If you practice medicine in the 21st century, you’re likely aware that obesity is prevalent in the United States. It has been labeled a public health crisis due to its overlap and causal relationship with many other health issues. This issue is not confined to the U.S.; the WHO has identified what it calls “an escalating global epidemic of overweight and obesity.”
While it’s crucial to address this trend, understanding the scope of the problem is essential.
Defining a Public Health Crisis:
There is no exact definition of a public health crisis. The Chicago Department of Public Health describes a public health emergency as “any adverse event (natural or man-made) that compromises the health of the population and has the potential to cause widespread illness.” An emergency implies the need for immediate action, as seen in viral outbreaks or natural disasters. Conversely, a crisis might be more chronic and has been applied to various non-epidemiological issues like pornography, gun violence, and racism.
Obesity is not listed as a public health emergency by The Health and Human Services (HHS). However, given the rapidly increasing rates, it can feel as urgent as any condition you treat.
Alarming Statistics of Obesity in America:
As of a 2023 report, obesity affects one in three adults and one in six children in America. The CDC’s National Health and Nutrition Examination Survey (NHANES) provides these alarming statistics:
- The prevalence of obesity in the U.S. was 41.9% from 2017 to March 2020.
- Twenty years earlier, in 1999-2000, the prevalence was just 30.5%.
- The estimated medical cost of obesity in the U.S. is nearly $173 billion annually.
- A 2023 World Obesity Atlas (WOA) report predicts that more than half of the global population will have obesity by 2035, with the U.S. near the top for highest prevalence.
Perhaps most concerning is the relationship between obesity and decreasing life expectancy. A 2014 NIH study showed that severe or class III obesity might shorten life expectancy by up to 14 years, similar to the impact of cigarette smoking.
Obesity Rates for Children and Adolescents:
Childhood obesity is a significant concern as it often leads to lifelong struggles with weight. The CDC reports that from 2017-2020:
- The prevalence of obesity among children and adolescents was 19.7%.
- For 2- to 5-year-olds, the prevalence was 12.7%.
- Among 6- to 11-year-olds, it was 20.7%.
- For 12- to 19-year-olds, it was 22.2%.
This means over 14 million U.S. children live with obesity, potentially facing conditions like high blood pressure, high cholesterol, type 2 diabetes, asthma, and joint problems.
Obesity Rates by Geography:
Obesity rates vary across the U.S. Adults in rural areas are more prone to obesity than those in urban areas, with significant regional differences. As of 2023, Louisiana, West Virginia, and Oklahoma had obesity rates of 40% or greater, while Washington, D.C. had a rate below 25%.
Obesity Rates by Race and Ethnicity:
Obesity disproportionately affects certain racial and ethnic groups. According to the CDC’s NHANES report:
- Non-Hispanic Black adults had the highest age-adjusted prevalence at 49.9%, with non-Hispanic Black women at 54.8%.
- Hispanic adults had a prevalence of 45.6%.
- Non-Hispanic White adults had a prevalence of 41.4%.
- Non-Hispanic Asian adults had a prevalence of 16.1%.
Among children, obesity prevalence was 26.2% for Hispanic, 24.8% for non-Hispanic Black, 16.6% for non-Hispanic White, and 9.0% for non-Hispanic Asian children.
Obesity and Socioeconomic Status:
Socioeconomic status significantly influences obesity rates. The CDC found that:
- Adults with college degrees had lower obesity prevalence than those with less education.
- Among women, obesity prevalence decreased with increasing income from 45.2% to 29.7%.
- Among men, there was no significant difference between the lowest (31.5%) and highest (32.6%) income groups.
Health Issues Associated with Obesity:
Obesity predisposes individuals to numerous chronic diseases, such as cardiovascular disease, cancers, type 2 diabetes, high cholesterol, high blood pressure, stroke, osteoarthritis, liver disease, sleep apnea, infertility, depression, and social isolation. Mental health issues are common, exacerbated by the stigma and repeated unsuccessful weight-loss attempts.
Causes of Increasing Obesity Rates:
Obesity is a “complex neurobehavioral disease” resulting from increased caloric intake and reduced physical activity. Influencing factors include genetics, diet, physical activity, sleep, stress, and socioeconomic status. Americans now consume 23% more daily calories than in 1970, with nearly half from flour and grains. Changes in eating habits, such as more processed foods and eating out, also contribute. Sedentary lifestyles and rising rates of depression and anxiety complicate the picture further.
Applying the Four Pillars of Obesity Treatment:
The Obesity Medicine Association (OMA) endorses a comprehensive care model known as the four pillars: nutrition therapy, physical activity, behavioral modification, and medical interventions.
Nutrition Therapy
A balanced diet is crucial for preventing and treating obesity. Patients should focus on whole grains, fruits, vegetables, low-fat dairy, and various proteins while reducing processed foods and sugar intake. Encourage hydration and connect patients with nutritional resources.
Physical Activity
The American Heart Association recommends 150-300 minutes of moderate-intensity aerobic activity weekly. Encourage patients to set realistic goals, like walking 10,000 steps daily, and celebrate small victories. Suggest reducing screen time and using wearable devices for motivation.
Behavior Modification
Lifestyle changes can be challenging. Behavioral techniques address barriers like eating out, cravings, emotional eating, and sedentary habits. Techniques like cognitive behavioral therapy and motivational interviewing can help patients set and achieve goals.
Medical Interventions
Medications and surgical options can aid in controlling obesity. Medications may suppress appetite or slow digestion, while surgical options are typically for severe cases. Consider each patient’s health history and needs when determining the appropriate intervention.
By applying these four pillars, medical professionals can treat the whole person, not just the symptoms of obesity, and help reverse these alarming trends.