America’s obesity problem is at epidemic proportions. Over 2/3 of Americans are overweight and 35.7% are considered obese. Estimates for health care costs associated with obesity are nearly $150,000,000,000 per year. It doesn’t look like the problem will be reversing any time soon because almost 20% of children in America are obese. Obesity contributes to approximately 325,000 deaths per year and is second only to smoking as the leading cause of preventable death in the United States. These staggering statistics are intimidating for those of us in the healthcare and related fields.
The epidemic influences our jobs as physicians, nurses, physical therapists, personal trainers, and dieticians. But it doesn’t just affect us on a professional level. We are also affected on a personal level, because everybody knows someone whose health is adversely effected by obesity. The health implications of obesity are inestimable, but we do know that the implications are significant.
The consequences of obesity extend into many areas of a persons life. While there are implications for the obese socially, economically, and psychologically, it is the 30-40 diseases that are known to be directly related to obesity that can wreck havoc on a person’s health. Many of these diseases are life-threatening.
Diabetes is strongly related to obesity. In fact, obesity has been shown to be the best predictor for carrying a new diagnosis of diabetes. Between 1997 and 2003, there was a 41% increase in the incidence of diagnosed diabetes. In 2003, normal weight individuals accounted for diabetes at a rate of 2/1,000 while 18.3/1,000 obese people were considered diabetic. As America becomes more obese, the rate of diabetes climbs with it. The CDC predicts that 1 in 3 American adults will have diabetes by 2050 if current trends continue. The impact that obesity has had on diabetes is difficult to understate, but other diseases are also found at higher rates in the obese population.
Hypertension is known to be roughly twice as prevalent in the obese population when compared to the non-obese. Upwards of 70% of adult hypertension is a direct result of excess body fat. Worldwide, 4.5 % of the global disease burden is a result of hypertension. We know that hypertension and obesity are tightly coupled, but obesity is also linked to high cholesterol.
High cholesterol is also known to be more common in the obese. Up to 50% of people with a BMI >30 have problems in some parameter of their cholesterol panel. Obesity is particularly bad to the cholesterol because it not only elevates the LDL cholesterol (the bad cholesterol) but it lowers the HDL cholesterol (the good cholesterol). Diabetes, hypertension, and high cholesterol all lead to a common pathway of increased heart disease in the obese.
Coronary artery disease (CAD) is markedly increased in the obese population. In the past, it was felt that this damage to the coronary vessels was “indirect” from the associated diseases such as diabetes, high blood pressure, and high cholesterol and not “directly” from the obesity itself. Certainly, the “indirect” heart damage is severe. Diabetics have 4 times the heart disease of non-diabetics. Hypertensive heart disease is the #1 killer in people with hypertension. High cholesterol will increase the risk for CAD by 30%. However, there is also emerging evidence that obesity “directly” damages the heart.
In a fascinating article, Drs. McGill, McMahan, and Gidding commented on a large study that documented atherosclerosis in young adults. This study was known as the Patholobiological Determinants of Atherosclerosis in Youth (PDAY) study. The researchers visually inspected the coronary arteries of persons age 15-34 at autopsy. They had some striking conclusions. First, obesity was “strongly” associated with the beginnings of atherosclerosis in the study population. This damage was independent from other risk factors and was causing damage to the heart “directly.” In other words, obesity indirectly damages the heart via a host of diseases, but it also directly damages the heart. Second, the damage to the coronary arteries starts early…during adolescence.
What should we be doing to address Americas obesity epidemic? First, start educating. People know obesity is bad for them but many do not know how bad it is for them. Some don’t know what to do to address their problem. Some are discouraged because of past failures. Education generally takes some self-motivation, but sometimes having a heart-to-heart with their physician, friend, or loved one can make all the difference. Second, start young. The damage begins early and lasts a lifetime. If we are serious about the effects of obesity, we will start by addressing it in our youth. Third, start somewhere. The optimal thing would be to address all modifiable risk factors simultaneously. Sedentary lifestyles, poor nutrition, and associated diseases should all be addressed aggressively. But if someone will only start with switching to diet drinks, at least that’s a start. If all they will commit to is a single appointment with their physician, again, it’s a start.
It is only with aggressive education and intervention that this Americas obesity epidemic will chart a new course. Policy makers and health care professionals certainly have a lot of work to do to ensure that this epidemic doesn’t reach in to future generations.