To address growing concerns over childhood obesity, the United States Preventive Services Task Force (USPSTF) recently recommended that children undergo obesity screening beginning at age 6. An Expert Committee recommends starting at age 2. Analysis is needed to assess these recommendations and investigate whether there are better alternatives. We model the age- and sex-specific population-wide distribution of BMI through age 18 using National Longitudinal Survey of Youth (NLSY) data. The impact of treatment on BMI is estimated using the targeted systematic review performed to aid the USPSTF. The prevalence of hypertension and diabetes at age 40 are estimated from the Panel Study of Income Dynamics (PSID). We fix the screening interval at 2 years, and derive the age- and sex-dependent BMI thresholds that minimize adult disease prevalence, subject to referring a specified percentage of children for treatment yearly. We compare this optimal biennial policy to biennial versions of the USPSTF and Expert Committee recommendations. Compared to the USPSTF recommendation, the optimal policy reduces adult disease prevalence by 3% in relative terms (the absolute reductions are <1%) at the same treatment referral rate, or achieves the same disease prevalence at a 28% reduction in treatment referral rate. If compared to the Expert Committee recommendation, the reductions change to 6 and 40%, respectively. The optimal policy treats mostly 16-year olds and few children under age 14. Our results suggest that adult disease is minimized by focusing childhood obesity screening and treatment on older adolescents.

Abstract

Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life. We prospectively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale (ESS) and the Short Form-12. Participants (n = 223; 79% women) with a mean body mass index (BMI) and ESS of 44.8 ± 7.9 kg/m(2) and 7.9 ± 4.5, respectively, received a vertical gastrectomy (76%) or Roux-en-Y gastric bypass (12%). Preoperatively, 30% of patients complained of excessive daytime sleepiness (ESS > 10). Patients with preoperative excessive daytime sleepiness were more obese (p = 0.002), had higher fasting glucose levels (p = 0.02), more likely to have a diagnosis of sleep-disordered breathing (p < 0.001), report snoring (p < 0.001), and had lower health-related quality of life measures particularly physical function (p < 0.001), depression (p = 0.006), and sexual satisfaction (p = 0.04) than non-sleepy patients. At 12-months postoperatively, most patients experienced a significant reduction in BMI (28.6 ± 5.5 kg/m(2), p < 0.001) and excessive daytime sleepiness (mean ESS 5.3 ± 3.3, p < 0.001). Patients with a clinically relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function (p = 0.009) and snoring (p = 0.010) and were more likely still using positive airway pressure therapy (p = 0.032) than patients without a clinically relevant improvement. Statistically and clinically significant improvements in all health-related quality of life measures were noted at 24 months. Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness.

Despite rapid growth in China, it is unclear whether the poor have benefited in terms of nutrition. This paper’s goal is to understand the prevalence of anemia among school children in western China.We report on results from seven cross-sectional surveys involving 12,768 age 8-12 students. Sample students were selected randomly from 283 primary schools in 41 poor counties of Ningxia, Qinghai, Shaanxi and Sichuan provinces. Data were collected through questionnaires and hemoglobin tests. The dataset represents 7 million age 8-12 children in poor western counties. The anemia prevalence was 34% using the WHO’s hemoglobin cutoff of < 120g/L. Students who boarded at school and girls were more likely to be anemic. Assuming the sample population is representative of poorregions in western China, nearly2.5 million 8-12 year old school children in the region may be anemic and many more iron deficient. Given China’s growth, such high prevalence of anemia is surprising and illustrative of the large health disparities in the country. Iron deficiency remains a significant nutrition issue, though there appears to be no effort to address this issue.

Opportunities to go to college and earn a degree have risen dramatically in China. Government investment into the college systems has skyrocketed and the size of universities has increased by more than five times over the past decade. With the rise in the opportunity to go to college, several questions naturally arise: Are the rural poor—perhaps those that would most benefit individually as well as provide spillovers to their home communities—being systematically excluded? If they are, what are the barriers that are keeping them from having access to higher education?

The overall goal of this paper is to answer these questions. To do so, we combine two sets of our own primary survey data. One survey covers a group of randomly selected high school students from the poor parts of Shaanxi province, one of China’s poorest provinces. The other survey is a census of all freshman entering into four universities in three poor provinces. With these data we seek to identify if China’s rural poor are being systematically excluded from the university system, and if so, why.

In the first part of the results section of the paper, we show that the participation rate of the poor accessing to college education is substantially lower than the students from nonpoor families. Clearly, there are barriers that are keeping the rural poor out. In the rest of the paper, we examine two general categories of barriers. First, according to our data from Shaanxi province, it does not appear that any real barriers appear at the period of time between the final year of high school and the first year of college. We find no empirical evidence that the College Entrance Exam (CEE) is biased against the poor; the exam scores of poor students are virtually the same as the exam scores of nonpoor students, holding all other factors constant. There is some evidence that the nature of the CEE process—particularly that the timing of when students find out about financial aid—distorts the decisions of poorer students regarding what college to attend and what major to pursue. At the same time, however, we observe that the admission rates between poor and nonpoor are statistically the same when poor students are admitted to university. Contrary to commonly held beliefs, we find that virtually every student who passes the entrance exam (poor and nonpoor alike) is able to find a way to pay the fees and tuition charges that are demanded upon matriculation and is able to enter college, despite the high costs.

Therefore, the paper concludes that if the real barriers are not at the time of admissions to college, there must be a second, remaining set of systematic barriers that prevent poor children from ever making it to the point where they take the CEE. In fact, a close reading of the literature and some of our own data demonstrate that the rural education system—in general—is putting rural children at a severe disadvantage at almost every point of the educational process (low rates of enrollment into early childhood education; low quality elementary schools; poor nutrition and low quality boarding facilities; high levels of high school tuition; a migrant schooling system that is outside of the public education system).

The paper concludes that the real barriers keeping the rural poor from pursuing a college education are being erected early in their educational experience—as early as preschool and elementary school—and are present throughout the entire schooling system.