Obesity in America: Causes, Effects, and Treatment

Introduction to Obesity

While it is common knowledge that many Americans are overweight, many people are surprised to learn that the number of people who are severely obese—at least 100 pounds overweight—quadrupled between 1986 and 2003, according to research (Gilles, 2003). Approximately one in every 50 adults is severely overweight, and recent reports indicate that severe obesity is not as rare as once believed.

Obese people face a high risk of heart disease (Texas Heart Institute, 2004). This is particularly alarming given that one-third of all Americans is obese. Recent studies have shown that obesity is linked to approximately 280,000 deaths in the United States every year, making it second only to cigarette smoking as a leading cause of preventable death.

The human body is composed of water, fat, protein, carbohydrates, vitamins, and minerals. Obesity simply means that a person has too much body fat (Texas Heart Institute, 2004). The size of one's waistline is one way to measure body fat; a high-risk waistline is considered more than 35 inches for women and more than 40 inches for men. Another way to measure obesity is body mass index (BMI), which is calculated as weight in kilograms divided by height in meters squared (BMI = kg/m²).

Physicians use BMI, which compares an individual's weight to his or her height, to determine obesity (Gilles, 2003). An obese person has a BMI of 30 or higher, while people with a BMI of 40 or more are classified as severely obese.

According to the National Health and Nutrition Examination Survey (NHANES), in 2000 the majority of American adults were either overweight or obese (CDCP, 2004). Obesity is best defined as an excessively high amount of body fat, or adipose tissue, in relation to lean body mass (Stunkard, p. 14). The assessment of body fat includes concern for both the distribution of fat throughout the body and the size of adipose tissue deposits. Body fat distribution can be measured by skinfold measurements, waist-to-hip circumference ratios, or a variety of other techniques, including ultrasound, computed tomography, and magnetic resonance imaging.

The percentage of children and adolescents considered overweight has more than doubled since the early 1970s (CDCP, 2004). About 15% of children and adolescents are now overweight. Despite the public health impact of obesity and overweight, these conditions were not a major public health priority in the past. Reversing the increasing trend of the obesity epidemic requires effective collaboration among government, voluntary, and private sectors, as well as a commitment to action by individuals and communities throughout the United States.

Causes and Effects of Obesity

Experts believe the increasing number of people who are obese in the United States is due to a combination of genetics, environmental factors, and psychological issues (Gilles, 2003). While obesity often has a genetic component, lifestyle behaviors such as overeating and physical inactivity also play a significant role. Psychological factors may additionally influence eating habits, causing people to eat in response to negative emotions such as boredom, sadness, or anger.

Because of the rising rate of obesity in the United States, health officials are becoming more active in the fight against it (Gilles, 2003). According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 60% of Americans over the age of 20 are overweight, and 25% are obese. About 280,000 people die every year from obesity-related conditions.

Severe obesity puts people at serious risk for the following health hazards (Gilles, 2003):

• Diabetes
• Heart disease
• High blood pressure
• Stroke
• Cancer

People who are severely obese tend to use healthcare services more frequently because many already have one or more chronic conditions (Gilles, 2003). For this and many other reasons, it is in the best interest of national leaders to make sustained efforts to reduce obesity.

It is no longer believed that obesity is simply caused by a lack of willpower in eating and laziness in exercising (Medical Network, 2004). Despite the fact that the underlying basis of obesity is not fully understood, the condition has been recognized since 1985 as a chronic disease caused by numerous interacting factors.

For some people, the cause of obesity is straightforward: they consume more calories than they burn through exercise and daily activity (Texas Heart Institute, 2004). Aging is another contributing factor: as people get older, the body cannot burn energy as quickly and requires fewer calories. As a result, people who eat and exercise the same way they did at age 20 may find that they gain weight as they grow older.

Gender also plays a role in obesity (Texas Heart Institute, 2004). Men burn more energy at rest than women and therefore require more calories to maintain their body weight. Women frequently gain weight after menopause because their capacity to burn energy decreases even further.

Obesity has a genetic dimension as well (Medical Network, 2004). If a person's parents are obese, his or her own risk is elevated because genes influence body shape and, in many cases, weight. However, genetic risk does not guarantee obesity. By learning to control diet and exercise habits, a person can prevent obesity; in some cases, medication or surgery may also help prevent or treat the condition.

Foods high in fat are major contributors to obesity. As the Medical Network (2004) notes: "Hot dogs, Big Macs, french fries, macaroni and cheese, nachos, potato chips, ice cream—all these high-fat American favorites are cheap, accessible and delicious. Is it any surprise that fatty foods are contributing to the soaring obesity rates in this country?"

An inactive lifestyle is another major cause of obesity (Medical Network, 2004). People who spend most of their time sitting have a higher risk for obesity, as do those whose fat intake exceeds 30% of their daily caloric intake. Studies show that people who exercise 20–30 minutes per day are less likely than sedentary people to be obese. The risk is even lower for those who combine an active lifestyle with a low-fat, low-calorie diet.

A slow metabolism is another contributing factor (Medical Network, 2004). The metabolic rate is the rate at which the body uses food as energy. Someone with a slow metabolism is more likely to store excess calories as fat and must work harder to lose weight. However, weight loss efforts may ultimately increase the metabolic rate. Because muscle burns more calories than fat—even at rest—reducing fat and building muscle through weight-bearing exercise helps the body burn calories more efficiently.

Finally, psychology plays a key role in obesity (Medical Network, 2004). Many people report that they overeat or binge when they feel stressed or depressed. Research suggests that approximately 30% of obese people are binge eaters. According to psychotherapist Shelia Harbet, Ph.D., overeating temporarily relieves the stress associated with negative emotions. Unfortunately, bingeing is often followed by feelings of guilt, shame, disgust, and depression. "Often, binge-eating episodes are followed by resolutions by the compulsive overeater to stop bingeing and adhere to diets," says Harbet (Medical Network, 2004). "These resolutions are eventually broken, filling compulsive eaters with guilt and depression, leading them back to binge eating again."