Obesity is a serious social problem in America. The effects of obesity in childhood are well documented in both the social science literature and medical journals. During the last 30 years, the percentage of obese children between the ages of 6 and 11 has risen 200% while the percentage of obese children between 12 and 19 has tripled (CDC, Preventing Childhood Obesity, 2010). Obesity in the United States has increased among all cohorts and ethnicities, spans across generations, and is not limited to income or educational levels. However, the incidence of obesity among African-American women is of particular concern given the prevalence and severity of the issue in America. Public health issue

More than two-thirds of Americans are now obese or overweight (Ogden et al., 2010).

Rates of adult obesity now exceed 20% in 49 states and D.C and 25% in 40 states. By way of comparison, in 1991, rates did not exceed 20% in a single state (Trust for America's Health, 2010). As of 2010, approximately 25 million U.S. children are obese or overweight, reflecting a three-hundred fold increase in childhood obesity since 1980 (National Center for Health Statistics, 2010).

b. Definition

According to the CDC (2010) the terms "overweight" and "obesity" are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. For adults, overweight and obesity ranges are determined by using weight and height to calculate a number referred to as the "body mass index" (BMI).

c. Measurement/BMI

For most individuals, BMI is correlated with the corresponding amount of body fat. An adult who has a BMI between 25 and 29.9 is considered overweight while an adult who has a BMI of 30 or higher is considered obese (CDC, 2010). For children and teens, BMI ranges above a normal weight have different labels (overweight and obese). Further, BMI ranges for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at various ages.

d. Population effected

Obesity is a nationwide issue in America; it affects all states in the union to varying degrees. However, the prevalence and incidence rate of obesity in the United States is particularly concentrated in the southern states. For example,

e. United States vs. other countries

While the United States is the leader in obesity rates among its citizens, the prevalence of obesity in other countries is equally troubling. For example, while the United States boasts a 30.6% obesity rate, Mexico, the second most "obese nation" is comprised of 24.2% obese citizens; the United Kingdom, ranked third among obese nations has 23% of their citizens officially obese. Interestingly, other countries also have excessive obesity rates: Slovakia: 22.4%, Greece: 21.9%, Australia: 21.7%, New Zealand: 20.9%, Hungary: 18.8%, Luxembourg: 18.4% and the Czech Republic: 14.8% round out (no pun) the top ten most obese nations on Earth (OECD Health Data, 2010).

f. Current Causes

Of course, obesity is a multi-faceted, multi-causal social problem. American society has become 'obesogenic,' characterized by environments that promote increased food intake, non-healthful foods, and physical inactivity. Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity (CDC, Obesity prevention, 2010).

Being overweight and obese result from an imbalance between food consumed and physical activity; all food and no exercise does not a trim body make. National data have shown an increase in the caloric consumption of adults and no change in physical activity patterns. But obesity is a complex issue related to lifestyle, environment, and genes. Many underlying factors have been linked to the increase in obesity, such as increasing portion sizes; eating out more often; increased consumption of sugar-sweetened drinks; increasing television, computer, electronic gaming time; changing labor markets; and fear of crime, which prevents outdoor exercise. Obese adults are at increased risk of type II diabetes, hypertension, stroke, certain cancers, and other conditions. Overweight adolescents often become obese adults (CDC, Obesity Still a Major Problem, 2006).

II. Epidemic

a. Rates of Americans

Over 23% of American adults report that they do not engage in any physical activity at all (Behavioral Risk Factor Surveillance, 2009). Only 56% of high school students had a physical education class at least once a week, and only 33% of high school students had daily physical education (Youth Risk Behavior Surveillance, 2010). Nearly one-third of all high school students watch three or more hours of TV and close to 25% of high school students play video or computer games or use a computer for non-school activities for three or more hours on an average school day (Youth Risk Behavior Surveillance, 2010).

Obesity correlates strongly with economics: 35.3% of adults earning less than $15,000 per year were obese compared with 24.5% of adults earning $50,000 or more per year. Schlosser (2001) notes that spending in fast food restaurants has increased more than 18 times (from $6 billion to $110 billion) in the past 30 years. Furthermore, Finkelstein et al. (2009) found that obesity-related medical costs constitute fully 10% of all annual medical spending in the United States. Obesity is associated with lower productivity at work, costing employers $506 per obese worker per year

b....

Rates of African-Americans
c. Rates of African-American females

d. Rates of African-American children

III. Co-Morbidities caused by Obesity

Approximately 75,000 new cases of diabetes, 14,000 new cases of coronary heart disease, and $1.4 billion in health care costs can be attributed to the consumption of sugar-sweetened beverages alone (American Heart Association, 2010).

With nearly 100 million obese and overweight adults in the United States, it is imperative that physicians and health care professionals understand the co-morbidity of obesity to better combat the multi-faceted issues obesity and being overweight cause. According to The National Heart, Lung, and Blood Institute (2010) obesity and overweight substantially increases the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers.

a. Diabetes

From 1991 to 2001, there was a 61% increase in diagnosed diabetes (including gestational) in Americans and a 74% increase in obesity, suggesting a statistically significant correlation between obesity and the development of diabetes.

b. Hypertension

Hypertension is a modifiable risk factor for cardiovascular disease that significantly affects one in three adults in the United States and contributes to one out of every seven deaths and nearly half of all cardiovascular disease -- related deaths in the United States (CDC, Vital Signs, 2011). Obesity has been consistently associated with hypertension and increased cardiovascular risk some suggesting that fully two-thirds of the prevalence of hypertension can be directly attributed to obesity (Krause et al., 1998).

c. Hyperlipidemia

Coenen and Hasty (2007) note that obesity is often accompanied by hyperlipidemia. Both obesity and hyperlipidemia are independently associated with atherosclerosis, nonalcoholic fatty liver disease (NAFLD), and insulin resistance (IR).

d. Heart disease

e. Stroke

f. Arthritis

g. Other diseases

IV. Perceived Barriers

a. Socioeconomic

b. Lack of education

c. Cultural

d. Decrease in exercise

e. Environmental

V. Practitioner Interventions and Management

a. Prevention

The Division of Nutrition, Physical Activity, and Obesity (DNPAO) is working to reduce obesity and obesity-related conditions through state programs, technical assistance and training, leadership, surveillance and research, intervention development and evaluation, translation of practice-based evidence and research findings, and partnership development. However, the issues surrounding obesity require early interventions, lifestyle and behavioral changes, nutrition information, and community outreach services.

b. Early identification

c. Lifestyle/Behavior modification

d. Nutrition education

e. Community resources

f. Medication/Surgery

VI. Conclusion

a. Meaning of epidemic for the future

b. Social issues/response

c. CDC reports

d. Initiatives/future of America (Michelle Obama)

e. Food labeling/fast food/changes in school nutrition

f. Media