Introduction
Obesity poses a major problem to the population since it comes with a raft of life-threatening problems. To date, there isn’t a universally accepted definition of obesity (MacDonald, 2003); several definitions exist, including absolute weight, body mass index and proportion of fat in the body. Obesity results from several factors acting alone or in combination; these include genetic predisposition, individual habits, social and economic environment and psychological issues.
Some of the conditions that can easily be preceded by obesity include dysfunctions of the vertebral column, pseudotumor cerebri, hypertension, type II diabetes mellitus, among others. Additionally, there are several malignant cancers whose incidence is increased by obesity, including colonic and breast cancers (MacDonald, 2003).
Obesity has been acknowledged as one of the leading health issues in the country, and the mortality and morbidity associated with the condition are expected to surpass that of tobacco as the leading cause of preventable death in the United States. Among the bigger concerns is the ability of the healthcare sector to support the management of this condition; this stems from the estimation of the cost of management of a single co-morbidity of obesity, diabetes mellitus, as USD100 billion per year. The total cost of the effects and the management of obesity is estimated to amount to about 10% of the healthcare expenditures in the united states (Koplan and Dietz, 1999). Additionally, in combination with the effects of a sedentary lifestyle, obesity is estimated to cause about 400,000 deaths every year (CDC, 2000).
The Epidemiology of Obesity
The problem of obesity has been on the increase in recent years, raising concerns about the ability to handle a large scale problem in the country. Obesity has been the subject of study and debate both from the scientific and lay sectors, and many conclusions have been made regarding the cause, effect and management of the condition.
One study put the proportion of adults in the United States with obesity at 64.5%, totalling over 120 million people (Hellmich, 2000). This is an increase from 45% in 1960. However, a more alarming increase has been that of obesity which has just about doubled in the last two decades affecting approximately 15% of kids aged between six and nine years old (Smolowe, 2002).
Although the outcomes of various studies vary regarding the prevalence of obesity in the United States, the general consensus is that the trend is generally that of increase over the last 20 to 30 years; additionally, the recognition of the fact that obesity in children is the new frontier for the disease. In 1999, a study carried out by the National Center for Health Statistics estimated that the proportion of people in the United States that had a body mass index (BMI) greater than 25 was 61% and thus classified as being overweight; additionally, those with a BMI>=30 thus classified as being obese made up 26% of the adult population.
The prevalence of obesity is affected by race, gender, age and socioeconomics; thus, it is not evenly distributed amount, specific risk groups. The prevalence is generally lower in men than in women; however, African-Americans and Mexicans of both genders tend to report more cases than their white male and female counterparts (Kuczmarski et al., 1994). An interesting factor of prevalence is that while it tends to be less in third world countries, it is higher in the upper socioeconomic classes in this group and higher in the lower groups in developed countries (DiGirolamo et al., 2000).
Dynamic epidemiology
Many studies reflecting the changes and current outlook of the prevalence and incidences of obesity in a population have been done and are very useful in measuring the disease and preparing management plans. However, the trends of sustained increase in the population are worrying.
This has led to a new line of thought in the study of obesity, what can be termed as ‘dynamic epidemiology’. This recognizes that the only solution to managing obesity in the population in the long term is by prevention of its occurrence in people who have not developed it. This is, of course, in conjunction with aggressive management in people who already have the condition.
This involves studying the patterns that the populations exhibit regarding loss and gain of weight in the population over a period of time. This answers several questions, including who becomes obese, why do they gain much weight, which is the high-risk groups and why are they; and to define the different patterns of weight gain for different phases of life of an individual (thus enabling the estimation of the pattern of obesity development from demographic information.
Epidemiology affects in a large way the methods used to manage a condition; knowing the cause of a disease (whether infectious or non-infectious) helps the management process to target the aspect of the condition that will lead to resolution of the condition. The fact that obesity has a multifactorial aetiology that may act alone or in combination makes it unpractical to have a one-size-fits-all approach since every person has a unique interplay of factors causing their obese status.
The generally accepted approach to excess weight and obesity is changing the eating habits and engaging in regular exercise; however, obesity as a condition has the unfortunate ability to recur if the regime is not followed correctly; consequently, there are as many success stories of management as there are of failure.
Redefining obesity
Dynamic epidemiology has raised questions of how obesity develops in the first place since it is not uniform in all people. For example, during gestation, why do some women gain weight, and some don’t; additionally, after parturition, why is it easier for some to lose the gained weight while it’s almost impossible for others to achieve the same? Therefore, does the way a person gain weight determine the success of trying to lose it?
This would enable people to be categorized into smaller epidemiological groups in whose management and prevention regimes are specifically aimed at the factors that are in play in the causation of weight gain. The main shift in the way obesity is in from that of a simple relationship between intake and expenditure of calories to that recognizing that there is usually a third dimension to the equation; thus, obesity results from an imbalance of calorie intake, expenditure and the overall metabolism of the body.
The mechanism of development of obesity has therefore been categorized into four pathways. The first is the simplest and obvious; a high intake of calories without an accompanying expenditure (overeating without exercising). The second pathway is family induced obesity, where the development starts when a person is a child influenced by the eating and exercise habits of the family. The third pathway is a genetic predisposition to an imbalance of metabolism leading to a gain in weight even in the face of normal calorie intake. The final pathway is a negative of a sudden low-calorie intake from a weight-loss diet on the resting metabolic rate (Jonas, 2004). By determining which pathway a person took in the development of obesity, it would be easy to formulate a management regime including various aspects of medical practice for effective weight loss and maintenance; for example, while surgical intervention, for example, the gastric bypass surgery, would benefit a person with an overeating disorder, psychological interventions would benefit someone with family-induced obesity.
However, there lies a danger in giving too much credit to non-controllable factors such as genes in the development of obesity. For example, the change in the prevalence of obesity in the United States between 1980 and 1994 is not comparable to the changes in the gene pool of the population in the same period (Koplan and Dietz, 1999); therefore, genetics are by far not responsible for most of the increasing incidence.
Management of obesity
Understanding weight loss
A comparison between individual efforts to lose weight and group programs show that the former has a bigger rate of success than the latter (Consumer report, 2000). In one study, it was shown that about 60% of people who tried to lose weight by themselves without group involvement were successful (Stem, 1987). Therefore, it is safe to conclude that a person who chooses to take control of their health is more successful than those who choose to get help for various reasons. However, the general consensus is that exercise plays a central role in weight loss; whether in the form of formal attendance to a gymnasium or through other activities that, although not specifically aimed at losing weight, result in an expenditure of a number of calories enough to maintain a negative balance of energy and breakdown of adipose tissue.
On the other hand, dieting as the sole method of losing weight may not be as successful as their proponents may suggest. Four basic categories of weight-loss diets are recognized; these include low-fat, low-calorie and low-carbohydrate diets. There has not been any difference in the outcome of these regimes after two years (Sacks et al., 2009). Whereas the short-term benefits of these regimes may be satisfactory, more often than not, the condition reverts back if it is the only method employed. Additionally, some diets may actually trigger obesity as the sudden withdrawal of calories from what the metabolism is used to result in a slowing down of the basal metabolic rate; this eventually results in the storage of more calories in the form of fat when the normal calorie levels are restored presumably when the diet period is over. The person thus experiences accelerated weight gain that may surpass even the pre-dieting weight.
Other than changes in the diet and increase of physical activities, other medical interventions mostly have modest outcomes that are generally not able to handle the large number of cases involved. This has increased the importance of surgery as a method of treating morbid obesity (MacDonald, 2003). Several methods of doing this surgery have been developed, and many have been abandoned for others that have lower risks of complications involved. The ability of weight-loss surgery to stem the tide of obesity is, however, questionable; this stems from obvious risks of surgical procedures, the ability of the healthcare system to do these surgeries on a large scale and handle post-operative emergencies that might arise. Therefore, while surgery has the potential of producing dramatic support for an individual with the proper management, it may not have a similar effect on the population outlook. Additionally, it would not work to mitigate some of the factors attributed to obesity, such as psychology.
Prevention of Obesity
Among the most profound effects of the increasing prevalence of obesity is the cost involved in the management of the primary condition and the co-morbidities such as diabetes mellitus, heart disease and other conditions. The future ability of the healthcare system to foot this bill is in question since deficiencies are already being seen in the capacity of the current.
The only hope, therefore, is preventing obesity before it occurs. The main question, therefore, is whether to classify obesity as a disease or purely as a consequence of a harmful lifestyle. This is of more importance to the healthcare insurance agencies that actually have to pay for these costs; and the (employers) who have to make contributions towards these bills for each of their employees. In the past, these parties have used incentive and penalty systems to reduce the cost of preventable morbidity (Walters, 2002).
Healthcare financiers are certainly more inclined to pay for disease-linked costs than for the costs of harmful effects of unhealthy lifestyles; thus, they tend to demand more personal accountability in issues surrounding such lifestyles by instituting penalties for failing to meet minimum requirements for coverage or for refusing coverage at all. Many healthcare providers have been tempted to institute similar measures in the issue of obesity (Walters, 2002).
However, we have to acknowledge the fact that as much as most of the obesity results from a personal inclination to consume more calories than expended, there is a significant aspect which the person can not control, and that simply demanding such a person may not give the desired results even with an attached threat of a penalty.
A comprehensive approach
Obesity management and control, therefore in the recent past, has taken a more comprehensive outlook that is aimed at tackling various factors attributed to obesity. Among the most significant of these is the incorporation of psychological care to persons with predispositions to obesity stemming from social conditioning and to those with metabolic disorders.
There also has been an identification of the importance of having policy target more than just primary healthcare in reducing the prevalence of the condition. For example, a prohibition of targeting children in fast-food commercials may reduce the consumption of excess calories by children (Brook, 2007); and minimise access to sugared beverages in schools [NIH]. Additionally, the effort has not been limited to the healthcare providers sector; other authorities such as city planners have to increase access to parks and increase pedestrian-reserved areas to increase the physical activity of the population (Brennan, 2006).
Conclusion
Many governments around the world have recognized obesity as being a major threat not only to the general population but also as a major threat to the economies stemming from loss of workforce and cost of the medical cost.
Despite this enlightenment, the prevalence keeps climbing; this can partly be blamed on looking at the condition through an inaccurate analysis that failed to recognize some factors. However, by using dynamic epidemiology that factors in all the events that may have led to obesity, there still may be the hope of stemming this tide.
References
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