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Attributable. The portion of expenditures directly associated with a condition.
Body mass index (BMI). A measure of body weight relative to height. BMI is a measure that is often used to determine if a person is at a healthy weight, overweight, or obese, and whether a person's health is at risk due to his or her weight. To figure out BMI, use the following formula:
Formula and Calculation
|Kilograms and meters (or centimeters)|| Formula: weight (kg) / [height (m)]2
With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Since height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters.
Example: Weight = 68 kg, Height = 165 cm (1.65 m)
|Pounds and inches|| Formula: weight (lb) / [height (in)]2 x 703
Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5'5" (65")
For adults 20 years of age and older, a BMI of 18.5 to 24.9 is considered healthy. A person with a BMI of 25 to 29.9 is considered overweight, and a person with a BMI of 30 or more is considered obese.
Note: BMI is used as a screening tool to identify possible weight problems for adults. However, BMI is not a diagnostic tool. For example, if a person has a high BMI, a health care provider would need to perform further assessments to determine if the excess weight is a health risk. These assessments might include evaluations of diet, physical activity, family history, blood tests and other appropriate health screenings.
It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body at.
BRFSS. Behavioral Risk Factor Surveillance System.
Calorie. A unit of energy in food. Foods have carbohydrates, proteins, and fats. Some beverages have alcohol. Carbohydrates and proteins have 4 calories per gram. Fat has 9 calories per gram. Alcohol has 7 calories per gram.
Carbohydrate. A major source of energy in the diet. There are two kinds of carbohydrates– simple and complex. Simple carbohydrates are sugars and complex carbohydrates include both starches and fiber. Carbohydrates have 4 calories per gram. They are found naturally in foods such as breads, pasta, cereals, fruits, vegetables, and milk and dairy products. Foods such as sugary cereals, soft drinks, fruit drinks, fruit punch, lemonade, cakes, cookies, pies, ice cream, and candy are often high in sugars.
Cholesterol. A fat-like substance that is made by the body and is found naturally in animal foods such as meat, fish, poultry, eggs, and dairy products. Cholesterol is needed to carry out functions such as hormone and vitamin production. Cholesterol is carried through the blood in small units called lipoproteins. There are two types of units that carry cholesterol: low-density lipoproteins and high-density lipoproteins. When cholesterol levels are too high, some of the cholesterol is deposited on the walls of the blood vessels. Over time, the deposits can build up and cause the blood vessels to narrow and blood flow to decrease. The cholesterol in food, like saturated fat, tends to raise blood cholesterol, which increases the risk for heart disease. Total blood cholesterol levels above 240 mg/dl are considered high. Levels between 200 and 239 mg/dl are considered borderline high. Levels under 200 mg/dl are considered desirable.
CPS. Current Population Survey.
Diabetes. A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose (sugar) from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes: type 1 diabetes and type 2 diabetes:
- Type 1 diabetes. A life-long condition usually occurring before the age of 30 in which the pancreas stops making insulin. Without insulin, the body is not able to use glucose (blood sugar) for energy. People with this disease must inject insulin, follow a specific eating plan and test blood sugar several times a day.
- Type 2 diabetes. The most common form of diabetes occurring most frequently in people who are overweight or obese. People with type 2 diabetes may be able to control their condition by losing weight through diet and exercise. They may also need to inject insulin or take medicine along with continuing to follow a healthy program of diet and physical activity. Although type 2 diabetes commonly occurs in adults, an increasing number of children and adolescents who are overweight are also developing type 2 diabetes.
Diet. What a person eats and drinks. Any type of eating plan.
Energy expenditure. The amount of energy, measured in calories that a person uses. Calories are used by people to breathe, circulate blood, digest food, maintain posture, and be physically active.
Fat. One of the three nutrients that provides calories to the body. All food fats have 9 calories per gram. Fat helps the body absorb fat-soluble vitamins, such as vitamins A, D, E, and K, and carotenoids. Some kinds of fats, especially saturated fats and trans fats [see definitions], may raise blood cholesterol and increase the risk for heart disease. Other fats, such as unsaturated fats [see definition], do not raise blood cholesterol. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids.
Generalized linear model. A type of non-linear estimation used to compute the relationship between a set of independent variables and a dependent variable that has a non-normal distribution. In this case, the independent variables are the demographics and the overweight and obesity indicators and the dependent variable is strictly positive medical expenditures, which is positively skewed.
Guide to Community Preventive Services. The Community Guide summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in the rigorous and systematic scientific reviews of published studies conducted by the review teams of the Community Guide (see Task Force on Community Preventive Services).200
Health risk appraisal (HRA). HRAs are a systematic way to collect information from individuals to identify health risk factors. A typical HRA instrument obtains information on demographic characteristics (e.g., sex, age), lifestyle (e.g., smoking, physical activity, alcohol consumption, diet), personal medical history, and family medical history. In some cases, physiological data (e.g., height, weight, blood pressure, cholesterol levels) are also obtained.
Note: Formally, health risk appraisal referred only to the questionnaire instrument whereas health risk assessment (also known as HRA) refers to the overall process (e.g., orientation, screening, interpretation, counseling) in which the instrument is used).201
Healthy weight. Compared to overweight or obese, a body weight that is less likely to be linked with any weight-related health problems, such as Type 2 diabetes, heart disease, high blood pressure, and high blood cholesterol. For adults, a Body Mass Index (BMI) [See "Body Mass Index (BMI)"] of 18.5 to 24.9 is considered a healthy weight, though not all individuals with a BMI in this range may be at a healthy level of body fat.
High-density lipoprotein (HDL). A unit made up of proteins and fats that carry cholesterol to the liver. The liver removes cholesterol from the body. HDL is commonly called "good" cholesterol. High levels of HDL cholesterol lower the risk of heart disease. An HDL level of 60 mg/dl or greater is considered high and is protective against heart disease. An HDL level less than 40 mg/dl is considered low and increases the risk for developing heart disease.
High blood pressure. Also known as "hypertension." Blood pressure rises and falls throughout the day. An optimal blood pressure is less than 120/80 mmHg. A blood pressure that stays high—greater than or equal to 140/90 mmHg—is consistent with high blood pressure. With high blood pressure, the heart works harder, arteries take a beating, and ones chances of a stroke, heart attack, and kidney problems are greater. Pre-hypertension is blood pressure between 120 and 139 for the top number, or between 80 and 89 for the bottom number. If blood pressure is in the pre-hypertension range, it is more likely that a person will develop high blood pressure unless they take action to prevent it.
Industry Setting. Subcategories of industries were based on the U.S. Department of Labor industry sectors.
- Companies. Worksite at a company or corporation that was not affiliated with government or education or was unspecified (can include but is not limited to manufacturing, insurance, or transportation companies).
- Schools of education. Worksite at an institution of education (i.e., public and private schools, colleges or universities)
- Government. Worksites affiliated with local, state, or federal government (can include but is not limited to public service agencies, police, firefighters, military, etc).
- Health care. Public or private hospitals, homecare, medical services.
- Unknown. Information was not provided in the article reviewed.
Lipoprotein. Compounds made up of fat and protein that carry fats and fat-like substances, such as cholesterol, in the blood.
Logistic regression. A type of non-linear estimation used to compute the relationship between a set of independent variables and a discrete dependent variable. In this case, the independent variables are the demographics and the overweight and obesity indicators and the dependent variable is the probability of having positive medical expenditures.
Low-density lipoprotein (LDL). A unit made up of proteins and fats that carry cholesterol in the body. High levels of LDL cholesterol cause a buildup of cholesterol in the arteries, commonly called "bad" cholesterol. High levels of LDL increase the risk of heart disease. An LDL level less than 100 mg/dl is considered optimal, 100 to 129 mg/dl is considered near or above optimal, 130 to 159 mg/dl is considered borderline high, 160 to 189 mg/dl is considered high, and 190 mg/dl or greater is considered very high.
Median effect size. A median effect size was calculated for each weight-related outcome.200 Individual effect sizes were calculated as follows:
- For studies with before-and-after measurements of weight-related outcome in intervention (I) and concurrent comparison groups, effect size = ΔI -ΔC.
- For studies with post-intervention measurements of weight-related outcome only in intervention and comparison groups, effect size = Ipost - Cpost, where Ipost = intervention group post measurement and Cpost = the control group post measurement.
- For studies with before-and-after measurements of weight-related outcome with no comparison group, effect size = Ipost - Ipre, where Ipost = the intervention group post measurement and Ipre = the intervention group baseline measurement.14
Absolute effect size (ΔI-ΔC) were determined when reported outcomes used the same measurements and units; otherwise, a percent relative effect size was calculated [(ΔI – ΔC)/Ibaseline].
MEPS. Medical Expenditure Panel Survey.
Metabolism. All of the processes that occur in the body that turn the food you eat into energy your body can use.
Needs Assessment. See "health risk appraisal (HRA)."
NHANES. National Health and Nutrition Examination Survey.
NHIS. National Health Interview Survey.
Obesity. For adults, a Body Mass Index (BMI) [See "Body Mass Index (BMI)"] greater than or equal to 30.
Overweight. For adults, a Body Mass Index (BMI) [See "Body Mass Index (BMI)"] of 25 to 29.9.
Physical activity (PA). Any form of exercise or movement. Physical activity may include planned activities such as walking, running, strength training, basketball, or other sports. PA may also include daily activities such as household chores, yard work, or walking the dog. It is recommended that adults get at least 150 minutes per week of moderate-intensity PA or its equivalent for general health benefits. Moderate-intensity physical activity is any activity that requires about as much effort as walking 2 miles in 30 minutes.
Prevalence. The total number of cases of a condition (new and pre-existing) in a population at a specific point in time.
Protein. One of the three nutrients that provides calories to the body. Protein is an essential nutrient that helps build many parts of the body, including muscle, bone, skin, and blood. Protein provides 4 calories per gram and is found in foods like meat, fish, poultry, eggs, dairy products, beans, nuts, and tofu.
Registered Dietitian (R.D.). A person who has studied diet and nutrition at a college program approved by the American Dietetic Association, completed 900 hours of supervised practical experience accredited by the Commission on the Accreditation for Dietetics Education, and passed an exam to become an R.D.
Return on investment (ROI). A form of cost-benefit analysis that measures the costs of a program (i.e., the investment) versus the financial return realized by that program.6
Trans fat. A fat that is produced when liquid fat (oil) is turned into solid fat through a chemical process called hydrogenation. Trans fatty acids in the diet raise blood cholesterol and risk of heart disease.
Task Force on Community Preventive Services. An independent, non-governmental, volunteer body of public health and prevention experts, whose members are appointed by the Director of CDC. The role of the Task Force is to 1) oversee systematic reviews led by scientists, carefully consider and summarize review results, make recommendations for interventions that promote population health, and identify areas within the reviewed topics that need more research.
Unsaturated fat. A fat that is liquid at room temperature. Vegetable oils are unsaturated fats. Unsaturated fats include polyunsaturated fats, and monounsaturated fats.
Waist circumference. A measurement of the girth of the waist. Fat around the waist increases the risk of obesity-related health problems. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches have a higher risk of developing obesity-related health problems, such as diabetes, high blood pressure, and heart disease.
Weight control. Achieving and maintaining a healthy weight by eating nutritious foods and being physically active.
Worksite obesity prevention and control program. A program that incorporates physical activity and nutrition related activities and may or may not be part of a larger employee health promotion programs. These programs delivered to employees by employers may demonstrate a reduction in a weight outcome (e.g., weight, Body Mass Index (BMI), body fat percentage).