By Susan Blumenthal, MD, MPA and Antonia Campbell
On June 7, 2016, two articles published in the Journal of the American Medical Association (JAMA) revealed that despite significant public and private sector efforts over the past decade, Americans are more obese than ever. One study found that in 2013-2014, the prevalence of obesity among men was 35 percent, and 40 percent among women. The other study revealed that obesity prevalence is 17 percent in children and adolescents, ages 2-19. The study also found that the rapid increase in obesity rates between 1980 and 2000 has leveled out in men and children over the past decade. Obesity rates have decreased in children aged 2-5 since 2003-2004 and stabilized in 6 to 12 year olds since 2007-2008. However, the researchers also found that obesity rates have continued to rise among women and adolescents since 1988. Additionally, the JAMA articles report that 5.5% percent of men and almost 10 percent of women are morbidly obese (BMI ≥ 40), significantly increasing their risk for serious medical complications.
These obesity trends are worrying news for a country which has invested hundreds of millions of dollars in research programs, development of new drugs, and campaigns to promote healthy behavior -- which seem to have had only a minimal effect on reversing the course of the obesity epidemic. In a corresponding JAMA editorial, the authors write, “the obesity epidemic in the United States is now three decades old, and huge investments have been made in research, clinical care, and development of various programs to counteract obesity. However, few data suggest that the epidemic is diminishing."
These findings are disturbing, given the grim implications of widespread obesity. Obesity has significant medical consequences, including Type 2 diabetes, coronary heart disease, stroke, high blood pressure, high cholesterol, gallbladder disease, osteoarthritis, sleep apnea, and respiratory problems. Obesity also increases the risk for endometrial, breast, prostate, and colon cancers. In addition, the condition incurs significant economic costs from expensive medical treatments for chronic illnesses, as well as indirect costs such as lower work productivity. A 2010 study estimates the health-care costs of treating adult obesity alone, such as doctors’ appointments, hospital stays, prescription medications, and home health care to be more than $315 billion – a 48% increase from 2005.
Recent research by Chetty and colleagues revealed that obesity is one of the most significant risk factors for variations in life expectancy across economic and geographic regions -- inequalities which account for as much as a 10-15 year life expectancy gap between the wealthiest and poorest one percent of men and women in the United States. Another study analyzing CDC preliminary mortality data found that death rates increased during the first nine months of 2015 compared with the same period in 2014 -- and did so “most notably involving causes of death related to obesity.” These conditions included heart disease, diabetes, chronic liver disease, stroke, and Alzheimer disease. As a result of obesity’s high costs to the U.S. health care system and its association with higher death rates in America, the epidemic poses a serious threat to the medical progress that has been made in our country over the past decades.
In fact, our nation may now be at a tipping point. Between 1961 and 1983, life expectancy rose across America, with no county experiencing a decrease in longevity. Between 1983 and 1999, however, life expectancy decreased significantly for men in 11 counties, and for women in 180 counties -- areas where there had also been a dramatic increase in obesity rates. The author speculates that this decline in longevity in the U.S. may continue in the years ahead, as today’s generation of children with high rates of obesity grow older and experience associated medical complications such as diabetes, heart disease, and stroke.
Obesity became a public health crisis during the last two decades of the 20 century, a problem scientists believe to be related to increased consumption of fat, sugar, and refined grains in the 1980s, and to declining physical activity among Americans. The CDC and NIH report that over the past forty years, obesity rates have more than tripled among children and doubled among adults. Since the 1960s, the American adult’s average weight has increased by almost thirty pounds. The reasons for this spike include a combination of dietary, behavioral and environmental factors which have transformed American’s lifestyles: a significant increase in the availability of cheap, high-calorie foods, aggressive advertising of these products to consumers, larger portion sizes, eating out more frequently, and the substitution of sugar-sweetened drinks for nutritious ones, especially among children. In addition, food insecurity, food deserts, the availability of fast food and highly processed products as well as a range of other factors make it difficult for millions of Americans to make healthy nutritional choices for themselves and their families. Finally, science has shown that the lack of physical activity is an independent risk factor for obesity. Technological changes in our society have reduced American’s physical activity: people spend more time driving cars and using computers and media, and physical education in schools has decreased, further contributing to the obesity epidemic in the United States.
While research has identified more than 50 genes linked to obesity, our genes are not what has changed over the past several decades. In addition to alterations in Americans’ lifestyles and environment, several studies suggest that epigenetic factors are also involved. For example, maternal obesity has been shown to affect an infant’s birth weight, which in turn is associated with childhood obesity. Therefore, maintaining a healthy weight during pregnancy is important to help prevent childhood obesity. Similarly, research has found that children of obese men are more likely to develop obesity, due to epigenetic factors passed down in sperm. Research also shows that obesity can begin early in life and tracks into adulthood, so interventions to achieve a healthy weight must continue throughout childhood and the entire lifetime.
In 2015, the NIH spent only $915 million on obesity research -- an inadequate amount to discover new treatment and prevention strategies given the health and economic toll of this public health problem on our society. Clearly, more research is needed. Reforms to tax and subsidy policies are also necessary, as well as new guidance for federal food assistance programs that can help make nutritious foods more accessible and affordable. From the farm to the fork, policymakers and consumers can make choices that will reshape the food landscape in the 21 century, moving away from the proliferation of highly processed products, towards the production and consumption of healthier foods and beverages.
As Benjamin Franklin once said, “an ounce of prevention is worth a pound of cure.” The personal and economic costs of obesity are staggering. Prevention must be put into practice in homes, schools, businesses, and communities. Given the lack of significant progress so far in reversing the obesity epidemic in America, a new approach is urgently needed. Obesity has proven to be an unrelenting public health problem which demands a “health in all policies” approach -- one that mobilizes all sectors of society, recruiting the food and restaurant industries, transportation companies, technology experts, the media, public health professionals, and educators, as well as individuals and families, to develop and implement innovative initiatives that will tip the scales on obesity towards health in the years ahead.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. She provided pioneering leadership in applying information technology to health, establishing one of the first health websites in the government (womenshealth.gov) and the“Missiles to Mammogram” Initiative that transferred CIA, DOD and NASA imaging technology to improve the early detection of breast and other cancers. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired many national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Dr. Rosalind Franklin Centennial Life in Discovery Award.
Antonia Campbell is a junior at Yale University majoring in Ethics, Politics & Economics. She currently works as a Health Policy Intern at New America in Washington, DC.