More die in the United States of too much food than of too little.

—John Kenneth Galbraith, The Affluent Society
(New York: Houghton Mifflin Co., 4th ed., 1984)

Americans in 2004 are fatter than ever, the heaviest since the government started tracking patterns of body weight for the U.S. adult population in the first half of the twentieth century. An estimated 100 million adults weigh more than is considered healthy, and of this group, more than forty-four million are considered obese. According to the Centers for Disease Control (CDC) and U.S. Surgeon General, overweight and obesity afflict more than two-thirds (67 percent) of Americans and constitute a public health problem of epic and epidemic proportions. (An epidemic is not a specific number of cases of a disease or condition; an epidemic exists when the number of cases exceeds that expected based on past experience for a given population.) Despite billions of dollars spent on diet programs, overweight and obesity are widespread and increasingly prevalent throughout the United States.

Although Americans' body weights had been incrementally increasing during the last century, overweight and obesity skyrocketed between 1980 and 2000. The CDC reports that during that time obesity among adults more than doubled, and obesity among adolescents tripled. Normal-weight adults are now a minority in the United States; nearly one-third of the adult population is obese, and childhood obesity is at an all-time high. Twenty states have obesity prevalence rates of 15–19 percent; twenty-nine states have rates of 20–24 percent; and one state reports a rate over 25 percent. (The prevalence rate is the number of cases of a disease or condition present during a specified interval of time, usually a year, divided by the population.) Figure 1.1 maps the geographic distribution of obesity throughout the United States in 2001. Table 1.1 shows the prevalence of obesity by state, in selected years from 1991 to 2001. In 2001 Colorado, Massachusetts, and Vermont reported the lowest prevalence rates of obesity, at 14.4, 16.1, and 17.1 percent, respectively. Mississippi reported the highest rate of obesity (25.9 percent), followed by West Virginia (24.6 percent), Michigan (24.4 percent), and Kentucky (24.2 percent).

Analysis of self-reported data collected by the CDC Behavioral Risk Factor Surveillance System reveals that the obesity epidemic affects men and women of all ages, races, ethnic origin, smoking status, and educational attainment. Table 1.2 shows that in 2001 the prevalence of obesity among U.S. adults was 20.9 percent, which reflects a 74.2 percent increase since 1991. During the same ten-year period, the prevalence of obesity nearly doubled among college graduates and young adults ages eighteen to twenty-nine and more than doubled among Hispanics, soaring from 11.6 percent in 1991 to 23.7 percent in 2001.

In the United States obesity is the second-leading cause of preventable death after smoking. However, obesity is poised to overtake smoking as the leading cause of preventable death by 2005, according to Ali H. Mokdad and others in their study, "Actual Causes of Death in the United States, 2000," published in the Journal of the American Medical Association in March 2004. There is conclusive scientific evidence that mortality (death) risk increases with increasing weight and that even slightly overweight adults—persons of average height who are 10 to 20 pounds above their ideal weights—are at increased risk of premature death. The rising prevalence of overweight and obesity not only foretell increasing adverse effects on health and longevity but also guarantee increased costs for medical care. Overweight and obesity increase the risk of developing a range of ailments including heart disease, stroke, selected cancers, sleep apnea (breathing stops for multiple, brief periods during sleep), respiratory problems, osteoarthritis (loss of joint bone and cartilage), gallbladder disease, fatty liver disease, and Type 2 diabetes. (Insulin is necessary for the body to be FIGURE 1.1
Obesity trends* among adults, Behavioral Risk Factor Surveillance System, 2001
(*BMI ≥30, or ∼ 30 lbs overweight for 5′4″ woman) able to use sugar, the basic fuel for the cells in the body. Persons with diabetes do not produce enough insulin or their cells are resistant to the effects of the insulin.) The CDC estimates that the annual medical costs of an obese person are nearly 38 percent higher than those incurred by a person of normal weight.

Overweight and obesity also exact a personal toll, with affected individuals at increased risk for emotional, psychological, and social problems. Overweight children, teens, and adults suffer from depression, low self-esteem, and other mental health and emotional problems more than their normal-weight counterparts. Along with a physical inability to participate in many activities, persons who are overweight or obese may encounter weight-based stigmatization, bias, and discrimination in school and at the workplace and may be excluded from opportunities for socialization.