HBO's 'The Weight of the Nation' series sends a warning about CKD risk

A recent HBO series on obesity in America shows how the government is helping us overeat and exposes our youngest generation to the risks of hypertension and diabetes.

The four-part series aired on May 14-15, and was developed alongside a consensus conference produced with the help of the Institute of Medicine and supported by the Centers for Disease Control and Prevention and the National Institutes of Health. The IOM released its own report on May 8 during the consensus conference, saying progress in arresting the obesity epidemic in the United States has been too slow.

The HBO series looks at the impact of obesity, both related to health care costs ($150 billion/year to treat the disease, with one half paid for by the taxpayer-funded Medicare and Medicaid programs), and on a personal level, as people struggle to lose weight.

In terms of the impact on the kidney, individuals who are obese face an 83% higher likelihood of developing kidney disease once they become adults. Most of that comes from the 25 million people who are either Type 1 or Type 2 diabetes, and --- potentially for the future --- are likely to spend time on dialysis. "Obesity is the driving force to insulin resistance; insulin resistance and obesity are the driving forces to hypertension," said one researcher on the HBO program. And once obesity begins in childhood, 77% are likely to stay obese into adulthood.

Obesity has risen sharply since the 1980s, mainly among the poor socio-economic classes. But from 2005-2008, the increase was seen among all social-economic classes.

Is being overweight good for dialysis patients?
A higher body mass index is associated with improved survival among patients with end-stage renal disease, according to recent data form the U.S. Renal Data System. "This finding is contrary to the increased mortality seen among obese individuals in the general population, and is particularly puzzling because obesity is generally associated with insulin resistance, lipid alterations, and other factors that increase the risk of cardiovascular death, the major cause of death among patients with ESRD," USRDS researchers said in the 2011 Annual Data Report. The issue is part of a special study on nutrition being conducted by the USRDS. A major goal is to systematically evaluate the contributions of these factors to the observed survival advantage of higher BMI.

Fixing the problem
The IOM report focused on five critical goals for preventing obesity:

Integrating physical activity into people's daily lives (few schools still offer or mandate physician education classes; the IOM suggested 60 minutes/day)
Making healthy food and beverage options available everywhere (consumption of sugary energy drinks are on the rise among kids)
Transforming marketing and messages about nutrition and activity
Making schools a gateway to healthy weight
Galvanizing employers and health care professionals to support healthy lifestyles

"As the trends show, people have a very tough time achieving healthy weights when inactive lifestyles are the norm and inexpensive, high-calorie foods and drinks are readily available 24 hours a day," said committee chair Dan Glickman, a former secretary of the U.S. Department of Agriculture. "Individuals and groups can't solve this complex problem alone, and that's why we recommend changes that can work together at the societal level and reinforce one another's impact to speed our progress."

The IOM report was sponsored by the Robert Wood Johnson Foundation.