Delaney Halloran – Healthy Living Simplified

The Obesity Pandemic: A Growing Problem

August 2, 2020 | General Health | No Comments

With the eyes of the world focused on the COVID-19 pandemic, in a way the other health concerns of our country have been swept aside in favor of weathering the present global catastrophe. But the reality is that there is another pandemic occurring in this country, albeit one that is non-communicable. Obesity rates in the United States have been on the rise steadily over the past several decades. Over the past 20 years the number of obese individuals has grown by nearly 10% in the United States [1]. But amid what is arguably a much larger and more serious concern, why should we focus our thoughts on obesity? I hope in this blog post to be able to walk you through obesity – what it is, how prevalent it is, how to manage it, and most importantly why we should care.

Obesity is a way of describing one’s body composition, and it is much more than just the number you see when you step on the scale. Factors like total body mass, percentage of body fat, height, muscle mass, and many other factors contribute to an individual’s body composition. While many factors contribute to obesity, healthcare providers define obesity using a ratio of one’s weight to their height, also known as body mass index (BMI), to simplify the complexity of this topic [2]. While not a perfect tool, over time we have learned that it is accurate for approximating someone’s risk of obesity-related complications. According to the Centers for Disease Control and Prevention (CDC) website, the values for BMI used to classify an individual as underweight, healthy weight, overweight, and obese are as follows [2]:

Below 18.5 – underweight
18.5 to 24.9 – healthy weight
25.0 to 29.9 – overweight
30 or higher – obese

To understand how this pandemic came to be, we should look closely at the history of obesity in the United States. Obesity is a relatively “new” health concern, with most research showing alarming progression of obesity in the past several decades. According to the CDC, in 1999-2000, 30.5% of adults were obese. Fast forward to 2017-2018 when research showed that 42.4% of adults (approximately two in every five adults) in the United States were obese [1]. And the upward trend appears to continue even today.

What is even more alarming is that the above research is limited to obesity only. Additional data from the CDC website shows that in 2015-2016, 71.6% of adults in the United States were overweight or obese [3]. This means that five years ago, only three out of every ten adults in our country were at a healthy weight, or were underweight. While it can be easy to acknowledge that excessive weight is a general health issue in America, it is much harder to ignore the gravity of the situation when going face-to-face with the data.

Now that we’ve seen just how significant the rise in obesity levels in this country has been, it is time to dig into why this has happened. What causes obesity, and what has happened over the past several decades to bring us to where we are today? Unfortunately, there is no clear answer. Scientists have come to learn that obesity is the result of many different factors coming together including human biology, behavior, and culture, as well as sociology and psychology [4].

At a first glance, looking into the biology of obesity can seem like a daunting task. But I find that when looking at the world around me, it is actually more straightforward to see how biology plays a role in the development of obesity. Many people (myself included) have had conversations with others in which the discussion of weight followed something along the lines of “Everyone in my family is big.” Such discussions imply that we recognize that there is a hereditary, biologic component of weight that plays a role in our lives. We know that every one of the cells of our body holds a copy of our own personal blueprints – the basic building block of life – DNA. When our cells read these blueprints, they are able to “build” proteins that the cells themselves need to carry out various functions. Some of these proteins are suspicious players in the development of obesity due to their various roles in managing body weight and amount of fatty tissues; however, there has been significant disagreement in the scientific community about these results [4]. Further examination of the roles of these proteins and others may lead to important clues about how our DNA, genetics, and biology contribute to obesity.

Behavior choices are another important factor in the development of obesity. Research has shown that consumption of specific foods – namely potato chips, sugary beverages, and meats – contribute the most to weight gain [5]. Increasing exercise was shown in the same study to decrease the amount of weight gain over time, and increased time spent watching TV increased weight gain over time [5]. This research shows that the behaviors of individuals – the things that we choose to do or not do – have a direct impact on our weight.

Finally, psychology and sociology also play a role in the development of obesity. Research has shown one’s socioeconomic status (SES) and the physical location where they live are risk factors in the development of obesity [6, 7]. For reference, SES is defined by the American Psychological Association as “the social standing or class of an individual or group…often measured as a combination of education, income and occupation” [7]. While we don’t yet understand the exact relationship between SES and obesity, scientists speculate that a lack of resources to educate people about healthy eating, the presence of food deserts (the scarcity of grocery stores within a reasonable distance), and fewer numbers of playgrounds/sidewalks (where children can safely participate in physical activity) may be part of the problem [8].

Knowing that obesity is so prevalent in our society, the question then becomes: “Why should we care?” The most striking reason is that a diagnosis of obesity carries with it an increased mortality, meaning that individuals who are obese are more likely to die from various medical complications [9]. Being obese places one at increased risk of developing diabetes, heart disease, diseases of fats that circulate in the blood, sleep apnea, asthma, cancer, and liver disease to name a few [9]. Interestingly, while many Americans recognize that obesity is an issue, they do not make the connection between obesity and its negative outcomes. A Cleveland Clinic study conducted in 2018 found that 87% of Americans don’t accurately describe the link between cancer and obesity, whereas the science speculates that 20% of cancers are directly linked to obesity and/or weight gain [10, 11, 12]. The same survey also found that 64% of Americans do not know that obesity can lead to stroke, and 57% did not know that obesity can lead to coronary artery disease [12]. Interestingly, survey data shows that most Americans are worried about their weight [12]. The disconnect therefore seems to be that many Americans worry about their weight, but do not know for what reasons specifically they should be worried about obesity.

The negative effects of obesity on health have been known for a while, but it wasn’t until we saw that COVID-19 seemed to disproportionately affect individuals with underlying comorbidities such as hypertension, kidney disease, and diabetes that many began to pay closer attention [13]. A sample of 463 patients who had COVID-19 in Detroit, Michigan in March 2020 were surveyed to determine underlying comorbidities. It was found that most (94.0%) of patients had at least one underlying comorbidity, the most common were hypertension, kidney disease, and diabetes [13]. The authors of this study also found that severe obesity was correlated to patients needing admission to the intensive care unit [13]. The unfortunate reality of our current global situation appears to suggest that individuals who are obese and have underlying comorbidities may be in greater danger from COVID-19.

How can we tackle obesity knowing that it is such a complex issue? Recommendations for treatment vary depending on the risk that one’s healthcare provider designates. The first treatment recommended for obese adults is lifestyle modification, including (but not limited to) diet, exercise, and adjustment of behavioral factors [14]. There are medications available to aid in weight loss, however these are not intended to be used without diet and exercise due to their limited efficacy when used alone [14]. Finally, with the science indicating a sociological component of obesity, I would also argue that we need to call on our government officials to increase the number of playgrounds, sidewalks, and grocery stores in areas that need them to provide people with opportunities for healthy living.

Obesity is a complicated issue that necessitates our attention as a country. The alarming rate at which obesity levels have increased as well as the many negative long-term consequences of obesity should create a sense of urgency in us. As with many pressing issues, the first thing that we can do is become more knowledgeable about the problem. I hope this blog post has provided some of the knowledge necessary to become informed about obesity, its consequences, and ways that we can treat it.

References:

(Editor’s Note: Some of the references used in this article were accessed with institutional login credentials for scholarly research. As a result, direct links to the full articles are not possible. For such articles, links to the publicly available abstracts are included below.)

By Delaney Halloran

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The Obesity Pandemic: A Growing Problem