Obesity in America: A Public Health Crisis – By Katelyn Newman (US News) / Sept 19 2019
Obesity is a public health issue that impacts more than 100 million adults and children in the U.S.
Obesity has become a public health crisis in the United States. The medical condition, which involves having an excessive amount of body fat, is linked to severe chronic diseases including type 2 diabetes, cardiovascular disease, high blood pressure and cancer. It causes about 1 in 5 deaths in the U.S. each year – nearly as many as smoking, according to a study published in the American Journal of Public Health.
The financial cost of obesity is high as well. According to the U.S. Centers for Disease Control and Prevention, “The estimated annual medical cost of obesity in the United States was $147 billion in 2008 U.S. dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight.”
While researchers say the obesity epidemic began in the U.S. in the 1980s, there has been a sharp increase in obesity rates in the U.S. over the last decade. Nearly 40% of all adults over the age of 20 in the U.S. – about 93.3 million people – are currently obese, according to data published in JAMA in 2018. Every state in the U.S. has more than 20% of adults with obesity, according to the CDC – a significant uptick since 1985, when no state had an obesity rate higher than 15%. Certain states have higher rates than others: there are more obese people living in the South (32.4%) and Midwest (32.3%) than in other parts of the country.
Sugar Taxes and Other Efforts to Reduce Obesity
Federal, state and local governments have moved to address obesity in several ways. On the federal level, several programs – such as the Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC) Program, Child and Adult Care Food Program (CACFP) and the Healthy Food FInancing Initiative – as well as the U.S. Departments of Agriculture and Health and Human Services work to make healthier foods affordable and available in underserved communities. To prevent childhood obesity in particular, there are also school and early childhood policies, such as Head Start – a comprehensive early childhood education program – school-based physical education and Safe Routes to School, which promotes walking and biking to and from school and increasing healthy eating and physical activity while reducing the risk of obesity.
In March, the American Academy of Pediatrics and the American Heart Association offered several public policy recommendations, including raising the price of sugary drinks, encouraging federal and state governments to limit the marketing of sugary drinks to kids and teenagers, having vending machines offer water, milk and other healthy beverages, improving nutritional information on labels, restaurant menus and advertisements, and supporting hospitals in establishing policies to discourage the purchase of sugary drinks in their facilities.
Meanwhile, states have implemented laws, largely through early childhood education settings, to improve access to healthy food and increase physical activity in order to promote a healthy weight. These policies stretch from breastfeeding, providing available drinking water and daily physical activity to limited screen time as well as meals and snacks that meet healthy eating standards set by the USDA or CACFP.
City governments have considered, and in some cases implemented, so-called “sin taxes” that aim to make potentially unhealthy food choices less attractive and accessible. Cities including Philadelphia, Boulder, Colorado, and Berkeley, California, levy a tax on sugar-sweetened beverages; The American Public Health Association noted in 2016 that the tax led to a 21% drop in the consumption of sugary drinks in Berkeley alone. (A proposal to expand it to all of California stalled this year.) In Philadelphia, the price of sugary beverages sold in supermarkets, mass merchandisers and pharmacies rose – and sales fell – after the city implemented a tax on those products, but a study found that sales in towns bordering Philadelphia increased.
Some researchers say there’s little proof that taxing food or drink choices really changes behavior. In spite of taxes and warnings about the health effects of drinking sugary beverages, eight of every 10 American households buys sodas and other sugary drinks each week, adding up to 2,000 calories per household per week, new research shows.
“Large authoritative systematic reviews of the peer-reviewed scientific literature have failed to illustrate any compelling evidence that economic interventions are effective in promoting any type of dietary behavior change,” says Taylor Wallace, principal and CEO of the Think Healthy Group and an adjunct professor in the department of nutrition and food studies at George Mason University.
But others contend that making it more expensive to buy sugary drinks is a step in the right direction.
“We need to ensure that people understand the threat of these products to their health, so they want to reduce their consumption,” says Sandra Mullin, senior vice president of policy, advocacy and communication for Vital Strategies, an organization that works to implement health initiatives, and a former public health official in New York City “And [hiking] the price is a prompt for them to do that.”
Learn more about obesity:
What is obesity?
Obesity is a chronic disease. It occurs when an excessive amount of body fat affects a person’s overall health.
How is obesity diagnosed?
According to the Obesity Action Coalition, a healthcare provider may diagnose a patient with obesity if his or her body mass index, or BMI, is 30 or greater. BMI is a value derived from the weight and height of a person; normal BMI ranges from 20 to 25. There is no lab test, blood screening or other diagnostic used to diagnose obesity.
What is morbid obesity?
Morbid obesity is diagnosed when a person has a BMI of 40 or greater. People can also be diagnosed with morbid obesity if their BMI is 35 if they are also experiencing health complications like high blood pressure or diabetes.
How is being overweight different from being obese?
Obesity has to do with having too much body fat and a Body Mass Index, or BMI, of 30 or more. Being overweight can involve having too much body fat, the Department of Health and Human Services says, but having extra muscle, bone or water can also be a factor.
What causes obesity?
Obesity occurs when a person takes in more calories than he or she burns through normal daily activities and exercise, according to the Mayo Clinic. It is not simply a matter of over-indulgence or a lack of self control, obesity researcher Dr. George Bray said at the first annual U.S. News Combating Childhood Obesity summit, held at Texas Children’s Hospital in May.
“Obesity isn’t a disease of willpower – it’s a biological problem,” he said. “Genes load the gun, and environment pulls the trigger.”
Certain scientific and societal factors – including genetics, the increased consumption of processed foods and sugar-sweetened beverages, and some medications and medical conditions – can increase a person’s risk of becoming obese. Age and pregnancy can also trigger weight gain.
Diet has an important connection to obesity. Studies show the amount of soybean oil Americans consume spiked in the 1960s and 1970s, most likely as highly processed foods became popular, and American adults and children started to weight more around that time, Bray said.
“The fats in our food supply may well be playing a part in our inability to regulate” food intake, Bray said at the obesity summit. Consumption of sugary soft drinks also skyrocketed between 1950 and 2000, he pointed out, as Americans tripled the amount of sweet beverages they drank each year.
Artificial sweeteners have also been linked to obesity. A study presented at the 2018 Experimental Biology meeting suggests artificial sweeteners alter how bodies process fat and obtain energy.
“Despite the addition of these non-caloric artificial sweeteners to our everyday diets, there has still been a drastic rise in obesity and diabetes,” one of the study’s authors, Brian Hoffmann, assistant professor in the department of biomedical engineering at the Medical College of Wisconsin and Marquette University, said. “In our studies, both sugar and artificial sweeteners seem to exhibit negative effects linked to obesity and diabetes, albeit through very different mechanisms from each other.”
What are some of the risk factors for obesity?
Genetic factors include: the amount of body fat a person stores, where it’s distributed and how efficiently his or her body metabolizes food into energy.
Medical conditions include: Prader-Willi syndrome, Cushing’s syndrome, arthritis and other diseases that can lead to decreased activity. Certain medications – some antidepressants, anti-seizure, diabetes, antipsychotic medications, steroids and beta blockers – can also cause weight gain.
Lifestyle and behavioral factors include: a lack of physical activity that burns calories, smoking, lack of sleep (which can lead to an increased desire to consume calories), eating an unhealthy diet.
Social and economic factors include: not having a safe space to exercise, not having enough money to afford healthier foods, food deserts where grocery stores that carry fresh fruits and vegetables are not available, lack of transportation to access healthy food options.
Can children be obese?
Obesity can be diagnosed at any age. The prevalence of obesity among children and adolescents between ages 2 and 19 was estimated to be 18.5% – more than one in six – between 2015 and 2016, with 13.7 million impacted, according to the CDC’s National Center for Health Statistics.
Children who are obese are at risk for developing premature heart disease, the American Heart Association reports. A study of nearly 2.3 million people monitored over the course of 40 years found that the risk of dying from heart disease was two to three times higher if they had been overweight or obese as teens.
Obesity is a problem in other countries as well. A study published in the Lancet in 2017 found that the number of obese 5 to 19 year olds worldwide increased from 11 million in 1975 and to 124 million in 2016. The researchers projected the number of children and adolescents who are obese will surpass those that are moderately or severly underweight by 2022.
How many adult men and women are obese?
U.S. adult obesity prevalence between 2015 and 2016 was nearly 40% – about 93.3 million people, according to the CDC. The highest rate (42.8%) was among adults between the ages of 40 and 59; the prevalence among adults age 20 to 39 years was 35.7%, and 41% among adults age 60 and older. There was no significant difference between men and women overall or by age group, according to the data brief.
What preventable diseases and health issues are associated with obesity?
Mental and physical health problems involving obesity include:
Type 2 diabetes
High blood pressure
Heart disease
Stroke
Gallbladder disease
Cancers (including breast, liver, pancreas, endometrial, colorectal, prostate and kidney)
High cholesterol
Osteoarthritis of weight-bearing joints
Sleep apnea
Respiratory problems
Gastroesophageal reflux disease
Urinary stress incontinence
Infertility
Depression
Sexual dysfunction
Physical disability
Lower work achievement
Social isolation
What are the financial costs of obesity in the U.S.?
Researchers from the University of Cincinnati in 2008 estimated the cost of medical care to diagnose and treat obesity and its associated health issues to be about $147 billion annually.
The CDC estimates the indirect costs of obesity-related health issues – including absenteeism, premature disability, declines in productiving and earlier mortality – to range from $3 billion and $6.4 billion annually.
Are certain races more likely to become obese than others?
At 25.8%, Hispanic children and adolescents between the ages of 2 and 19 had the highest prevalence of obesity between 2015 and 2016, according to the National Center for Health Statistics. Meanwhile, obesity prevalence was about 22% among black youths; 14.1% among non-Hispanic whites; and 11% among non-Hispanic Asians. While the report notes that there were no significant differences in the prevalence of obesity between boys and girls by race and Hispanic origin, Hispanic boys in particular had a higher prevalence of obesity than non-Hispanic black boys.
Similarly, non-hispanic black (46.8%) and Hispanic (47%) adults in the U.S. have higher obesity rates than non-Hispanic white (37.9%) and non-Hispanic Asian (12.7%) adults, according to the NCHS. Rates of obesity were especially high among black and Hispanic women, according to the report, surpassing 50%.
How is obesity treated?
Treatment of obesity primarily involves changing a patient’s behavior, but surgery to reduce the size of a patient’s stomach or alter the digestive tract and medication may also be options for those who have trouble losing weight on their own.
The National Institute of Diabetes and Digestive and Kidney Diseases says common treatments include eating more healthy foods, incorporating more physical activity and changing other habits, such as taking the stairs instead of the elevator. Developing a healthy eating plan with fewer calories, setting realistic and measurable goals, participating in formal weight-management programs and seeking help from family, friends, health professionals and support groups can make it easier to develop healthier habits, though the federal agency warns that setbacks occur and people should be prepared.
Experts say obese patients who lose 5% to 10% of their body weight – about 10 to 20 pounds for a 200-lb person with a BMI indicating obesity, for example – can reduce his or her risk of obesity-related health problems like type 2 diabetes as well as lower blood pressure and cholesterol levels.
Can obesity be prevented?
When it comes to suggestions about how to prevent obesity, common principles stand out across local, state and federal guidelines:
increase physical activity
improve nutrition through increased consumption of fruits and vegetables
encourage breastfeeding
encourage mobility between work, school and communities.
Some researchers also say that the food industry has a role to play in solving the obesity crisis: Making highly processed and fast food much more expensive could curb consumption and lower the obesity rate in the U.S. over time.
“My former brethren in the soft drink business really fought the issue of obesity early on rather than stepping up and saying, ‘OK, we don’t wish to be blamed totally for this issue but we still can do something,'” Hank Cardello, a former food company executive who now works as a food policy analyst at the Hudson Institute, a Washington, D.C. think tank, said during the U.S. News Combating Childhood Obesity summit in May. “Larger portions, the whole supersize phenomenon – it’s actually proven that that made more money for them” while helping trigger the national obesity epidemic, he explained.
What are the most-obese states in America?
According to the CDC, as of 2017 (the most-recent data available) the most-obese states in America are:
West Virginia (38.1% of adults)
Mississippi (37.3%)
Oklahoma (36.5%)
Iowa (36.4%)
Alabama (36.2%)
Louisiana (36.2%)
Arkansas (35%)
Kentucky (34.3%)
Alaska (34.2%)
South Carolina (34.1%)
What are the least-obese states in America?
These states have the lowest obesity rates in the U.S., according to the CDC:
Colorado (22.6% of adults)
Hawaii (23.8%)
California (25.1%)
Utah (25.25%)
Montana (25.27%)
New York (25.7%)
Massachuestts (25.9%)
Nevada (26.7%)
Connecticut (26.9%)
New Jersey (27.3%)
Is obesity a problem in other countries?
The World Health Organization estimates 39% of women and 39% of men ages 18 and older are overweight, with the highest prevalence of obesity on the island of Nauru, at 61%. (The U.S. ranked 12th worldwide, at 36.2%).
Among the 20 most-populous countries worldwide, the United States had the highest level of age-standardized childhood obesity, at 12.7%, while China and India had the highest numbers of obese children in 2015, according to a 2017 University of Washington study. Further, the United States and China had the highest number of obese adults, the study found. That same year, the researchers determined excess body weight to be associated with about 4 million deaths and 120 million disability-adjusted life-years lost.
Rates of adult obesity among the 36 countries in the Organization for Economic Cooperation were highest in the U.S., Mexico, New Zealand and Hungary. They were lowest in Japan and South Korea in 2017, according to an OECD “Obesity Update” report.
Obesity causes about 1 in 5 deaths in the U.S. each year – nearly as many as smoking, according to a recent study. Getty Images
