Splitting at the Seams: The Latest on Obesity

October 2003

You don’t need to skim the latest statistics to notice that obesity is on the rise. Just pound the pavement of the local mall, where a cross section of humanity rushes by, and you’ll quickly agree with researchers: America is waging a battle against the bulge.

According to the Centers for Disease Control and Prevention (CDC), Atlanta, 31% of Americans are obese, with a Body Mass Index (BMI) over 30, and 4.7% are severely obese, with a BMI over 40. The American Obesity Association, Washington, D.C., reports that obesity is the second leading cause of preventable death in the United States, and costs the country upwards of $100 billion in health care annually.

Obesity increases the risk of hypertension, diabetes, heart disease, stroke, gallbladder disease and certain types of cancer. These factors have helped make obesity a high-priority health issue. In the past, the government, health-care and insurance industries swept obesity under the rug, turning a blind eye to an impending epidemic. And still, despite its high profile, obesity receives little health-insurance reimbursement for its treatment, and the National Institutes of Health (NIH), Bethesda, MD, allocates less than 1% of its budget to obesity research.

Sizing things up
Today, Americans see obesity in a new light, thanks to an increase in awareness and information. The U.S. Department of Health and Human Services targets obesity in its Health Agenda, and public health leaders advocate the importance of trimming down America. Additionally, the genetic link to obesity is more clearly defined in the 2002 update to The Human Obesity Gene Map, which reveals that more than 300 genes, markers and chromosomal regions are linked with human-obesity phenotypes.

Childhood and adolescent obesity also is gaining more attention. The number of overweight children and adolescents has doubled in the last two to three decades. Children experience the same obesity-related diseases as adults, and childhood and adolescent obesity is a key predictor of adult obesity. Morbidity and mortality increases in adults who were overweight as youngsters, even if they lose weight during adulthood. Research is now examining whether genetic, maternal and fetal factors affect a child’s potential for obesity during growth.

So, why are so many Americans overweight or obese? The answer lays in obesity’s complex nature, which includes social, cultural, genetic, physiologic, metabolic, behavioral and psychological factors.

Eat less, move more
Adding to the obesity conundrum are the prolific weight-loss treatments currently available, which are as varied and confusing as a stroll down the “diet” section of a bookstore. Amazon.com stocks 2,016 diet books, many of which tout a particular diet as the only “true” secret to weight loss.

According to the journal Obesity Research, all popular and traditional diets can result in weight loss. Despite the various diets that exist with different combinations of foods and macronutrients, it appears that it all comes down to counting calories. A caloric intake of 1,400 to 1,500 calories per day (without physical activity) will produce weight loss. After all, it requires a simple deficit of 3,500 calories to burn a pound of body fat.

When dieting, nutrition must also be considered, as many weight-loss diets neglect ensuring adequate intakes of nutrients such as vitamins E, A, B6 and B12, thiamin, folate, calcium, magnesium, iron, zinc, potassium and dietary fiber. Providing consumers with packaged, low-calorie, nutrient-dense foods is helpful in the battle for weight control. And by following the current daily-intake recommendations for protein (10% to 35% of calories), carbohydrates (20% to 35% of calories) and fat (20% to 35% of calories) within a reduced-calorie diet, a healthful weight-loss program may be created that meets the nutritional needs of an individual.

The issues of appetite transcend the math of low-calorie diets. Neurochemical factors, gastric signals, content of the diet, sensual qualities of the food, genetics, environment, cost, and cultural and emotional factors all come into play. Difficult to achieve, long-term compliance seems to be largely related to psychological issues rather than macronutrient composition of the diet. Using behavioral support, counseling and group therapy has shown an increased chance for long-term weight-loss success.

A decrease in physical activity due to more sedentary jobs and increased use of transportation contributes to our expanding waistlines. Moderate physical activity, in conjunction with a low-calorie diet, is a key to weight loss.

Weighing the alternatives
When diet and exercise just don’t work, other alternatives are available. Drug therapy combined with diet and behavior therapy is one option. Surgery is recommended if the BMI is over 40, or ranges from 35 to 39.9 and causes serious medical conditions.

Weight-gain prevention is steadily gaining more focus. Attention is being drawn to our era of “super-size” caloric levels, with fast-food meals providing as many as 1,780 calories in a single dose, as well as physical inactivity, with more time spent playing Gameboys rather than a game of basketball.

Successfully managing obesity requires looking at the long term and tailoring an individual plan that meets a person’s lifestyle. By looking at patterns and creating a weight-loss program that addresses dietary changes, increases physical activity and emphasizes behavioral modification, it is possible. It’s a simple plan for a weighty problem.

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