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OB/GYN Editorial FEBRUARY 2005
The Obesity Epidemic: It's Spreading
Terence W. Starz, MD
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In a recent New Yorker magazine cartoon, two witches are watching a hefty Hansel and Gretel nibbling at their gingerbread house. One witch observes, "Remember when we used to have to fatten the kids up first?" The United States is the fattest country in the world. Both adults and children are affected by this epidemic. Over 60% of our adults are overweight, with almost half of these individuals being obese. In addition, more than 30% of our youth are overweight.
Obesity is not just a cosmetic problem. The implications of obesity for our country are tremendous. The impact on our health, on our productivity, on the whole perception of our country, where we are now, and where we are going in the future, is intimately tied to obesity. How did we get into this situation? Quite simply, we are victims of our own success. Over the past 30 years, there have been major changes in our lifestyles, with two factors contributing greatly. First, our average caloric intake has increased significantly by 300 to 500 calories per day. Second, our physical activity has decreased. This is a disastrous combination for weight gain. The explanations for these changes are multiple. The pace and complexity of our society has increased dramatically. Significant technological advances coupled with major changes in our family and other social structures have insidiously resulted in dramatic alterations in our diets and physical activity. We frequently eat out, buy pre-prepared food, and spend more of our recreational time in front of the television or the computer.
Our country produces a vast quantity of food that is readily available and relatively inexpensive, and we are encouraged to eat as much of it as we want. We have been inundated with diets of all different combinations, each promising to quickly and painlessly dissolve away our unwanted extra pounds. Somehow, in all of this, we have overlooked the basic laws of thermodynamics: energy stores (fat) equals energy intake minus energy expenditure.
Ironically, as a society we have increased our emphasis on our health, spending 15% of the country's gross national product on medical expenditures last year. When we examine the root cause or contributing factors to many of the most
common diseases from which
we suffer—hypertension, myocardial infarctions, diabetes, and osteoarthritis—body weight and physical activity play a tremendous role. In fact, in a recent report, poor diet and physical inactivity are considered the most common modifiable behavioral health risk factors for mortality next to tobacco use.
So where along the spectrum of the problem of obesity do we direct our energies? The likelihood of an obese child having weight difficulties and the concomitant health and social problems for the rest of his or her life is highly predictable. For the obese adult, his or her quality of life and work productivity is often significantly impacted. Obesity is a problem that will not be resolved until our society makes the commitment to change our behaviors and attitudes about nutrition and physical activity. The medical community must take the lead through a coalition of leaders in education, industry, public health, and insurance, coupled with consumers and legislators, to determine how we can most effectively design and implement innovative policies and programs to reduce and prevent obesity and to make our country the healthiest in the world.
Terence W. Starz, MD
Associate Advisory Board Member
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