Issues Facing Americat will be Toulmin Essay. Please follow the instructions provided.First, choose one of the essays from the section “Issues Facing America” listed in the “Supplemental Readings” section of the course lessons. Then, explain to the class where you believe the following terms are found in the essay if applicable: claim, support, warrant, backing, rebuttal, and qualifier. Give citations to back up your points, and create a final works cited citation for this essay.300 WordsEmail 1 of 1Report Information from ProQuestAugust 24 2015 23:29Table of contentsDocument 1 of 1Prevalence and Trends of Severe Obesity Among US Children and AdolescentsAuthor: Skelton, Joseph A, MD; Cook, Stephen R, MD, MPH; Auinger, Peggy, MS; Klein, Jonathan D, MD, MPH; Barlow, Sarah E, MD, MPHAbstract:
To determine the extent to which the 2007 definitions for severe obesity (body mass index [BMT] ≥99th percentile for age and gender) and morbid obesity (BMI 3:40 kg/m^sup 2^) affects different groups of American children and adolescents and has increased over time. Analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES) II, III, and 1999-2004; 12 384 US children and adolescents ages 2 to 19 years were included in the analysis. Outcome measures were the proportion of subjects with severe and morbid obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables. In 1999-2004, 3.8% of children 2 to 19 years old had a BMI in the ≥99th percentile, with higher prevalence among boys than girls (4.6% vs 2.9%; P < .001). Prevalence was highest among blacks, 5.7% and Mexican Americans, 5.2%, compared with whites, 3.1% (P < .001). The prevalence differed by the PIR category as well (4.3% for those with PIR ≤3 vs 2.5% for those with PIR > 3; P = .002). BMI ≥40kg/m^sup 2^ was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI ≥99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2 to 19 years of age. Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender, and poverty. This places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.Links: Full text:
HeadnoteObjective.-To determine the extent to which the 2007 definitions for severe obesity (body mass index [BMT] ≥99th percentile for age and gender) and morbid obesity (BMI 3:40 kg/m^sup 2^) affects different groups of American children and adolescents and has increased over time.Methods.-Analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES) II, III, and 1999-2004; 12 384 US children and adolescents ages 2 to 19 years were included in the analysis. Outcome measures were the proportion of subjects with severe and morbid obesity, with age, gender, race, and poverty-income ratio (PIR) as key variables.Results.-In 1999-2004, 3.8% of children 2 to 19 years old had a BMI in the ≥99th percentile, with higher prevalence among boys than girls (4.6% vs 2.9%; P < .001). Prevalence was highest among blacks, 5.7% and Mexican Americans, 5.2%, compared with whites, 3.1% (P < .001). The prevalence differed by the PIR category as well (4.3% for those with PIR ≤3 vs 2.5% for those with PIR > 3; P = .002). BMI ≥40kg/m^sup 2^ was found in 1.3% of adolescents ages 12 to 19 years, with similar associations with race and poverty. The overall prevalence of BMI ≥99th percentile has increased by more than 300% since NHANES II (1976), and over 70% since NHANES III (1994) in children 2 to 19 years of age.Conclusions.-Rates of severe childhood obesity have tripled in the last 25 years, with significant differences by race, gender, and poverty. This places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.KEY WORDS: adolescents; children; morbid obesity; nutrition surveys; trendsAcademic Pediatrics 2009;9:322-9The American Academy of Pediatrics currently recommends the use of body mass index (BMI) to screen for obesity in clinical practice.1,2 The terms overweight or obese are used to describe a child or adolescent whose BMI is ≥95th percentile for age, on the basis of the current growth curves from the Centers for Disease Control and Prevention (CDC), with obese being the most currently recognized designation.3,4 A variety of studies have shown increases in the rates of obesity among children and adolescents,5-7 with the most recent national data showing a prevalence of 17%. 8 However, few data exist on how common severe or extreme obesity is among US children and adolescents.An expert committee convened by the American Medical Association, the CDC, and the Department of Health and Human Services proposed a new classification of severe childhood obesity in 2007: BMI S:99th percentile for age and gender.4 The committee based this recommendation on data from National Health and Nutrition Examination Survey (NHANES) 1999-2004 that found about 4% of children in the United States had a BMI in the ≥99th percentile.9 This study applied the 99th percentile cut point to a longitudinal cohort, the Bogalusa Heart Study participants, and found that severely obese children had higher rates of obesity and morbid obesity as adults. These severely obese children also had higher prevalence of cardiovascular risk factors and higher levels of adiposity, as measured by serum cholesterol and triglyceride levels, blood pressure, and skinfold measurements.9 The classification of severe obesity in children has been recently used in pediatric research, which documented the frequent recognition of this condition in a large academic medical system (8% of 60 711 children and adolescents had a BMI in the ≥99th percentile, with 76% being correctly identified as such).10 Childhood obesity has also been shown to be significantly associated with increasing inpatient hospital costs, increasing more than threefold from 1979-1981 to 1997-1999.11Expert panels have made recommendations regarding when to consider bariatric surgery in obese adolescents.12,13 Regional and institution-specific reports have provided some data on the degree of severe childhood obesity, especially in subspecialty clinics.14-17 Providers are now considering aggressive forms of therapy because conventional approaches are often ineffective.18,19 The recommendations have suggested several criteria to consider an adolescent for bariatric surgery, which include BMI ≥40 kg/m^sup 2^ with serious obesity-related comorbidities or BMI ≥50 kg/m^sup 2^ with less severe comorbidities.12Studies have shown higher rates of obesity among racial/ethnic minorities for both adults and children.5,6,8 Another strong risk factor for obesity appears to be poverty, with studies showing the paradox of those at risk of hunger as having some of the highest rates of obesity, independent of ethnic background.20,21 Data about adults from the Behavioral Risk Factor Surveillance System Survey demonstrated a near tripling of class 3 obesity rates in adults (BMI ≥40 kg/m^sup 2^) from 0.78% in 1990 to 2.2% in 2000, with African American women and those who did not finish high school disproportionately affected.22 It is unknown whether these sociodemographic risk factors are associated with severe obesity in childhood. There is a gap in the literature regarding extreme forms of obesity in children and adolescents (BMI 299th percentile and 240 kg/m^sup 2^), which is particularly important in light of the increasing use of bariatric surgery in adolescent age groups.The aim of this report was to examine the change in prevalence of extreme levels of pediatric obesity (severe obesity, BMI 299th percentile; morbid obesity, BMI ≥40 kg/m^sup 2^) between 1976-1980 and 1999-2004; to examine how sociodemographic categories, such as poverty and race/ethnicity, are associated with severe obesity (BMI ≥99th percentile); and to determine whether severe obesity carries higher cardiovascular risk factors than simple obesity (BMI 95th to 98.9th percentile).METHODSNational Health and Nutrition Examination SurveyIn NHANES, a representative sample of the noninstitutionalized US population is selected by a complex multistage probability sampling design. This study examined data from NHANES conducted at 5 time periods: 1976-1980, 1988-1994,23 1999-2000,24 2001-2002,25 and 2003-2004.26 After being interviewed in their homes, subjects were invited to be examined in a mobile examination center. Height and weight measurements were obtained by standardized techniques and with standardized equipment. Weight was measured on a Toledo self-zeroing weight scale, and height was measured with a stadiometer to the nearest millimeter. Identical procedures for conducting anthropometry were used throughout NHANES surveys to ensure comparability of anthropometric measures over time. Quality control procedures were observed to minimize body measurement errors as a result of body positioning or in reading and recording the measurements.Other variables included in our analyses were gender, age, race/ethnicity (ie, white, black, Mexican American, and other, representing smaller groups including American Indian, Alaska Native, Native Hawaiian, Guamanian, Samoan, Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other Asian, and other race) and poverty-income ratio (PIR). Poverty-income ratio is the ratio of the midpoint of observed family income category to the official poverty threshold (scaled to family size). Poverty-income ratio accounts for family size and is independent of inflation, as the poverty threshold is based on annual US Census Bureau data. A PIR value of < 1 identifies individuals who are below the federal poverty level. Higher PIR levels (PIR 1 to 3, PIR >3) indicate relatively higher socioeconomic status, which have been shown to be protective factors for adult obesity.27,28Obesity CategoriesAmong children and adolescents, obesity was defined at or above the 95th percentile of the age and gender-specific BMI growth chart from the CDC.29 Obese subjects were also categorized into 3 groups of increasing severity: BMI 95th to 96.9th percentile, BMI 97th to 98.9th percentile, and BMI ε99th percentile. The BMI 297th percentile was included in these analyses because there are alternate versions of the 2000 CDC growth curves with the 97th percentile lines, and this cut point could therefore be tracked clinically.7 The cutoff of BMI >99th percentile was applied from recent expert committee recommendations.4 A subanalysis was conducted on adolescents, 12 to 19 years of age, to describe those with a BMI of 240 kg/m^sup 2^.Statistical AnalysisData were analyzed by SAS version 9. 1 (SAS Institute, Cary, NC) and SUDAAN version 9.0 (Research Triangle Institute, Research Triangle Park, NC). Pregnant girls were excluded from the analyses. All analyses used sample weights to account for differential probabilities of nonresponse, noncoverage, and selection into the sample. Standard errors were estimated by Taylor series linearization. Bivariate (unadjusted) analyses were conducted to determine associations with different levels of obesity, ?2 tests were used to test hypotheses at the overall significance level of P RESULTSPopulation Characteristics and Obesity, NHANES 1999-2004The study population included 12 384 children, representing approximately 71 million US children ages 2 to 19 years. A total of 123 pregnant girls were excluded from the analysis. Nearly 16% of children 2 to 19 years were obese (BMI 295th percentile) in 1999-2004, with 10.8% having a BMI in the ≥97th percentile and nearly 4% having a BMI in the ≥99th percentile. On the basis of these data, die estimated number of children in the US with a BMI in the 299th percentile is 2.7 million. Detailed demographic data including gender, age group, race/ ethnicity, and PIR are shown for children across all BMI categories (Table 1). In both groups (BMI 97th-98.9th percentile and 299th percentile), there were significant differences by race/ethnicity, with minority groups (black, Mexican American) having higher prevalence of severe obesity than whites (P < .001). There were also differences by PIR, with PIR >3 (most affluent) having the lowest prevalence. In BMI 97th-98.9th percentile, there were significant differences by age groups, with the highest percentage found in older age groups (12 to 19 years). There were significantly more boys with a BMI in the >99th percentile than girls (P =.001).Absolute BMI Values as Cut Point for Severe ObesityAn estimated 418 000 US adolescents, ages 12 to 19 years, had a BMI of S:40 kg/m2 on the basis of a prevalence of 1 .3% by 1999-2004 data. Detailed demographic data are shown (Table 2). Again, minority populations had significantly higher prevalence, with 3.4% of black teens having a BMI of ≥40 kg/m^sup 2^ (P Severe Obesity Trends: NHANES II (1976-1980), NHANES m (1988-1994), NHANES 1999-2004When compared with children 2 to 19 years from NHANES ?, the overall prevalence rate of BMI ≥99th percentile increased by >300% from 0.8% in 1976-1980 to 3.8% in 1999-2004 (P Cardiovascular Risk FactorsWhen compared with adolescents with BMI in the 95th-96.9th percentile, youth with a BMI in the ≥99th percentile had significantly different mean levels of systolic and diastolic blood pressure, high-density lipoprotein cholesterol, and insulin. Additionally, liver function tests and waist circumference were higher in those with a BMI in the ≥99th percentile (Table 3). Fasting total and low-density lipoprotein cholesterol, triglycerides, and glucose did not differ between these groups. When the Adult Treatment Panel III (of the National Cholesterol Education Program) criteria for metabolic syndrome (with glucose ≥110 mg/ dL and glucose ≥100 mg/dL) were applied, a third of the children with a BMI in the ≥99th percentile (32% and 33%, respectively) were classified as having the metabolic syndrome, significantly more than the 13% to 17% in the 95th to 97th percentile range.DISCUSSIONOur analysis found that among the almost 4% (2.7 million) of US children who have a BMI in the 299th percentile for age/gender (1999-2004), there were significant differences by race, gender, and poverty. The higher prevalence among black and Mexican American youth and among youth of lower income reflects the associations between these groups and the larger group of children with a BMI in the 295th percentile. Overall, prevalence of BMI 299th percentile has increased by over 300% since 1976, and by over 70% since 1994. This analysis also demonstrated a high prevalence of teens with a BMI of ≥40 kg/ m^sup 2^ (>400 000 children). This level of severe adiposity is part of the initial criteria for considering bariatric surgery in adolescents.12 Given the immediate and future health risk and costs associated with this growing prevalence, these groups need more careful attention.Higher socioeconomic positions seem to protect against morbid and severe obesity. Explanations for this association may include the easy availability and low cost of energy-dense snacks in poor, inner-city neighborhoods.30 In contrast, fresh fruits and vegetables are often not available, and adequate amounts are expensive.31 Recent reports confirm the seemingly paradoxical connection of poverty, food insecurity, and obesity.21 Even more surprising is that the risk may carry through to the morbidly and severely obese. The effect of poverty on levels of physical activity is unknown. One report showed an increased risk of obesity in 7-year-olds when they perceived their neighborhood as unsafe,32 whereas others have shown an inverse effect of income on sedentary activity.33 All of these findings implicate the environment as an important factor, but one over which the child has little control. Most worrisome is that vulnerable populations are experiencing the worst increase in severe obesity, as rates in whites and the affluent have plateaued.Many cardiovascular risk factors, such as higher waist circumference, insulin resistance (evidenced by elevated fasting insulin), blood pressure, and lower high-density lipoprotein cholesterol, were associated with a BMI in the &99th percentile in this study. The application of adult criteria of the metabolic syndrome to this population showed that more than a third met the criteria. The higher rates of increased alanine aminotransferase levels among severely obese youth supports the recent expert committee recommendations for pediatric primary care providers to routinely assess liver transaminases as a screen for nonalcoholic fatty liver disease. These findings demonstrate the significant health risks facing this morbidly obese group.Anthropometric cut points for severe obesity in youth are sought in order to guide use of aggressive interventions, such as bariatric surgery, that may be more effective but have higher risk and costs than behavior-based treatment.34 Recent criteria for identification of adolescents for bariatric surgery propose absolute BMI >40 kg/m2 with a comorbidity,12 but this cut point may not capture those younger adolescents who have dangerous levels of obesity despite having a BMI of 99th percentile is a cut point that identifies greater risk of later obesity and cardiovascular complications compared with obese children with lower BMI percentile.9 In addition, this cut point identifies the same deviation from median BMI across ages and genders. In contrast, a BMI of 40 kg/m2 defines a higher deviation from median BMI in younger adolescents compared with older adolescents and in boys compared with girls. Greater than 99th percentile, because it accounts for age and gender, can be applied to préadolescents and even preschool children. Although surgery and medication are not appropriate for these younger children, increased resources to support intensive behavior-based programs may lead to an effect that justifies greater cost. Classification of severe obesity allows assessment of the health burden and the health care system needs of these children. Treatment of hypercholesterolemia and diabetes is reimbursable by insurers, yet these diseases are quite rare across pediatric populations (0.8% of US teens have hypercholesterolemia requiring pharmacotherapy,35 and only 0.18% have diabetes36). The higher prevalence of severe childhood obesity among generally disadvantaged sectors of society heightens the need for greater research, prevention, and treatment efforts, as well as a coordinated approach to public health efforts.Limitations to our analysis include small sample sizes among some minority groups with a BMI of ^40 kg/m2. As with other analyses that use NHANES, results with small sample sizes may have relatively large standard errors (>30%) and could therefore be statistically unstable and should be interpreted with caution. The tables identify these comparisons, most common in the NHANES ? cohort. The data are cross-sectional, and causality cannot be inferred from any of the associations found. Povertyincome ratio is an imperfect marker of socioeconomic status, with other factors such as parent education levels being superior measures of socioeconomic position.37There are 2.7 million children with a BMI that puts them at significantly increased risk of multiple medical and psychological comorbidities, and it is likely that their obesity will continue into adulthood. Over 400 000 adolescents might meet criteria for bariatric surgery. These highBMI groups seem likely to increase in number. With prevalence rates high and climbing, the expert committee recommendations have endorsed the category of severe obesity as part of the clinical criteria to direct medical screening and to initiate referral for care. However, specialized clinical and behavioral services appropriate for severely obese children may be unavailable or may not be covered by medical insurance.38 At the same time, primary-care pediatricians face many barriers to clinical screening and management, including lack of training, tools, referral resources, and reimbursement. This mismatch of need and services is greatest among the poor and among children in minority groups, who have both the highest severe obesity rates and the greatest difficulty accessing health care. No simple answers exist, but the best chance for success is immediate attention to this problem in both primary- and tertiary-care systems, supported by collaboration and mobilization of health care insurers and regional systems, and by broad social and community support for healthier lifestyles for children.ACKNOWLEDGMENTSThe study was funded in part by a NHLB I/NTH Mentored PatientOriented Research Career Development Award (K23 HL086946) (Stephen R. Cook); an AHRQ Mentored Clinical Scientist Development Award (K08 HS013901) (Sarah E. Barlow); and by grants 53344 and 63356 from the Robert Wood Johnson Foundation (Jonathan D. Klein).ReferencesREFERENCES1. Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics. 2003;112:424-430.2. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102:E29.3. Ogden CL, Troiano RP, Briefel RR, et al. Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics. 1997;99:E1.4. Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007; 120.S164-S192.5. Hedley A, Ogden C, Johnson C, et al. 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Pediatrics. 2002;110: 210-214.AuthorAffiliationJoseph A. Skelton, MD; Stephen R. Cook, MD, MPH; Peggy Auinger, MS; Jonathan D. Klein, MD, MPH; Sarah E. Barlow, MD, MPHAuthorAffiliationFrom the Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Skelton); Departments of Pediatrics (Dr Cook and Dr Klein) and Neurology (Ms Auinger), University of Rochester School of Medicine and Dentistry, Rochester, NY; and Department of Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Barlow).Address correspondence to Joseph A. Skelton, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina 27157 (e-mail: jskelton@ ).Received for publication January 5, 2009; accepted April 8, 2009.Subject: Studies; Obesity; Children & youth; Gastrointestinal surgery; Behavior; Risk factors; Community support; Preschool children; Hospital costs; Clinical medicine; Drug therapy; Committees; PovertyMeSH: Adolescent, Child, Child, Preschool, Female, Humans, Male, Nutrition Surveys, Prevalence, Retrospective Studies, Socioeconomic Factors, United States — epidemiology, Obesity, Morbid — epidemiology (major)Publication title: Academic PediatricsVolume: 9Issue: 5Pages: 322-9Number of pages: 8Publication year: 2009Publication date: Sep/Oct 2009Year: 2009Publisher: Allen Press Publishing ServicesPlace of publication: LawrenceCountry of publication: United KingdomPublication subject: Medical Sciences–PediatricsISSN: 18762859Source type: Scholarly JournalsLanguage of publication: EnglishDocument type: PERIODICALDocument feature: Tables References GraphsAccession number: 19560993ProQuest document ID: 208561739Document URL: Copyright: Copyright Allen Press Publishing Services Sep/Oct 2009Last updated: 2012-03-19Database: ProQuest Research LibraryBibliographyCitation style: APA6Skelton, J. A., M.D., Cook, Stephen R,M.D., M.P.H., Auinger, P., M.S., Klein, Jonathan D,M.D., M.P.H., & Barlow, Sarah E,M.D., M.P.H. (2009). Prevalence and trends of severe obesity among US children and adolescents. Academic Pediatrics, 9(5), 322-9. Retrieved from Copyright © 2015 ProQuest LLC. All rights reserved. – ……………..Answer Preview…………….
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The claim in this research paper is that obesity is prevalence among children and adolescents in the United States. In order to back this claim, researchers conducted an intensive study where the target population was children and teenagers. According to the study carried out to prove this claim, age, gender and poverty played a huge role in obesity and overweight. For instance, the obesity problem was prevalence among the Mexican American and black youths. At the same time, it was relatively lower among teens………………APA337 Words Added to cart
