Our fight with fat—why is obesity getting worse?

December 27, 2017 by Kenneth Cusi, The Conversation
A woman exercising. Thousands of people will be doing the same this week in an effort to lose weight, a perennial resolution. Credit: UConn Rudd Center for Food Policy and Obesity, CC BY-SA

Gyms across the country will be packed in the new year with people sticking, however briefly, to their New Year's resolution to lose weight. Most of them do not know that the cards are stacked against them and that weight loss is much more complicated than working out and not eating dessert.

Years into the , millions of Americans have tried to lose weight, and millions of them have failed to do so long term.

It's so serious now that close to 40 percent of Americans are obese. The average woman in the United States today weighs about 168 pounds, or roughly the same as an average man in 1960.

Not that that guys' waists haven't ballooned, too. Men have gained on average nearly 30 pounds since John F. Kennedy's inauguration in 1961.

From 1976 to 1980, just under 1 in 7 American adults, or 15.1 percent, were obese.

Now, despite people's concerted efforts, obesity is at its highest level ever, with about 40 percent of U.S. adults and 18.5 percent of children, considered obese. This is itself an increase of about 30 percent, just since 2000 when roughly 30 percent of American adults were obese.

The U.S., and increasingly the world, is in the grip of a real epidemic – the seriousness of which is lost in our obsession with diets. One study estimated an additional 65 million obese Americans by 2030, and increased medical costs between US$48 billion to $66 billion a year.

As an endocrinologist, I study obesity and treat people with obesity every day. Here are some things I see, and some things I see that could begin to address the problem.

Costs across the board

Obesity, defined as a body mass index of at least 30, is about far more than vanity. It impairs quality of life and exacerbates health risks involving many medical conditions in children and adults. Obese people incur more medical costs, live shorter lives and miss more work than their thinner counterparts.

The health risks include gallbladder disease, osteoarthritis, gout, sleep apnea, polycystic ovarian syndrome, cardiovascular disease and a broad spectrum of cancers, such as pancreatic, liver, breast and kidney cancers.

Obesity also leads to metabolic conditions such as hypertension, Type 2 diabetes and nonalcoholic fatty liver disease, which has long been overlooked as a life-threatening consequence of poor eating habits. This disease was rare until 1980.

The associated with obesity are enormous – and growing. One study estimated the annual of obesity in the United States in 2008 dollars at $209.7 billion. To put that in perspective, consider that that's almost half the amount of the estimated federal deficit for fiscal year 2018. About 1 in 5 dollars are spent to treat obesity-related illness.

The costs are also high to individuals. Compared with normal-weight individuals, obese patients spend 46 percent more on inpatient costs, 27 percent more on outpatient care and 80 percent more on prescription drugs.

A sickness of American society?

Obesity's roots are in American culture, from the stress of the workplace to the onslaught of food advertising, to our tradition of holiday overindulgence. The taste buds of our youth are raised on junk food and sugary treats, habits that follow children into adulthood.

American society is structured around productivity and long work hours. This leads to unbalanced lives, unhealthy lifestyles and unhappy people. Stress and lack of sleep can contribute to obesity.

For many families struggling between paychecks, the foods that make the most financial sense are the processed, packaged, fatty choices serving up the most calories.

Meal portions at restaurants have sharply increased in recent decades as well. The percentage of our food budget spent on out-of-home dining climbed to 46 percent in 2006, up 20 percent since 1970. The temptation of unhealthy food greets us on every street corner, in our breakrooms and at our favorite supermarkets. We Americans are eating too much yet we can't seem to reverse it. Why?

Some blame the epidemic on the advent of the microwave and the growth of fast food options since the 1970s. Also, our food choices have changed, with food industries mass market fattening foods to children.

Americans are more sedentary than we were decades ago. Our lives are tied to computer screens, big and small, in both our jobs and our homes. Our children are now raised on hand-held devices that serve as surrogate playmates in a world where "playing ball" is more likely to be done via internet connection than the actual playing field.

Our fight with fat—why is obesity getting worse?

Blaming the victim?

Many of us invoke "willpower" in our fight against fat, blaming and shaming ourselves and others for not losing weight. While many people have lost weight in the short term, they struggle to break the cycle of food addiction and unhealthy food choices. Yet scientists have learned that this is not about a shortage of willpower but about an abundance of physiological factors that make the body hold onto fat.

Patients standing alone with just their willpower and the latest diet to guide them invariably face great difficulty against a complex disease like obesity. Going it alone may be a barrier to appropriate treatment options, such as behavioral modification counseling, anti-obesity drugs and bariatric surgery.

Weight regain is common, as structured diets are hard to follow over the long haul. The body resists long-term calorie restriction by sending signals to our brains that trigger a craving for food, making diets prone to failure.

Because of the frustration of failure, many people are simply giving up on slimming down, making obesity an accepted social norm. One study has shown a declining percentage of men and women trying to lose weight since 1988, perhaps due to a lack of motivation after failed efforts.

Fixes

Even so, we're making some progress battling this epidemic. Studies show obesity appears to be plateauing in Caucasians, though not in ethnic minorities. But the numbers are already so high, "plateauing" seems more euphemistic than hopeful.

Scientific research has shown that the fixes are not about dieting, however. The solutions are complex and will take time and resources. Patients need more support than they are receiving.

Clearly, our country needs a greater systematic effort in the realms of public health, the government and industry. For starters, our political leaders should make combating obesity a top priority. Our nation faces many challenges, and the obesity epidemic has fallen to the bottom of a long list of health care problems.

Schools could play a role. Students should receive additional education in schools on good eating habits and how to control stress.

As someone who sees this devastating illness every day, I believe that health care insurers need to be more willing to pay upfront to manage obesity before it becomes a much more expensive disease to treat. Given the structure of health insurance now, physicians simply cannot spend the time needed with patients to properly communicate and educate.

Studies have shown that many insurers exclude treatments for .

Each of us needs to become an advocate for a healthier way of life. Adults can start by teaching our youngsters about good dietary habits, by insisting on a better balance in the workplace, and by demanding more accountability from the and health industries, and our government. Doing that will help ensure a brighter and healthier future for our children.

Explore further: Nearly 4 in 10 U.S. adults now obese (Update)

Related Stories

Nearly 4 in 10 U.S. adults now obese (Update)

October 13, 2017
(HealthDay)—Almost forty percent adults in the United States are now obese, continuing an ever-expanding epidemic of obesity that's expected to lead to sicker Americans and higher health care costs.

Survey reveals surprising mismatch between perception and reality of obesity in America

November 6, 2017
Nearly 40 percent of American adults and 20 percent of children carry enough extra weight to warrant a diagnosis of obesity. That's the highest obesity rate among the world's affluent nations, and it's already shortening ...

Obese older adults who survive cardiac surgery may have higher risk for poor functioning

November 10, 2017
More than one-third of Americans are considered obese based on their Body Mass Index (BMI). BMI measures the ratio between your height and weight. A BMI of 30 or above signals obesity. As more and more of us age, we also ...

Don't blame food stamps for obesity in America

September 5, 2017
Politicians and scholars sometimes cast obesity as a problem that largely afflicts the poor. But as most obese adults aren't poor and most low-income adults aren't obese, this is a misconception.

U.S. pays a hefty price for obesity

September 26, 2017
(HealthDay)—A U.S. adult who is "healthy" but obese could eventually cost society tens of thousands of dollars in medical care and lost wages, a new study estimates.

Excess weight increases costs across health care settings

June 2, 2017
(HealthDay)—Excess weight is associated with increased costs across health care settings, with the highest percentage increases seen in costs for medications, according to research published online May 22 in Obesity Reviews.

Recommended for you

Evening hours may pose higher risk for overeating, especially when under stress, study finds

January 16, 2018
Experiments with a small group of overweight men and women have added to evidence that "hunger hormone" levels rise and "satiety (or fullness) hormone" levels decrease in the evening. The findings also suggest that stress ...

Bariatric surgery prolongs lifespan in obese

January 16, 2018
Obese, middle-age men and women who had bariatric surgery have half the death rate of those who had traditional medical treatment over a 10-year period, reports a study that answers questions about the long-term risk of the ...

Sugar-sweetened drinks linked to overweight and obesity in children, adults: Analysis of new studies

December 23, 2017
A new review of the latest evidence on sugar-sweetened beverages (SSBs)- which includes 30 new studies published between 2013 and 2015 (and none of them industry sponsored) - concludes that SSB consumption is associated with ...

As income rises, women get slimmer—but not men

December 21, 2017
(HealthDay)—A comprehensive survey on the widening American waistline finds that as paychecks get bigger, women's average weight tends to drop.

Policy and early intervention can curb obesity rates

December 18, 2017
More information and emphasis on dietary lifestyle changes that prevent obesity, and its comorbidities, have not reduced the rise in obesity in U.S. adults and adolescents, according to a recent study in the New England Journal ...

Warning labels can help reduce soda consumption and obesity, new study suggests

December 15, 2017
Labels that warn people about the risks of drinking soda and other sugar-sweetened beverages can lower obesity and overweight prevalence, suggests a new Johns Hopkins Bloomberg School of Public Health study.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.