U.S. overweight population leads world; obesity kills more than 300,000

Americans are getting fatter every year, and it’s killing us. According to the National Institutes of Health, more than 300,000 deaths a year in the United States are attributed to obesity.
   
The estimated direct and indirect costs of obesity and being overweight in this country is $117 billion a year, exceeding the annual costs of tobacco-related illnesses. In fact, one recent study revealed that obesity has more negative health consequences and affects a larger percentage of Americans than smoking, alcohol abuse or poverty.
   
“Obesity is deadly, and people die of it,” said Dr. A. Kenneth Olson, Internal Medicine and Clinical Nutrition Consultant for Baptist Medical Center, Montclair, in Birmingham. “It’s an epidemic in the Western culture, especially in our country. The easiest statistic to remember is that to be of normal weight in our society is to be in the minority.”
   
The United States has the highest percentage of obese people in the world. In a nation that should know more about nutrition than any other, nearly 31 percent of the population is obese. That’s up from 13 percent in 1960, according to the Centers for Disease Control and Prevention (CDC). From 1980 to 2000, obesity among American adults doubled and the number of obese children and teenagers nearly tripled.
   
Alabama, with 24.5 percent of its adults obese, ranks seventh in the nation on the obesity charts and has an additional 37.2 percent who are overweight, according to the Alabama Center for Health Statistics.
   
The most common tool for determining obesity and excess weight is the body mass index (BMI). A measure of an adult’s weight in relation to height, BMI is calculated metrically as weight divided by height squared. (See related graphic for conversion to American measurements.) People with a BMI of 25 to 29.9 are considered overweight, while those with a BMI of 30 or above are considered obese.
   
Adults whose BMI is 30 or higher have a 50–100 percent greater risk of death from cardiovascular disease, and higher risks of high blood pressure, stroke, diabetes, arthritis and cancer than adults whose BMI is in the normal range (20–25), according to a 2001 report by the U.S. Surgeon General.
   
Weight alone may not be an indicator of fat, however, according to Dr. Gary D. Foster, an assistant professor of psychiatry at the School of Medicine at the University of Pennsylvania and editor of the Obesity and Eating Disorders newsletter. In his article “Obesity,” from the Microsoft Encarta Online Encyclopedia 2003, Foster points out that a bodybuilder may have a high BMI because of a high percentage of muscle tissue, which weighs more than fat. “Likewise, a person with a sedentary lifestyle may be within a desirable weight range but have excess fat tissue,” Foster stated. “In general, however, the higher the BMI, the greater the risk of developing serious medical problems.”
   
Experts believe health problems resulting from obesity are so severe they threaten to reverse many of the health gains achieved in the United States in recent decades. According to the National Institute of Diabetes and Digestive and Kidney Diseases, almost 70 percent of heart disease cases in the United States are linked to excess body fat, and obese people are more than twice as likely to develop hypertension.
   
“Men tend to carry this excess fat around their waists, which is the worst place for heart disease and hypertension,” said Heidi Hataway, assistant director of the nutrition and physical activity unit of the Alabama Department of Public Health.
   
In addition, obese women face nearly twice the risk for developing breast cancer, and all obese people have a 42 percent higher chance of developing colorectal cancer. Almost 80 percent of patients with Type 2 diabetes mellitus, also known as non-insulin-dependent diabetes mellitus, are obese.
   
“Obesity is a horrible disease, and it’s very complex,” Olson said. “Health problems related to and especially exacerbated by obesity and being overweight include not just diabetes, heart disease and high blood pressure, but cancer, sleep problems (apnea), respiratory problems, a wide variety of gastrointestinal symptoms including heartburn and reflux, gallbladder problems, infertility, skin problems, edema in legs with skin ulcers, menstrual problems, high cholesterol and triglycerides, depression and blood clots. There are others, and there are huge social problems as well.”
   
Obesity is expensive, too. Of the $117 million estimated cost of obesity in the United States in 2000, $61 billion went for direct medical costs and $56 billion for indirect costs such as disability and death. In fact, obesity accounts for at least 5 percent of the national health expenditures in the United States.
   
The causes of obesity are multi-faceted, including a genetic predisposition toward retaining fat, a low basal metabolic rate (the minimum energy required to maintain normal body function) and the size and number of an individual’s fat cells. But health experts agree changing lifestyles over the past century, including increased calorie consumption and reduced physical activity, have played a key role.
   
“Most folks believe there are two things going on: We’re less active, and we’re eating more often and more high-fat foods,” Hataway said. “Americans like things that are high in fat and high in sugar, and we use a lot of fat in food preparation. We have sweet teeth. In Alabama, we drink a lot of sweet tea.”
   
In the United States and other developed countries, wider food options have contributed to a change in eating habits. Surveys indicate that people eat out more frequently than in the 1970s, and restaurants typically serve larger portions of food than those served at home. Prepackaged foods and soft drinks are more accessible now.
  
Fast-food restaurants in particular are taking some heat because of their offers to “super-size” an already fat- and calorie-laden meal. “The food industry is being looked at and is looking at itself in how it promotes big servings to promote more business,” Olson said. “Some of the fast-food chains present meals hundreds of calories beyond what is needed.”
   
“Obesity is also related to socioeconomic factors,” Hataway said. “The amount of food eaten and the amount of physical activity have strong cultural and behavioral components.”
   
In Alabama, the prevalence of obesity among persons with annual incomes at or below $15,000 was 30.9 percent in 2001. In comparison, for persons with incomes at or above $75,000, 20.8 percent were obese.
   
Obesity occurred in 26.3 percent of adults with less than a high school education, compared to 18.5 percent among college graduates.
   
Geographically, counties in the lower third of the state are more likely to have high percentages of adults at risk for obesity and obesity-related health problems. White males have the highest percentage of extra weight in Alabama, while black Alabamians have the highest percentage of obesity. “Clearly, the most severe burden is among blacks and those with the least income and education,” Hataway said.
   
Inactivity is a major problem in trying to normalize weight. Adults and children spend less time in physical activities such as sports, jogging or even walking than they did in years past.
   
Longer hours at sedentary jobs and increased participation in sedentary recreational activities such as browsing the Internet, playing video games and watching television contribute to the problem.
   
Some studies have shown that more than 26 percent of adults don’t participate in a leisure-time physical activity, and physical education programs in the schools have declined as well.
   
Research also has shown, however, that even a modest weight loss of five to 10 percent that is maintained over time produces significant health benefits, including decreased blood cholesterol, lower blood pressure and a decreased likelihood of developing diabetes.
   
Psychological issues complicate the weight loss process. Depression is quite common among people who are obese or overweight, and this can cause psychological inertia and block their weight loss progress.
   
When people are depressed, eating can be a soothing, temporary solution to a wide variety of negative emotional states, Olson said. “The emotional component of overeating should never be ignored.”