What is obesity? | Why is obesity an important health problem?
Maryland Behavioral Risk Factor Surveillance System (BRFSS) | Obesity in Montgomery County
Factors associated with Obesity | Strategies for Addressing Obesity | Contact Us

What is obesity?
Obesity and overweight results when body fat accumulates over time as a result of a chronic energy imbalance (consuming more calories then you are using). Obesity and overweight are labels for ranges that can be determined using the Body Mass Index (BMI), which looks at height and weight in relation to body fat.¹

For Adults
Typically an adult having a BMI of 30 or higher would be considered obese
If one's BMI is between the ranges of 25-29.9 this is considered being overweight.

For more information on adult BMI visit the Centers for Disease Control and Prevention's website: Healthy Weight - it's not a diet, it's a lifestyle!

Waist Circumference
Waist circumference is another way one can check their weight by measuring their waist line. It is important for one to be aware of where excess body fat is located on one’s body especially around the abdominal area. Carrying excess body fat around one’s waist can place one at greater risk of developing obesity-related conditions such as type II diabetes.²

You are at higher risk of developing obesity-related conditions if you are:

• A non-pregnant woman with waistline over 35 inches
• A man with waistline over 40 inches

For Children and Teens
Similar to adults where BMI charts are used, growth charts are also used to assess physical growth and body measurements of children and adolescents. Growth charts allow health care professionals to compare body measurements of males and females within different age groups. Health care professionals will be able to monitor children and adolescent growth and identify any possible health and/or nutrition-related health problems.³

To calculate the BMI for Children and Teens, see the BMI Percentile Calculator for Child and Teen

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Why is obesity an important health problem?

• Over the years the prevalence of obesity continues to increase in the U.S.
• Serious health conditions are related to obesity, including,
• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)
• Obesity has taken a huge toll on the U.S. healthcare system
• Nationwide, since 2003, an estimated $75 billion of adult medical expenditures were attributable to obesity
• In Maryland, an estimated $1.5 billion of adult medical expenditures were attributable to obesity.⁴

Maryland Behavioral Risk Factor Surveillance System (BRFSS)

Obesity and Overweight Among Adults⁵

• Obesity in Maryland continues to rise in spite of the national objective to reduce the obesity rate to 15 percent.
• In 2007, 62.7% of Maryland adults were overweight or obese
• In the past decade, adult obesity prevalence has worsened in all jurisdictions
• 22 out of 24 Maryland jurisdictions had an obesity prevalence of 20% or more
• 11 out of 24 had an obesity prevalence over 30%

Obesity and Overweight Among Children⁶

• There is insufficient data available on weight status among children in Maryland; however the Pediatric Nutrition Surveillance System (PedNSS) provides information on weight status among low-income children from birth to five years that are in federally-funded maternal and child health programs.
• According to PedNSS there has been an increase in the prevalence of overweight in children ages 2-5 from 8.2% in 1997 to 14% in 2002.
• In 2007, according to the Special Supplemental Nutrition Program for Women, Infants, and Children, better known as the WIC Program, the distribution of overweight children ages 2-5 in Maryland total was 17%.⁷
• Within the counties, Montgomery County has the highest distribution with 21%.⁸

Obesity in Montgomery County

According to the Center for Maternal and Child Health, Maryland does not have a system to track BMI trends in children.  Current surveillance systems that are used to provide some information on the prevalence of childhood obesity include:

• Local efforts from schools, clinics, centers
• Behavioral Risk Factor Surveillance System
• Women, Infants and Children Program
• Youth Behavioral Risk Factor Surveillance

Obesity and Overweight among Adults

• In comparison to other counties, central Maryland counties including Montgomery, generally have the lowest percentage of adults overweight or obese.
• Although Montgomery County may have one of the lowest percentages of adults overweight or obese, the county does not meet the national health goal of 60 percent of adults who are at healthy weight.

Obesity and Overweight among Children

• One of the few sources for Montgomery County child weight data is the WIC Program
• From 2004 to 2007 there was a small decline in the distribution of overweight children ages 2-5 WIC program participants (23% in 2004 to 21% in 2007).
• However, Montgomery County’s rate of overweight 2-5 year old WIC participants (21%) is higher than the Maryland rate (17%).

• This chart is based off the distribution of children ages 2-5 in the Maryland WIC program.
• WIC is a federally funded program and serves over 8.2 million women, infants and children in 10,000 clinics nation wide.

Factors associated with Obesity⁹

Behavioral

• Sedentary behavior
• Media (television, DVDs, movies) has been associated with the prevalence of obesity.
• Television viewing specifically has been associated with:
• Lowering children’s metabolic rate
• Contributing to excessive snacking and eating in front of the TV resulting in increased energy consumption.
• Decreasing the time children spend on physical activity

• Physical activity – major findings indicate that physical activity has many health benefits; the benefits increase with the level of physically active.
• According to the Center for Disease Control and Prevention (CDC), children who are physically active, “are more likely to remain physically active throughout adolescence and possibly into adulthood.”

• Energy Consumption – there is limited evidence on specific foods and/or dietary patterns that may contribute to excessive energy (calorie) intake in children and adolescents.
• Some evidence suggests that large portion sizes, sugary foods and beverages, energy-dense foods and eating out contribute to excess energy intake among children and adolescents.
• New evidence in recent studies suggests that consumption of sugar-sweetened drinks may be linked to weight gain and obesity among children and adolescents.

Environmental - food intake and physical activity can be influenced by what happens within the home, school, community and childcare settings.

• Home – parents play a significant role in children's behavior in relation to physical activity and eating behavior.
• School – children ages 5-17 spend a significant amount their time in school. Within a school setting children are provided the opportunity to learn and adopt a healthy eating lifestyle and participate in activities.
• Community – The surrounding environment within a community can have an impact on physical activity and how individuals eat. For example, a lack of sidewalks and pathways, numerous fast food restaurants, or lack of recreational facilities may discourage individuals from participating in physical activities or eating healthy.
• Child care – According to the CDC many children ages 5 and younger with working parents are in child care. Child care providers share a responsibility with the parents in caring for the child during their developmental years. This is another place where healthy eating and physical activity can be incorporated in to children’s lives.
• Safety Concerns – having access to safe facilities for children plays a key role in physical activity.
• Media – Food items with minimum nutritional value are heavily marketed through television and other outlets, especially targeting children.

Genetics

• There have been recent studies indicating that individuals’ susceptibility of gaining excess body weight may be increased due to certain genetic characteristics.
• Genetic susceptibility to excess weight may exist along with environmental and behavioral factors such as, excess calories and minimal physical activity.
• With increasing rates of obesity among the U.S. population, it can not solely be due to genetic factors alone, but with a variety of factors.

Strategies for Addressing Obesity

• Physical activity
• Nutrition – healthy eating (e.g. more fruits and vegetables and fewer calories and fat)
• Policies/Plans (e.g. nutrition labeling; advertising to children; zoning)
• Community planning (sidewalks, hiking/biking trails, farmers markets)
• Free and safe places to be physically active
• Breast feeding

Physical Activity

• Physical activity plays an important role in maintaining a healthy life
• "Physical activity is one of the most important things you can do for your health"¹⁰
• There are many benefits of physical activity such as:¹¹
• Controlling weight
• Strengthen bones and muscles
• Increases life expectancy
• Reduce risks for type 2 diabetes and some cancers

• Physical activity can be divided into several types: Aerobic, muscle-strengthening and bone-strengthening.
• Within each physical activity comes many health benefits and can be achieved in a variety of ways.
• Types of Physical Activity¹²
  • Aerobic activity – involves the bodies large muscle groups moving in a rhythmic manner for a sustained period of time causes the heart to beat faster then usual. This includes walking, running, bicycling, swimming and jump roping.
  • Muscle-strengthening activity – allows the body’s muscles to hold or work against an applied force or weight. This includes using weights (dumbbells, barbells), elastic bands, push-ups, crunches etc…
  • Bone-strengthening activity – helps promote bone growth and strength by producing force on the bones. This includes aerobic and muscle-strengthening activities.
  • The amount of physical activity and the health benefits associated with physical activity differ among age groups.
• Physical activity among children and adolescents:
  • According to the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines, children and adolescents should do at least one hour or more of physical activity varying from moderate to vigorous intensity daily.
    Key Guidelines for Children and Adolescents
• Physical activity among adults:
• According to the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines, adults should do at least 150 minutes a week of moderate-intense physical activity or 75 minutes a week of vigorous-intense aerobic physical activity.
• Adults should increase their aerobic physical activity to 300 minutes for additional health benefits.
  Key Guidelines for Adults
• Physical activity among older adults:¹³
  • Due to chronic conditions occurring as one ages, older adults should be as physically active as their abilities and conditions allows them.
  • Older adults should be involved in activities that will improve their balance if they’re at risk for falling.
    Key Guidelines for Older Adults

• Just like physical activity nutrition plays an essential role in maintaining health.
• To eat healthy and have a well-balanced diet, it is important to become familiar with the six food groups: grains, fruits, vegetables, dairy, meats and nuts/seeds/legumes.
• USDA: MyPyramid.gov
• Nutrition for Everyone

• EatRight.org provides food and nutrition information individuals can use and keep in mind.
• The food guide pyramid has also been adapted to fit the nutritional needs of older adults.
• To learn about eating right for people 50 years or older see the Tufts University Food Guide Pyramid for Older Adults.

• Portion sizes vs. Serving sizes¹⁴
• Difference between portion size and serving size
• Portion size refers to how much food is available at a given time (e.g. one pie)
• Serving size refers to the amount of food that contains the quantity of nutrients from that food listed on the Nutrition Facts Label (e.g. one 3 inch slice).
• To differentiate between the two using another example: the serving size for a beverage is 8oz, but the portion or container is a 20oz bottle which is actually two and a half servings.

Policies/Plans

• In Montgomery County there have been discussions on policies and plans that address nutrition and physical activity.
• Nutrition labeling – In 2007 Montgomery County Council members worked with D.C. City Council to introduce a menu labeling proposal for chain restaurants. If adopted by the full council, then restaurants such as Wendy's would have to post nutrition information on their menus.
• Click on this link to learn more about some of the recommendations to policy makers:  Childhood Obesity: 2008 Survey of the National Capital Region
• In Montgomery County  there are policies and plans that may encourage physical  activity:¹⁵
• The County's master plan for parks – a county-wide plan for creating trails within parks and provided more recreational space.
• Creation of parking meter districts – a portion of the revenue is devoted to bicycle and walking projects and promotion.
• Maryland's Nutrition and Physical Activity/Obesity Prevention (NPA) Program, previously funded by the CDC, helped promote physical activity and nutrition through monitoring and evaluating activities.¹⁶
• One of the main goals of NPA was to, "increase the number of community and state policies, environmental support and legislative actions planned, initiated, and modified for the prevention and control of obesity." To learn more about NPA visit, "Maryland's Plan for Addressing Obesity"
• Although NPA is no longer funded by the CDC there are organizations such as the Maryland Healthy Eating & Active Lifestyle Coalition that continue to support the efforts of the program.

Community Planning

• Montgomery County’s master plan for parks incorporates trails for walking, hiking and biking around the county.
• There are various trails within Montgomery County that individuals can use recreation, physical activity, commuting and exploring.
• For more information on Montgomery County Park Trails, visit the Montgomery County Park & Planning "Park and Trail Directory".
• The City of Rockville Department of Recreation offers various activities that encourage the community to “Step Up to Health”.  For more information about City of Rockville, visit: City of Rockville Dept. of Recreation & Parks
• Activities/programs offered are:
• WALK Rockville
• 2009 Ride and Stride for Rockville
• Take a Walk About Town Center
• There are many farmers markets opened during the seasons in Montgomery County
• The are many benefits that communities can gain from farmers markets such as:
• Promoting nutrition education and wholesome eating habits.¹⁷
• Gives people access to fresh and naturally grown fruits and vegetables
• Helps boost economic spending in the community

• There have been studies comparing babies who have been breastfed for than 3 months to those that have not.
• Babies who are breastfed are less likely to become overweight when their older.¹⁸
• Breastfeeding may reduce the chances of children becoming overweight through adolescence and adulthood.¹⁹
• For a research review of breastfeeding and pediatric overweight, see Research to Practice Series, No. 4, July 2007, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity

Contact Us

For addition information or questions, please email us at obesity@montomerycountymd.gov.