By 2030, 42% of Americans will be obese and 11% will be severely obese, a new study published in American Journal of Preventive Medicine forecasts. If these trends prove accurate, this will further hinder efforts to contain healthcare costs.
The study was conducted in 2009-2010 and used data collected for the 1990-2008 Behavioral Risk Factor Surveillance System, a state-based, cross-sectional survey conducted by the CDC and state health departments.
Estimating a Growing Problem
While the estimates are an improvement over previous studies, which put the 2030 obesity rate at just over half of all Americans, the new projection for the severely obese is greater than the 9% previously predicted.
To determine their estimates, researchers incorporated multiple factors that affect obesity rates, including current CDC data; U.S. Census population projections; unemployment projections; projections of the prices of gas, alcohol, fast food, and healthy foods; and the number of restaurants per 10,000 people.
Unemployment, limited access to healthful dining, and the rising costs of living compounded with high prices for healthful foods have all been associated with higher levels of obesity.
Though childhood obesity trends were not studied as part of this research, they are a major concern in relation to rising obesity rates; nearly half of all severely obese adults were obese as children, according to research cited by Bill Dietz, director of the CDC’s Division of Nutrition, Physical Activity, and Obesity.
The aging population and its link to obesity are also of concern, as many overweight and obese adults turn into obese and severely obese adults over time. The severely obese – with a BMI of 40 or more or roughly 100 pounds overweight – is at highest risk for health conditions linked to excess weight, including Type II diabetes, hypertension, and cardiovascular disease. These and other obesity related conditions lead to drastically reduced productivity and increased medical costs.
“Should these forecasts prove accurate, the adverse health and cost consequences of obesity are likely to continue to escalate without a significant intervention,” noted senior author Justin Trogdon of RTI International.
Huge Cost Savings with Obesity Reduction
Reducing the projected obesity rates by just one percentage point would lead to 2.6 million fewer obese adults in 2020 and 2.9 million fewer obese adults in 2030.
This would equate to $4 billion of savings in obesity-related medical expenses in 2020 and $4.7 billion in 2030. Additionally, if the obesity prevalence could be maintained at 2010 levels, the total savings in medical expenditures over the next 20 years would be close to $550 billion.
Researchers further noted that potential variables such as increased access to recreational facilities, improvements in urban planning that increase walking, work-site health programs, public health campaigns, and new weight-control drugs and technologies, could have an inverse effect on obesity and should be explored, as “successful interventions that generate even small improvements in obesity prevalence…could result in substantial savings.”
An Obesogenic Environment
The Centers for Disease Control and Prevention, the National Institutes of Health and the Institute of Medicine held a conference this past week in Washington, D.C. to discuss how to address the obesity epidemic. The conference is just one segment of a project called “The Weight of the Nation,” which includes an HBO documentary airing May 14th and 15th, striving to bring attention to this “growing” issue.
The Institute of Medicine refutes the notion that obesity occurs because individuals lack willpower. Instead, it attempts to address the societal factors that contributed to the increase in obese adults since 1980, when only 15% of adults were classified as such.
Sweeping changes will need to be made across all aspects of daily life to reverse the nation’s obesogenic or fat-promoting culture. “People need to make healthy choices, but the healthy choices must first be available and accessible in order to make them,” said William Dietz, M.D.
The IOM cites the increased consumption of sugar – particularly in sodas and other sweet beverages – as one of the strongest links to obesity. While a penny per ounce tax could reduce consumption by 24%, soda industry lobbyists have worked diligently to prevent this law from passing in several states.
It also suggests that the government assistance offered to wheat, cotton, and other commodity-crops prohibits farmers from planting fruits and vegetables. This limits the availability of fresh produce and makes it cost-prohibitive for all Americans to consume the recommended amounts. The IOM recommends removing the ban.
Food activist Michael Pollan, author of Food Rules, takes it one step further and calls for the government to eliminate subsidies that make high-fructose corn syrup, partially hydrogenated oils, and other unhealthful ingredients cheap. Instead he promotes eating unprocessed foods, more fresh produce, and smaller portions.
Yet another theory suggests that refined sugars and grains (refined carbohydrates) affect insulin levels and lead to the accumulation of fat. A University of California, Davis study showed that sugars have a negative effect on metabolism and insulin levels and affect our bodies in ways that other nutrients do not. This “all-calories-are-not-created-equal” theory, if true, requires us to drastically change our eating habits and our eating guidelines.
Solving the Crisis
On May 8th, the Institute of Medicine released a new report, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation” as part of the CDC conference. The report provides results of a comprehensive review of obesity prevention-related recommendations along with strategies and actions steps that have the greatest potential to reduce the obesity crisis.
In their report, the IOM identified five essential areas that need improvement:
Physical Activity – where Americans have become more reliant on cars and walking and biking have decreased. The panel recommended tax incentives for developers to build sidewalks and trails.
Food & Beverages – over the past 40 years, calorie intake has increased and high calorie foods are often available in large portion sizes at low prices. The panel recommends making healthy food and drink available everywhere Americans eat.
Marketing – the most frequently marketed foods and beverages are higher in added fats & sugars. The panel recommends that marketers take voluntary action to make substantial improvements in marketing aimed at children and adolescents 2-17.
Health Care & Workplace – health care providers and employers are not taking full advantage of their opportunity to prevent obesity. The panel recommends that employers and insurers do more to combat obesity such as increasing the support structure for obesity prevention, diagnosis and treatment.
Schools – many schools offers and promote high-calorie, low-nutrition foods. The panel recommends making schools the focus of anti-obesity efforts, since preventing at a young age is easier than reversing it. Ensuring children get at least an hour of physical activity, barring high calorie foods & beverages, and offering healthful nutritious foods are some examples.
We live in an increasingly obesogenic society with strong food-industry-driven political forces that work against us. Getting the population healthier seems to be a losing battle. If we continue the trajectory we’re on, the healthcare tab will be huge, and today’s young kids will have an even shorter lifespan than their parents.
Research shows us that our health can benefit from eliminating (as much as possible) sugars and refined grains (“white” bread, pasta, rice, etc.) and starchy vegetables (potatoes).
Replace the old grain-based Food Pyramid with the updated Healthy Eating Plate. Eat unprocessed food that is as close to its natural state as possible and avoid ingredients that are difficult to pronounce. Diets like the Paleo Diet are a good place to begin. Adding exercise to our daily routine can only help to boost our metabolism and overall health.
For those who are overweight or obese, losing just 5% to 10% of body weight can help combat the transition to obesity or severe obesity that occurs with age and metabolic slowdown.
We also need to combat obesity in our children by teaching them how to eat and exercise. Young children and young adults are especially vulnerable to the marketing messages the food-industry spends billions to promote. Limit their consumption, if any, of sugary sodas, juices, and junk foods. Promote active play outdoors and participation in sports. Engage them in making responsible health choices.
If we don’t address these issues individually and early on, 2030 will arrive sooner than we know, and our health and healthcare system simply cannot afford such a disaster.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.