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'This is a public health emergency'

Read more about the CARDIAC project at cardiacwv.org. See individual county results at cardiacwv.org/results.php

See also: Putting the pieces together: At-risk children identified, but who follows up on care?

Map: County by county comparison of childhood obesity, high blood pressure

Charts: Disease risk by weight; W.Va. & U.S. obesity rates among children

Read more: The Shape We're In

CHARLESTON, W.Va. -- "Every week, I see 12-year-olds who weigh 300 pounds or more," West Virginia University pediatrician Dr. Pamela Murray said.

Whole families arrive at her office from rural counties with their children. Parents, aunts, grandparents -- they fill her office chairs, looking for help.

One heavy child after another walks through her door with high blood pressure and cholesterol. "They are at high risk of developing chronic diseases in the future, type 2 diabetes, heart disease, stroke and hypertension, among others," she said.

Nidia Henderson, wellness director of the West Virginia Public Employees Insurance Agency, sees the same thing. "It's heartbreaking," she said.

"We're seeing younger and younger people with type 2 diabetes and weight problems that put them at high risk of diabetes. I got a call about a 200-pound 11-year-old who lives in a remote area. We have nowhere to refer her. And that's just one example.

"The national obesity crisis is hitting West Virginia hard," she said.

"There needs to be serious discussion of this and soon," Murray said.

Every West Virginian is affected, whether they know it or not.

In 2009, health care economist Ken Thorpe warned West Virginia legislators that, if the state can't reduce the number of people of all ages with chronic diseases, its total health care spending -- public, private, everyone -- will double by 2018, to $22.5 billion a year.

Adult West Virginians are used to seeing themselves at the top of lists for heart attacks, strokes and one chronic disease after another: diabetes, heart disease, high blood pressure, kidney failure.

But how many realize obesity is a leading cause of each disease?

"Lower obesity, and you lower the rest," Thorpe told the Legislature. It's a domino effect, he said. Obesity leads to diabetes, diabetes leads to heart disease and so forth.

Children raise a red flag for West Virginia's future, said Jamie Jeffrey, director of the Children's Medicine Center at CAMC Women and Children's Hospital.

"It's just crazy," she said. "One in three children we see now is at risk of future heart disease and diabetes because of obesity.

"We're seeing hundred-pound 3-year-olds who can't walk."  The extremes have become more common, she said. "Those children will die early, period, period, if we don't do something."

But "normal" has also become heavier. Jeffrey and her staff analyzed the statistics on their 9-year-old patients. "Forty-nine percent are either overweight or obese," she said.

"If we keep going this way, these kids are going to have adult diseases, including high blood pressure, diabetes and heart attacks in their 30s and 40s. It's ultimately going to lead to them dying younger than we are."

"I want to make this point," she said. "Children need to be included in every discussion of chronic disease reduction in this state. The discussion needs to start there. But when people talk about doing something about chronic disease, they usually talk about programs that will help adults," she said. "It doesn't seem to occur to them to talk about kids.

"It's a no-brainer," she said. "If we want to make a difference in the obesity epidemic we're seeing in adults, we need to start with the kids.  It can be more easily prevented in childhood. They'll be adults in 10 years."

A deeper, widespread problem

For 13 years, West Virginia University pediatric cardiologist Bill Neal and his CARDIAC project have documented the very problems Murray, Jeffrey and Henderson see.

Each year since 1998, medical students have weighed and measured more than 135,000 West Virginia schoolchildren in all 55 counties. In classrooms, libraries and gyms, they have drawn blood samples, taken blood pressure, recorded height and weight.

Thirteen years ago, the CARDIAC project began in three counties. Neal intended to screen only for a rare inherited heart disease. "We quickly realized we were seeing a deeper, far more widespread problem," he said.

Last year, in 2010-11, CARDIAC found:

  • 24 percent of West Virginia fifth-graders -- one in four -- have high blood pressure.
  • 26 percent have high cholesterol.
  • 29 percent are obese. That means they are heavier than 95 percent of children their height and age in the national norm group.
  • "It's not about their appearance," Neal said. "It's about their health."

    "Many of these children are in the early stages of type 2 diabetes," he said. Type 1 diabetes, about 5 percent of cases, cannot be prevented. But type 2 diabetes can. It begins in the body about 10 years before it surfaces, he said. It can easily be prevented then by exercise and healthy eating, he said.

    "That's what's most frustrating," he said.

    "It's a public health emergency," PEIA's Henderson said. "These kids are at serious medical risk.

    "When CARDIAC first began screening, a lot of people didn't believe the problem was that bad," she said. "Now it's hard not to see it."

    "West Virginia children are developing adult diseases early in life because of their lack of physical activity, because of obesity and overweight," said Gina Wood, manager of the West Virginia Diabetes Prevention and Control Program. "That is frightening.

    "Where is the public concern?" she asked. "We are very alarmed when our children and adults die of acute diseases like flu. But there doesn't seem to be the same amount of concern about the chronic illnesses that are easily preventable."

    "Why aren't parents in the streets? If that many fifth-graders suddenly developed a deadly condition like bird flu, parents would be standing in courthouses all over the state demanding that something be done," said Sam Zizzi, West Virginia University professor of sports and exercise psychology.

     "It's happening so slowly and invisibly, it doesn't make headlines," he said. "We've gotten used to it, but that doesn't make it any less dangerous.

    CARDIAC also measures kindergartners and second graders. In 2010:

  • Eighteen percent of West Virginia kindergartners entered school obese.
  • Twenty three percent of second-graders were obese. Five years earlier, it was 19 percent.
  • "The problem can start earlier," CAMC's Jeffrey said. "High birth weight babies are at risk. Babies that are not breast-fed are at greater risk of obesity."

    West Virginia has the nation's lowest rate of breastfeeding.

    Since 1998, CARDIAC had tested, on average, 43 percent of eligible children. Their numbers match those from the state Department of Education, said Melanie Purkey, director of the department's Office of Healthy Schools. 

    Enormous cost

    Chronic diseases associated with obesity eat up 70 cents of every West Virginia health care dollar, according to Thorpe, the economist who predicted the state's health care would doubt by 2018.

    In that sense, the CARDIAC project measures the state's future financial risk.

  • Diabetes alone costs West Virginia more than $1 billion a year, according to the American Diabetes Association. 
  • Diabetes in West Virginia has tripled since 1980.
  • West Virginia already spends 13 percent more than other states do on health care, according to Thorpe's analysis.
  • The medical bills of obese people average 42 percent higher than bills of people of normal weight, according to a 2009 study by RTI International.
  • In 2003, West Virginia spent $2.3 billion to treat chronic disease, according to a Milken Institute analysis. Taxpayers paid much of it.
  • Many doctors don't mention it

    Every year, CARDIAC sends a letter to the parents and doctor of every child with high numbers. It basically says: Talk with your child's doctor and make a plan. If your child gets more exercise and eats a better diet and quits drinking pop, the numbers will come down.

    How many parents took their child to the doctor, changed their child's diet or got their child up and moving? Nobody knows.

    CARDIAC has surveyed parents, with limited success. One finding: Only 20 percent of parents of obese children said their doctor told them their child's weight could lead to diabetes and chronic disease.

    Those findings echoed a 2011 national survey. In that survey, four in five obese adults said their doctor had not told them their weight threatens their health.

    School nurses receive a copy of the CARDIAC findings, but no statewide policy requires them to follow up.

    School nurses are overwhelmed with the duties they already have, says Becky King, who coordinates school nurses for the state Office of Healthy Schools.

    Hopeful signs

    "We have some hopeful signs," Dr. Neal said.

  • Obesity rates for fifth-graders haven't risen significantly for ten years. They have held steady around 28 percent. During that time, adult obesity climbed steadily to 32.5 percent.
  • "Those are still terrible rates," Neal said of the fifth-grade numbers, "but at least they're not rising. It may mean we're doing something right."

  • The state has expanded Medicaid and CHIP insurance, until 95 percent of children are covered. "That may be part of the reason the numbers aren't climbing," Neal said.
  • Fifth-graders' high blood pressure rates have held steady around 24 percent -- "not good, but not rising," Neal said.
  • Kindergarten obesity is also staying level (although second-grade numbers are climbing).
  • In 2009, West Virginia's low-income 2- to 4-year-olds were less obese than the national average, 13 percent, compared with 15 percent, by CDC data. "We'd need three or four years like that before we can call it a trend," Neal said, "but we should keep watching."
  • In some ways, obese kids need a different kind of help than obese adults do, Dr. Jeffrey said. Kids need more physical activity during school and ways to be active after school, she said, an alternative to texting and video games. Counties need ways to build and maintain community centers and parks. "The whole community has to be thinking about this, for it to work," she said.

    In Morgantown, Dr. Murray agreed. "Medical solutions are not the answer for most kids. We need ways to get them moving and get them eating a more healthy diet."

    The Centers for Disease Control have predicted that one in three children born in 2000 would be diabetic by 2050. "It will be one in two in West Virginia if we don't do something about it," Neal said. 

    In 2011, CARDIAC collaborated with WVU and Marshall faculty to launch two major school research projects on ways to help obese children. CARDIAC staff also helped organize a state physical activity plan released in mid-January.

    "I don't know what it will take to make real progress," Neal said, "but we're going to keep trying."

    Reach Kate Long at (304) 348-1798 or katelong@wvgazette.com. "The Shape We're In" was produced with the assistance of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communication and Journalism.


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