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Damico Johnson 003 Obesity One morning you wake up, and you ask yourself when did

this happen? You question at what point in your life it all went wrong. When did it become easier to spend hours on the couch or more convenient to supersize it instead of exercising and eating balanced meals? When did your body morph into something so unrecognizable to you? When did you become fat? When did you become obese? Though a bit extreme, many Americans are asking themselves those exact questions. Poor diet and lack of physical activity, today, is ranked second among the factors leading to death in the United States. Since obesity leads to many chronic diseases, Public health advocates are finding ways to stop the onset of a possible epidemic of obese Americans. Obesity is defined as an excess proportion of total body fat. A person having 20% or more weight than their normal is considered obese. (1). In both public and medical health perspectives obesity is more defined in terms of Body mass index (BMI). BMI is a calculation solely based on height and weight and is a better indicator of obesity than weight alone. BMI is calculated by dividing the persons weight in kilograms by the height in meters squared to obtain a ratio. A ratio higher than 30 is considered obese according to the National Institute of Health (NIH). (1). The prevalence of obesity has increased in the last decade and has nearly doubled the decade before, according to the National Health and Nutritional Examination survey (NHANES) conducted in 2005. From 1960 to 2004 the number of overweight individuals increased from 44.8 percent to 66 percent in the US. (2). The prevalence of obesity during this same time more than doubled among adults from 13.3 percent to 32.1 percent.

(2). The reality that Americans are becoming fatter is an exceedingly alarming and unhealthy trend. In 2006, two-thirds or about 66 percent of Americans were overweight or obese. (1). Among the adult population ages 20-74, 71 percent of men are overweight to obese. Amid this group white non Hispanic males are 67 percent more likely to be overweight to obese as opposed to the 59 percent of non Hispanic black males. (1). Amongst women, the occurrence of obesity is higher among non Hispanic black women than their white non Hispanic women counterparts. Obesity among black women account for 79.6 percent of the overweight female population compared to the 52.6 percent of white women. For most Americans obesity occurs when a person consumes more calories than they burn, which means people are eating too much and exercising too little. Physical activity and poor diet and nutrition are the number one causes of obesity in the US. However, there are a plethora of other causes of obesity. Socioeconomic factors play a detrimental role in the prevalence of obesity. Poorer women are much more likely to be overweight than wealthier women, however this prevalence of men does not vary much with income. (4). A Possible reason for this is because wealthier families have more discretionary income to spend on gyms and trainers. The greater pervasiveness of obesity in black women compared to white women doubtless contributes to poorer health amongst blacks. (3). This health disparity may be accounted for in part by the lower socioeconomic status of blacks, who live in households with a median income much lower than their white counterparts. Genetic makeup also plays a role in obesity. Obesity, like thinness tends to run in families. In a study conducted by NHANES on adults adopted as children found that their weights more closely related to their biological

parents weight than their adoptive parents weight. This showed that environmental factors have a far less influence than the genetic makeup of the individual.(4). This study also found that the chances of obesity drastically increase if both the mother and the father are overweight. The cost of obesity is an unhealthy toll many Americans are paying. Excess weight and obesity are major threat to peoples health. In 2004, Poor diet and lack of physical activity was listed as the second actual cause of death, killing more than 365,000 people. (2). These two factors are very closely intertwined poor diet and lack of physical activity lead to obesity. Many studies have shown that obesity increases the risk of cardiovascular disease, diabetes, most kinds of cancer and a variety of other chronic diseases. Obese pregnant women are at a higher risk for complications during pregnancy. Most studies also show an increase in mortality rates associated with the obese. People who are obese have a 10-50 percent increased risk of death from all causes, compared to health weight individuals. (2). Obesity and their related health problems also have a significant economic impact in US health care. As the prevalence of obesity has increased over the years, so have the cost associated with health care, these cost can be direct or indirect. The direct cost of health care are the cost associated with preventative, diagnostic, and treatment services related to obesity. In 2004, medical expenses accounted for 9.1 percent of total US medical expenditure which adds up to 148 billion dollars, with the majority of this expenditure being paid by Medicare and Medicaid. (4). Of the total expenditure direct cost accounted for 92.6 billion dollars. Indirect costs are the value of wages lost by individuals who are unable to work because of illness or disability, as well as the value of

future earnings lost by premature death. (2). In 2004, these indirect cost added up to 56 billion dollars. The indirect cost does not however, include the cost of lost productivity due to obesity and overweight which totals 3.9 billion dollars. (2). Lost productivity refers to the cost associated with work days lost, doctors office visits, restricted activity days and bed days.

Public health advocates are seeking to promote healthier eating patterns, to encourage individuals to exercise more and reduce the percentage of people who are overweight. The government and public health officials have taken two approaches to fight obesity, education and regulation. The federal government has developed recommendations on how individuals should eat to maintain health and prevent chronic disease. The educational process was furthered by the Food and Drug Administration (FDA) requirements for labeling prepared foods, which must accurately identify the percentage of the daily value provided. The FDA revised its labeling requirements to have more informed and health conscience consumers (6). Education about obesity includes simply informing people about the risks associated with overweight and obesity. Public health advocates also promote that health education messages be delivered by medical physicians during office visits. The governments educational efforts have stressed the importance of eating less saturated fat, more fruits and vegetables. Public health officials have also tried to change lifestyles. Although Public health officials and the government have made attempts to inform and educate the masses, with the increased rate of obesity it is very unlikely the people have gotten the message.

If the American populous stays on its current track I predict a very fat future. Americans have developed a sense of instant gratification, in todays society where it is quicker to get a tummy tuck during lunch than to go spend hours in the gym. The public health measures designed to curve obesity can only work if people are willing to make lifestyle changes. The government cannot tell people what foods they can and cannot eat and what amounts of it to consume, they can only recommend. Reducing or eliminating the education programs would only lead to fatter more rotund Americans. The problem of obesity does need to be addressed more seeing as it leads to numerous other health afflictions.

Works Referenced 1. National Center of Health Statistics Prevalence of Overweight and Obesity among Adults: United States 2000-2002. Accessed 01/09/10 2. National Center for Chronic Disease Prevention and Health Promotion, Defining overweight and Obesity, Accessed 02/19/10 3. National Institute of Health Statistics Related to Overweight and Obesity Accessed 01/09/10 4. U.S Department of Health and Human Services, The Cost of Obesity to US Healthcare: 2006 Accessed 02/03/10 5. Williamson DF, Thompson TJ, Thun M, et al. Intentional weight loss and mortality among overweight individuals. Diabetes Care. 2000;23:1499-1504. 6. Serdula MK, Byers T, Mokdad AH, et al. Americans: Eating themselves to Death Diabetes Care. 2004;23:1499-1504. 7. Ronald C. Plotnikoff1,2 PhD, Nandini Karunamuni1 MSc, Lorian Taylor2 RD MPH PhD (Cand.), Cathy Schmidt2 BSc, (2009), An Examination of the Relationship Between DietaryBehaviours and Physical Activity and Obesity in Adults, Canadian Journal of Diabetes, 33(1):27-34.