Obesity in the United States

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Obesity in the United States is a major health issue, resulting in numerous diseases, specifically increased risk of certain types of cancer, coronary artery disease, type 2 diabetes, stroke, as well as significant increases in early mortality and economic costs.

Cancer group of diseases

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans.

Coronary artery disease artery disease characterized by plaque building up along the inner walls of the arteries of the heart resulting in a narrowing of the arteries and a reduced blood supply to the cardiac muscles

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), involves the reduction of blood flow to the heart muscle due to build-up of plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

Type 2 diabetes Type of diabetes mellitus with high blood sugar and insulin resistance

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

Contents

An obese person in the United States incurs an average of $1,429 more in medical expenses annually. Approximately $147 billion is spent in added medical expenses per year within the United States. This number is expected to increase approximately $1.24 billion per year until the year 2030. [1]

From 23% obesity in 1962, estimates have steadily increased. 2014 figures from the CDC found that more than one-third (36.5%) of U.S. adults age 20 and older [2] and 17% of children and adolescents aged 2–19 years were obese. [3] A second study from the National Center for Health Statistics at the CDC showed that 39.6% of US adults age 20 and older were obese as of 2015-2016 (37.9% for men and 41.1% for women). [4]

Obesity in an adult is defined as a BMI of 30 and above. Overweight in an adult is defined as a BMI of greater than 25 and less than 30, (so 25.01-29.9999). For children, obesity is defined as BMI 95th percentile or greater for gender/age on a growth chart and overweight is defined as BMI 85th percentile to 94.999th%. [5]

Overweight or obese: For the following statistics, adults is defined as age 20 and over. The overweight + obese percentages for the overall US population are higher reaching 39.4% in 1997, 44.5% in 2004, [6] 56.6% in 2007, [7] 63.8% (adults) and 17% (children) in 2008,; [8] [9] in 2010 65.7% of American adults and 17% of American children are overweight or obese, and 63% of teenage girls become overweight by age 11. [10] In 2013 the Organisation for Economic Co-operation and Development (OECD) found that 57.6% of American citizens were overweight or obese. The organization estimates that 3/4 of the American population will likely be overweight or obese by 2020. [11] A forecast based on early long-term trends suggests that more than 85% of adults will be overweight or obese in the U.S. by 2030. [12]

Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year [13] and has increased health care use and expenditures, [14] [15] [16] [17] costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs. [18] This exceeds health care costs associated with smoking [17] and accounts for 6% to 12% of national health care expenditures in the United States. [19]

Health care prices in the United States describes market and non-market factors that determine pricing, along with possible causes as to why prices are higher than other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during 2015 health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion or 17.8% GDP. Proximate reasons for the differences with other countries include: higher prices for the same services and greater use of healthcare. Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While the annual inflation rate in healthcare costs has declined in recent decades; it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015.

Smoking Practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gasses and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment.

Prevalence

The National Center for Health Statistics estimates that, for 2015-2016 in the U.S., 39.8% of adults aged 20 and over were obese (including 7.6% with severe obesity) and that another 31.8% were overweight. [20]

Obesity rates have increased for all population groups in the United States over the last several decades. [13] Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased by a factor of five, from one in two thousand to one in four hundred. [21]

There have been similar increases seen in children and adolescents, with the prevalence of overweight in pediatric age groups nearly tripling over the same period. Approximately nine million children over six years of age are considered obese. Several recent studies have shown that the rise in obesity in the US is slowing, possibly explained by saturation of health-oriented media. [21]

Race

Rates of obesity in US by race. ObesitySexRace.jpg
Rates of obesity in US by race.

Obesity is distributed unevenly across racial groups in the United States. [22] Some of these races tend to populate low socioeconomic status neighborhoods and therefore can lack the resources such as safe play areas, as well as grocery stores with affordable fruits and vegetables. furthermore, minority households can be more prone to obesity because of cultural food preferences and family norms. [23]

Caucasian

The obesity rate for Caucasian adults 18 years and older (over 30 BMI) in the US in 2015 was 29.7%. [24] For adult Caucasian men, the rate of obesity was 31.1% in 2015. [25] For adult Caucasian women, the rate of obesity was 27.5% in 2015. [25] The most recent statistics from the NHANES of age adjusted obesity rates for Caucasian adults 20 years and older in the U.S. in 2016 was 37.9%. [26] The obesity rates of Caucasian males and Caucasian females from the NHANES 2016 data were relatively equivalent, obesity rates were 37.9% and 38.0%, respectively. [27] This large jump in obesity rate could possibly be attributed to the fact when teenagers of 18 and 19 years old are classified as adults instead of adolescents, their much lower rates of obesity skew and bring down the adult average.

Black or African American

The obesity rate for Black adults 18 years and older (over 30 BMI) in the US in 2015 was 39.8%. [24] For adult Black men, the rate of obesity was 34.4% in 2015. [25] For adult Black women, the rate of obesity was 44.7% in 2015. [25] The most recent statistics from the NHANES of age adjusted obesity rates for Black adults 20 years and older in the U.S. in 2016 was 46.8%. [26] According to the obesity rates of from the NHANES 2016 data, Black males had significantly lower than Black females, their rates were 36.9% and 54.8%, respectively. [27] BMI is not a good indicator in determining all-cause and coronary heart disease mortality in black women compared to white women. [28] This is perhaps caused by the fact that black females tend to have less body fat, especially visceral fat, for a given BMI or waist measurement than both White and Latina women. [29]

American Indian or Alaska Native

The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2015 was 42.9%. [24] No breakdown by sex was given for American Indian or Alaska Native adults in the CDC figures. [24]

Asian

The obesity rate for Asian adults 18 years and older (over 30 BMI) in the US in 2015 was 10.7%. [24] No breakdown by sex was given for Asian adults in the CDC figures. [24] In more recent statistics from the NHANES in 2016 of a breakdown by sex was provided. Asian adults 20 years and older had a total obesity rate of 12.7%. The rate among Asian males was 10.1% and among Asian females it was 14.8%. Asian Americans have substantially lower rates of obesity than any other racial or ethnic group. Notably, however, there is discussion that Asians should have a lower BMI cut-off for obesity than other races/ethnicities since they have higher health risks at a lower BMI. [26] [27]

Hispanic or Latino

The obesity rate for the Hispanic or Latino adults 18 years and older category (over 30 BMI) in the US in 2015 was 31.8%. [24] For the overall Hispanic or Latino men category, the rate of obesity was 31.6% in 2015. [25] For the overall Hispanic or Latino women category, the rate of obesity was 31.9% in 2015. [25] According to the most recent statistics from the NHANES in 2016 Latino adults had the highest overall obesity rates. Latino Adults age 20 and older had reached an obesity rate of 47.0%. [26] Adult Latino men's rate was 43.1%, the highest of all males. For adult Latina women the rate was 50.6%, making them second to African-American women. [27]

Mexican or Mexican Americans

Within the Hispanic or Latino category, obesity statistics for Mexican or Mexican Americans were provided, with no breakdown by sex. [24] The obesity rate for Mexican or Mexican Americans adults (over 30 BMI) in the US in 2015 was 35.2%. [24]

Native Hawaiian or Other Pacific Islander

The obesity rate for Native Hawaiian or Other Pacific Islander adults (over 30 BMI) in the US in 2015 was 33.4%. [24] No breakdown by sex was given for Native Hawaiian or Other Pacific Islander adults in the CDC figures. [24]

Sex

Over 70 million adults in U.S. are obese (35 million men and 35 million women). 99 million are overweight (45 million women and 54 million men). [30] NHANES 2016 statistics showed that about 39.6% of American adults were obese. Men had an age-adjusted rate of 37.9% and Women had an age-adjusted rate of 41.1%. [26]

The CDC provided a data update May 2017 stating for adults 20 years and older, the crude obesity rate was 39.8% and the age adjusted rate was measured to be 39.7%. Including the obese, 71.6% of all American adults age 20 and above were overweight. [31] [32]

Age

Historically, obesity primarily affected adults. From the mid-1980s to 2003, obesity roughly doubled among U.S. children ages 2 to 5 and roughly tripled among young people over the age of 6, but statistics show that obesity in 2-6 year olds has dropped, from 14.6% to 8.2%. [33] In recent years from 2015-2016, U.S. adults was 39.8% (crude). Overall, the prevalence among adults aged 40–59 (42.8%) was higher than among adults aged 20–39 (35.7%). No significant difference in prevalence was seen between adults aged 60 and over (41.0%) and younger age groups. [34]

Newborns

Mothers who are obese and become pregnant have a higher risk of complications during pregnancy and during birth, and their newborns are at greater risk for preterm birth, birth defects, and perinatal death. There are more possible risks to children born to obese mothers than pregnant women who are not obese. Newborns are also at risk for neurodevelopmental issues. Obese women are in the position to possibly put their child at risk for compromised neurodevelopmental outcomes. It is not known the whole effect that obesity can have on the neurodevelopmental of the child. Reports concluded that "children born to mothers with gestational diabetes, which is linked with maternal obesity, are at a higher risk for lower cognitive test scores and behavioral problems." [35] Obese women are less likely to breastfeed their newborns, and those who start doing so are likely to stop sooner. [36] Children who were breastfed every extra week by age 2 had a lower chance of being obese if the hospitals were informative about breastfeeding with mothers or if mothers chose to breastfeed that played a role in the child's weight. [37] [ non-primary source needed ]

Children and teens

The rise of overweight among ages 6-19 in the US. PrevalenceOverweightAge6-19.GIF
The rise of overweight among ages 6-19 in the US.

From 1980 to 2008, the prevalence of obesity in children aged 6 to 11 years tripled from 6.5% to 19.6%. The prevalence of obesity in teenagers more than tripled from 5% to 18.1% in the same time frame. [38] In less than one generation, the average weight of a child has risen by 5 kg in the United States. [1] In 2014 it was reported 17.2% of youth aged 2–19 were considered obese and another 16.2% were overweight. [39] Meaning, over one-third of children and teens in the US were overweight or obese. Statistics from a 2016-2017 page on the CDC's official website that 13.9% of toddlers and children age 2-5, 18.4% of children 6-11, and 20.6% of adolescents 12-19 are obese. [32] The prevalence of child obesity in today's society concerns health professionals because a number of these children develop health issues that weren't usually seen until adulthood. [40]

Some of the consequences in childhood and adolescent obesity are psychosocial. Overweight children and overweight adolescents are targeted for social discrimination, and thus, they begin to stress-eat. [41] The psychological stress that a child or adolescent can endure from social stigma can cause low self-esteem which can hinder a child's after school social and athletic capability, especially in plump teenage girls, and could continue into adulthood. [42] Teenage females are often overweight or obese by age 12, as, after puberty, teenage girls gain about 15 pounds, specifically in the arms, legs, and chest/midsection.[ citation needed ]

Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 19.6%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%. [43]

In 2000, approximately 39% of children (ages 6–11) and 17% of adolescents (ages 12–19) were overweight and an additional 15% of children and adolescents were at risk of becoming overweight, based on their BMI. [44]

Analyses of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999–2000, 2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall, in 2003–2006, 11.3% of children and adolescents aged 2 through 19 years were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile. [45]

Trend analyses indicate no significant trend between 1999–2000 and 2007–2008 except at the highest BMI cut point (BMI for age 97th percentile) among all 6- through 19-year-old boys. In 2007–2008, 9.5% of infants and toddlers were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% were at or above the 95th percentile; and 31.7% were at or above the 85th percentile of BMI for age. [46]

In summary, between 2003 and 2006, 11.3% of children and adolescents were obese and 16.3% were overweight. A slight increase was observed in 2007 and 2008 when the recorded data shows that 11.9% of the children between 6 and 19 years old were obese and 16.9% were overweight. The data recorded in the first survey was obtained by measuring 8,165 children over four years and the second was obtained by measuring 3,281 children.

"More than 80 percent of affected children become overweight adults, often with lifelong health problems." [47] Children are not only highly at risk of diabetes, high cholesterol and high blood pressure but obesity also takes a toll on the child's psychological development. Social problems can arise and have a snowball effect, causing low self-esteem which can later develop into eating disorders.

Adults

There are more obese US adults than those who are just overweight. [48] According to a study in The Journal of the American Medical Association (JAMA), in 2008, the obesity rate among adult Americans was estimated at 32.2% for men and 35.5% for women; these rates were roughly confirmed by the CDC again for 2009–2010. Using different criteria, a Gallup survey found the rate was 26.1% for U.S. adults in 2011, up from 25.5% in 2008. Though the rate for women has held steady over the previous decade, the obesity rate for men continued to increase between 1999 and 2008, according to the JAMA study notes.[ citation needed ] Moreover, "The prevalence of obesity for adults aged 20 to 74 years increased by 7.9 percentage points for men and by 8.9 percentage points for women between 1976–1980 and 1988–1994, and subsequently by 7.1 percentage points for men and by 8.1 percentage points for women between 1988–1994 and 1999–2000." [49] [50] According to the CDC, "obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults." [2]

Elderly

Although obesity is reported in the elderly, the numbers are still significantly lower than the levels seen in the young adult population. It is speculated that socioeconomic factors may play a role in this age group when it comes to developing obesity. [51] Obesity in the elderly increases healthcare costs.[ clarification needed ] Nursing homes are not equipped with the proper equipment needed to maintain a safe environment for the obese residents.[ citation needed ] If a heavy bedridden patient is not turned, the chances of a bed sore increases. If the sore is untreated, the patient will need to be hospitalized and have a wound vac placed. [52]

In the military

An estimated 16% percent of active duty U.S. military personnel were obese in 2004, with the cost of remedial bariatric surgery for the military reaching US$15 million in 2002. Obesity is currently the largest single cause for the discharge of uniformed personnel. [53] A financial analysis published in 2007 further showed that the treatment of diseases and disorders associated with obesity costs the military $1.1 billion annually. Moreover, the analysis found that the increased absenteeism of obese or overweight personnel amounted to a further 658,000 work days lost per year. This lost productivity is higher than the productivity loss in the military due to high alcohol consumption which was found to be 548,000 work days. Problems associated with obesity further manifested itself in early discharge due to inability to meet weight standards. Approximately 1200 military enlistees were discharged due to this reason in 2006. [54]

The rise in obesity has led to fewer citizens able to join the military and therefore more difficulty in recruitment for the armed forces. In 2005, 9 million adults aged 17 to 24, or 27%, were too overweight to be considered for service in the military. [55] For comparison, just 6% of military aged men in 1960 would have exceed the current weight standards of the U.S. military. Excess weight is the most common reason for medical disqualification and accounts for the rejection of 23.3% of all recruits to the military. Of those who failed to meet weight qualifications but still entered the military, 80% left the military before completing their first term of enlistment. [56] In light of these developments, organizations such as Mission: Readiness, made up of retired generals and admirals, have advocated for focusing on childhood health education to combat obesity's effect on the military. [57]

Prevalence by state and territory

Adult obesity rates in the U.S. by state (2013)

20.2-24.0%
24.0-25.0%
25.0-26.8%
26.8-28.7%
28.7-30.4%
30.4-32.7%
32.7-34.0%
34.0-35.2% United States Map of Obesity Prevalence by State (2013).svg
Adult obesity rates in the U.S. by state (2013)
  20.2–24.0%
  24.0–25.0%
  25.0–26.8%
  26.8–28.7%
  28.7–30.4%
  30.4–32.7%
  32.7–34.0%
  34.0–35.2%
Obesity rates in the U.S. by state (1985-2010) Obesity state level estimates 1985-2010.gif
Obesity rates in the U.S. by state (1985–2010)

The following figures were averaged from 2005–2007 adult data compiled by the CDC BRFSS program [58] and 2003–2004 child data [A] from the National Survey of Children's Health. [59] [60] There is also data from a more recent 2016 CDC study of the 50 states plus the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. [61]

Care should be taken in interpreting these numbers, because they are based on self-report surveys which asked individuals (or, in case of children and adolescents, their parents) to report their height and weight. Height is commonly overreported and weight underreported, sometimes resulting in significantly lower estimates. One study estimated the difference between actual and self-reported obesity as 7% among males and 13% among females as of 2002, with the tendency to increase. [62]

The long-running REGARDS study, published in the journal of Obesity in 2014, brought in individuals from the nine census regions and measured their height and weight. The data collected disagreed with the data in the CDC's phone survey used to create the following chart. REGARDS found that the West North Central region (North Dakota, South Dakota, Minnesota, Missouri, Nebraska, and Iowa), and East North Central region (Illinois, Ohio, Wisconsin, Michigan, and Indiana) were the worst in obesity numbers, not the East South Central region (Tennessee, Mississippi, Alabama, Kentucky) as had been previously thought. [63] Dr. P.H., professor in the Department of Biostatistics in the UAB School of Public Health George Howard explains that "Asking someone how much they weigh is probably the second worst question behind how much money they make," "From past research, we know that women tend to under-report their weight, and men tend to over-report their height." Howard said as far as equivalency between the self-reported and measured data sets, the East South Central region showed the least misreporting. "This suggests that people from the South come closer to telling the truth than people from other regions, perhaps because there's not the social stigma of being obese in the South as there is in other regions." [64]

The area of the United States with the highest obesity rate is American Samoa (75% obese and 95% overweight). [65]

States, District,
& Territories
Obese adults (mid-2000s)Obese adults (2016) [61] [66] Overweight (incl. obese) adults
(mid-2000s)
Obese children and adolescents
(mid-2000s) [67]
Obesity rank
Flag of Alabama.svg  Alabama 30.1%35.7%65.4%16.7%3
Flag of Alaska.svg  Alaska 27.3%31.4%64.5%11.1%14
Flag of American Samoa.svg  American Samoa 75% [65] 95% [68] 35% [65] [69]
Flag of Arizona.svg  Arizona 23.3%29.0%59.5%12.2%40
Flag of Arkansas.svg  Arkansas 28.1%35.7%64.7%16.4%9
Flag of California.svg  California 23.1%25.0%59.4%13.2%41
Flag of Colorado.svg  Colorado 21.0%22.3%55.0%9.9%51
Flag of Connecticut.svg  Connecticut 20.8%26.0%58.7%12.3%49
Flag of Delaware.svg  Delaware 25.9%30.7%63.9%22.8%22
Flag of Washington, D.C..svg  District of Columbia 22.1%22.6%55.0%14.8%43
Flag of Florida.svg  Florida 23.3%27.4%60.8%14.4%39
Flag of Georgia (U.S. state).svg Georgia 27.5%31.4%63.3%16.4%12
Flag of Guam.svg  Guam 28.3%22% [70]
Flag of Hawaii.svg  Hawaii 20.7%23.8%55.3%13.3%50
Flag of Idaho.svg  Idaho 24.6%27.4%61.4%10.1%31
Flag of Illinois.svg  Illinois 25.3%31.6%61.8%15.8%26
Flag of Indiana.svg  Indiana 27.5%32.5%62.8%15.6%11
Flag of Iowa.svg  Iowa 26.3%32.0%63.4%12.5%19
Flag of Kansas.svg  Kansas 25.8%31.2%62.3%14.0%23
Flag of Kentucky.svg  Kentucky 28.4%34.2%66.8%20.6%7
Flag of Louisiana.svg  Louisiana 29.5%35.5%64.2%17.2%4
Flag of Maine.svg  Maine 23.7%29.9%60.8%12.7%34
Flag of Maryland.svg  Maryland 25.2%29.9%61.5%13.3%28
Flag of Massachusetts.svg  Massachusetts 20.9%23.6%56.8%13.6%48
Flag of Michigan.svg  Michigan 27.7%32.5%63.9%14.5%10
Flag of Minnesota.svg  Minnesota 24.8%27.8%61.9%10.1%30
Flag of Mississippi.svg  Mississippi 34.4%37.3%67.4%17.8%1
Flag of Missouri.svg  Missouri 27.4%31.7%63.3%15.6%13
Flag of Montana.svg  Montana 21.7%25.5%59.6%11.1%45
Flag of Nebraska.svg  Nebraska 26.50%32.00%63.90%11.90%18
Flag of Nevada.svg  Nevada 23.6%25.8%61.8%12.4%36
Flag of New Hampshire.svg  New Hampshire 23.6%26.6%60.8%12.9%35
Flag of New Jersey.svg  New Jersey 22.9%27.4%60.5%13.7%42
Flag of New Mexico.svg  New Mexico 23.3%28.3%60.3%16.8%38
Flag of New York.svg  New York 23.5%25.5%60.0%15.3%37
Flag of North Carolina.svg  North Carolina 27.1%31.8%63.4%19.3%16
Flag of North Dakota.svg  North Dakota 25.9%31.9%64.5%12.1%21
Flag of the Northern Mariana Islands.svg  Northern Mariana Islands 16% [71]
Flag of Ohio.svg  Ohio 26.9%31.5%63.3%14.2%17
Flag of Oklahoma.svg  Oklahoma 28.1%32.8%64.2%15.4%8
Flag of Oregon.svg  Oregon 25.0%28.7%60.8%14.1%29
Flag of Pennsylvania.svg  Pennsylvania 25.7%30.3%61.9%13.3%24
Flag of Puerto Rico.svg  Puerto Rico 30.7%26% [72] [73]
Flag of Rhode Island.svg  Rhode Island 21.4%26.6%60.4%11.9%46
Flag of South Carolina.svg  South Carolina 29.2%32.3%65.1%18.9%5
Flag of South Dakota.svg  South Dakota 26.1%29.6%64.2%12.1%20
Flag of Tennessee.svg  Tennessee 29.0%34.8%65.0%20.0%6
Flag of Texas.svg  Texas 27.2%33.7%64.1%19.1%15
Flag of Utah.svg  Utah 21.8%25.4%56.4%8.5%44
Flag of Vermont.svg  Vermont 21.1%27.1%56.9%11.3%47
Flag of the United States Virgin Islands.svg Virgin Islands (U.S.) 32.5%
Flag of Virginia.svg  Virginia 25.2%29.0%61.6%13.8%27
Flag of Washington.svg  Washington 24.5%28.6%60.7%10.8%32
Flag of West Virginia.svg  West Virginia 30.6%37.7%66.8%20.9%2
Flag of Wisconsin.svg  Wisconsin 25.5%30.7%62.4%13.5%25
Flag of Wyoming.svg  Wyoming 24.0%27.7%61.7%8.7%33

^ Except territories, whose data is from the late 2000s to 2010s

Epidemiology

Obesity is a chronic health problem. It is one of the biggest factors for type II diabetes, and cardiovascular disease. It is also associated with cancer (e.g. colorectal cancer), osteoarthritis, liver disease, sleep apnea, depression and other medical conditions that affect mortality and morbidity. [74]

According to the NHANES data, African American and Mexican American adolescents between 12 and 19 years old are more likely to be overweight than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14% respectively. Also, in a national survey of American Indian children 5–18 years old, 39 percent were found to be overweight or at risk for being overweight. [75] As per national survey data, these trends indicate that by 2030, 86.3% of adults will be overweight or obese and 51.1% obese. [76]

A 2007 study found that receiving Food Stamps long term (24 months) was associated with a 50% increased obesity rate among female adults. [77]

Looking at the long-term consequences, overweight adolescents have a 70 percent chance of becoming overweight or obese adults, which increases to 80 percent if one or more parent is overweight or obese. In 2000, the total cost of obesity for children and adults in the United States was estimated to be US$117 billion (US$61 billion in direct medical costs). Given existing trends, this amount is projected to range from US$860.7-956.9 billion in healthcare costs by 2030. [76]

Food consumption has increased with time. For example, annual per capita consumption of cheese was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in 2000; the average person consumed 389 grams (13.7 oz) of carbohydrates daily in 1970; 490 grams (17 oz) in 2000; 41 pounds (19 kg) of fats and oils in 1909; 79 pounds (36 kg) in 2000. In 1977, 18% of an average person's food was consumed outside the home; in 1996, this had risen to 32%. [78]

Contributing factors

Obesity rates of adult females from 1960-2015. Adult female obesity in the United States.svg
Obesity rates of adult females from 1960-2015.

Numerous studies have attempted to identify contributing factors for obesity in the United States. These studies have resulted in numerous hypotheses as to what those key factors are. A common theme is that of too much food and too little exercise, however. Dieting can be useful in lowering someone's body weight, though which foods should be avoided is very confusing to the public. The public has trouble determining what to eat and what not to eat as well as how much or how little they should. For example, while dieting, people tend to consume more low-fat or fat-free products, even though those items can be just as damaging to the body as the items with fat are. As far as the theoretical contributing factor of too little exercise, one contributing factor is that only a small amount, 20%, of jobs require physical activity. Therefore, most of our time working is spent sitting. [79]

Obesity rates of adult males from 1960-2015. Adult male obesity in the United States.svg
Obesity rates of adult males from 1960-2015.

Other factors not directly related to caloric intake and activity levels that are believed to contribute to obesity include air conditioning, [80] the ability to delay gratification, and the thickness of the prefrontal cortex of the brain. [81] [ better source needed ] [82] Genetics are also believed to be a factor, with a 2018 study stating that the presence of the human gene APOA2 could result in a higher BMI in individuals. [83] Also, the probability of obesity can even start before birth due to things that the mother does such as smoking and gaining a lot of weight. [79]

Total costs to the US

There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability. [84] [14] In particular, diabetes has become the seventh leading cause of death in the United States, [85] with the U.S. Department of Health and Human Services estimating in 2008 that fifty-seven million adults aged twenty and older were pre-diabetic, 23.6 million diabetic, with 90–95% of the latter being type 2-diabetic. [86]

Obesity has also been shown to increase the prevalence of complications during pregnancy and childbirth. Babies born to obese women are almost three times as likely to die within one month of birth and almost twice as likely to be stillborn than babies born to women of normal weight. [87]

Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year [13] (including increased morbidity in car accidents) [88] and has increased health care use and expenditures, [14] [15] [16] [17] costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs. [18] This exceeds health-care costs associated with smoking or problem drinking [17] and, by one estimate, accounts for 6% to 12% of national health care expenditures in the United States [19] (although another estimate states the figure is between 5% and 10%). [89]

The Medicare and Medicaid programs bear about half of this cost. [17] Annual hospital costs for treating obesity-related diseases in children rose threefold, from US$35 million to US$127 million, in the period from 1979 to 1999, [90] and the inpatient and ambulatory healthcare costs increased drastically by US$395 per person per year. [16]

These trends in healthcare costs associated with pediatric obesity and its comorbidities are staggering, urging the Surgeon General to predict that preventable morbidity and mortality associated with obesity may surpass those associated with cigarette smoking. [15] [91] Furthermore, the probability of childhood obesity persisting into adulthood is estimated to increase from approximately twenty percent at four years of age to approximately eighty percent by adolescence, [92] and it is likely that these obesity comorbidities will persist into adulthood. [93]

Effects on life expectancy

The United States' high obesity rate is a major contributor to its relatively low life expectancy relative to other high-income countries. [94] It has been suggested that obesity may lead to a halt in the rise in life expectancy observed in the United States during the 19th and 20th centuries. [95] [96] In the event that obesity continues to grow in newer generations, a decrease in well being and life span in the future generations may continue to degenerate. According to Olshansky, obesity diminishes "the length of life of people who are severely obese by an estimated 5 to 20 years." [95] History shows that the number of years lost will continue to grow because the likelihood of obesity in new generations is higher. Children and teens are now experiencing obesity at younger ages. They are eating less healthy and are becoming less active, possibly resulting in less time lived compared to their parents' . [95] The life expectancy for newer generations can expect to be lower due to obesity and the health risks they can experience at a later age.

Anti-obesity efforts

The National Center for Health Statistics reported in November 2015:

Trends in obesity prevalence show no increase among youth since 2003–2004, but trends do show increases in both adults and youth from 1999–2000 through 2013–2014. No significant differences between 2011–2012 and 2013–2014 were seen in either youth or adults. [97]

Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias. [98] State legislators in California, for example, passed laws banning the sale of machine-dispensed snacks and drinks in elementary schools in 2003, despite objections by the California-Nevada Soft Drink Association. The state followed more recently with legislation to prohibit their soda sales in high schools starting July 1, 2009, with the shortfall in school revenue to be compensated by an increase in funding for school lunch programs. [99] A similar law passed by the Connecticut General Assembly in June 2005 was vetoed by governor Jodi Rell, who stated the legislation "undermines the control and responsibility of parents with school-aged children." [100]

In mid-2006, the American Beverage Association (including Cadbury Schweppes, Coca-Cola, and PepsiCo) agreed to a voluntary ban on the sale of all high-calorie drinks and all beverages in containers larger than 8, 10 and 12 ounces in elementary, middle and high schools, respectively. [101] [102]

Non-profit organizations such as HealthCorps work to educate people on healthy eating and advocate for healthy food choices in an effort to combat obesity. [103]

Former American First Lady Michelle Obama led an initiative to combat childhood obesity entitled "Let's Move". Obama said she aimed to wipe out obesity "in a generation". Let's Move! has partnered with other programs. [104] Walking and bicycling to school helps children increase their physical activity. [74]

In 2008, the state of Pennsylvania enacted a law, the "School Nutrition Policy Initiative," aimed at the elementary level. These "interventions included removing all sodas, sweetened drinks, and unhealthy snack foods from selected schools, 'social marketing' to encourage the consumption of nutritious foods and outreach to parents." [105] The results were a "50 percent drop in incidence of obesity and overweight", as opposed to those individuals who were not part of the study. [105]

In the past decade there have been school-based programs that target the prevention and management of childhood obesity. There is evidence that long term school-based programs have been effective in reducing the prevalence of childhood obesity. [106]

For two years, Duke University psychology and global health professor Gary Bennett and eight colleagues followed 365 obese patients who had already developed hypertension. They found that regular medical feedback, self-monitoring, and a set of personalized goals can help obese patients in a primary care setting lose weight and keep it off. [107]

Major United States manufacturers of processed food, aware of the possible contribution of their products to the obesity epidemic, met together and discussed the problem as early as April 8, 1999; however, a proactive strategy was considered and rejected. As a general rule, optimizing the amount of salt, sugar and fat in a product will improve its palatability, and profitability. Reducing salt, sugar and fat, for the purpose of public health, had the potential to decrease palatability and profitability. [108]

Media influence may play an important role in prevention of obesity as it has the ability to boost many of the main prevention/intervention methods used nowadays including lifestyle modification. The media is also highly influential on children and teenagers as it promotes healthy body image and sets societal goals for lifestyle improvement. Examples of media influence are support for the "Let's Move!" campaign and the MyPlate program initiated by Michelle Obama, and the NFL's Play60 campaign. These campaigns promote physical activity in an effort to reduce obesity especially for children. [109]

In 2011 The Obama Administration introduced a $400 million Healthy Food Financing Initiative, the goal of the program is to "create jobs and economic development, and establish market opportunities for farmers and ranchers," as described by the secretary of agriculture, Tom Vilsack. [110]

Food labeling

Ultimately, federal and local governments in the U.S. are willing to create political solutions that will reduce obesity ratings by "recommending nutrition education, encouraging exercise, and asking the food and beverage industry to promote healthy practices voluntarily." [105] In 2008, New York City was the first city to pass a "labeling bill" that "require[d] restaurants" in several cities and states to "post the caloric content of all regular menu items, in a prominent place and using the same font and format as the price." [105]

Accommodations

[111] Along with obesity came the accommodations made of American products. Child-safety seats in 2006 became modified for the 250,000 obese U.S. children ages six and below. [112] The obese incur extra costs for themselves and airlines when flying. Weight is a major component to the formula that goes into the planes take off and for it to successfully fly to the desired destination. Due to the weight limits taken in consideration for flight in 2000, airlines spent $275 million on 350 million additional gallons of fuel for compensation of additional weight to travel. [112] Accommodations have also been made in work place environments for workers, including those such as chairs with no armrests and access to work outside of the office. [113]

See also

Documentaries:

Related Research Articles

Body mass index Measure of relative weight based on an individuals mass and height

Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m2, resulting from mass in kilograms and height in metres.

Obesity Medical condition in which excess body fat harms health

Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values. Obesity increases the likelihood of various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis, and depression.

Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to so-called "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.

Childhood obesity condition where excess body fat negatively affects a childs health or well-being

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term overweight rather than obese is often used when discussing childhood obesity, especially in open discussion, as it is less stigmatizing.

Overweight having more body fat than is optimally healthy

Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.

Epidemiology of obesity

Obesity has been observed throughout human history. Many early depictions of the human form in art and sculpture appear obese. However, it was not until the 20th century that obesity became common — so much so that, in 1997, the World Health Organization (WHO) formally recognized obesity as a global epidemic. Obesity is defined as having a body mass index (BMI) greater than or equal to 30 kg/m2, and in June 2013 the American Medical Association classified it as a disease, with much controversy.

Obesity in Canada

Obesity in Canada is a growing health concern, which is "expected to surpass smoking as the leading cause of preventable morbidity and mortality … and represents a burden of Can$3.96 (US$3.04/€2.75) billion on the Canadian economy each year."

Obesity in the United Kingdom is a significant contemporary health concern, with authorities stating that it is one of the leading preventable causes of death. In February 2016, former Health Secretary Jeremy Hunt described rising rates of childhood obesity as a "national emergency".

According to 2007 statistics from the World Health Organization (WHO), Australia has the third-highest prevalence of overweight adults in the English-speaking world. Obesity in Australia is an "epidemic" with "increasing frequency." The Medical Journal of Australia found that obesity in Australia more than doubled in the two decades preceding 2003, and the unprecedented rise in obesity has been compared to the same health crisis in America. The rise in obesity has been attributed to poor eating habits in the country closely related to the availability of fast food since the 1970s, sedentary lifestyles and a decrease in the labour workforce.

Classification of obesity

Obesity classification is a ranking of obesity, the medical condition in which excess body fat has accumulated to the extent that it has an adverse effect on health. The World Health Organization (WHO) classifies obesity by body mass index (BMI). BMI is further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. In children, a healthy weight varies with age and sex, and is obesity determination is in relation to a historical normal group.

Obesity in North Africa and the Middle East is a notable health issue. In 2005, the World Health Organization measured that 1.6 billion people were overweight and 400 million were obese. It estimates that by the year 2015, 2.3 billion people will be overweight and 700 million will be obese. The Middle East, including the Arabian Peninsula, Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in obesity. Subsequently, some call this trend the New World Syndrome. The lifestyle changes associated with the discovery of oil and the subsequent increase in wealth is one contributing factor.

The social stigma of obesity or anti-fat bias has caused difficulties and disadvantages for overweight and obese people. Weight stigma is similar and has been broadly defined as bias or discriminatory behaviors targeted at individuals, because of their weight. Such social stigmas can span one's entire life, as long as excess weight is present, starting from a young age and lasting into adulthood. Several studies from across the world indicate overweight and obese individuals experience higher levels of stigma relative to their thinner counterparts. In addition, they marry less often, experience fewer educational and career opportunities, and on average earn a lesser income than normal weight individuals. Although public support regarding disability services, civil rights and anti-workplace discrimination laws for obese individuals have gained support across the years, overweight and obese individuals still experience discrimination, which may have implications to physiological and psychological health. These issues are compounded with the significant negative physiological effects associated with obesity.

Prevalence of childhood obesity has increased dramatically worldwide. In 2010 that the prevalence of childhood obesity during the past two to three decades, much like the United States, has increased in most other industrialized nations, excluding Russia and Poland. Between the early 1970s and late 1990s, prevalence of childhood obesity doubled or tripled in Australia, Brazil, Canada, Chile, Finland, France, Germany, Greece, Japan, the UK, and the USA.

Below are average adult human heights by country or geographical region. The original studies and sources should be consulted for details on methodology and the exact populations measured, surveyed, or considered.

This article provides a global overview of the current trends and distribution of metabolic syndrome. Metabolic syndrome refers to a cluster of related risk factors for cardiovascular disease that includes abdominal obesity, diabetes, hypertension, and elevated cholesterol.

Childhood obesity is defined as a body mass index (BMI) at or above the 96th percentile for children of the same age and sex. It can cause a variety of health problems, including high blood pressure, high cholesterol, heart disease, diabetes, breathing problems, sleeping problems, and joint problems later in life. Children who are obese are at a greater risk for social and psychological problems as well, such as peer victimization, increased levels of aggression, and low self-esteem. Many environmental and social factors have been shown to correlate with childhood obesity, and researchers are attempting to use this knowledge to help prevent and treat the condition. When implemented early, certain forms of behavioral and psychological treatment can help children regain and/or maintain a healthy weight.

Childhood obesity in Australia

Obesity is defined as the excessive accumulation of fat and is predominantly caused when there is an energy imbalance between calorie consumption and calorie expenditure. Childhood obesity is becoming an increasing concern worldwide, and Australia alone recognizes that 1 in 4 children are either overweight or obese.

Obesity in Thailand has been flagged as a major source of health concern, with 32% of the population identifying as overweight and 9% obese. With reference to 2016 data from the World Health Organisation (WHO), Thailand has one of the highest incidence of overweight citizens in the South East Asian region, second to only Malaysia. The Thai National Health Examination Surveys (NHES) found that obesity in Thailand more than doubled during the period 1991-2014. This spike in obesity levels has been largely attributed to increased access to junk food, and unhealthy switches from active to sedentary lifestyles. These factors are closely linked to economic growth in the country.

According to the World Health Organization (2015), the "worldwide population of overweight and obese adults increased between 1980 and 2013 from 30 percent to 38 percent in women, and 29 percent to 37 percent in men". The prevalence of obesity continues to rise in all age groups in this developing country.

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