Rising Obesity Rates in America – A Public Health Crisis

Published Date: July 15, 2022

woman with obesity standing outdoors on running path checking fitness watch

Research has shown that obesity is reported to be a public crisis in the US (1,2,3). Worldwide obesity has tripled since 1975 (18). Obesity is a condition with excessive body fat. The prevalence of obesity in the US in adults in 2020 was estimated to be 42.4%. According to the most recent data from CDC in 2021, more than 7 in 10 U.S. adults aged 20 and older are either overweight or obese (3). These rates considerably vary between different states and regions. Adults living in rural areas are more prone to obesity than adults in urban areas, and there is a significant difference in the prevalence of obesity in the Northeast and Southern regions. In the U.S, Mississippi has the highest rate of obesity in the country at 40.8% and Colorado has the lowest at 23.8% (4,5). Moreover, there has been an upsetting escalation in childhood obesity affecting one in every five youngsters in the US (6).

How is obesity diagnosed?

For understanding the actual size of the American obesity epidemic, it is significant to understand the meaning of being overweight or obese. Nutritionists and doctors categorize people as healthy, underweight, overweight, or obese. These classifications are obtained through body mass index (BMI). BMI = (weight in pounds x 703) / (height in inches x height in inches)

According to the CDC (8):

  • If your BMI is less than 18.5, it is in the underweight range.
  • If your BMI is 18.5 to 24.9, it is within the normal weight range.
  • If your BMI is 25.0 to 29.9, it is in the overweight range.
  • If your BMI is 30.0 or higher, it is within the obese range.

According to the chart below, a person can calculate their BMI using their height and weight and analyze in which category they fall (7).

(pic courtesy: vertex42, LLC)

What has caused the increasing rates of obesity?

Obesity is a “complex neurobehavioral disease” resulting from increased caloric intake and reduced physical activity. Fat accumulation occurs when a person ingests more calories than they can burn through normal daily activities and exercise. Many other factors influence the occurrence of obesity, including body-weight genes, poor diet, type and quantity of food consumed, little physical activity, lack of sleep, stress, social-economic factors, etc.

Certain medications and medical conditions can also predispose one to become obese. Genetic diseases such as Prader-Willi can cause childhood obesity. Increasing age, arthritis, and inability to move around also result in weight gain. Hormonal disorders such as low thyroid hormone and elevated cortisol levels have been reported to cause weight gain. Medications such as anti-seizure, some anti-depressants, anti-psychotics, steroids, and beta-blockers can also cause weight gain. Pregnancy can also trigger weight gain. It is observed that women who smoke during pregnancy have more chances that their children will suffer from obesity in the future (19). Excessive weight gain in infancy also results in obesity (20).

What chronic diseases and health issues are associated with obesity?

Obesity negatively affects almost all body systems; mental and physical (9,10). Having obesity predisposes one to develop several chronic diseases such as cardiovascular disease, cancers, type 2 diabetes, elevated cholesterol, high blood pressure, stroke, osteoarthritis, fatty liver disease, sleep apnea, infertility, depression, and social isolation. Individuals with obesity are 1.5 to 2.5 times more likely to die due to heart disease than individuals with regular BMI. Obesity results in 1 in 5 deaths annually indicating the high weight of this chronic disease and its need for prevention in the worldwide public healthcare system (9,10).

How to prevent and treat obesity?

“Obesity isn’t a disease of willpower – It’s a biological problem,” says obesity researcher Dr. George A. Bray, professor emeritus at Louisiana state university.  Prevention and treatment of obesity boil down to changing a person’s behavior, and building and sustaining healthy habits. Preventing obesity through eating a healthy and balanced diet is effective. One can focus on consuming whole grains, fruits and vegetables, fat-free or low-fat milk, and milk products daily. Include a variety of proteins such as seafood, lean meats, poultry, eggs, legumes, soy, and nuts.

Vegetables and fruits are a low-calorie food, therefore make most meals with vegetables and fruits ½ the plate. Make whole grains ¼ of the plate and proteins the remaining 1/4th of the plate. Consume fats and oil in moderation (11).

Cutting back on processed food intake is beneficial in reducing sugar intake and thus weight gain. It is recommended to not exceed sugar intake for females over six teaspoons daily and nine teaspoons for men. Minimize the use of artificial sweeteners and consider using some amount of honey. Focus on drinking more water daily (11).

Increased physical activity and an adequate amount of sleep results in positive outcomes (12,13). The American heart association recommends 150-300 minutes of moderate-intensity aerobic activity weekly (12). Walking 10,000 steps daily is another way to target a reasonable physical activity goal (13). Limit the use of television and mobile phones (14). Eating together and increasing the frequency of shared family meals is related to overall positive health (15). 

Behavioral techniques to address diet abnormalities due to eating out, food cravings, snacking, and emotional eating must be undertaken.

Medical and surgical options are also used to control obesity. Some of the medications used to treat obesity are Phentermine, Liraglutide, Semaglutide, Bupropion-Naltrexone, Orlistat, etc (16,17). Most of these medications work by suppressing the appetite or delaying the time of passage of food from the stomach to the intestine causing a sensation of fullness for a prolonged time and thus decreasing the appetite. However, these medications cannot be prescribed to any or everybody. Depending on the medical history of the patient and the side effect profile of the drugs the health care provider determines if these drugs can be prescribed or not. Surgical approaches to reducing weight are also very popular. The surgical approach is usually reserved for very obese individuals and involves reducing the size of the stomach or altering the digestive tract allowing for weight loss.

Consider discussing with your health care provider about a healthy lifestyle, balanced diet, and physical activity to maintain or lose weight. Consider asking your health care provider if you may be a candidate for medical and/ or surgical treatment if you suffer from excessive weight gain.

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Written by: Kanica Yashi, MD, MPH, DABOM

Dr. Kanica Yashi is an American board-certified Internal Medicine and Obesity Medicine expert, practicing in Cooperstown, New York. Dr. Yashi is also certified in medication-assisted- treatment helping patients with opioid addiction. She is a skilled educator, and researcher involved with multiple studies as well as holds important leadership positions with the Obesity Medicine Association and the New York chapter of the American College of Physicians. She also serves as an associate editor for the journal Obesity Pillars. Dr. Yashi is passionate about her practice of obesity medicine and her hobby of “cooking” and is in process of combining the two by making a page for “whole-some” Asian meals especially keeping in mind the nutrients and calories. She also loves swimming, traveling, and spending time with her daughter and husband.

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