Obesity, like malnutrition, is a worldwide health problem. Many adults and children of various socioeconomic classes and ethnicities are overweight or obese. Disproportionately more lower-income people are considered too heavy, women are more frequently overweight than men, and there are variations among ethnic groups.
I. Scope of the Problem
II. Contributing Factors
Scope of the Problem
The usual metric for obesity is body mass index (BMI), which is a numerical relationship between height and weight that correlates well with percent of body fat. BMI is an imperfect measure, however; it is often inaccurate for very muscular or big-boned people or those with atypical builds (people who have very broad shoulders or who are very tall or very short, for example).
The Centers for Disease Control and Prevention (CDC) defines adults with a BMI over 25.0 as overweight and over 30.0 as obese. Children and teens have adjusted calculations to account for growth and size changes. Using these measures, in 2004 approximately 66 percent of U.S. adults were overweight or obese—an increase from the 47 percent who were overweight in 1976. Seventeen percent of children ages 2 to 19 are overweight or obese, up from approximately 6 percent. Across the globe, despite the prevalence of malnutrition and starvation in some areas, the World Health Organization (WHO) estimates that there are approximately 1 billion overweight or obese individuals.
The health impacts of obesity are numerous. They include increased susceptibility to type II diabetes (formerly known as adult-onset diabetes but now emerging in younger children), cancer, cardiovascular disease and stroke, and respiratory diseases. These illnesses cause untold suffering and billions of dollars in lost work and medical expenses. Older women who are overweight or obese show lower rates of osteoporosis (bone thinning), but this advantage is off set by the increased rate in the number of falls and injuries.
Dietary reasons for the increase in obesity include the prevalence of low-cost, calorie-dense, but nutritionally poor foods—such as “fast foods” and sodas containing high fructose corn syrup (HFCS)—and the inaccessibility of fresh foods such as high-quality fruits and vegetables. These dietary concerns are coupled with increasing hours spent at work (reducing time for home cooking or exercise), increasingly sedentary activities such as sitting in front of televisions and computers, lack of exercise facilities, and a decline in walking and bicycling as forms of transportation.
These multiple factors all contribute to variations in obesity rates as well as to the growing prevalence of obesity. For example, poor urban areas have fewer good food options—with less fresh food and more fast-food restaurants—as well as fewer playgrounds, exercise facilities, and opportunities to walk safely. Gender and cultural factors play into this as well. For example, despite the rapid increase in women’s sports over the last 30 years in the United States, it is still acceptable for women not to play sports (in some subcultures, vigorous exercise is actually discouraged), leading to lower activity levels and deteriorating fitness.
Environmental factors make nutritious eating and adequate exercise difficult to achieve; therefore these have become the focus of renewed public health efforts to improve the lifestyles of overweight persons. The focus on environmental factors makes it impossible to use a “fat gene” explanation for the rapid increase in obesity or more simplistic explanations that blame overweight persons for their own lack of willpower. When calorie-rich foods are more easily available and lower in cost than healthful foods and exercise is difficult to schedule, “willpower” is insufficient to change health opportunities and behavior.
The complete failure of the weight-loss industry, despite nearly $40 billion in annual expenditures by U.S. consumers on diet programs and aids, furthers skepticism about explanations that blame overweight people for their condition, such as “healthism.” Healthism is defined by obsessive attention to the body and the medicalization of bodily differences that creates an individualistic response, rather than a social or political response, to dietary issues. Healthism is both a public ideology and a private obsession that may have an influence on the rise of eating disorders such as bulimia or anorexia and that prevents a critical examination of contextual definitions of health. For example, the U.S. military is concerned about obesity rates among youth because it affects the availability of eligible recruits. Those who question the role of the military may be skeptical about such “obesity crisis” assertions.
For similar reasons, those in the size-acceptance or fat-acceptance community reject the representation of obesity trends as a crisis or the idea that a person’s size is anybody else’s business. Activists and food industry respondents argue that the BMI is not a good measure, asserting the current crisis may merely reflect more accurate statistics. Measurable increases in chronic disease over the past 30 years, however, mean that at least some dimensions of increasing obesity are real and represent a crisis in public health. Approximately 300,000 U.S. deaths per year are attributable to the effects of obesity, making it a more significant cause of death than tobacco use.
Healthism leads to what scholar Joan Brumberg (1997) termed “body projects,” the relentless search for perfection particularly aimed at women (and increasingly, at men), resulting from intense media saturation of thin, flawless bodies and perfect complexions. A purely individualistic focus on obesity fosters healthism and body projects, enhancing guilt and stress for those whose BMI is not in line with medical standards; thus too, healthism avoids scrutiny of the social and political factors that make healthier dietary choices and vigorous exercise unattainable for many adults and youth.
Some doctors contend that the weight problem is attributable to family fragmentation at mealtime. Preparing meals together and sitting down and enjoying them together will make a difference, they argue. This position holds that fast and already prepared foods dominate the kitchen table and are filled with preservatives and empty calories that pack on weight without nourishing the body.
For all of these reasons, U.S. First Lady Michelle Obama made promoting healthful lifestyles and fighting childhood obesity the focus of her agenda. In May 2010, calling childhood obesity an epidemic, she unveiled her action plan for the newly formed Childhood Obesity Task Force. In the following February she launched the “Let’s Move!” campaign to solve childhood obesity within a decade. That effort concentrates on schools and families.
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