Cohort. The authors concluded that the prevalence of chronic conditions among children and youth increased significantly during this interval. However, it is not clear whether these increases are real or a function of what is classified by researchers or reported by parents as a chronic condition.Obesity is a major risk factor for a number of chronic diseases that can reduce longevity, quality of life, and economic productivity. However, the elevation of obesity from risk factor to chronic condition status, especially when based on body mass index (BMI) alone, is misleading and largely responsible for the reported increase in the prevalence of chronic conditions. Body mass index, including a significant proportion of heights and weights that were reported by parents rather than objectively measured, is not a gold standard for assessing fatness or obesity, particularly with children.
2In addition, the category of behavior and learning problems, which experienced almost a 5-fold increase between baseline and the last assessment, is equally problematic. It is not clear whether this increase represents the actual change in the underlying condition or is an artifact of increased diagnosis (by health professionals), labeling (by parents and educators), and treatment (marketing of new drugs) of a condition whose prevalence has remained largely unchanged. An almost 5-fold increase over a relatively short time period would necessitate a similar magnitude of change in the contributory factors such as neurophysiologic deficits or genetic factors in this time period, which appears to be highly unlikely.In the absence of an objective measure of asthma, the increased prevalence reported in this study might be due in part to secular changes resulting in greater awareness, reporting, and naming of symptoms rather than actual changes in its incidence or prevalence.3 This is supported by recent evidence suggesting no increase or even a decrease in asthma prevalence over the last few years in several Western countries.
3The transitory nature or temporal fluctuations of the chronic conditions reported in this study further underscores potential problems associated with relying on subjective rather than objective diagnostic criteria to define chronic conditions and with using parent-reported data to examine incidence and prevalence trends of chronic health conditions over time.