The continuing news about health care mergers and acquisitions, Affordable Care Act–related legislation and regulation, and a tough flu season can obscure critical developments in public health.
Buried in recent headlines is the sobering fact that obesity is still on the rise in the United States. The latest federal data show that nearly 40 percent of American adults were obese in 2015–16, up from 34 percent in 2007–08. The prevalence of severe obesity also went up during the same period, from 5.7 percent to 7.7 percent.1 In 1985, no state had an obesity rate higher than 15 percent. In 2016, five states had rates over 35 percent.
Obesity is a grave public health threat, more serious even than the opioid epidemic. It is linked to chronic diseases including type 2 diabetes, hyperlipidemia, high blood pressure, cardiovascular disease, and cancer. Obesity accounts for 18 percent of deaths among Americans ages 40 to 85, according to a 2013 study challenging the prevailing wisdom among scientists, which had placed the rate at around 5 percent. This means obesity is comparable to cigarette smoking as a public health hazard; smoking kills one of five Americans and is the leading preventable cause of death in the United States.
The obesity crisis may be less dramatic than the opioid epidemic now gripping the nation, but it is just as deadly. Opioids accounted for around two-thirds of the 64,000 deaths related to drug overdose in 2016. Excess body weight leading to cancer causes about 7 percent of cancer-related deaths, or 40,000 deaths each year. This number doesn’t include deaths from the many other medical conditions associated with obesity. Obese people are between 1.5 to 2.5 times more likely to die of heart disease than people with normal body mass indices (BMIs).
There are also substantial economic losses associated with obesity. The medical costs of prevention, diagnosis, and treatment are estimated at $147 billion in 2008 dollars. Reduced economic productivity adds to these losses.
Because rising obesity is attributed to an increase in caloric intake and a reduction in physical activity, many proposed solutions emphasize food and exercise. While such remedies may help in individual cases, policy solutions are almost certainly required to fight this alarming epidemic.
Despite the thriving U.S. weight-loss market (worth $66 billion in 2017), there is no evidence that diet-related programs will curb obesity. Numerous studies indicate that diets are not effective in controlling or reversing weight gain. In fact, 50 percent of dieters weighed more than 11 pounds over their starting weight five years after their diet, according to one study.
A comprehensive discussion of the policy solutions to obesity is beyond the scope of this piece, and the jury is still out on which policies — targeting sugar consumption through taxes on sugary food and beverages, regulating nutrition labels to make them more effective in informing consumers, and limiting the advertising and marketing of unhealthy food, particularly to children — might curb the epidemic.
Taxing potentially harmful food products has shown some promise, though it is a politically fraught approach. A small number of American cities, including Philadelphia, Boulder, Colo., and Berkeley, Calif., have begun taxing sugar-sweetened beverages. Early results show that an excise tax on sugary drinks led to a 21 percent drop in their consumption in Berkeley.
Berkeley is hardly the epicenter of the obesity problem in the U.S., as the map shows, but the intervention’s success offers hope for the rest of the country. A peer-reviewed modeling study based on the Berkeley experience estimated that if a national sugar-sweetened beverages tax were implemented, it would result in lower national consumption of these drinks and reduced adult and child BMIs. Whether such a policy could be replicated nationally remains uncertain.2
When it comes to nutrition labels, there’s almost no evidence that these have an effect on consumers’ dietary intake, body weight, and overall health.
Evidence suggests that advertising and marketing influences food preferences and choices among children. One study from the United Kingdom found that 8.7 percent of the sugar brought into the home was in food and drink that were advertised or sold at a discount. Although limits on advertising pose First Amendment challenges in the U.S., protecting children from aggressive advertising of sugary drinks and other unhealthy foods could have an impact on the childhood obesity epidemic.
One ray of hope from the most recent federal data is that youth obesity plateaued between 2005–06 and 2013–14. The study’s authors couldn’t explain why, but told the New York Times that “something different is happening with adults and youth.” Efforts to address childhood obesity are underway across the country: The Childhood Obesity Declines Project found that multilayered initiatives, supported by cross-sector partnerships, contributed to reductions in childhood obesity rates in four communities.
As we search for solutions at home, it’s worth noting that the obesity epidemic has leaped from our shores to the developed and even the developing world. Among OECD countries, Mexico has the second-highest rate of obesity (after the U.S.), followed closely by New Zealand and Hungary. Obesity is also on the rise in middle-income and poor countries: China, India, and Brazil are grappling with the epidemic.
Opiates can kill quickly and dramatically, but obesity kills just as surely. This epidemic deserves urgent attention. Providing affordable health care to Americans will prove increasingly difficult as weight gain continues to ravage the United States.
1 Obesity is defined as a body mass index (BMI) of 30 or more, and severe obesity is defined as a BMI of 40 or more.
2 The model simulated the 2015 U.S. population above the age of 2 at the baseline and followed them for 10 years until death, or age 100 years. As with all simulation models, this is a best estimate in the absence of direct evidence.