There has been a movement of late, in defense of obese people, to draw attention to societal “fat shaming.” No one should be made to feel any less because of their physical shape and appearance. But too much focus on fat shaming in defense of unhealthy lifestyles is a diversion that helps no one.
The data tells its own story.
The Centers for Disease Control and Prevention reports that more than 40 percent of American adults are obese (based on the NHANES survey covering 2017-2020), with obesity defined as a person with a body mass index (BMI) of 30 or more. This is up from 30 percent in 1990-2000. No matter how obesity is defined, the eye test reveals that America’s obesity epidemic is ravaging our nation, and it’s one of the drivers that is straining our health care system.
Obesity is a complex disease. Some argue that if people just ate less, the problem would vanish. Such a simplistic view does not take into account how hormones may contribute to obesity, making it difficult for people to moderate their caloric intake and attain a healthy weight.
America simultaneously suffers from both an obesity and a food insecurity problem. Access to healthy foods (like fruits and vegetables) is often exacerbated by their cost and availability. It is very difficult to eat a healthy diet if you cannot afford it or if there are no outlets in your neighborhood that offer healthy foods.
Focusing only on weight misses the full spectrum of issues associated with obesity. That is why organizations like the American College of Physicians are highlighting the importance of addressing the complexity of obesity and access to treatments.
Excess weight is the most visible symptom of obesity, but it is not the cause. Much like how active alcoholics drink too much, the underlying problem is the addiction that drives such behavior, not the outward display of drunkenness associated with excessive drinking. Can the same be said about those who are obese? Is this why support groups like Overeaters Anonymous use the Alcoholics Anonymous format as the basis for their program?
Obesity has been estimated to cost our nation nearly $173 billion annually in medical costs. A 2016 study pushed this number up to $1.7 trillion annually, including both direct and indirect costs. So what are some of the hidden economic costs that society is paying?
Life expectancy
Life expectancy in the United States has taken a precipitous turn over the past two years. Though the COVID-19 pandemic initiated this drop, its persistence into a second year, when the trend has reversed in other nations, suggests that other factors are contributing to this downward trend. One such factor may be obesity, which is known to shorten people’s lives. When people die prematurely, the value they contribute to society is permanently lost.
Productivity
Given that obese people are more likely to miss time from work, the price of lower productivity and the associated higher labor costs impact the prices of goods and services. Almost every product purchased is part of a global supply chain. Higher costs along any link of such chains impact global competitiveness for products. Given that the United States has the highest obesity rate among industrialized nations, this may translate into higher costs of products to enter the supply chain, and for Made in America products, higher costs to consumers.
Transportation
Americans enjoy the spacious comfort provided by SUVs. In fact, Americans now purchase more SUVs than sedans. Everything else being equal, a heavier vehicle consumes more fuel than a lighter vehicle. This is independent of whether the vehicle uses gasoline, is hybrid or is fully electric. Moreover, with the average American now around 20 pounds heavier than they were in 1990, that extra weight requires extra fuel to move. The same can be said with air travel, trains and public transportation. Moving extra weight, in any form, requires more fuel.
Obese people are also more likely to be injured or die in automobile accidents. Part of this problem may be that they are less likely to wear seatbelts. No matter what the cause, more injuries and deaths are another cost that society pays for obesity.
Goods
The number of square feet of garment material that goes into clothing that are size XL or XXL is more than for sizes small or medium. Obesity pushes the most common clothing sizes higher, which requires more fabric to be used and ultimately more effort (and energy) to manufacture.
The future
Any one factor impacted by obesity would not move the economic dial. Yet collectively, all these factors mean that our nation is paying a significant price for the obesity epidemic beyond higher health care costs.
The bad news is that the world is catching up. The World Obesity Atlas forecasted that more than one-half of the world’s population could be obese by 2035. With it will come the same economic impacts that are being accrued in the United States.
The news only gets worse with future generations. Childhood obesity continues to rise, with around one-fifth of all children and adolescents now obese.
Obesity is the perfect storm for economic distress. It makes the population less healthy, less productive and more costly to support.
Yet there is hope. Medical treatments are being developed and implemented to arrest obesity’s spread.
What is certain is that obesity is less about extra weight and more about genetics, hormones and lifestyle. No one should be blamed for being obese. At the same time, everyone who is obese must take responsibility for engaging in a solution that can work for them.
Once the focus is directed on the cause and less on the outward manifestation, progress can be made to address the problem, and the accompanying economic implications can be attenuated.
Sheldon H. Jacobson, Ph.D., is a founder professor in computer science and the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign. A data scientist, he applies his expertise in data-driven risk-based decision-making to evaluate and inform public policy and public health. He has published several research papers on the relationship between obesity, transportation, and fuel consumption.