Why is it such a problem?

For the past few years, there has been lots of talk about obesity and how it’s becoming an epidemic. This has led to the issue of fat-shaming being called out by many, including celebrities. While no one should be made fun of, it’s essential that the health dangers associated with obesity are known. What are these hazards? How do you minimize your risk?

Obesity EpidemicBetween 1975 to 2016, global obesity nearly tripled, according to the World Health Organization (WHO). In the United States, roughly 69% of adults are overweight and 36% are obese. Adults aren’t the only ones affected. Per data from the Center for Disease Control and Prevention (CDC), approximately 38.2 million kids under 5 were reported to be overweight or obese in 2019. The prevalence of obesity in children and adolescents increases the likelihood of adult obesity, heightening weight-related risk factors for many diseases, such as high blood pressure, high cholesterol, and high blood sugar. According to the American Heart Association, the long-term consequences are devastating, with the likelihood that today’s children may be the first generation in US history to lead shorter and less healthy lives than their parents. The rise in obesity is concerning because, in 1985, no state had an obesity rate higher than 15%. By 2010, 36 states had obesity rates of 25% or more, and 12 had obesity rates of 30% or higher. In 2016, five states had rates over 35%.

The CDC breaks down obesity based off of body mass index (BMI). It’s not a direct measurement of body fat but an estimation. If your BMI is below 18.5 you’re underweight, 18.5 – 24.9 signifies you’re a healthy weight, 25.0 – 29.9 indicates you’re overweight, 30 – 40 means you’re obese, and 40 or more signals you’re severely obese. If your BMI is 30 – <35, you’re assigned to Obese Class 1; if your BMI is 35 – <40, you fall into Obese Class 2; and if your BMI is ≥40, you’re in Obese Class 3. To figure out your BMI, divide your weight in pounds by your height in inches squared and multiply by 703. Since BMI doesn’t directly measure body fat, some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

One of the concerns with the increase in obesity is how it’s viewed by the American public…as a cosmetic problem. Many don’t realize how much of a health problem it is and that they can do something about it. From a 2013 study, obesity accounts for 18% of deaths among Americans between 40 and 85. Obesity is a complex issue because it’s linked to dozens of chronic illnesses and conditions, including diabetes, heart disease, and cancer. Since it impacts how your body uses insulin to control blood sugar levels, it raises your risk of insulin resistance and diabetes. Since 1995, the rate of diabetes has risen by nearly 70%. Cardiovascular disease is the leading cause of death, accounting for a quarter of all US deaths in 2007. Obesity is a leading risk factor since it raises your chances of having high blood pressure and abnormal cholesterol levels. Excess body weight leading to cancer causes about 7% of cancer-related deaths (40,000) each year, which is the second leading cause of death. This number doesn’t include deaths from any of the other medical conditions associated with obesity, which makes obesity more serious even than the opioid epidemic. Opioids only accounted for about two-thirds of the 64,000 deaths related to drug overdose in 2016. While opiates kill quickly and dramatically, obesity kills just as surely. As a public health hazard, obesity compares to cigarette smoking, which kills 1 in 5 Americans. Smoking is considered the leading preventable cause of death in the US. There have also been numerous studies demonstrating a link between obesity and many other health conditions, such as depression. Sleep apnea and asthma are more common in obese individuals. It’s associated with cognitive decline, including memory loss and decreased thinking skills. It can reduce fertility rates in both men and women and increases the chance of miscarriage. Obesity is a leading cause of arthritic pain, injuries, and weakening muscles and joints. It increases the chance of developing heartburn, gallbladder disease, and liver problems.

Besides the health implications of obesity, it has staggering economic impacts. A recent study from Harvard’s School of Public Health approximates that it may account for as much as $190 billion (21%) of all US medical expenses every year. The estimated per capita medical care cost for obese patients is between 36 – 150% higher than non-obese patients. This makes obesity the most expensive health condition. The indirect costs are far more difficult to calculate because they include lost productivity from leave of absences from work, higher transportation costs, and higher insurance rates. The average US company with 1,000 or more employees loses $285,000 per year from such costs due to obesity. A different aspect of the problem is the diet industry, which has grown bigger, faster, and smarter over the years. Currently, over 75 million Americans are trying to lose weight. This means that the market for diet drugs, books, pills, meal replacements, and commercial weight-loss chains is gigantic. It’s valued at over $60.9 billion. Despite this, there’s no evidence it’s helping to stop the obesity epidemic.

Obesity isn’t caused by a single factor. However, it tends to run in families. Since family members not only share genes but similar eating and activity habits, this isn’t surprising. Poor sleep and stress also contribute to weight gain because most people tend to crave foods high in calories and carbohydrates when they’re sleep-deprived or feeling strained. Age also plays a role because hormonal changes and decreases in muscle mass that naturally occur increase the risk of obesity. Quitting smoking is often associated with weight gain since people use food to cope with smoking withdrawal. Several other things can influence your chances of being obese, like education, income, where you live, race, and gender. According to the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), in 2016, just over 22.2% of adult college graduates had obesity; whereas, 35.5% of adults with less than a high school education were obese. Per data from the National Health and Nutrition Examination Survey (NHANES) between 2011-2014, almost 30% of adults with incomes at 400% or more of the federal poverty level were obese when compared to adults with incomes between 100 – 400% of the federal poverty level. The BRFSS data also shows that just shy of 29% of adults living in urban or metropolitan areas had obesity versus the 34% of adults living in rural areas. Blacks rank higher than all other races in the CDC’s three obesity classes. Next are Hispanics, followed by Whites and then Asians. When it comes to gender, a higher percentage of men are in the first two classes, but more women fall into the third. One CDC report shows blacks consume up to 33% more fast food than whites, which isn’t surprising since eating healthy costs more. Since the majority of black individuals earn less money and live in less safe environments, they’re more likely to purchase cheaper unhealthy foods and not get enough physical activity.

While all of the data shows how certain things can influence whether or not you have obesity, as the CDC points out, weight gain and loss is based on the total calories consumed versus total calories used. Your body stores excess calories as fat. However, the role of diet is very complex. Even though calories add up, no matter where they come from, it’s not just how much you eat but what you eat. For instance, eating a cookie with 100 calories is different from eating 100 calories worth of vegetables. It’s also important to look at packaging because many of the low-fat snacks that have been developed actually are higher in calories than their regular-fat equivalents. Research published by the WHO found that a rise in fast food sales was linked to a rise in BMI. Since this type of food makes up about 11% of the average American diet, it’s not shocking that a high percentage of people are overweight. We’re also consuming more of other types of food. The U.S. Department of Agriculture (USDA) states that the average American ate almost 20% more calories in the year 2000 than they did in 1983 due to an expansion of meat consumption. Compared to the 1950s, when each person ate about 138lbs of meat each year, each one of us eats an average of 195lbs of meat per year now. During that same time, consumption of added fats increased by around 60% and grain consumption grew 45%. The effects of added sugars from soda and energy drinks are being seen as well.

One reason people are obese could be related to the mixed messages they receive about diet and exercise. The media has a tendency of confusing things by reporting the results of scientific studies out of context. In addition, contradictory reports about what you should and shouldn’t be eating are constantly being published. Since the 1970s, popular nutrition wisdom and fad diets are constantly changing. For instance, in the 1990s, the enemy was fat. So, low-fat and fat-free products were the rage. Unfortunately, it took us a long time to learn that fat-free and full-flavored isn’t as good as we think. Most food companies were just exchanging hydrogenated oils and sugar in for the animal fats they removed. Hydrogenated oils are restructured vegetable oils that contain high levels of trans-fats, which can raise your bad cholesterol, lower your good cholesterol, and increase your risks of developing heart disease, stroke, and diabetes. Added sugar also causes major problems since high-quantities of sugar disrupt our metabolisms, resulting in surges in insulin, ultimately contributing to weight gain and diabetes. The other problem with fad diets is that they’re not effective in controlling or reversing weight gain. One study found that 50% of dieters weighed more than 11 pounds over their starting weight five years after their diet.

The other component of the obesity epidemic is the lack of exercise. CDC data shows that 80% of Americans don’t get enough of it. One aspect is that the majority of us are sitting throughout our workday more than in the past. In the 1960s, 50% of jobs required individuals to be at least moderately physically active; nowadays, only 20% of jobs require it. Some research suggests Americans burn 120 to 140 fewer calories a day than they did 50 years ago due to the lack of movement. We have modern conveniences that allow us to be more sedentary, such as riding lawn mowers, washing machines, and automatic garage door openers. We spend a significant amount of our time in cars going places rather than walking or bicycling there. Even in our free time, we don’t participate in activities that encourage us to move. We spend a lot of time looking at computers, tablets, phones, and television screens. According to a study conducted by Kaiser Permanente, 33% of Americans say they don’t walk even ten minutes at any point during the week. Another 33% say they don’t walk enough to meet the CDC’s minimum threshold for physical activity. When you combine inactivity and a sedentary lifestyle with extra calorie consumption, it’s easy to gain weight.

To tackle the obesity epidemic, we need to focus on solutions that emphasize both food and exercise. One of the problems is that the message about eating well is more complicated than the messages of other health campaigns. We can’t tell people, “Don’t eat.” Instead, we need to give guidance like, “Eat plenty of this while cutting back on that and remember to exercise frequently.” The main focus should be on environmental factors and policies. This will foster individual behavior changes rather than rely on individual changes to transform the environment because that’ll never happen. To be successful, the campaign against obesity will have to be massive. It’s going to need to include education for doctors on how to talk to their patients about obesity in ways that’ll reach them without causing shame, new school programs to encourage physical activity, and placing responsibility on restaurants/fast-food chains to develop healthier foods options. There is growing evidence that prevention programs can reverse the current obesity trends. Data from the Healthy Communities Study demonstrate that children living in areas that promote physical activity and good eating habits had lower BMIs and waist circumferences than children in areas that didn’t. In 2018, a study published in Public Health Reports observed states that implemented CDC-funded nutrition and physical activity programs from 2000 to 2010 decreased the odds of obesity in adults between 2.4 – 3.8%.

A critical component in combating the obesity epidemic is using healthcare providers as a counterforce. The Harvard School of Public Health supports this concept. Part of this is using doctors and other practitioners to provide useful information and encouragement. Obesity is a sensitive subject to discuss since overweight people often feel stigmatized, which is why talking about it in a non-threatening way is essential. The first step is to identify that there is a health concern and discuss the consequences of not addressing it. While going through the interviewing process, it’s key to evaluate the patient’s readiness to accept the need for intervention and participation. When talking over the next steps, its vital practitioners engaging in motivational language and provide accurate, easy-to-understand information, so they need to know what resources are available in their communities that they can refer patients to. The other part is health insurance companies can incentivize their participants to stay in shape by covering preventive screenings and wellness programs. Many public health officials are aware of this need, which is why the Affordable Care Act requires insurers to take steps to address obesity. Providing affordable healthcare to Americans is a key step to fighting obesity. This is paramount since we, as a country, can’t afford to treat it and its consequences. Instead of a disease-care system, we need to shift to a real healthcare system that focuses on preventative medicine.

Another thing that the Harvard University School of Public Health recommends is restricting easy access to junk food. To do this, healthy food options must be more widely available through subsidies, labeling standards need to be improved, and sugary drinks should be taxed. According to Berkley’s early study data, results indicate that a tax on sugary drinks led to a 21% drop in their consumption. In addition to food, the Harvard School of Public Health endorses the concept that communities strive to create living environments that encourage walking and biking rather than car travel. It’s also key to involve several types of organizations, such as schools, health departments, and local businesses, because this means you’re more likely to achieve positive results than only if one sector is involved. This also means that federal, state, and local agencies should work together to create policies that make good food choices and physical activity less expensive, more convenient, and easier to access. By investing in programs that level the playing field, it’ll help eliminate the social and economic factors that make it more difficult for some people to fight the obesity epidemic. The good news is that there has been a dramatic shift in policymakers’ attitudes toward obesity, which is an important first step. The bottom line to remember is that results will come gradually.

The area of critical focus when it comes to obesity is the initiatives aimed at combatting the epidemic in kids and teens. The most notable of these is the federal Let’s Move program launched in 2010 by Michelle Obama. The project aims to cut obesity rates in kids in several different ways. The first is physical education. Unfortunately, many schools aren’t giving kids the exercise they need. Recess times are being cut short across the country to make time for more academics. In 2012, the CDC reported that 50% of the nation’s high school students don’t participate in any physical education course. Most often, this is the result of budget cuts. Sports programs are also being reduced due to budgets being slashed. To provide sports programs, schools are charging parents additional fees, which makes it harder for lower-income kids to participate. These kids are already disproportionately affected by obesity. The goal of the Let’s Move initiative is for kids to get 60 minutes of physical activity a day. The other focus is healthy meals, which caused the USDA to release new rules to enhance school lunches and breakfasts’ nutritional quality. Furthermore, many school districts have banned junk food and sugary sodas. An added measure is focusing on advertising and marketing targeting children because it can influence their food preferences and choices.

On top of the obesity epidemic, there’s a new pandemic that’s threatening the health of everyone. The relationship between COVID-19 and obesity is troublesome. A recent report found that people with obesity who caught the virus were more than twice as likely to end up in the hospital and nearly 50% more likely to die. A different study showed that among nearly 17,000 people hospitalized with COVID-19, over 77% had excess weight or obesity. According to researchers at the University of North Carolina, they found that people with BMIs over 30 were at much greater risk for hospitalization, intensive care, and death from the virus. Since the US has one of the highest obesity rates globally, it’s not unexpected that we’re being impacted more severely than other areas. Obesity disproportionately affects black or Hispanic and these groups are contracting and dying from COVID-19 more than other groups.

Why does obesity cause such a severe reaction to COVID-19? Experts think that people with extra weight struggle to mount a vigorous immune response to the virus for various reasons. Physically, fat can compress parts of the lungs making it difficult for them to expand, impeding breathing. Likewise, intubating obese people is more complex because fat deposits around the neck can make proper positioning challenging and when they’re sedated for the procedure, their muscles relax and fat can compress their airway. Another problem is medication. Standard doses for critical medications usually stop at certain weights. While healthcare professionals can calculate appropriate amounts for the severely obese, there isn’t a simple linear relationship between weight and dosage. For example, opioids, the most commonly used pain killers, are stored in fatty tissue, so it can accumulate over time, leading to complicated dosing. Obesity is associated with a wide range of comorbidities, which intensifies vulnerabilities to the infection’s worst impacts. The blood of obese people seems to be more prone to clotting, resulting in blockages in blood vessels throughout the body and starving tissues of oxygen. The other problem is the virus itself can stimulate parts of the body’s hormone system and often provokes a powerful inflammatory response. Fat sends out hormones and other signals that make nearby cells not function appropriately. Scientists have discovered that fat tissue appears to suppress the body’s initial immune response to the virus. Eventually, the body’s immune system starts to fight, but this delayed reaction might do more harm than good because the immune cells responding go wild, giving rise to unrestrained inflammation throughout the body. An additional issue with this type of immune response is the impact the inflammation can have long-term. It can erode the immune system’s ability to generate “memory” cells that store information about past encounters with pathogens. This could be problematic for the first coronavirus vaccines. If a person’s immune cells don’t remember the pathogen, the vaccines might not be effective at preventing infection. It’s important to realize that after mask-wearing and social distancing, the best way to prevent contracting severe COVID-19 is to lose weight.

It’s important not to confuse a national health problem with your own individual efforts to lose weight to live a healthier life. There’s no question that changing society will be hard, but changing yourself is considerably easier since you’re in complete control. While the ultimate goal should be to reach and stay at a healthy weight, even a small amount of weight loss can improve or prevent health problems associated with obesity. The initial aim is a modest weight loss of 5% to 10% of your total weight. It can be difficult to figure out what you need to do, so working with a team of health professionals, such as a dietitian, behavioral counselor, or an obesity specialist, can help you understand and make the necessary changes. Keep in mind that the best treatment methods for you will depend on the severity of your obesity, your overall health, and your willingness to participate in the weight-loss plan. You should anticipate participating in a comprehensive weight-loss program for at least six months. Numerous dietary supplements promise to help you shed weight quickly. The effectiveness, particularly long-term, and safety of these products is often questionable. Since these products aren’t regulated by the Food and Drug Administration (FDA), ingredients might not be standard and can cause unpredictable harmful side effects. In addition, they might cause dangerous interactions with prescription medications. So, talk to your doctor before taking any dietary supplements.

The three most important things you can do are to make dietary changes, increase physical activity, and change some of your other behaviors. When it comes to diet, the first step is to review your current habits. Avoid drastic and unrealistic changes. Instead, avoid sugar-sweetened beverages, limit alcohol consumption, restrict intake of saturated fats/sweets/salt, drink at least 8-10 glasses of water daily, and fill half your plate at each meal with vegetables or fruit. Besides eating more fruits, vegetables, and whole-grain carbohydrates, concentrate on consuming lean sources of protein, like beans, lentils, soy, and lean meats. Fish is a great option because it has a significant amount of nutrients—try to eat it twice a week. By eating larger portions of foods with fewer calories, you’ll reduce your caloric intake and decrease your hunger level. This means focusing on low-calorie, nutrient-dense foods and eat three regular meals a day with limited snacking. You can still occasionally enjoy small amounts of high-fat, high-calorie foods. Remember only to eat when you’re actually hungry, not when the clock says it’s time to eat.

A key part of treating obesity is increasing physical activity. You should try to put in at least 60 minutes daily. Every week, you should get 150 to 300 minutes of moderate-intensity activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To be safe, you’ll need to gradually increase the amount you exercise as your endurance and fitness level improves. Keep in mind that even just walking is beneficial compared to doing nothing. Regular aerobic exercise is the most efficient way to lose excess weight; however, any extra movement helps. So, by making simple changes throughout your day, it can add up. Some things to try are parking farther from store entrances, take the stairs instead of the elevator, and setting an alarm to remind yourself to get up and move around periodically. You could also wear a pedometer to track how many steps you take throughout the day. You should try to reach 10,000 steps daily.

Other elements affect your weight as well, such as sleep, stress, and personal obstacles. Behavior modification in these areas is crucial to losing and maintaining weight loss. Sometimes, participating in a behavior modification program is beneficial. Everyone is different, so are their barriers to losing weight. This is why tailoring your changes to address your individual concerns is so important. It’s imperative to maintain healthy sleep habits. The CDC recommends getting seven or more hours of sleep each night for adults between 18 and 60. Stress can make it more difficult to lose weight, so learning different techniques to manage it is vital. It’s essential to regularly monitor your weight because research has shown that individuals who weigh themselves at least once a week are more successful in keeping off excess weight. By identifying situations that prompt out-of-control eating, you’ll be able to implement strategies to stop this behavior. Sometimes, it’s easier to recognize these triggers with others’ help, such as a counselor or by participating in a support group. By consistently sticking to your healthy-weight plan the majority of the time, including weekends, vacations, and holidays, you’ll increase your chances of long-term success. It’s vital to know and avoid the food traps that cause you to eat.

In some cases, prescription medications and weight-loss procedures are additional options, but they’re meant to be used alongside diet, exercise and behavior changes, not instead of them. Your doctor may recommend weight-loss medication if other diet and exercise programs haven’t provided the results you had hoped and you meet one of these criteria: your BMI is 30 or greater or your BMI is greater than 27 and you have medical complications of obesity, like diabetes, high blood pressure or sleep apnea. The FDA has approved several medications to treat obesity, including Orlistat (Alli, Xenical), Phentermine and topiramate (Qsymia), Bupropion and naltrexone (Contrave), and Liraglutide (Saxenda, Victoza). While taking these medications, you’ll need close medical monitoring. It’s vital to consider that weight-loss medication doesn’t work for everyone, and the effects may diminish over time. Often, when you stop taking the medication, you regain much or all of the weight you’ve lost.

When it comes to weight loss procedures, there are several different types. Collectively, they’re known as bariatric surgery. The most common operations are gastric bypass surgery, adjustable gastric banding, biliopancreatic diversion with duodenal switch, and gastric sleeve. The goal is to limit the amount of food you’re able to comfortably eat, decrease the absorption of food and calories, or do both. The expected weight loss varies from 5% to 20% of total body weight loss. Since they can pose serious risks, they’re usually only approved for people who’ve tried other methods to lose weight that hasn’t worked and have extreme obesity (BMI of 40 or higher) or a BMI of 35 to 39.9 and have a serious weight-related health problem, such as diabetes or high blood pressure. In either case, you need to be committed to making the necessary lifestyle changes because they aren’t a miracle obesity cure, which means they don’t guarantee that you’ll lose all of your excess weight or that you’ll keep it off long term. Your success depends on your commitment to making lifelong changes in your eating and exercise habits.

Unfortunately, it’s common to regain weight no matter what obesity treatment methods you try. This is why you always have to remain vigilant. There are things you can do to avoid regaining weight. The first is to set realistic goals that don’t set you up for failure. They can be daily or weekly. Keep changes small and build upon them because this will make you more likely to stick with it in the long run. Don’t isolate yourself. Instead, surround yourself with people who will support you and help you reach your goals. Keep a record of your food intake and activities. This will assist you in remaining accountable and motivated. Learn as much as you can about obesity, nutrition, and exercise. This will provide you with a better understanding of why you developed obesity and what you can do about it.

The obesity epidemic demands urgent attention. It needs to be addressed to ensure the health of the nation. Unfortunately, despite the recent attention on the issue, no discernable progress has been seen, which has led experts to state that the epidemic will get worse before it gets better. Part of the problem is that there are no quick fixes. To lose weight, and keep it off, people need to adopt healthy habits, such as daily exercise and a long-term commitment to eating healthy, that they can maintain over time. This is challenging to do because it’s not an easy path, which means individuals will need encouragement and education as to why it’s important. In addition, we need to make systemic changes to how we, as a country, deal with obesity. It’ll take a significant amount of effort and some time, but we can conquer the obesity epidemic!