a 2-fold increase in the risk of mortality.

Obesity results from a combination of factors such as age, genetics, medication, and environmental and dietary patterns (CDC, 2020b). Studies have found that obesity can run in families (National Institute of Health (NIH), 2020). According to Moores (2020), genetics can affect how the body processes food into energy and how fat is stored. Moores equally suggested that older age can lead to a slower metabolic rate, making it easier to gain weight. Lack of physical activity has also been linked with a high BMI. Active people are more likely to maintain a healthy weight and less likely to develop chronic diseases compared to those who lead a sedentary lifestyle (NIH, 2020). The Physical Activity Guideline for Americans recommends that adults should perform at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity, along with 2 days of strength training per week to maintain a healthy weight. Studies have also found that dietary factors play a major role in obesity. The dietary guideline for Americans highlights eating whole grains, fruits, vegetables, lean protein, low-fat, fat-free dairy products, and drinking water which is not the typical western diet of large meals high in refined grains, red meat, unhealthy fats, and sugary drinks that are consumed by most of the individuals (CDC, 2020b). Environmental factors such as low socioeconomic status, illnesses such as Cushing’s disease and polycystic ovarian syndrome, and drugs such as steroids and some antidepressants have also been associated with obesity (CDC, 2020b).

As with most health issues, the burden of obesity is not felt equally across all parts of society. Studies show that the poor have higher rates of obesity than those with higher incomes (Harvard School of Public Health (HSPH, 2020). Those with less education have higher rates of obesity than those with more education (HSPH, 2020). The Maryland Behavioral Risk Factor Surveillance shows that certain minority groups, especially African-American adults, have a significantly higher prevalence of obesity than White adults in the state of Maryland (37.3% and 25.5%, respectively) (DHMH, 2014). Adults with a college education and household income of $75,000 and greater are significantly less likely to be obese (DHMH, 2014). Likewise, in the 2014 Howard County health assessment survey, respondents who identified as African-Americans were more likely to experience health access difficulty in Howard County.

Social Justice

To reduce the incidence of obesity and the health disparity among residents in Howard County, efforts are focused on population health initiatives. The Bureau of Health Promotion implements wellness initiatives that are aimed at reducing health risk factors, improving wellness and safety, and maintaining a productive and active Howard County community and workforce. The Howard County Local Health Improvement Coalition (LHIC) was formed as part of the Department of Health and Mental Hygiene’s State Health Improvement Process (SHIP) to identify and reduce health disparities and achieve health equity among Howard County residents. Using local health data and input from stakeholders throughout the County, the coalition developed the 2012-2014 Action Plan, setting goals and strategies for the top three priority areas; access to care, behavioral health, and healthy weight (Howard County LHIC, 2015).

The CAREAPP (Community Access to Resources through Enhanced Technology for Providers and Public) is a community-wide project that was formed to support healthy living beyond traditional healthcare settings in Howard County. Through the program, electronic resource and referral systems were created for the residents to bridge the inequality gap in accessing the available healthcare resources, thus making optimal wellness a reality for all residents (HCHD, 2020b).

Programs such as the Medical Assistance Transportation Program (MATP) have been used to help transport residents to necessary medical appointments (HCHD, 2020b). The Journey to Better Health (J2BH) is another health improvement initiative established to aid in identifying and managing chronic disease in Howard County. The program seeks to conduct screenings for obesity and obesity-related complications and provide classes on chronic disease self-management within the community (HCHD, 2020b). Given the incidence of obesity, the associated complications, the economic burden, and the health disparities among residents of Howard County, it is prudent that such programs are in place.

References

Abdelaal, M., le Roux, C. W., & Docherty, N. G. (2017). Morbidity and mortality associated with obesity. Annals of translational medicine, 5(7), 161.

https://doi.org/10.21037/atm.2017.03.107

Castro-Añón, O., Pérez de Llano, L. A., De la Fuente Sánchez, S., Golpe, R., Méndez Marote, L., Castro-Castro, J., & González Quintela, A. (2015). Obesity-hypoventilation

syndrome: increased risk of death over sleep apnea syndrome. PLoS ONE, 10(2), e0117808. https://doi.org/10.1371/journal.pone.0117808

Centers for Disease Control and Prevention. (2020). Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html

Centers for Disease Control and Prevention. (2020b). Adult Obesity Causes & Consequences. https://www.cdc.gov/obesity/adult/causes.html

Eckdahl, T. T. (2019). Obesity : The Venus of Willendorf: Vol. First edition. Momentum Press.

Ghanta, R. K., LaPar, D. J., Zhang, Q., Devarkonda, V., Isbell, J. M., Yarboro, L. T., Kern, J. A., Kron, I. L., Speir, A. M., Fonner, C. E., & Ailawadi, G. (2017). Obesity Increases Risk-Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery. Journal of the American Heart

Howard County Health Department. (2020). Bureau of Population Health. https://www.howardcountymd.gov/Departments/Health/Population-Health

Howard County Health Department. (2020b). 2018 Annual Report. https://www.howardcountymd.gov/LinkClick.aspx?fileticket=2ysG4TXvtBQ%3d&tabid=2540&portalid=0

Howard County Health Department (2014). Howard  County health assessment survey summary. https://www.howardcountymd.gov/LinkClick.aspx?fileticket=j-J6k8Gcpv4%3d&tabid=2540&portalid=0

Howard County Local Health Improvement Coalition. (2015). 2012‐2014 Wrap-Up Report. http://hclhic.org/images/pdf/FullWrap-UpReport-2012-2014LHICActionPlan.pdf

Harvard T. H. School of Public Health. (2020). Obesity Prevention Source

Obesity Trends

Kim, D. D., & Basu, A. (2016). Estimating the Medical Care Costs of Obesity in the United States: Systematic Review, Meta-Analysis, and Empirical Analysis. Value in Health, 19(5), 602–613. https://doi-org.proxy-hs.researchport.umd.edu/10.1016/j.jval.2016.02.008

Maryland Department of Health (2020) Obesity. https://phpa.health.maryland.gov/ccdpc/healthy- lifestyles/Pages/obesity.aspx#:~:text=The%20prevalence%20of%20obesity%20in,who%0were%20obese%20had%20diabetes.

Maryland State Department of Health and Mental Hygiene. (2014). Public health needs assessment. https://pophealth.health.maryland.gov/Documents/Maryland%20Public%20Health%20Needs%20Assessment%202014.pdf

Moores, D. (2020). Obesity. https://www.healthline.com/health/obesity#risk-factors

National Institute of Health. (2020). Overweight and Obesity. https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity

Scarfone, A. (2012). Nearly 25% of Howard County is Obese, Data Show. https://patch.com/maryland/elkridge/speak-out-is-obesity-a-concern-in-howard-county

Tsai, A. G., Williamson, D. F., & Glick, H. A. (2011). The direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obesity reviews: an official journal of the International Association for the Study of Obesity, 12(1), 50–61. https://doi.org/10.1111/j.1467-789X.2009.00708.x

World Health Organization (2020). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and overweight#:~:text=Of%20these%20over%20650%20million%20adults%20were%20obese.,tripled%20between%201975%20and%202016