Obesity: America's Biggest Problem

The Centers for Disease Control and Prevention (CDC) considers America's collective, growing waistline to be an epidemic – a widespread health problem. In the 1960s, only about 13% of Americans were obese. According to the Weight-Control Information Network, a service from the National Institute of Diabetes and Digestive and Kidney Diseases, today more than a third of Americans (about 32% of men and 35% of women) are obese – defined as having a Body Mass Index (BMI) over 30 and excessive weight from fat (adipose) tissue – and roughly another third are overweight, defined as a BMI between 25 and 30 with excess weight attributable to fat, muscle, bone, and water.  Almost 6% of the population is morbidly obese (has a BMI greater than 40).  Even First Lady Michelle Obama has made decreasing the rates of childhood obesity through educational and other initiatives a personal priority. Whether you have first- or second-hand experience with the physical and emotional consequences of obesity or you simply have been affected by the social costs including $147 billion (an average of about $1,400 per patient more than normal-weight counterparts) spent on treatment of related co-morbidities in 2008 (Finkelstein, 2009), obesity is a problem that impacts everyone.

What are the risk factors for obesity?

• Genetics – A May 2011 study published in Nature Genetics reported that there may be a primary regulator gene for obesity (i.e., KLF14). However, having the genetic propensity does not mean that becoming obese is an inevitable consequence (Read Addiction and Genetics).
• Binge Eating Disorder – This eating disorder is characterized by eating excessively large portions of food in a single episode; unlike bulimia, people with this disorder do not over-exercise or otherwise compensate for their binging, which translates into a high caloric intake that, over time, could lead to obesity (Read Eating Disorders: What You Should Know and Binge Eating Disorder: What Are the Signs?).
• Poverty – Unfortunately, processed and fast foods tend to be less expensive than fresh fruits and vegetables, lean meats and dairy products, and whole grains. Individuals who are on a tight budget are more likely to make grocery decisions based on affordability than on the product’s impact on health.  People who are in a lower socioeconomic bracket may also be unable to afford a gym membership, reducing the number of places to exercise safely.
• Race – The highest rates of obesity are found among non-Hispanic Black women (~50%) and men (~37%).
• Medical Problems – Certain conditions – including polycystic ovary syndrome, Cushing’s syndrome, Prader-Willi syndrome, poor thyroid function, and low metabolism – can, but are unlikely to – be the cause obesity.
• Pregnancy – Some women have trouble losing weight after pregnancy and this may be a contributing factor to obesity (Read Alcohol & Pregnancy: A Risky Gamble).
• Some Medications: Certain medicines used to treat diabetes, seizure disorders, depression, and psychosis as well as beta blockers and steroids – in combination with other factors like a sedentary lifestyle – can lead to obesity.
• Sedentary Lifestyles – Although we can blame the shift from a nomadic to an agricultural society on our ancestors, few Americans exercise enough for weight loss or even maintenance and rely on cars, elevators, desk jobs, video games, television, and other sedentary methods of transportation, employment, and recreation.
• Family Habits – Children often learn eating habits from their parents and retain these over the course of their lives.
• Diet – Diets high in fat and sugar – like burgers, pizza, and regular soda – combined with super-sized portions contribute to the problem.
• Smoking Cessation – Some individuals who stop smoking may overeat to replace their former habit (Read Does Nicotine Addiction Run Your Life?).
• Insufficient Sleep:  Adequate sleep helps to regulate hormones that control appetite. If you are not sleeping enough, you may crave carbohydrates or other high-calorie foods.
• Age: Although children are not immune from developing obesity, age-related changes – such as hormones, decreased muscle mass and corresponding drops in metabolism, and sedentary lifestyles – tend to increase the chances of obesity.
• Overeating as a Coping Mechanism: Have you ever felt stressed (say, from a job deadline) or depressed (say, after a nasty break up) only to find that you had devoured an entire bag of chips or a carton of ice cream without even enjoying it?  Cortisol (the stress hormone) can increase the body’s cravings for unhealthy foods, and dopamine (the neurotransmitter associated with “rewards” in addiction as well as in behaviors like sex and eating) can bring short-term relief.  However, relying on chocolate to make us feel better over an extended period of time can put us at a greater risk for obesity.
• Depression: According to Psychology Today, depression and obesity often co-occur, but researchers do not fully understand which condition, if either, causes the other.  As mentioned above, depressed individuals may overeat, which can result in obesity; however, being obese can make an individual develop a poor body image and low self-esteem, which contributes to depression (Read 10 Ways to Improve Your Body Image).
• Other Factors: Nutrition Action published a number of external cues that can lead people to unconsciously overeat.  Among these are product packaging (e.g., 100-calorie packs seem to help people with self-control); product names (i.e., we are more likely to be lured by “decadent cake” than “sheet cake”); inaccurate calorie estimates for foods that people believe to be healthy (e.g., “organic” and “low fat”); cravings or “reward” justifications after exercising or other personal achievements; imitating the portion sizes and speed of eating of our companions; and (in)visible reminders of how much food we just ate (e.g., having a waiter remove plates from an all-you-can-eat buffet versus leaving them on the table).

What other health problems does obesity lead to?

• Type 2 diabetes
• High blood pressure
• High cholesterol
• Heart disease
• Certain cancers (kidney, colorectal, breast, and endometrial)
• Gallbladder disease
• Stroke
• Osteoarthritis
• Respiratory problems like sleep apnea
• Nonalcoholic fatty liver disease (Read Alcoholism from the Inside)
• Menstrual abnormalities(Read How Addictive Substances Affect Reproductive Health)
• Pregnancy complications

How is obesity treated?

Most physicians will first advise obese patients to attempt to lose weight with diet and exercise.  If these methods are ineffective, bariatric surgery, including the lap band or gastric bypass, may be an alternative.