We are living in an era of epidemics. From communicable diseases like Ebola and measles that have the potential to become true epidemics, to other health threats that are branded epidemics like opioids and vaping, serious health threats are in the news and on our minds almost every day. And for good reason. These public health crises seem to arise quickly and circulate rapidly through the population, prompting swift action to stem their spread.
But there are other health problems that have reached epidemic proportions that haven’t captured our attention or inspired action in the same way. Among these is obesity, which is a real epidemic with significant consequences now and in the future in the United States and around the world. Like other epidemics, obesity affects a large and growing number of people. Currently, 40 percent of U.S. adults are considered obese, and another 30 percent are overweight. This means that less than a third of adults are at a health body weight.
Even more concerning is the fact that nearly 20 percent of children are obese. When combined with the tendency for weight gain in adulthood, this suggests that obesity will be with us for some time. It’s concerning that the obesity prevalence is even higher among some racial and socioeconomic groups. These are the same groups that are likely to suffer from other health problems and often have limited access to health care.
Obesity is a grave health concern, largely because it rarely occurs in isolation. Excess body fat, especially when combined with physical inactivity, is also linked to type 2 diabetes, high blood pressure and abnormal blood lipids. This combination is called the metabolic syndrome, which greatly increases the risk of heart disease and stroke and has been shown to reduce quality of life and life expectancy. Other consequences of obesity include a higher risk of many cancers, cognitive dysfunction, fatty liver disease and musculoskeletal disorders like low back pain and osteoarthritis. Low fitness and physical inactivity leads to reduced strength, endurance and flexibility, meaning many obese people are unable to handle occupational requirements or activities of daily living. Obesity and poor fitness are even threats to military readiness and national security.
Why has the obesity epidemic not inspired more action to reverse its course? First, obesity is so common that we tend to perceive it as normal. Second, the basic cause of obesity – an imbalance between the energy intake (what we eat) and energy expenditure (what we do for activity) – is simple to understand, but difficult to change. The factors that influence our eating and activity behaviors are biological, social, economic and environmental. And since these are behaviors, talking about obesity can be perceived as a personal judgement about laziness and self-control.
Third, reversing the obesity epidemic will require changing attitudes, public policy and public health approaches regarding food, eating and activity on a societal level.
Many see public policy as the key to addressing obesity on a broad scale. Taxes on soda and fast food have been proposed as a way to reduce the intake of those foods and support the consumption of healthier options. An encouraging report on a tax on sugary drinks in Berkeley, Calif., showed a significant reduction in soda consumption over three years. What we don’t know is whether a soda tax that works in a progressive city in Northern California would also be effective – or be supported at all – in small towns in middle America.
The idea of taxation is a nonstarter for many, even for those who don’t normally purchase soda or fast food. Another approach is to end subsidies that enable the food industry to produce and sell junk food. Indeed, consumption of food from heavily-subsidized commodities is associated with greater risk of metabolic and cardiovascular disease. Redirecting money from subsidies promoting the production of unhealthy food to support the availability of healthier options could be an effective approach to addressing obesity.
Stopping a problem as great as the obesity epidemic will require large-scale interventions, many of which will demand individual and political initiative. The recent responses to opioids, infectious diseases like Ebola and measles, and other health concerns like smoking and vaping show that we can make appropriate public health and public policy decisions when we need to.
We must first accept that obesity is an epidemic and thus deserves our full attention and effort. Until then, being honest about the health effects of obesity and empowering people to make healthier choices is our best approach.
Brian B. Parr, Ph.D., is an ACSM certified clinical exercise physiologist and an associate professor in the department of exercise and sports science at the University of South Carolina, Aiken. Follow him on Twitter @drparrsays.