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The Widening of America

By Joanna Cosgrove | October 1, 2009

Sobering statistics are prompting the health community to brainstorm new ways to combat the obesity epidemic.

Despite a push for healthier food options and healthier lifestyles, America is getting fatter. With roughly 72 million Americans falling into the category of overweight or obese, it's clear that the healthcare community is not winning the war on obesity.

According to Ken Fujioka, MD, director of the Center for Weight Management and director of the Nutrition and Metabolic Research Center, Department of Endocrine and Diabetes in La Jolla, CA, the mantra of diet and exercise seem to be falling on deaf ears. The country is worse off and there is no end in sight. "America and the world continue to get heavier," he said. "What is worse is that kids are now getting much heavier at a more rapid pace and the number of morbidly obese Americans (two times a normal weight) is also increasing at an alarming rate."

Obesity in and of itself is not a singular condition. Being overweight or obese is also associated with diabetes, heart disease and high cholesterol, hypertension (high blood pressure), kidney and gallbladder disease, osteoarthritis (degeneration of cartilage and joints), stroke, sleep apnea, asthma and other breathing disorders. The medical costs of obesity are estimated to be more than $147 billion per year.

"We have certainly seen an increased awareness about the problem of obesity, the rapid increases we have seen over the last decades, and the associated health outcomes," commented Peter Katzmarzyk, PhD, FACSM, associate executive director for Population Science, professor and Louisiana Public Facilities Authority Endowed Chair, Pennington Biomedical Research Center in Baton Rouge, LA. "Unfortunately we do not have any data suggesting that we are having an impact on obesity rates. The trend has been for increasing obesity rates since the early 1980's and these increases seem to be continuing. So, we are worse off now, and the evidence that diabetes rates have also been increasing quite substantially is further evidence that we haven't turned the obesity trends around yet."

A recent report from America's Health and the Robert Wood Johnson Foundation ("F as in Fat: How Obesity Policies Are Failing in America 2009") found adult obesity rates increased in 23 states and did not decrease in a single state in the past year. In addition, the percentage of obese or overweight children is at or above 30% in 30 states.

Mississippi had the highest rate of adult obesity at 32.5%, making it the fifth year in a row that the state topped the list. Four states were listed as having rates above 30%, including Mississippi, Alabama (31%), West Virginia (31 %) and Tennessee (30%). Eight of the 10 states with the highest percentage of obese adults are in the South. Colorado continued to have the lowest percentage of obese adults at 19%.

The report also found current adult obesity rates exceed 25% in 31 states and exceed 20% in 49 states and Washington, D.C. Two-thirds of American adults are either obese or overweight. In 1991, no state had an obesity rate above 20%. In 1980, the national average for adult obesity was 15%. Sixteen states experienced an increase for the second year in a row, and 11 states experienced an increase for the third straight year.

Mississippi also had the highest rate of obese and overweight children (ages 10 to 17) at 44%. Minnesota and Utah had the lowest rate at 23%. Eight of the 10 states with the highest rates of obese and overweight children are in the South. Childhood obesity rates have more than tripled since 1980.

What's more, the current economic crisis could exacerbate the obesity epidemic. The study said that food prices, particularly for more nutritious foods, are expected to rise, making it more difficult for families to eat healthy foods. At the same time, safety-net programs and services are becoming increasingly overextended as the numbers of unemployed, uninsured and underinsured continue to grow.

In an ongoing effort to quell the rise in childhood obesity, 19 states have enacted nutritional standards for school lunches, breakfasts and snacks that are stricter than current USDA requirements-a positive step considering that five years ago, only four states had legislation requiring stricter standards.

Making Productive Changes

Staggering statistics aside, physicians have a few ideas about what more can be done, including changing the emphasis on exercise. "Recently there has also been a focus on getting more physical activity throughout our entire day rather than just focusing on purposeful exercise," said Dr. Katzmarzyk. "Any movement results in energy expenditure and we have engineered physical activity out of our daily lives. We need to bring back all types of incidental physical activity, and at the same time reduce sedentary behavior."

He also said that we collectively need to look for novel approaches that go beyond the individual level. "It is clear that simple education will not work, we need to make the healthy choices the easy choices," he said. "In other words, we need to change the environment-both physical environment and policy environment-to promote healthy eating and physical activity. Thus, we need to begin working with city planners and transportation folks to begin designing our environment to be more healthful."

Dr. Fujioka agreed that the nation's waistline may benefit from better public policy. "We've got to have public policy, taxing high calorie foods would be a good start (soda, high fat fast food, etc.), changing our environment is what it will take (more ways to walk to work, etc.)," he said, noting that newer medications also hold a lot of promise. "The safety profiles of the newer medications are very well studied and so far appear good. Also, we are now getting much better weight loss with medications, diet exercise and behavior modifications."

Earlier this month, The Obesity Society, Silver Spring, MD, steering committee members of the Strategies to Overcome and Prevent (STOP) Obesity Alliance, and two former U.S. Surgeons General-David Satcher MD, PhD, and Richard H. Carmona, MD, MPH-joined together at the meeting held at the Newseum in Washington, DC, to develop effective recommendations to urge policymakers to act on the inclusion of obesity as the largest and most urgent driving factor in healthcare reform.

The four recommendations the groups support include standardized and effective clinical interventions, enhanced use of clinical preventive services to monitor health status and help prevent weight gain, especially for individuals who are already overweight and are at risk of becoming obese; effective, evidence-based community programs and policies that encourage and support healthy lifestyles, focus on health literacy, address health disparities, and represent a significant investment in population-based prevention of obesity; and coordinated research efforts to build the evidence for all three of the above elements, continuously improving quality of care, bolstering our understanding of what does and does not work in various settings, and helping to translate the scientific research into practice recommendations for real-world clinical settings and communities.

"Health reform will succeed only if we address obesity and the chronic diseases it causes," said Robert Kushner, MD, president of The Obesity Society. "Obesity is the number one, most serious health issue facing the country. It is also the largest single driver of our increasing healthcare costs and we need to address it now."

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