Obesity is a complex chronic disease characterized by excessive fat deposits (adipose tissue) capable of impairing health. It’s credited with leading to onset of type 2 diabetes and can also orchestrate heart disease. It can also affect bone marrow, reproduction as well as increase the risk of certain cancers. Other disabilities caused by this condition are sleep apnea, stroke, and early mortality. Obesity is a leading preventable cause of death worldwide. Its main symptom is increased fat.
Causes
The causes of obesity are complicated, and they range from individual to socioeconomic to environmental factors. The major causes are excessive consumption of energy-dense foods and lack of physical exercise. Other causes include urbanization, lack of supportive policies, lack of access to a healthy diet, genetics, sedentary work and lifestyles, mental disorders, poor economic policies, automation and exposure to endocrine disrupting chemicals. It should however be noted that consuming more low fat or fat free foods can just be as damaging to the body as consuming foods containing fats. The issue of lack of physical exercise is brought about mainly by the fact that only a small percentage of jobs in the US workforce (20%) require physical activities and so this propagates development of obesity due to lack of exercise.
Other factors that contribute to increase in obesity in the US include lack of ability to delay gratification, genetics, maternal behavior during pregnancy such as smoking or significant weight gain, and the population of microbes (fungi, bacteria, viruses) in a person’s gastrointestinal tract.
Prevention and Treatment
Obesity is easier to prevent than to treat. But the two go hand in hand. This involves change in the food industry, societal changes, access to a healthy lifestyle and personal choices. Treatment is done by change in diet, exercise, medication and surgery.
Many people suffering from obesity try to reduce weight. In some cases, it works out while in others it’s a temporary remedy since it requires a complex approach. There’s no effective, well defined, evidence-based intervention for preventing obesity. The complex approach necessitates interventions at societal, community, family and individual levels which should work together. Since diet changes and exercise are the main treatments recommended by professionals, consumption of energy-dense foods should be reduced and increase in dietary fiber encouraged if they are available and affordable. Medication can also be used along with a suitable diet to reduce appetite and decrease fat absorption. Surgery can be recommended in order to reduce stomach volume or length of the intestines leading to reduced ability to absorb nutrients from foods. This option is turned to when medication, diet and exercise fail to achieve the goal.
Obesity in the US
Over 70 million adults in the US are obese (35 million men and 35 million women).99 million are overweight. (45 million men and 54 million women).a 2016 study by NHANES shows that 39.6 of American adults are obese.
CDC defines an adult (a person aged 20 years and above) with a BMI of 30 or greater as obese and those with a BMI of 25-29.9 as overweight. In the classification of obesity, those with BMI of 30-34.9 are in class 1 obesity,35-39.9 are in class 2 obesity and 40 and above are in class 3 obesity which is referred to as extreme or severe obesity and it was previously referred to as morbid obesity. Ironically, evidence suggests that the lifetime cost of medical treatment for obese individuals is lower than that of healthy weight people logically because unlike obese people who tend to die of metabolic diseases at a relatively younger age, healthy weight people tend to live longer and are likely to develop chronic diseases that need to be attended to continually. The National Center for Health Statistics at the CDC showed in their most up-to- date statistics that 42.4% of American adults were obese. (43% men and 41.9% women). In the US, most people’s diets are high in calories’ content, often from fast foods and high calorie beverages. What escalates the situation is the fact that people with obesity tend to eat more before filling full or get hungry soon. Sometimes they eat more due to stress and anxiety associated with obesity.
A 2007 study showed that receiving food stamps long-term (24 months) contributed to a 50% increase in obesity rate among female adults. The total cost for obesity related complications was estimated to be US$117 billion whereby US$ 61 billion went to direct medical costs.
The growing healthcare costs compounded with substantial mortality and morbidity and the rapid increase in prevalence is making obesity a major public health problem in the US.
Effects on Life Expectancy
The US high obesity rate is a major contributor to its relatively lower life expectancy in comparison to other high-income countries. As a cause of type 2 cancer, obesity is associated with about 20% of cancer deaths in women and 14% in men. Obesity has also led to a halt in the rise in life expectancy observed in the US in the 19th and 20th centuries. It has also been observed that the life expectancy of newer generations is bound to decrease because of reckless eating habits and less physical exercise. According to Olshansky, obesity is responsible for cutting down the life expectancy of people who are severely obese by an estimated 5-20 years.
Medical complications related to obesity have been on the increase lately. These include type 2 diabetes, hypertension, cardiovascular disease and general disability. It should be noted that diabetes is the seventh leading cause of death in the US. Obesity has also increased prevalence of pregnancy and birth complications whereby babies born to obese women are three times likely to die within one month of birth and twice likely to be stillbirths as compared to children born of normal weight mothers.
Prevalence
Nation Center for Health Statistics estimates that between the years 2015 and 2016 39% of adults of 20 years and above were obese. Of these,7.6% were suffering from severe obesity while 31.8% were overweight. In 2018, severe obesity was at 9.2% while obesity was at 42.4%. The rates have increased for all population groups over the past several decades. Studies indicate that generally, lower income is associated with higher risk of obesity.
The distribution of obesity rates is classified below;
Race
Obesity is distributed unevenly across racial groups in the US. It’s more severe among Non-Hispanic black adults and lowest among Non-Hispanic Asian adults. Studies show that some of these races lack resources such as healthcare support, safe play areas, grocery stores with affordable less calories foods such as fruits and vegetables and in some cases the family cultural preferences and norms in relation to the foods they eat have contributed a great deal in the increase in obesity cases in their community.
Sex
Statistics show that 70 million Americans are obese. The distribution is 35 million men and 35 million women. It has also been found out that 99 million are overweight whereby 45 million are women while 54 million are men. The CDC crude obesity rate was measured at 39.8%.
Age
As per history, obesity primarily affected adults. But the trend has changed with time with children obesity rates growing significantly in recent decades. The consequences of the increase in children and adolescents’ obesity cases are psychosocial and social discrimination which lead to stress. This psychological stress from social stigma can cause low self-esteem which in turn can hinder a child’s social and athletic capability. This especially affects plump teenage girls and if not checked it can continue into adulthood. More than 80% of affected children morph into obese adults.
There are more obese US adults than overweight according to the CDC. Obesity consistently remained highest among middle aged adults since 2011. Recent updates indicate that 44.8% of Americans in their 40s and 50s are obese in which case 40% of young adults and 42.4% of older adults are obese.
In the case of the elderly, the numbers are still significantly lower than those experienced in the young adult population.
Total Cost to the US
There are approximately 100,000 to 400,000 deaths in the US per year including morbidity in car accidents that are associated with obesity. $117 billion is used in direct (preventive, diagnostic and treatment) and indirect (absenteeism, loss of future earnings due to premature deaths) annually. This exceeds healthcare costs on smoking and drinking and accounts for 6-12% of natural healthcare expenditure in the US. Medicare and Medicaid programs bear half the cost. It’s predicted that preventable morbidity and mortality associated with obesity may come to surpass that associated with cigarette smoking.
Military
In the military,16% of active US military personnel were obese in 2004 which made the cost of remedial bariatric surgery for the military US$15 million. Currently, the largest single cause for discharge of uniformed personnel in the US is obesity.
A financial analysis published in 2007 indicated that treatment of diseases and disorders associated with obesity was US$1.1 billion annually. Absenteeism due to obesity related cases stood at 658,000 days per year which was higher than that caused by excessive consumption of alcohol which stood at 548,000 days per year. There have also been cases of early discharge due to inability to meet weight standards. Fewer citizens are also eligible to join forces due to obesity and some who manage to join despite their overweight problems end up retiring early. In 2005,9 million adults (27%) were too overweight to be considered for service.
Policy Changes
There have had to be adjustments that come with a cost to meet the requirements of obese citizens. Child safety belts became modified for the 250,000 obese children of 6 years and below in 2006. Although the obese incur extra costs for themselves while flying, due to weight limits on flights, airlines have to spend extra money on additional gallons of gas for the extra weight. There have also been changes made at workplaces where chairs with no armrest are made and sometimes access to work outside of the office is considered. There has also been focus on more robust office chairs to accommodate obese employees.
Curbing Obesity in the US
Due to its contribution to deaths, other complications and financial constraints and losses, some measures have been put into place to try and reduce the rates and levels of obesity in the US. Some of these measures include:
School districts moved to ban sodas, junk foods and candy from vending machines and cafeterias following pressure from parents and anti-obesity advocates.
There has also been an increase in the taxation of sugary foods which is cost effective because studies have shown that with an increase of around 20% in price after taxation, there was 14% to 20% decrease in consumption of such foods.
Nonprofit organizations such as Health corps also embark on educating people on healthy eating and healthy food choices in order to combat obesity.
Movements such as former first lady Michele Obama’s ‘Let’s Move’ was formed to help reduce childhood obesity whereby participants are engaged in walking and cycling to increase physical activities which prevents obesity or reduces adipose tissue in the body.
Programs such as ‘Eat Smart, Move More, Weigh Less’ which began in 2007 in North Carolina State University has now gone beyond North Carolina and it advocates for healthy eating and increased exercise.
In 2008, Pennsylvania enacted a law. The School Nutrition Policy Initiative which was aimed at removing all sodas, sweetened drinks and unhealthy snack foods from selected schools and marketplace. This registered a 50% drop in incidences of obesity and overweight.
Media influence is also vital in boosting the campaigns against junkie foods and those for healthy eating. Its support of initiatives such as ‘Let’s Move’ is of importance.
In 2011, the Obama administration introduced a $400 healthy food financing initiative.
Healthy Start is an early childhood education program that helps prepare children for school and since it reaches over 1 million children with economic hardships, research has shown that those reached are likely to eat better than children who don’t participate in the program.
Safe Routes is another initiative that makes it safe and convenient for children to cycle or walk to and fro school which enhances their involvement in physical activities hence curbing early obesity cases.
There is also the Child and Adult Food Care Program (CACFP) which provides federal funding to many states obligated with reimbursing providers for the cost of providing healthy foods to customers. About 4.3 million children and 130,000 adults participate in this program each year and the goal is to increase children’s intake of healthy foods and reduce the intake of foods with a lot of sugar and fats.
The Supplemental Nutrition Assistance Program Education program (SNAP-Ed) is mandated with teaching people how to shop and cook healthy food and measures to take to stay active. The program encompasses nutrition education that improves food security in the US especially in the low-income population, policy improvement, social media campaigns, among other educational measures.
Food labeling
Local and federal governments are ultimately willing to create political solutions that can reduce the rates of obesity by recommending nutrition education and encouraging exercise as well as asking the Food and Beverage industry to promote healthy practices that are geared towards a healthier nation voluntarily.
New York City was the first to pass a labeling bill in 2008. The bill required that restaurants post the calorie content of all regular menu items. The idea is to make the customers have knowledge of what they are taking and given that most of them have been educated and made aware of the effects of unhealthy eating, there would be reduced cases of unhealthy eating.
Adding elaborate labels to food and drink products can help improve diets. In a 2021 study, it was revealed that proper labeling reduces the amount of unhealthy food purchased because the consumers are more health conscious about the foods they buy. Many states adopted policies that allow only healthier drinks like milk and water.
The Affordable Care Act also requires chain restaurants to post calorie content and information on their menus and menu boards and also to provide additional information such as saturated fat or added sugar when called upon to provide by the customer. The Food and Drug Administration rules that enforced this took effect from 2018.
Calorie labeling can be said to have been beneficial in the fight to curb obesity or at least reduce the rates and levels of obesity because the increased awareness has reduced high calorie foods and drinks purchase hence reduced calorie intake. It’s estimated that US$ 8 billion will be saved in 20 years due to menu labeling policy.