Health Care Poverty Homelessness Housing and Employment - Obesity—a Twenty-first Century Epidemic

As a society we can no longer afford to make poor health choices such as being physically inactive and eating an unhealthy diet; these choices have led to a tremendous obesity epidemic.

Vice Admiral Richard H. Carmona, MD, MPH, FACS, U.S. Surgeon General

The Centers for Disease Control and Prevention (CDC) reported in 2004 that chronic diseases accounted for seven of every ten deaths in the United States and more than 75% of medical care expenses. The CDC noted that many of these chronic diseases were preventable. Physical inactivity and unhealthy eating were identified as contributing factors to obesity, cancer, cardiovascular disease, and diabetes. Together these two behaviors were responsible for at least four hundred thousand deaths each year. Only tobacco use caused more preventable deaths. Among other factors, the CDC cited the increase in food portions as a major factor in unhealthy eating choices. The standard size soft drink, for example, long established as eight ounces, grew to a twelve-ounce size. Many restaurants promoted even larger sixteen- and twenty-ounce sizes.

Weight gain among Americans was noted as early as 1976, according to CDC data. Its 2000 data revealed that nearly 59% of Americans, both adults and children, were obese. Figure 5.4 provides a visual image of the growth of the obesity epidemic by state from 1991 to 2002.

Responsibility for America's Overweight Problems

In a 2003 survey Wirthlin Worldwide asked Americans to rank on a one to ten scale (one equaled "no responsibility" and ten equaled "total responsibility") how much responsibility various individuals and organizations should have for helping them to be healthy. When asked "Who is responsible for my health?" personal responsibility ranked highest at 8.2 on a 1-to-10 scale. Respondents, however, also wanted schools, the media, food and beverage companies, the government, and fast food restaurants to share the responsibility. (See Figure 5.5.) These views were more prevalent among lower income and less educated persons, who, the survey report noted, were often the most frequent customers for convenience foods and fast food restaurants.

Seventy-nine percent of Americans surveyed by Wirthlin Worldwide in 2003 said obesity was an extremely or very serious problem. When asked to rate factors that contributed to health, women ranked weight highest (7.7 on a 1–10 scale), while men identified quality of diet as

FIGURE 5.4

most important (7.2). Use of nutritional supplements was least important to both men and women.

The problem of obesity affected all ages, races, sexes, and socioeconomic levels. The CDC budgeted $34 million in 2003 and $39 million in 2004 to fund state initiatives to address problems of physical activity, poor nutrition, and obesity.