Obesity: A Growing Public Health Crisis In America

Research on this epidemic began in the 1980s, but since then the number affected continues to increase at a sharp rate in America over the last decade; among those over the age of 20 nearly 40% are obese, that’s around 93.3 million people according to an article published in JAMA. While certain states have higher rates such as those in the South at 32.4% and the Midwest at 32.2% every single state in American has more than 20% of adults with obesity according to the CDC, this is a significant increase from 1985 when no state had an obesity rate higher than 15%. 

Officials have tried to move towards addressing obesity in several ways via The Federal Supplemental Nutrition Assistance Program, Women, Infants, and Children Program, Child and Adult Care Food Program, and the Healthy Food Financing Initiative, as well as the US Departments of Agriculture and Health and Human Services are working to try to make healthier foods more affordable and available in underserved communities. 

In schools early childhood policies such as Head Start are paired with comprehensive early childhood educational programs to help fight childhood obesity. School based physical education and Safe Routes to School promote walking or biking to and from school, and increasing healthy eating habits as well as physical activity to help reduce the risk of obesity. 

As good as these attempts are they are not enough. The American Academy of Pediatrics, along with the American Heart Association have made several public policy recommendations to also help fight this increasing epidemic which includes increasing the price of sugary drinks, having vending machines that only offer water, milk, and other more healthy beverages at schools and other public facilities, improving nutritional information on labels, restaurant menus and advertising, and supporting hospitals to establishing new food policies that are healthier and discourage the purchase of sugary drinks. 

States have also implemented laws to help improve access to healthy foods and increase physical activity to promote a healthy weight, which are largely through early childhood education settings. Policies range from breastfeeding, providing drinking water and daily activity, to limiting screen time and healthier eating habits that meet standards set by the CACFP and USDA. 

Some cities have taken it a bit further to implement a sugar/sin tax which is aimed at helping people to make better choices by making unhealthier ones less attractive and accessible. Philadelphia, Boulder, and Berkeley have all imposed a tax on sugary drinks to which The American Public Health Associated suggests led to a 21% decrease in the consumption of these drinks in the city of Berkeley alone. California has a proposal to expand the tax to all of the state which was stalled this year. In Philadelphia the price of sugary beverage was increased and sales fell after the city implemented a tax, but a study found sales increased in towns bordering the city. 

Despite the taxes, policies, and research sending warnings about the health effects of drinking sugary beverages 8 out of 10 American homes purchase soda/pop and other sugary drinks on a regular basis, which can add an additional 2,000 calories or more per household. 

"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.

"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."

Obesity may be diagnosed if a patient has a BMI greater than 30, and morbid obesity is diagnosed when BMI is greater than 40. Obesity typically occurs when a person takes in more calories than is burned with normal daily activity and exercise, although certain societal and scientific factors can also increase the risk of obesity.

"Obesity isn't a disease of willpower – it's a biological problem. Genes load the gun, and environment pulls the trigger," says obesity researcher Dr. George Bray.

Diet and levels of physical activity are the most important connections to obesity. Studies suggest that along with the increase of soybean oil that began to spike in the 1970s as highly processed foods became popular Americans began to start weighing more. 

"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.

Studies have also linked artificial sweeteners to obesity as they alter how the body processes fat and obtains 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."

"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.

Obesity is associated with both mental and physical health problems such as type 2 diabetes, stroke, heart disease, high blood pressure, gallbladder disease, certain cancers, sleep apnea, high cholesterol, osteoarthritis, respiratory problems, gastroesophageal reflux disease, urinary stress incontinence, depression, infertility, sexual dysfunction, physical disability, lower work achievement, social isolation, and early death.

The cost of medical care to diagnose and treat obesity and associated health issues is estimated to be $147 billion annually. The indirect costs of obesity related health issues including absenteeism, premature disability, declines in productivity, and early death are estimated to range from $3-6.4 billion annually. 

When it comes to treating obesity common principles and guidelines suggest increased physical activity and improved nutrition primarily via making behavior and lifestyle changes. Losing 5-10% of body weight for those that are obese can help to reduce risk of obesity realted health problems. 

According to the CDC close to 40% of American adults were obese between 2015-16; 42.8% in the 40-59 age group, 35.7% in the 20-39 age group, and 41% in the 60+ age group. Among those under the age of 19: 18.5% in the 2-19 age group were obese that’s more than 1 in 6 children and adolescents with 13.7 million being impacted by obesity. 

According to the CDC the most obese states are: West Virigina at 38.1%, Mississippi at 37.3%, Oklahoma at 36.5%, Iowa at 36.4%, Alabama at 36.2%, Louisiana at 36.2%, Arkansas at 35%, Kentucky at 34.3%, Alaska at 34.2%, and South Carolina at 34.1%. 

Obesity affects other countries around the globe, not just America, W.H.O estimates that globally 39% of men and women aged 18 and older are overweight. However, among the 20 most populous countries America has the highest levels of age standardized childhood obesity at 12.7%.