Introduction
Research data, backed up by the Center for Disease Control and Prevention indicates that 30% of people in the US are obese (Hill, 2002). Moreover, children in the United States are becoming increasingly obese (Hill, 2002). The U.S. Center for Disease Control and Prevention is responsible for tracking obesity in the nation. It has found that obesity is on the rise in the United States. Many States have double the number of obese people since 1990 (Donnelly, 2007). Three states have reported that one third of their adult populations are obese. If statistics include overweight people along with officially obese people, 60% of all Americans would be considered as weighing more than they should (Donnelly, 2007). This is largely due to the increasing popularity of fast-food with high fat and carbohydrate content, large food portion sizes and the sedentary life-styles of recent times (Hill, 2002). With respect to children, researchers say that parents and schools can make a difference by paying attention to their diet and physical activities (Hill, 2002). The awareness regarding the dangers of obesity is not a recent phenomenon. As early as the fourth century B.C., Hippocrates observed, “Sudden death is more common in those who are naturally fat than in the lean.’ (Weck, 1986). Statistics underline the dangers of obesity. Obesity is the fastest growing cause of death in America according to U.S. Surgeon General Richard Carmona. He describes obesity as “a health crisis affecting every State, every city, every community, and every school across our great Nation” (2003).
The Dangers of Obesity
The dangers of obesity to a person’s health are many and it increases the risk factors for various diseases such as diabetes, cardiovascular diseases. Studies have shown that there is a direct link between obesity and Type II diabetes, especially in the case of older people. According to one particular study, it was found that among the 50-to-59-year age group, about 2 percent of normal-weight individuals had diabetes. This occurrence increased to 4 percent for those who were 50 percent overweight and 8 percent for those in the 100 percent overweight group (Weck, 1986). Obese people find it difficult to breathe due to the layers of fat in the chest. This means, the heart is forced to work harder in order to pump blood to all parts of the body, thereby leading to heart disorders. A study at Mayo Clinic has shown while hearts of normal people weighted 91/2 ounces, hearts of obese people weighed almost 13 ounces. This increased to 16 ounces when the obese person had high blood pressure. The enlargement of the heart is due to a physiologic process called left ventricle hypertrophy. High blood pressure and life-threatening erratic pulse are some of the outcomes of left ventricle hypertrophy. Obese people are also prone to atherosclerosis due to high blood cholesterol levels. Artheroclerosis refers to the deposition of plaque along the arteries. In serious cases, the plaque can block the flow of blood to vital organs such as the heart, brain or kidney. Narrow blood vessels also cause the heart to pump harder causing high blood pressure which in turn can lead to severe complications such as stroke, paralysis, kidney failure and heart attack. Statistics indicate that about 25% of all cardiac disorders are linked to obesity. Women who are obese face complications during pregnancy and child birth. They also are a high risk group when it comes to “gallstones, blood clots, and a condition known as toxemia of pregnancy, characterized by excessive vomiting and convulsions” (Weck, 1986). Moreover, obesity in pregnant women can lead to back, leg and joint aches. It has been found that obese women with hormonal problems are at high risk to get cancer of the breast and uterus (Weck, 1986). This has been explained through recent animal studies. Body fat produces additional estrogen that increases the risk of cancer in obese women. There is also a direct link between consumption of fats and cancer. Obese people find it very difficult to move around with ease. Hence they become inactive. This inactivity can cause osteoarthritis. Moreover, the additional weight of obese people can aggravate arthritis of the hips, knees and ankles. The hormone Estrogen produced by the fat cells in obese women can create a hormone imbalance and hamper their fertility (Weck, 1986). Another health danger faced by obese people is that they may face difficulty in breathing during sleep causing disturbed sleep patterns. This also causes sleepiness during the day. Obesity also can cause “liver cirrhosis, premature aging of the immune system, gallstones, kidney stones, blood clots, and varicose veins” (Weck, 1986). Obese people also face increased risk of mortality during surgery (Weck, 1986).
Economic and Technologic Factors
The causes of obesity have been explored from many different angles. According to doctors, it may be explained by various genetic, psychologic or physiologic factors. Jayachandran Variyam holds that economic prosperity is also one of the main factors. He cites the fact that food prices have been steadily falling since 1952. There has been a 12% drop in food prices from 1952 to 2003. However, Variyam points out that this price decline is all the more when we consider factors such as reduced time of preparation, greater variety, increasing number of restaurants and vending machines. Due to technological advances in processing and packaging, seasonal foods are available all through year and there are a large number of ready-to-eat foods (Variyam, 2004).
Harvard University’s David Cutler, Edward Glaser, and Jesse Shapiro have found that people ate more when the time cost of food declined and this is a major cause of obesity since 1980. Health economists Darius Lakdawalla and Tomas Philipson have noted, people have become more sedentary due to increasing mechanization and with the popularity of service oriented jobs (Variyam, 2005). It is ironical to find that while machines do most of the hard labor, people are forced to pay money for exercising. There is now no need to push a lawn mower to cut the grass or to do laundry. The saved up energy needs to be used voluntarily and hence people join gyms or spots clubs. One main technological advance that has contributed to the rise of obesity is the advances in the entertainment and electronics industries. There are now a large number of electronic goods and services that provide entertainment to passively sitting individuals – ipods, video games, networking through computers, cable TV, DVDs, and the Internet (Variyam, 2005). Due to these advances, people are tempted to spend time in passive entertainment, thereby reducing further the expenditure of physical energy.
The pattern of eating is also to be noted. As people become rich, they switch to eating more refined cereal food, more meats and prepared foods. They also look for foods that are more tasty and convenient to prepare. With rising incomes, people also enjoy eating out at restaurants and public eateries. “ERS studies show a 10-percent increase in income leads to a 4.6-percent increase in a household’s away-from-home food expenditures compared with a 1.3-percent increase in at-home food expenditures” (Variyam, 2005). American expenditure on eating out has increased from 28 percent in 1962 to 47 percent in 2003. Further studies have found that foods eaten in restaurants and hotels are richer in calories and hence can cause obesity. Health economists Shin-Yi Chou, Michael Grossman, and Henry Saffer have found that areas with larger number of restaurants are linked with greater obesity rates over time (Variyam, 2005). Thus, technological changes that have raised the economy of the nation have also served to reduce the price of food and decreased the physical activity of the people thereby causing “a steady weight gain across all segments of U.S. society” (Variyam, 2004). The World Heart Federation has stated that “obesity will overtake tobacco smoking as the biggest cause of heart disease” if this pattern of low physical activity and increased food intake continues (Kirby, 2002).
Poverty and Obesity
Adam Drewnowski, professor of epidemiology and medicine at the University of Washington, says that poor people are generally obese. Food that has high quality fiber are more expensive than high calorie foods. In his words: “Refined grains, added fats, and added sugar – The problem is that diets full of these are inexpensive, while diets with whole grains, fresh vegetables and fresh fruits are not as affordable. They’re even slipping out of grasp for middle-class people” (Donnelly, 2007). Rates of obesity have been found to be very high in the southern states with high levels of poverty, according to reports by the CDC in 2005. This finding further reinforces the statement of Adam Drewnowski (Donnelly, 2007).
Child Obesity
Stephen R. Daniels says it’s very important to pay attention to the issue of rising obesity in children. This problem can reverse the modern era’s steady increase in life expectancy – he observes. This means, the youth of today’s world may have shorter lives than their parents. Researchers have found that children face the same risks of obesity as adults in the health context. Daniels notes: “Even when the disorders do not present themselves in childhood, childhood obesity or overweight increases the risk of their developing in adulthood” (Daniels, 2006). Childhood obesity has also been found to lead to depression.
Sonia Caprio feels that obesity should be recognized as a disease and obese people should be able to get coverage for its treatment just as other diseases do. According to Caprio, the most effective programs against obesity are those that combine diet, behavioral modification, exercising and parental involvement (Caprio, 2006). However, these programs are not available to children at primary pediatric care centers. The pediatric primary care providers find themselves inadequate to treat child obesity. They are also frustrated by “insufficient patient motivation and a lack of parental concern”. Caprio opines that the obese child should be evaluated with a detailed medical examination. Further, the nutrition, physical activity and family environment of the obese child should be studied. Childhood obesity can also happen through longs hours spent in watching television and playing video games. Children also tend to eat more while watching advertisements on television. Studies have shown a direct relation between television viewing and obesity. Caprio says that childhood obesity can be controlled only by acting at all levels – medical, social, political, and educational. Some measures that can be effective in curbing childhood obesity are “nutrition programs, regulations of the marketing of junk food to children, eliminating energy-dense foods and sodas from schools, and promoting physical activity” (Caprio, 2006).
Treating Obesity
Obesity was initially treated with drugs such as amphetamines, thyroid hormones, diuretics and laxatives. Jules Hirsch, the Rockefeller researcher says that these drugs fail to treat the root cause of obesity and hence they are not truly effective. According to him the drugs merely control appetite, metabolism or the absorption of food in the intestines (Pool, 2001). Hirsch points out that the body will stick to a certain set point despite drug therapy and this can cause many problems. He says the best way to curb obesity would be to understand how obesity develops, how a person’s genes interact with the environment, and then developing treatments based on such understanding (Pool, 2001). Sobal and Maurer point out that treatment of obesity has changed radically – earlier, treatment for obesity was based on the individual needs of the patient; current systems however, base their treatment plans on the extent of obesity and presence of co-morbid conditions that increase risk (Sobal and Maurer, 1999).
Conclusion
Obesity has been studied as a genetic problem, a disease, a behavioral issue and as a psychological issue. Various plans and programs have been devised for fighting the obesity epidemic. There are many new weight-loss drugs on the market. However, it must be said that there is no substitute for lifestyle changes. Only through making lifestyle changes, obesity can be successfully overcome. The best options to prevent or reduce obesity are to eat in a healthy manner – taking foods with fiber such as fruits and vegetables, avoiding junk food, reducing meat intake, increasing water intake and exercising regularly.
Annotated bibliography
1. Hill, G. (2002). New survey underscores rise in obesity. CNN. 2002
The research – a survey including 4,115 adult men and women conducted in 1999 and 2000 — shows more than 30 percent of people in the United States are obese. That’s an 8 percent increase over data collected from 1988 through 1994, according to the study published Tuesday in the Journal of the American Medical Association.
There are also more extremely obese adults — 4.7 percent of the population versus 2.9 percent in the 1988-1994 study.
The percentage of overweight American adults rose from 55.9, in the earlier study, to 64.5.
“Although these increases in obesity… appear dramatic compared with previous surveys, they may also be viewed as part of a longer-term trend for increases in body size in affluent and well-nourished societies,” the authors write.
The increase in obesity isn’t just for grownups. Researchers also surveyed 4,722 children from birth to 19 years of age and found they’re also getting fatter.
Five percent more young people between the ages of 12 and 19 – at 15.5 percent — are now overweight than found in the earlier study. In 6 to 11-year olds, an increase of 4 percent was seen. And there are now 3.2 percent more overweight 2 to 5-year olds.
The researchers used body mass index – or BMI — to identify obesity. Overweight was defined as having a BMI of 25 or higher. A BMI of 30 or greater is considered obese and extreme obesity means having a BMI of 40 or more.
The researchers cite several possible reasons for the increase including:
- Increasing food portion sizes
- Consumption of high-fat fast foods
- Increasingly sedentary lives
While reversing the trend of obesity “likely will be difficult” the researchers conclude, they do offer suggestions. “Interventions may focus on parental behaviors because parents determine the diet and physicial acitivity practices of their children,” they write. “School-based programs also may help change diet and reduce sedentary behaviors.
2. Variyam N. J. (2005). The Price is Right: Economics and the Rise in Obesity. AmberWaves. 2005.
In 2003, U.S. Surgeon General Richard Carmona said in testimony before the House of Representatives: “I welcome this chance to talk with you about a health crisis affecting every State, every city, every community, and every school across our great Nation. The crisis is obesity. It’s the fastest growing cause of death in America.”
One thing is clear: The obesity problem didn’t occur overnight. In fact, it has been emerging for decades but only recently has it reached crisis proportions and grabbed national headlines. While Americans at the turn of the 20th century may have aspired to be plump, by now most people are aware of the health problems associated with excess weight. Diet books top the bestseller list, the electronic and print media overwhelm us with nutrition do’s and don’ts, but progress is slow or even nonexistent. The reality is that we eat too much and move too little.
Americans are indeed among the heaviest people on earth. Not only are we getting fatter, but we’re doing it at a younger age. How we got to this point is a complex story with genetic, physiologic, psychologic, sociologic, and economic subplots. Here, we look at the economic plot line. But be forewarned. Economics does not provide all the answers. Even so, examining the past under an economist’s lens may help us unearth and evaluate potential solutions.
Food prices, whether at the store or at a restaurant, have been declining relative to prices of all other items. Between 1952 and 2003, the ratio of food prices to the price of all other goods has fallen by 12 percent. But the drop is more dramatic if we factor in “quality” improvements—the reduced time cost of acquiring and preparing food (convenience), greater variety, and omnipresent restaurants and vending machines. Foods that once were available only seasonally are now available year-round. Advances in food processing and packaging have introduced a multitude of ready-to-eat foods, available virtually anywhere and at any time.
Harvard University’s David Cutler, Edward Glaser, and Jesse Shapiro have suggested that the increase in food consumption prompted by the falling time cost of food is the major cause behind the surge in obesity since 1980. They note: “Technological innovations—including vacuum packing, improved preservatives, deep freezing, artificial flavors, and microwaves—have enabled food manufacturers to cook food centrally and ship it to consumers for rapid consumption. In 1965, a married woman who didn’t work spent over two hours per day cooking and cleaning up from meals. In 1995, the same tasks took less than half the time.”
As health economists Darius Lakdawalla and Tomas Philipson have noted, in earlier agricultural and industrial times, the opportunity cost of physical activity was virtually zero. Energy expenditure came with one’s work, which was strenuous—essentially, people were paid to exercise. With increased mechanization and the shift of jobs into service industries, the opportunity cost of physical activity began to rise. In today’s post-industrial society, physical labor is rarer and people must pay to—and budget time for—exercise.
Although job-related changes in physical activity may partly explain the longrun trend in weight gain, they cannot account for the post-1980 surge in obesity, especially since this uptrend has affected children as well. One trend that has sapped physical activity from all age groups in the last few decades is technological advances in the entertainment and electronics sectors. The supply and variety of passive entertainment options—from cable TV to video games, DVDs, and the Internet—has exploded. Since time is finite, this creates an incentive to forgo physical activity for more plentiful passive entertainment. The net effect of technological advances in the work place, at home, in transportation, and in leisure-time choices is a reduction in daily energy expenditure, leaving individuals with a stark choice: whether or not to fill the gap through voluntary physical activity.
At subsistence income levels, people spend most of their income on food and choice is determined mainly by price and availability. As incomes grow, preferences exert a greater role—people buy less coarse grains, cereals, and potatoes, for example, and buy more meats and prepared foods. Demand rises for foods that supply additional quality attributes beyond basic nutrients, such as tastiness, convenience, and ease of preparation.
Nowhere is this effect of rising incomes more visible than Americans’ habit of dining out. As income increases, people tend to spend a greater share of additional income on dining out than on foods prepared at home. ERS studies show a 10-percent increase in income leads to a 4.6-percent increase in a household’s away-from-home food expenditures compared with a 1.3-percent increase in at-home food expenditures. With the foodservice industry offering more choices—from fast food to a growing array of ethnic restaurants—the share of total food expenditure that Americans spend on dining out has risen from 28 percent in 1962 to 47 percent in 2003.
Other ERS research shows that, ounce for ounce, foods eaten away from home are more calorie-dense than foods prepared at home, and thus could be a factor in the obesity surge. Health economists Shin-Yi Chou, Michael Grossman, and Henry Saffer have linked higher restaurant density with greater obesity rates over time and across geographical areas. But the growing demand for dining out suggests that our preference for convenience, time savings, and variety is outweighing concerns about obesity.
3.Variyam N. J. (2004). Technological Changes Contribute to Rise in Obesity. AmberWaves. 2004.
By any measure, more Americans are heavier today than ever before. Nearly 2 out of 3 adults now meet or exceed the clinical definition of overweight, and 3 out of 10 children are overweight or at risk for overweight. Especially alarming to public health experts is the rapid weight gain witnessed since the mid-1970s. Since then, obesity has doubled among adults and tripled among adolescent boys and girls.
Technological progress has also altered incentives for the type and amount of food people eat. A more efficient agricultural system has cut food prices, especially of calorie-dense foods. Advances in food processing and packaging have introduced a multitude of ready-to-eat foods, available virtually anywhere and at any time. This has reduced the time “cost” of food preparation and consumption. People have responded to these incentives by increasing the quantity and variety of foods they consume.
At the same time, technology-driven progress in medical and epidemiological research warns us of the serious health consequences of obesity. These warnings should act as a disincentive against choices that lead to excess body weight, but apparently have not. By studying how people evaluate long-term health consequences when making short-term food and activity choices, economists hope to better understand the causes behind the increase in obesity.
4. Weck, E (1986). The Dangerous Burden of Obesity. FDA Consumer. Volume: 20. 1986. Page Number: 16+. 1986. U.S. Government Printing Office;
Concern over the health effects of obesity goes back virtually to the beginning of medical science. In the fourth century B.C., Hippocrates observed, “Sudden death is more common in those who are naturally fat than in the lean.’
But it is obesity’s effects on the major body systems that produce the greatest health risks for the seriously overweight. Among the effects:
Diabetes:
Studies corroborate a direct relationship between adult-onset diabetes and obesity. As weight increases, an increasing percentage of prople become diabetic. The tendency is greatest in older people. In one study, for example, in the 50-to-59-year age group, about 2 percent of normal-weight individuals had diabetes. The incidence rose to 4 percent for those who were 50 percent overweight and 8 percent for those in the 100 percent overweight group.
Cardiovascular disease: In the obese, it takes more energy to breathe because of the weight of fat on the chest. The heart is obliged to work harder to pump blood to the lungs and to the excess fat tissue throughout the body. Medical investigators have found that being overweight affects the size of the heart. In a study at the Mayo Clinic, investigators found that normal hearts weighed an average of about 9 1/2 ounces, while the hearts of the obese weighed almost 13 ounces. And when obesity was combined with high blood pressure, the weight rose to more than 16 ounces. The enlargement process is called left ventricle hypertrophy. The condition can result in high blood pressure and life-treatening erratic heartbeats.
Obese people also tend to have high blood cholesterol levels, making them more prone to atherosclerosis–a narrowing of the arteries caused by deposits of a material called plaque. Atherosclerosis becomes life-threatening when blood vessels are so narrowed or blocked that vital organs such as the heart, brain or kidney are deprived of blood.
As the blood vessels narrow in the obese, the heart is forced to pump harder, and blood pressure rises. High blood presure carries a multitude of risks, including stroke, kidney failure, and heart attack. Overweight persons are twice as likely to develop high blood pressure as those of normal weight. Whether obesity is a direct cause of high blood pressure is still being debated by medical investigators. Nevertheless, statistically, about one-quarter of all heart and blood vessel problems are associated with obesity.
Sterility: In women, fat tissue is involved in the production of the female sex hormone estrogen. Apparently, an excess of fat leads to the production of too much estrogen and too little of another sex hormone, progesterone. The imbalance between these two vital sex hormones tends to disrupt the normal menstrual cycle, preventing the release of an egg from the ovaries. The result is female sterility.
Obesity appears to have little effect on sexual function in men. But in extreme cases it’s conceivable that male sterility could be caused by obesity. If rolls of fat around the groin are so massive they envelop the scrotum, they may raise the temperature of the testes enough to render semen infertile.
Pregnancy problems: Obese women tend to have more difficulties in pregnancy. The diabetes and high blood pressure associated with obesity pose risks for both mother and child. Overweight pregnant women are also more apt to be afflicted with gallstones, blood clots, and a condition known as toxemia of pregnancy, characterized by excessive vomiting and convulsions. Also, with their skeletal systems already taxed by excess weight, the added weight of pregnancy is apt to produce aches in the back, legs and joints. Difficulties during childbirth also are more common in obese women than in women of normal weight.
Cancer: Estrogen stimulates cell growth, so its overproduction in obese women is linked to a higher rate of cancer of the breast and uterus. Recent animal studies suggest that in obese postmenopausal women, body fat may play a role in the production of additional estrogen and, thus, in increasing the risk of cancer. By itself, body fat is thought to be a storehouse for carcinogenic chemicals in both women and men.
Animal studies have found a relationship between the intake of calories and fats and the incidence of cancer. After reviewing the medical literature, Dr. Artemis Simopolous, former chairman of the NIH Nutrition Coordinating Committee, observed that persons 40 percent or more above average weight suffer from a higher death rate from cancer. In men, the threat stems principally from cancer of the colon and rectum. In women, the excess deaths are caused by cancer of the gallbladder, breast, cervix, endometrium, uterus and ovaries.
In the morbidly obese, the airways also can become obstructed during sleep, resulting in poor rest at night and drowsiness during the day. Obese patients may awaken startled and find themselves chocking or gasping.
Other problems: Obesity can contribute to other health or life-threatening conditions, including scarring of the liver (cirrhosis), premature aging of the immune system, gallstones, kidney stones, blood clots, and varicose veins. Obese people also seem to be more accident prone, due to physical clumsiness. And they appear to be at greater risk of death during surgery.
There is convincing evidence that a long list of health problems is associated with obesity. Medical specialists are careful to stress that they have yet to establish a clear-cut cause-and-effect relationship for some. However, for diseases such as diabetes, cancer, heart disease, and high blood pressure, studies show that the obese can lower their risks to the levels associated with normal-weight people by ridding themselves of excess fat.
5. Donnelly, Kathleen (2007). Obesity in America. Web.
Each year, the U.S. Centers for Disease Control and Prevention updates its series of maps that show how the rate of obesity is expanding. States where, as recently as 1990, 10 percent or fewer adult residents were obese now report levels double that. In the latest edition of the maps, three states estimate that a third of all adults are obese.
Add those merely overweight (defined as having a body mass indexof between 25 and 29.9) to those officially obese (BMI of 30 or higher), and the number of adults who weigh more than they should reaches six in 10. It’s a once shocking statistic that now seems numbingly familiar to anyone who has visited a food court lately. What’s harder to understand is why as a country we can’t hold the line on obesity.
Adam Drewnowski, director of the nutritional sciences program and professor of epidemiology and medicine at the University of Washington, studies the relationship between poverty and obesity. His research suggests that “energy-dense foods,” those that are high in calories but not necessarily high in nutrients, tend to be less expensive than more nutritious choices.
“Refined grains, added fats, added sugar,” he says. “The problem is that diets full of these are inexpensive, while diets with whole grains, fresh vegetables and fresh fruits are not as affordable. They’re even slipping out of grasp for middle-class people.”
If you lay a map showing rates of obesity over a map illustrating rates of poverty, Drewnowski says, it’s likely you’ll find a high degree of correlation. For example, rates of obesity estimated by the CDC in 2005 are highest in the Southern states. The U.S. Census estimates that for the same year, the South had the highest level of poverty of all U.S. regions. Drewnowski contends that’s not a coincidence, and says that closer study of obesity and poverty rates by ZIP code show a correlation in areas across the U.S.
“We’re showing that the rates of obesity by state are very well predicted by the poverty level in that state,” he says. “So as far as we’re concerned, poverty is probably a better predictor of obesity and diabetes than race or education.”
No longer a purely personal issue
The burgeoning percentage of heavy Americans has broader economic consequences as well. Researchers at the CDC and RTI International, a nonprofit think tank, estimated that 2003 health care costs attributable to obesity reached $75 billion, with taxpayers picking up about half of the bill through programs such as Medicare and Medicaid.
6. Emma Jane Kirby (2002). Obesity rise prompts health warning. 2002. Web.
The World Heart Federation is warning that obesity will overtake tobacco smoking as the biggest cause of heart disease unless the current trend of unhealthy lifestyles stops.
At least a billion people across the globe are now extremely overweight, putting a massive strain on worldwide healthcare systems.
Obesity – which can cause heart disease, strokes and diabetes – is on the increase across the globe.
According to the World Heart Federation, an estimated 22 million children under the age of five are now severely overweight.
Nearly one in three children in the United States between the ages of five and 14 are obese, compared to one in six 30 years ago.
The World Heart Foundation says diet and lifestyles need to change
But obesity is not a condition which solely affects the western world.
Increasingly, low and middle income countries are suffering from the condition, often due to a change in their diets, as they substitute fibre intake for a much higher consumption of saturated fats and sugar.
In Beijing, for example, one in five children of school age are now obese.
The World Heart Federation says obesity can also be blamed for spiralling health costs.
The US spends almost a tenth of its national healthcare budget on overweight patients, and in western countries as much as 2.8% of total sick care costs can be attributed to obesity.
7. Pool, Robert (2001). Fat: Fighting the Obesity Epidemic. Oxford University Press. New York. Publication Year: 2001.
Is there, then, a role for drugs in weight loss? Jules Hirsch, the Rockefeller researcher who pioneered the study of the fat cell and who collaborated with Rudy Leibel in his seminal study of the effects of weight loss and gain on metabolism, believes there is, but not for the current generation of drugs. None of today’s drugs, he notes, treats the root cause of obesity, which is a body with a set point that is too high. Instead, the drugs attempt to keep the body artificially below that set point by affecting appetite, metabolism, or the absorption of food in the intestines. The body maintains its set point through a variety of interrelated systems, and when a drug affects one of these systems—appetite, say—the body will compensate in another area, for instance, by slowing down the metabolism. To get around this, the drug treatment must push exceptionally hard on one system or moderately hard on several systems, and either of these approaches makes it likely that the drugs will have unwanted side effects. Using drugs to modify the behavior of systems that are functioning perfectly is asking for trouble, Hirsch concludes.
The better approach, he says, is to learn how obesity develops, to understand how a person’s genetic makeup interacts with the environment to determine the set point, and then to develop treatments and preventive strategies based on that understanding. Such treatments would be more effective and less likely to be harmful in unforeseen ways. This is no help for someone who wants to lose weight right now, but it could prevent a repeat of the Redux/fen-phen fiasco.
8. Sobal, Jeffery and Maurer, Donna (1999). Weighty Issues: Fatness and Thinness as Social Problems. Aldine De Gruyter. New York. 1999.
A related perspective is to view the limited success in long-term weight loss maintenance as a situation to be expected when the data on which to base interventions are inadequate. Some dietitians and other health professionals have dealt with the weight dilemma by noting that there is much that is not understood about obesity. They call for new interventions and urge expansion of research efforts. While more understanding of obesity would be helpful, dietitians still face the issue of what to do with their current patients. The response seems to be to continue doing what they have always done and hope that they are not making matters worse.
Several years ago there was a movement to develop a system of characterizing obesity that would provide guidance in matching patients to a treatment modality that best suited their needs. The goal was ambitious, involving a number of factors. Unfortunately, this goal was not fulfilled. Current systems often assign patients to treatments solely on the basis of the extent of their obesity and the presence of co-morbid conditions that increase risk ( Bray 1992, NIH 1998). The manual published by the Shape Up America! campaign and the American Obesity Association ( 1996) continues giving primary attention to the extent of obesity and health risks, but expands the factors used to select treatment to include patient interest, risk-benefit ratio, and treatment history.
A weight dilemma can be denied by observing that even if patients do not lose or regain what they have lost, they still may have benefited from the program ( Kolasa 1996). These benefits might include increased nutrition knowledge, acquisition of exercise skills, making new friends, or the support of caring health professionals. Yet, as Satter ( 1997) pointed out, it is difficult for someone to feel successful about an effort when they have failed at the main goal.
Dietitians have discussed the ethics of encouraging participation in a weight loss program by predicting significant losses. Some assert that to promise to all what only a few will achieve is quackery. Others counter that such predictions are essential marketing strategies and that participants who fail to achieve the promised losses have only their own limited motivation to blame. Still others note that the apparent immediate failure of an intervention does not mean that the learning may not be applied in
9. Caprio, Sonia (2006). Treating Child Obesity and Associated Medical Conditions. The Future of Children. Volume: 16. Issue: 1. Publication Year: 2006.
With American children on course to grow into the most obese generation of adults in history, Sonia Caprio argues that it is critical to develop more effective strategies for preventing childhood obesity and treating serious obesity-related health complications. She notes that although pediatricians are concerned about the obesity problem, most are ineffective in addressing it.
Treatment should begin, Caprio explains, with a thorough medical exam, an assessment of nutrition and physical activity, an appraisal of the degree of obesity and associated health complications, a family history, and full information about current medications. Caprio also summarizes the current use of medications and surgery in treating child obesity and argues that for severe forms of obesity, the future lies in developing new and more effective drugs.
Caprio explains that today’s most effective obesity treatment programs have been carried out in academic centers through an approach that combines a dietary component, behavioral modification, physical activity, and parental involvement. Such programs, however, have yet to be translated to primary pediatric care centers. Successfully treating obesity, she argues, will require a major shift in pediatric care that builds on the findings of these academic centers regarding structured intervention programs.
To ensure that pediatricians are well trained in implementing such programs, the American Medical Association is working with federal agencies, medical specialty societies, and public health organizations to teach doctors how to prevent and manage obesity in both children and adults. Such training should be a part of undergraduate and graduate medical education and of continuing medical education programs.
Caprio also addresses the problem of reimbursement for obesity treatment. Despite the health risks of obesity, patients get little support from health insurers, thus putting long-term weight-management programs beyond the reach of most. Caprio argues that obesity should be recognized as a disease and receive coverage for its treatment just as other diseases do.
Although pediatricians are concerned about the problem of obesity, most feel unprepared, ill equipped, and ineffective in addressing it. Many studies, as well as a survey of pediatricians, dietitians, and pediatric nurse practitioners, confirm that pediatricians do indeed face many challenges in treating childhood obesity. (3) Most pediatric primary care providers are not trained to provide the extensive counseling on nutrition, exercise, and lifestyle changes that is required to treat obesity, and most are pessimistic that treatment can be successful. Most also have insufficient time and attention to dedicate to the obese child, a problem compounded by the lack of reimbursement by third-party payers. Pediatricians also lack support services, especially access to mental health professionals, nutritionists, or exercise physiologists. And they are frustrated by insufficient patient motivation and a lack of parental concern. (4) In a study of obese African American children, many parents neither perceived their children as very overweight nor felt that weight was a health problem for their child. (5) Although comparable data are not available for white children, this study suggests that many African American parents do not perceive obesity as a pediatric health concern.
The child’s activity level should also be assessed. Studies that use motion sensors show that children who spend less time in moderate activity are at a higher risk than their more active counterparts of becoming obese during childhood and adolescence. (12) Television watching and video games contribute to more sedentary leisure activities as well as to increased snacking and inappropriate food choices prompted by television advertising. Many hours of television viewing are positively correlated with overweight, especially in older children and adolescents. (13)
The Future of Pediatric Obesity
The key to successfully treating childhood obesity ultimately lies in developing and funding a targeted research agenda. At the top of that agenda should be basic research into the biology and physiology of regulating appetite during the various developmental stages of childhood. Research should also focus on the mechanisms that regulate body fat distribution during adolescence as well as gender and ethnicity differences in body composition and fat distribution. Other key research areas include the differing susceptibility to weight gain during childhood and adolescence; the underlying changes in physical activity at puberty; more clinical studies on the efficacy of specific prevention and treatment programs; and the effort to move from efficacy to broad effectiveness.
Until recently, childhood obesity has been considered a clinical problem for specialist pediatricians. Now, however, the problem must be approached in a more global manner. The public health community must consider the urgent need to institute preventive programs. Given the reluctance of policymakers to institute changes, particularly those that are unpopular or expensive, it is important to establish objective evidence of the beneficial impact of any preventive or treatment programs. To stop the epidemic of childhood obesity, acting on all levels–medical, social, political, and educational–is fundamental. A broad range of action would include conducting nutrition education campaigns, regulating the marketing of junk food to children, eliminating energy-dense foods and sodas from schools, and promoting physical activity.
In an outstanding 2003 editorial in the Archives of Pediatric and Adolescent Medicine, Leona Cuttler, June Whittaker, and Eric Kodish suggested forming a national pediatric obesity panel under the aegis of the National Institutes of Health, the Centers for Disease Control and Prevention, or the Institute of Medicine. (55) Including representatives of major stakeholders, the panel would shape policy, analyze the best practices through rigorous evaluation, disseminate information accrued, revise policy at regular intervals as new information is gained, and become a central trusted voice. Under such a panel’s leadership, the United States could transform its approach to treating childhood obesity and ultimately stem the epidemic that threatens so many of the nation’s children.
10. Daniels, R. Stephen (2006). The Consequences of Childhood Overweight and Obesity. The Future of Children. Volume: 16. Issue: 1. Publication Year: 2006. Page Number: 47+. Princeton University-Woodrow Wilson School of Public and International Affairs.
Researchers are only gradually becoming aware of the gravity of the risk that overweight and obesity pose for children’s health. In this article Stephen Daniels documents the heavy toll that the obesity epidemic is taking on the health of the nation’s children. He discusses both the immediate risks associated with childhood obesity and the longer-term risk that obese children and adolescents will become obese adults and suffer other health problems as a result.
Daniels notes that the possibility has even been raised that the increasing prevalence and severity of childhood obesity may reverse the modern era’s steady increase in life expectancy, with today’s youth on average living less healthy and ultimately shorter lives than their parents–the first such reversal in lifespan in modern history. Such a possibility, he concludes, makes obesity in children an issue of utmost public health concern.
Health professionals have long known that being overweight carries many serious health risks for adults. Medical researchers have also investigated how obesity affects the health of children and adolescents, but work in this area has advanced more slowly. The epidemic of overweight and obesity in children and adolescents, however, has intensified the pace of research. In the face of this new epidemic, researchers are raising the question of whether children face the same set of health risks as adults–or whether their risks are unique. The answer, to a certain extent, is both. Many health conditions once thought applicable only to adults are now being seen in children and with increasing frequency. Even if the conditions do not appear as symptoms until adulthood, they may appear earlier than usual in a person’s lifetime if the person had weight problems in childhood. Further, children are also more vulnerable to a unique set of obesity-related health problems because their bodies are growing and developing.
As the prevalence and severity of childhood obesity increase, concern about adverse health outcomes in childhood and adolescence is rising. Table 1 shows the prevalence in children and adolescents of various health problems associated with obesity. In what follows, I will provide details on how obesity affects various important body systems. Obesity can cause great damage to the cardiovascular system, for example, and being overweight or obese during childhood can accelerate the development of obesity-related cardiovascular disease. Likewise, obesity is linked with many disorders of the metabolic system. Such disorders, heretofore seen primarily in adulthood, are now appearing in children. Even when the disorders do not present themselves in childhood, childhood obesity or overweight increases the risk of their developing in adulthood. Much the same generalization applies to the obesity-related disorders in the other bodily systems.