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 2006 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 127 million adults weigh more than is considered healthy, and of this group, more than sixty 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 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 1985 and 2003. 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. In 1991, four states had obesity prevalence rates of 15%-19%, and no states had rates at or above 20%. By 2003, fifteen states had obesity prevalence rates of 15%-19%; thirty-one states had rates of 20%-24%; and four states reported rates of more than 25%. (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 1991, 1996, and 2004.
The prevalence of obesity varies by state. An analysis of 2004 data from the CDC's Behavioral Risk Factor Surveillance System (F as in Fat: How Obesity Policies Are Failing in America 2005, Washington, DC: Trust for America's Health, 2005) revealed that Colorado reported the lowest percentage of obesity (16.8%) in 2004, followed by Massachusetts (18.4%), Vermont (18.7%), Rhode Island (19%), Montana (19.7%), and Connecticut (19.7%). More than 25% of adults in twelve states were obese in 2004. Mississippi reported the highest rate of obesity (29.5%), followed by Alabama (28.9%), West Virginia (27.6%), Tennessee (27.2%), and Louisiana (27%).
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 1.1 shows that while the prevalence of obesity among U.S. adults disproportionately affects older age groups, African-Americans, and Hispanics, and declines with increasing educational attainment, from 27.4% among people with less than a high school education to 15.7% among those who attended college, no group remains untouched by this epidemic.
Researchers Khoa Dang Truong and Roland Sturm looked at various sociodemographic groups to assess whether U.S. weight-gain trends varied in response to education, income, race/ethnicity, and gender. An analysis of data from the Behavioral Risk Factor Surveillance System found that overall, each sociodemographic group experienced generally similar weight gains, although women gained more weight than men. On average, individuals in the lowest-income group gained as much weight as those in the highest-income category, and there were no differences across racial or ethnic groups except that non-Hispanic blacks gained more weight than other groups. The only significant difference in terms of FIGURE 1.1 Obesity trends among U.S. adults, 1991, 1996, and 2004weight-gain trends was that people with college degrees gained less weight than did others ("Weight Gain Trends across Sociodemographic Groups in the United States," American Journal of Public Health, vol. 95, no. 9, September 2005).
In the United States obesity is the second-leading cause of preventable death after smoking. In 2005 there were about 35,000 more deaths attributable to smoking than to obesity. However, obesity is poised to overtake smoking as the leading cause of preventable death in 2006, 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—people of average height who are ten to twenty 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 able to use sugar, the basic fuel for the cells in the body. People 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% 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, FIGURE 1.1 Obesity trends among U.S. adults, 1991, 1996, and 2004 [CONTINUED]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, people 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.
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