Photo: Jean Scheijen

This story is part of a reporting partnership that includes WHYY,  and Kaiser Health News.

It’s not news that Americans are dealing with an obesity epidemic. But the problem is particularly acute among African-American women.

Four in five African-American women are obese or overweight, according to the U.S. Office of Minority Health, and carrying those excess pounds can spike the risk for several conditions including heart disease, Type 2 diabetes, high blood pressure and stroke.

Members of the Anderson Monarchs soccer team practice as their coach looks on. The team, which was started at Philadelphia's Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

About half of African-American women in the U.S. are obese, compared to 30 percent of white women. Black women not only carry more weight, but they start adding extra pounds years before their white counterparts.

So when does it begin, this excess and unhealthy weight? Research suggests the problem starts early, and it may have a lot to do with when girls give up regular exercise.

Experts want kids to exercise at least 60 minutes every day, but among all children, black girls are most likely to report they got no physical activity in the past week.

A lack of access to exercise opportunities may be one big reason why, says Shiriki Kumanyika, an epidemiologist and public health professor at the University of Pennsylvania.

Research shows that opportunities for recess, sports, physical education — or just to go outside — aren’t spread evenly among children.

“If you kind of add up those situations in urban, inner-city neighborhoods — where most African-Americans live — they are not as available. That’s been documented,” says Kumanyika, who studies patterns of illness and health behavior.

But research suggests that even those girls who do engage in sports and other forms of regular physical activity tend to abandon it in their teen years — and that’s true not just for urban girls or black girls, but all girls.

A National Institutes of Health study that followed girls for 10 years, beginning at age 8 or 9, found that, over time, leisure-time physical activity declined dramatically. That drop off was steepest for African-Americans girls.

“What they found was that by the age of 17 — so that’s the junior, senior year of high school — more than half of black girls, and nearly a third of white girls were reporting no leisure time physical activity at all,” says Temple University researcher Clare Lenhart.

There are lots of reasons why teen girls drop exercise from their lives, says Lenhart: “They have found changes in enjoyment of activities, in peer support or social support for physical activity. They found a lot of competing interests — be it part-time jobs or caring for younger siblings or other family members.”

Walter Stewart says he’s witnessed the phenomenon first-hand. He’s the longtime coach of the Anderson Monarchs, a soccer team of mostly African-American girls from inner-city Philadelphia.

Members of the Anderson Monarchs soccer team gather as their coach Walter Stewart talks to them. The team, which was started at Philadelphia's Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

Members of the Anderson Monarchs soccer team gather as their coach Walter Stewart talks to them.

The team, which was started at Philadelphia’s Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

“Eighth grade — that’s where it gets to be difficult,” he says. “They are making the transition from young kids to more teenagers, and they are more interested in boys and what boys think.”

Jennifer Johnson was determined not to let that happen to her daughter, Alexandria. Johnson discovered the Monarchs when she was looking for an affordable way to keep Alexandria active.

Alexandria is now 15 and an assistant coach with the team, but her interest in soccer dipped in middle school, around age 12, says Johnson.

“In come the friends, and in come the extracurricular activities at school, and as a parent you really have to press on. I said to her, ‘If it’s not this, you will be involved in something,’” Johnson says.
So Alexandria stuck with soccer, and so did her mother — Johnson is on the sidelines at games and during most practices.

That’s an approach that obesity researchers would approve of. Researchers say that family support — especially mom’s presence — may motivate girls to keep playing.

Researchers are beginning to count up the cost of obesity, and say women can pay a hefty price in dollars– and health.

A sedentary lifestyle and obesity may account for 25 to 30 percent of some major cancers, including colon, kidney and breast cancer in postmenopausal women, according to the National Cancer Institute. Avoiding weight gain, by contrast, can cut cancer risk.

In September 2011, researchers at Boston University reported that overweight and obesity in African-American women increases their risk of death, particularly from heart disease.

The investigators reviewed body mass index–a measure of body fat–and death rates for participants in the ongoing Black Women’s Health Study. A BMI of 25 is considered overweight. The study found a significant increased death risk at a BMI of 27.5–that’s the BMI for a 5-foot-4-inch tall woman who weighs 160 pounds.

Nearly 10 percent of all health care spending in the United States, $147 billion a year, is related to the obesity epidemic. Individually, obese people cost nearly $1,500 more a year in medical expenses compared to healthy-weight people, according to estimates from researchers at George Washington University. Some of that extra expense is paid by individuals, some is passed along to their employers.

Photo of soccer ball courtesy of Jean Scheijen

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Economist: A Person Already?

One evening in late September John Perkins, a veteran of the civil-rights movement, attended a rally at a Baptist church in Jackson in support of what he called “a total justice issue,” … It was concerned with Amendment 26, a measure on Mississippi’s ballot this November that defines a person as being “every human being from the moment of fertilisation, cloning or the functional equivalent thereof”. The reason for the measure is straightforward; its consequences less so. The Supreme Court, in its landmark Roe v Wade ruling in 1973, held that the right of a woman to terminate her pregnancy in the first trimester was guaranteed by her constitutional right to privacy. … The measure is expected to pass. … But what happens once the measure passes is unclear. … Would embryos be counted as people for the purposes of a census? Could a pregnant woman be charged with child abuse if she smokes, or be denied chemotherapy if it might hurt the fetus? From Mississippi’s tiny unborn people come strange legal questions (10/8).

The Economist: A New Prescription For The Poor

Medicaid, America’s health programme for the poor, is in the process of being transformed. Over the next three years, New York will move its entire Medicaid population into “managed care”, paying companies a set rate to tend to the poor, rather than paying a fee for each service. New York is not alone. States from California to Mississippi are expanding managed care. It is the culmination of a steady shift in the way most poor Americans receive their health-care treatment. Medicaid is America’s single biggest health programme. This year roughly one in five Americans will be covered by Medicaid for a month or more. It gobbles more federal and local money than any state programme, other than education. … Most Americans with private insurance are still horrified by thoughts of health-management organisations and prefer to pay fees for each medical service. For the poor, managed care is becoming the norm (10/8).

The Atlantic: The Quiet Health-Care Revolution

CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24 percent below average; hospital stays 38 percent shorter; an amputation rate among diabetics 60 percent lower than average. Perhaps most remarkable of all, these improved outcomes have come without increased total cost. Though they may seem expensive, CareMore’s “upstream” interventions—the wireless scales, the free rides to medical appointments, etc.—save money in the long run by preventing vastly more costly “downstream” outcomes such as hospitalizations and surgeries. As a result, CareMore’s overall member costs are actually 18 percent below the industry average (Tom Main and Adrian Slywotzky, November 2011).

Mother Jones: Herman Cain: Alive Because He’s Rich

Herman Cain by Gage Skidmore

Last month, during a GOP presidential debate, former Godfather’s Pizza CEO Herman Cain scored major points when he spoke about his personal experience surviving stage IV cancer. Cain claimed that if he’d been covered under President Barack Obama’s health care plan, he’d be dead by now. He suggested that if bureaucrats had been involved, his treatment would have been delayed and probably would have led to an early death. It was a compelling story, but an incomplete one. As Cain makes clear in his new book, This is Herman Cain! My Journey to the White House, he is probably alive today because he’s rich. And that’s not something Obamacare would have affected one way or another. … The sort of treatment Cain received would have put many people into bankruptcy, even if they had health insurance, thanks to caps and co-payments and other tricks insurance companies use to shift costs onto patients. Cain has never mentioned just what sort of health insurance he had during his cancer treatment, or what he has now. Multiple calls and emails over several weeks requesting information about his health care coverage went unreturned. These omissions are glaring because as a 65-year-old stage IV cancer survivor, Cain would be all but uninsurable if he tried to get insurance now on the private market (Stephanie Mencimer, 10/11).

American Medical News: Pain Management For Practice Breakups

Attorney John Fanburg likes to say that medical partnerships are “marriages without love.” He should know, as part of what keeps him busy is helping medical practices divorce as peacefully as possible. There may not be love, but there is plenty of emotion embedded in a medical practice partnership, whether the practice is made up of two or two dozen doctors. When the partnership fails, there is much at stake: Professional reputations, health insurance contracts, vendor relationships, employees’ livelihoods — and, most important, patients’ health and happiness — are at risk. Even a relatively amicable split can be emotionally and professionally draining (Emily Berry, 10/10).

PHOTO: Photo: Michal Zacharzewski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

In these communities, more than one in four people rely on Medicaid, the shared federal-state health program for the poor, compared with fewer than one in eight whites.

Blacks and Latinos are not only more likely than whites to suffer from chronic diseases such as diabetes, asthma and certain cancers, but they are also more likely to experience complications, to have poorer outcomes and to die prematurely from those conditions, according to the report.

The report comes as the debt deal’s super committee continues to meet on Capitol Hill, facing a Nov. 23 deadline to vote on recommendations to reduce the federal deficit by at least $1.2 trillion over the next decade.

The document’s findings include:

• Among blacks with cancer, more than one in five  is covered by Medicaid.

• More than one-third of blacks with chronic lung disease have Medicaid.

• Among Latinos with chronic lung disease, nearly two in five have Medicaid coverage.

• About a quarter of Latinos with diabetes and heart disease or stroke are covered by Medicaid.

According to the report, not having health insurance can contribute to poor health outcomes. In 2010, 20.8 percent of blacks and 30.7 percent of Latinos did not have insurance, compared to 11.7 percent of whites.

If diseases like cancer, diabetes, asthma and heard disease aren’t detected early and managed appropriately, poor outcomes, medical complications and death are harder to prevent, the report states.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

New data from the Centers for Disease Control and Prevention show that while the overall number of people who are infected with HIV each year is relatively steady — approximately 50,000 new infections each year — there was a 48 percent increase in the number of young HIV-infected African American men who have sex with men from 2006 to 2009.

“We are very concerned about this trend for this group and as they age in the future,” said CDC Director Thomas Frieden. Of the 1.2 million people infected with HIV in the U.S., more than 500,000 are black, according to the Kaiser Family Foundation. (KHN is a program of the foundation).

The new numbers, which are published in PLoS One, are able to dissect the spread of HIV across race and gender better than previous data. This multi-year estimate is the first time that the CDC used information from a new test that distinguishes between long-standing or recent infections.

“While we are glad that number [of new infections per year] is not increasing … the number of HIV infections remains far too high,” Frieden said during a telephone briefing today. According to the study, “the largest number of new HIV infections was among white men who have sex with men.”

Pessimistic outlook

In a fact sheet, the CDC seemed pessimistic about the future: “The current level of HIV incidence in the United States is likely not sustainable. Prevention efforts in recent years have successfully averted significant increases in new HIV infections, despite the growing number of people living with HIV and AIDS who are able to transmit the virus. However, an analysis by CDC and Johns Hopkins University researchers indicates that the growing population of people with HIV and AIDS will lead to significant increases in new HIV infections if current prevention efforts are not intensified.“

“We are overhauling how we give out money to states and localities to make sure that we are giving money to where it’s needed most for the populations groups that need it most, for the interventions that are most effective, particularly things like testing linkage to care, availability of low cost simple effective preventions such as condoms,” Frieden said.

Carl Schmid, deputy executive director for the AIDS Institute, a Washington-based national advocacy group, says it’s about time more money gets allocated to prevention. “It’s cost effective,” he said. “It costs a lot more to treat someone who has HIV than it does to prevent the case. … That’s the argument we are using on The Hill.”

Schmid says that consistently, the U.S. allocated only 4 percent of its HIV/AIDS spending on prevention. In May, Schmid testified before Congress, saying, “Preventing all the new 56,000 cases in just one year would [save] an astounding $20 billion in lifetime medical costs.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

A new study that looks at weight change over decades finds that the obesity epidemic in teens and young adults has its roots in the late 1990s and early 2000s, when body weights began to rise. But not everyone was affected equally.

“Females are at greater risk than males, and black females are at greatest risk,” said study co-author Kathleen Mullan Harris, adding that young adults seem vulnerable to weight gain. “There need to be preventive messages focused on this period.”

In the study, which appears online in the Journal of Adolescent Health, researchers analyzed statistics from four nationwide health surveys conducted over more than 40 years from 1959 to 2002, focusing on whites, African-Americans and Hispanics between the ages of 12 and 26.

The weights of young people remained fairly steady over the 1960s, 1970s and 1980s. But then they began to put on pounds. In the first few decades of the surveys, for example, 18-year-olds had an average body mass index (BMI) of 22. But average BMI grew to about 24.5 by 2000.

The average weight of an 18-year-old female who is 5 feet 5 inches tall grew from 132 pounds to 147 pounds; the average weight of an 18-year-old male at 5 feet 9 inches rose from 149 pounds to 166 pounds.

BMI is a measurement that takes both height and weight into account. For adults, BMI between 25 and 29.9 is considered overweight, and BMI of at least 30 is considered obese. For children and adolescents, BMI calculation now also takes gender and age into account.

Adults with a Body Mass Index (BMI) of 25 to 29.9 are considered overweight, while those with a BMI of 30 or more are considered obese. Use the BMI calculator widget on the right to determine your BMI.

Over time in the study, the weight of females grew at a faster rate than that of males. From 1999 to 2002, African-American females had the highest weight levels and the fastest rate of weight gain.

Teens began putting on extra weight in the 1990s, the researchers say, while young adults did in around 2000. The researchers didn’t analyze statistics from years more recent than 2002, although Harris said it appears that the weight boom is beginning to slow, at least among adults overall. However, she said, some research suggests that on average, young people are still putting on pounds.

“For young people in particular, it has do to with more of a sedentary lifestyle and an increasing portion of weekly meals that are fast food,” Harris said.“There’s more TV watching and sitting in front of the computer, as well as more video game playing.”

Jason Fletcher, an assistant professor of public health at Yale University who studies childhood obesity, said the study findings provide new information about what’s been happening to the bodies of adolescents as they transition to adults.

“Another message is that simple explanations of the obesity increase are unlikely to be true,” Fletcher said. “They fail to capture the large differences in the obesity increases by race and gender.”

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.