Childhood Obesity: Factors Affecting Physical Activity
(06-DEC-06, GAO-07-260R).
The latest data show continued increases in rates of childhood
obesity. For example, obesity rates for children 6 to 11 years
old are estimated to have increased from 15.1 to 18.8 percent
between 1999 and 2004. The Department of Health and Human
Services estimates that 20 percent of children and youth in the
United States will be obese by 2010. There are numerous negative
health outcomes and financial consequences related to childhood
obesity. Researchers have found that childhood obesity is
associated with a number of disorders including hypertension,
insulin resistance, sleep apnea, menstrual abnormalities, and
orthopedic problems. According to one estimate, insured children
treated for obesity are approximately three times more expensive
for the health system than the average insured child. Some
researchers have suggested that childhood obesity is largely the
result of a decline in regular physical activity. In our October
2005 report, we surveyed experts on the key strategies to include
in the design or implementation of a program to prevent or reduce
childhood obesity. The program strategy identified by experts as
most important was "increasing physical activity." Congress asked
us to provide information on the factors affecting physical
activity in children.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-07-260R
ACCNO: A63927
TITLE: Childhood Obesity: Factors Affecting Physical Activity
DATE: 12/06/2006
SUBJECT: Adolescent health
Children
Health care planning
Health statistics
Medical research
Obesity
Physical fitness
Preventive health care services
Research reports
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GAO-07-260R
* [1]PDF6-Ordering Information.pdf
* [2]Order by Mail or Phone
December 6, 2006
The Honorable Bill Frist
Majority Leader
United States Senate
Subject: Childhood Obesity: Factors Affecting Physical Activity
Dear Senator Frist:
The latest data show continued increases in rates of childhood obesity.^1
For example, obesity rates for children 6 to 11 years old are estimated to
have increased from 15.1 to 18.8 percent between 1999 and 2004.^2 The
Department of Health and Human Services estimates that 20 percent of
children and youth in the United States will be obese by 2010. There are
numerous negative health outcomes and financial consequences related to
childhood obesity. Researchers have found that childhood obesity is
associated with a number of disorders including hypertension, insulin
resistance, sleep apnea, menstrual abnormalities, and orthopedic problems.
According to one estimate, insured children treated for obesity are
approximately three times more expensive for the health system than the
average insured child.^3
Obesity results from an imbalance between the amount of energy consumed
and the amount of energy expended. While there are many elements that
affect the energy balance (for example, genetics, growth, and physiology),
children and their parents can influence both energy consumed through diet
and energy expended through physical activity. Some researchers have
suggested that childhood obesity is largely the result of a decline in
regular physical activity. In our October 2005 report,^4 we
surveyed experts on the key strategies to include in the design or
implementation of a program to prevent or reduce childhood obesity. The
program strategy identified by experts as most important was "increasing
physical activity."
^1Some experts use the term obesity to refer to children and adolescents
who have a body mass index (BMI) that is at or above the sex-specific 95th
percentile for their age on the BMI charts developed by the Centers for
Disease Control and Prevention (CDC) in 2000. CDC uses the term
overweight, instead of obese, to describe children and adolescents with
this BMI range.
^2C.L Ogden, M.D. Carroll, L.R. Curtin, M.A. McDowell, C.J. Tabak, and
K.M. Flegal, "Prevalence of Overweight and Obesity in the United States,
1999-2004," JAMA, vol. 295, no. 13 (2006). These data are for children at
or above the 95^th percentile of BMI for age and sex.
^3Thomson Medstat, Childhood Obesity: Costs, Treatment Patterns,
Disparities in Care, and Prevalent Medical Conditions, 2006,
http://www.medtstat.com/pdfs/childhood_obesity.pdf, (downloaded Nov. 3,
2006). Thomson Medstat used medical claims to estimate total health care
spending for children who receive a diagnosis of obesity.
^4GAO, Childhood Obesity: Most Experts Identified Physical Activity and
the Use of Best Practices as Key to Successful Programs, GAO-06-127R
(Washington, D.C.: Oct. 7, 2005).
You asked us to provide information on the factors affecting physical
activity in children. Enclosure I contains the information we provided to
your staff at our November 15, 2006, briefing.
To carry out our work, we conducted a literature review. We selected 53
articles that described work focused on factors affecting rates of
physical activity for school-aged children, published from 2003 through
2006. Enclosure II is a bibliography of the materials we reviewed. To
select the articles, we reviewed study abstracts identified in your
request letter and conducted a literature search of five databases.^5 We
focused on studies of children and adolescents and excluded studies of
infants and preschool-aged children. For purposes of this report, we use
the term obese to refer collectively to the terms obese and overweight,
which were both used by authors. We supplemented the studies with
information obtained from organizations that recently published
information on childhood obesity including the Institute of Medicine and
the Trust for America's Health. Our literature search was not exhaustive,
and for this report we did not discuss all of the articles we reviewed,
but instead highlighted selected articles to provide examples of findings.
We conducted our work from August 2006 through November 2006 in accordance
with generally accepted government auditing standards.
In summary, the articles we reviewed identified a number of factors
affecting levels of physical activity in children. We categorized the
factors presented in the articles we reviewed into three
groups--demographic factors, cognitive and behavioral factors, and
community factors. Demographic factors include socioeconomic status and
race. Cognitive and behavioral factors include attitudes, beliefs, and
perceptions and sedentary behaviors.^6 Community factors include the built
environment^7 and school-based physical activity. The articles and
additional materials we reviewed identified additional research needs,
such as using objective measures of physical activity and sedentary time.
The body of research we examined suggests that multiple factors that
affect physical activity among children may contribute to childhood
obesity.
- - - - -
As we agreed with your office, unless you publicly announce the contents
of this report earlier, we plan no further distribution until 30 days
after the date of this letter.
^5We also contacted several experts in the field to help us identify
relevant literature.
^6Sedentary behaviors include, for example, television watching, video
game playing, and computer use.
^7The built environment is broadly defined to include land use patterns,
the transportation system, and design features that together provide
opportunities for travel and physical activity.
At that time, this report will be available at no charge on the GAO Web
site at http://www.gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last page
of this report.
If you and your staff have any questions or need additional information,
please contact me at (202) 512-7101, or [email protected] . Major
contributors to this report were Linda Kohn, Assistant Director; Shannon
Slawter; and Julie Thomas.
Sincerely yours,
Cynthia A. Bascetta
Director, Health Care
Enclosures
Enclosure I
Enclosure II
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