It seems the past few blog posts have been focusing on our discussion of obesity and I'm going to add to our body of knowledge, so to speak. Since my parents are healthcare professionals, the “obesity epidemic” has occasionally come up in conversation over the years so I had some biases that our class discussion let me see. For example, I found that I associate increased body mass with worse health. I generally don’t dislike people that are sick, but I feel like the reason that I judge people with very large body masses is because I think eventually their weight will either cause or contribute to ill health. And I can understand why healthcare professionals might perceive obese people in a negative light. My mom has a permanent (although relatively minor) injury from trying lift a 300 lb patient when she was working as a nurse. I also remember a section of a memoir called “Complications: A Surgeon’s Notes on an Imperfect Science” written by a ER surgeon named Atul Gawande that describes the extra trouble he runs into when trying to do tracheotomies and insert central lines on obese people. I am not saying that it is ok to treat obese people worse, merely pointing out that I can understand why healthcare professionals might have negative opinions.
Anyway, since I had heard obesity described as an epidemic, I decided to go to the Center for Disease Control and Prevention (the CDC) and see what they had to say about prevalence, causes, and possible fixes. After thoroughly exploring the website, it became obvious that it really is an epidemic. This graphic shows how it has developed over the last 25 years. First of all there is a difference between overweight and obesity. Overweight is a BMI between 25 and 29.9 while obesity is a BMI greater than 30. (If you want to check your BMI, you can do so here courtesy of the CDC) Increased BMI is a concern because it increases a person’s chance of developing hypertension, heart disease, diabetes and cancer. Medical costs attributed to both overweigh and obesity was between 51.5 and 78.5 billion dollars in 1998 which is about 10% of that year’s total healthcare expenditure. Weight gain is the result of taking in more calories than are expended (the previous post demonstrates that net caloric intake or expenditure is the only determinant of weight gain or loss.)
I also ran across a Grand Rounds Presentation about the childhood obesity epidemic. The CDC epidemiologists attribute the almost 20% obesity rate in children and teens to changes in familial eating habits, less activity, and more times spent watching TV and on the computer (as explained in an earlier post, time spent viewing TV is time spent watching advertisements for fast food.) In order to fix the problem, the CDC suggests integrated approaches that aim to decrease caloric intake and increase energy expenditure. This seems like a pretty intuitive approach but will still be a challenge.
The most interesting part about the Grand Rounds was how the epidemiologists considered lack of access to healthy food a direct and significant contributor to childhood obesity. They referred to the food deserts presented in "The Grocery Gap," the same policylink article that we read when we were discussing food deserts in class. Providing healthy food and increased exercise was the base of the case studies where the percentage of childhood and adolescent obesity was successfully decreased.