Overcoming Obesity in America

Obesity is not a new problem. Forty years ago, four of every 10 Americans were overweight or obese. But obesity is a growing problem, and it's growing quickly; today, two of every three Americans need to lose weight.

Why Worry?
Most people worry about their weight because they want to look good. Appearance is important, but the consequences of being overweight go well beyond image and self-esteem. Excess body fat has serious consequences for the body's metabolism, including:

• Higher levels of triglycerides
• Higher levels of LDL ("bad") cholesterol
• Lower levels of HDL ("good") cholesterol
• Decreased tissue responsiveness to insulin and higher insulin levels
• Higher blood sugar levels

Ugly numbers are more worrisome than an unflattering profile, for they explain the dramatic increase in illnesses in the United States that cause an enormous burden of death and disability, including:

• Coronary artery disease and heart attacks
• High blood pressure and strokes
• Diabetes mellitus
• Many forms of cancer
• Fatty liver, which may progress to cirrhosis
• Osteoarthritis
• Depression and social isolation

It's a sobering picture, and the bottom line is even more staggering. Obesity is a major cause of premature death. The damage is evident in all age groups and with all degrees of overweight, but the toll is heaviest in the heaviest people, and obesity has a greater impact the earlier it occurs. For example, a very obese 25-year-old man can expect to lose 13 years of life -- 22 percent of his life expectancy -- due to obesity. A 40-year-old man who's simply overweight may lose more than three years of life, but a 40-year-old man who's obese may lose nearly six years.

All in all, obesity and lack of exercise are responsible for about 1,000 deaths in the United States every day. And if present trends continue, obesity will soon overtake smoking as the leading preventable cause of death in America (it's already responsible for a poorer, overall health-related quality of life than smoking). Obesity also consumes $39 billion of our health care dollars annually.

Why the Bulge?
Obesity is a complex problem, and scientists don't fully understand the many genetic, biological and behavioral factors involved. But it's obvious that human genetics and biochemistry take generations to change, while the rate of obesity is skyrocketing, having increased more than 5 percent since 2000 alone. That magnitude of change can only depend on human behavior -- or, in this case, misbehavior.

Diet and exercise are the only behavioral factors that regulate body fat. Both are problems in America. But although fewer than a quarter of us get the exercise we need, we're not any more sedentary than our parents. The culprit, then, must be diet.

The Super-Sizing of America
A 2004 study proved the proposition: Americans are eating more. Researchers at the Centers for Disease Control and Prevention (Atlanta, Ga.) evaluated the caloric consumption of average Americans between 1971 and 2000. For men, the average daily consumption increased from 2,450 to 2,618 calories. That's a jump of 168 calories a day. It may not seem like much, but over the course of a year, it will add 17 pounds. The news is worse for women, who added 335 calories a day over the 30-year span.

Americans are eating more both at home and away. Portion size and calories consumed increased in all food categories. The greatest increase was in soft drinks, salty snacks, hamburgers, French fries and Mexican food. From this list, you'll surely predict another important finding: The greatest increase in portions and calories occurred at fast-food establishments.

In 2001, Americans spent more than $110 billion on fast food. The appeal is obvious in today's busy world, but the feeding frenzy doesn't depend on convenience alone. Advertising feeds the nation's appetite for fast food, with children a major target. It's no surprise that one survey found that 96 percent of American schoolchildren recognized Ronald McDonald, placing him just behind Santa Claus among fictional icons.

Jumbo servings add to the problem. A typical serving of McDonald's fries contains three times more calories today than when the franchise began. A "regular" soda at Burger King contained 12 ounces in 1954, but a "small" cup contained 16 ounces and a "medium" portion 21 ounces in 2002. The emphasis on large, relatively inexpensive portions has spilled over to many foods, from cookies to popcorn to steaks.

In one year, an American adult consumes 40 pounds of white bread, 41 pounds of potatoes, 30 pounds of cheese, and 77 pounds of added fats (butter, lard and cooking oil), plus 52 gallons of soda. In all, the U.S. Department of Agriculture reports that food consumption rose by 8 percent, or about 140 pounds per person per year, during the '90s.