Despite a long and continuing perception that obesity is the result of a failure of the individual, health organizations, local and state legislatures -- and even the U.S. Surgeon General's Office - are recognizing obesity as a serious disease and a growing public health problem that must be addressed by communities nationwide.
The U.S. Centers for Disease Control and Prevention has ranked obesity the number-one health threat in the United States. The U.S. Surgeon General is calling obesity a "nationwide epidemic," increasing at alarming rates and costing the country's health care system an estimated $117 billion per year.
Obesity is on the Rise
Physicians consider an individual obese if s/he weighs more than 20 percent above expected weight for age, height and body build. Morbid or malignant obesity is weight in excess of 100 pounds above that expected for age, height and build. The American Obesity Association (AOA) calculates that 127 million adults (nearly 65 percent) in the United States are overweight or obese. What's more, 300,000 deaths per year are associated with obesity and overweight - a figure that comes startlingly close to the 400,000 annual deaths associated with cigarette smoking.
Americans spend in excess of $30 billion annually on weight-loss products and services, yet the waist lines of Americans are growing. In Colorado, an ambulance company has retrofitted its vehicles with a plus-size compartment to handle overweight and obese patients. And, an Indiana manufacturer of funeral caskets now offers a double-size model that is 38 inches wide versus the standard 24 inches.
A report by the Centers for Disease Control and Prevention concludes that Americans are fat "because we eat a lot." Adult women eat 335 more calories per day than in 1971 and adult men consume an additional 168. In addition to the excess calories, an increasingly sedentary lifestyle (one in four Americans doesn't get any exercise), coupled with the abundant availability of fast-food and other high-fat foods, have provided a recipe for weight gain and created a dangerous obesity epidemic.
The term obesity is often used as short-hand for overeating or lack of exercise, and the AOA notes that obesity fits the medical definitions of disease: "an interruption, cessation or disorder of a bodily function, organ or system."
Scientists of all stripes now agree that environmental factors, such as easy access to fast-food, and high stress rates - once considered a radical and even ridiculous proposition - play a major role in the obesity problem. Obesity is recognized as a disease in the United States and internationally by government agencies, health organizations, researchers and medical professionals.
According to the North American Association for the Study of Obesity, obesity is associated with significantly increased risk of diabetes, hypertension, certain forms of cancer, sleep disorders and osteoarthritis. The increasing prevalence of obesity and its associated risks and complications places a tremendous burden on our health care system.
So, what can be done about obesity?
Legislatures, food companies, schools, the health care system, corporations, and organizations of all types want to help address the nation's obesity epidemic. But differences of opinion make it difficult to agree on actionable ideas and solutions.
Scientists, government officials, community activists, and media all agree that American consumers need to be better educated on the issue.
States and cities throughout the nation are finding ways to encourage weight loss. Few ideas have become law, but several states have considered bills that would, among other things, get children exercising, warn restaurant eaters about fat, sugar and cholesterol, and ban sugary sodas and snacks from vending machines.
Arkansas Governor Mike Huckabee, who lost 105 pounds, developed a "Healthy Arkansas" initiative - not an attempt to regulate lives but to make healthy living desirable and doable. The program is designed to educate people and offer financial incentives for state employees to reduce obesity rates.
In Louisiana, that state is paying for government employees' gastric bypass surgeries in an experiment to reduce health care costs.
Public campaigns aimed at urging people to change their eating habits are also popular. Billboards in West Virginia, where costs related to obesity have more than doubled since 1995, feature photos of bulging stomachs and couch potatoes, and exhort people to "Put Down the Chips and Trim Those Hips." In addition, the state agency that insures public employees is offering exercise benefits and diet counseling.
Other proposed fixes include wide-scale public health and policy interventions. One innovative public intervention program -- "America on the Move" is based on calculations showing that the average American who is gaining an extra pound or two a year must burn approximately 100 extra calories a day to "break even" at the end of the year.
Shape Up America! is a non-profit national initiative to raise awareness of the importance of healthy eating and increased physical activity for weight management and disease prevention. Founded by former U.S. Surgeon General C. Everett Koop in 1994, Shape Up America! relies on a broad coalition of industry, medical, health, nutrition and physical fitness experts to develop and communicate information to the public and to health care professionals.
In the political arena, nearly 150 obesity-related bills have been introduced around the country, including companion bills in the House and Senate that would extend nutrition labeling beyond packaged foods to include foods at fast-food and other chain restaurants.
Clearly, obesity is a complex phenomenon. There are many factors that contribute to causing obesity, including genetics, behavior and the environment, blurring the lines between personal culpability and genetic and environmental accountability.
Use It to Lose It
They're everywhere - on television and radio, on the Internet and in magazines: fast and miraculous ways to lose weight. But if there really was a miracle solution, more than 65 percent of adult Americans would not be overweight.
The AOA reports that approximately 40 percent of women and 25 percent of men attempt to lose weight each year, and 55 percent of Americans are actively trying to maintain current weight. Consumers spend nearly $30 billion on diet drinks, diet foods, appetite suppressants, diet books and videos, medically supervised weight-loss programs and fitness club memberships each year to lose weight or prevent weight gain.
But losing weight involves more than ordering your cheeseburger without the bun or stocking up on the many new "carb friendly" foods. In fact, the plethora of low-carb choices serves little purpose than to give consumers permission to overeat because they think that as long as the food is low-carb, they can eat as much as they want. In fact, calorie counts stay the same - or even increase. Calories do matter. Portion size is also important. For instance, restaurant servings can be up to five times a normal, single serving.
Medical experts and nutrition professionals alike agree that staying healthy requires making smart choices. In fact, most nutritionists warn away from any diet that eliminates entire categories of nutrients. The best strategy is to watch intake of so-called "empty calories" such as soft drinks, snacks and french fries and to exercise most days of the week for at least 30 minutes.