Obesity in the United States

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According to 2007 statistics from the World Health Organization (WHO), the United States has the highest prevalence of overweight adults in the Anglosphere.[1]
Historical U.S. obesity rate, 1960–2004[2]

Obesity in the United States has been increasingly cited as a major health issue in recent decades. While many industrialized countries have experienced similar increases, obesity rates in the United States are among the highest in the world.[3]

Of all countries, the United States has the highest rate of obesity. From 13% obesity in 1962, estimates have steadily increased, reaching 19.4% in 1997, 24.5% in 2004,[4] 26.6% in 2007,[5] and 33.8% (adults) and 17% (children) in 2008.[6][7] In 2010, the Centers for Disease Control and Prevention (CDC) reported higher numbers once more, counting 35.7% of American adults as obese, and 17% of American children.[8]

According to a study in The Journal of the American Medical Association (JAMA), in 2008, the obesity rate among adult Americans was estimated at 32.2% for men and 35.5% for women; these rates were roughly confirmed by the CDC again for 2009–2010. Using different criteria, a Gallup survey found the rate was 26.1% for U.S. adults in 2011, up from 25.5% in 2008. Though the rate for women has held steady over the previous decade, the obesity rate for men continued to increase between 1999 and 2008, the JAMA study notes. Moreover, "The prevalence of obesity for adults aged 20 to 74 years increased by 7.9 percentage points for men and by 8.9 percentage points for women between 1976–1980 and 1988–1994, and subsequently by 7.1 percentage points for men and by 8.1 percentage points for women between 1988–1994 and 1999–2000."[9][10]

Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year[11] and has increased health care use and expenditures,[12][13][14][15] costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs.[16] This exceeds health-care costs associated with smoking or problem drinking[15] and accounts for 6% to 12% of national health care expenditures in the United States.[17]

Contents

Prevalence [edit]

Obesity in the U.S., 2011, by state
Obesity rates in the U.S., 1985–2010

Obesity rates have increased for all population groups in the United States over the last several decades.[11] Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased by a factor of five, from one in two thousand to one in four hundred.[18]

There have been similar increases seen in children and adolescents, with the prevalence of overweight in pediatric age groups nearly tripling over the same period. Approximately nine million children over six years of age are considered obese. Several recent studies have shown that the rise in obesity in the US is slowing, possibly explained by saturation of health-oriented media or a biological limit on obesity.[18]

Race [edit]

Obesity is distributed unevenly across racial groups in the United States.[19]

Caucasian [edit]

The obesity rate for Caucasian adults (over 30 BMI) in the US in 2010 was 26.8%.[20] For adult Caucasian men, the rate of obesity was 27.5% in 2010.[21] For adult Caucasian women, the rate of obesity was 24.5% in 2010.[21]

Black or African American [edit]

The obesity rate for Black adults (over 30 BMI) in the US in 2010 was 36.9%.[20] For adult Black men, the rate of obesity was 31.6% in 2010.[21] For adult Black women, the rate of obesity was 41.2% in 2010.[21]

American Indian or Alaska Native [edit]

The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2010 was 39.6%.[20] No gender breakdown was given for American Indian or Alaska Native adults in the CDC figures.[20]

Asian [edit]

The obesity rate for Asian adults (over 30 BMI) in the US in 2010 was 11.6%.[20] No gender breakdown was given for Asian adults in the CDC figures.[20]

Hispanic or Latino [edit]

The obesity rate for the Hispanic or Latino adults category (over 30 BMI) in the US in 2010 was 31.9%.[20] For the overall Hispanic or Latino men category, the rate of obesity was 30.7% in 2010.[21] For the overall Hispanic or Latino women category, the rate of obesity was 33.1% in 2010.[21]

Mexican or Mexican Americans [edit]

Within the Hispanic or Latino category, obesity statistics for Mexican or Mexican Americans were provided, with no gender breakdown.[20] The obesity rate for Mexican or Mexican Americans adults (over 30 BMI) in the US in 2010 was 34.1%.[20]

Native Hawaiian or Other Pacific Islander [edit]

The obesity rate for Native Hawaiian or Other Pacific Islander adults (over 30 BMI) in the US in 2010 was 43.5%.[20] No gender breakdown was given for Native Hawaiian or Other Pacific Islander adults in the CDC figures.[20]

By age group [edit]

Historically, obesity primarily afflicted adults, but this has changed in the last 2 decades. 15-25 percent of American children and adolescents are now obese. Children and adolescents who are obese are likely to be obese in adulthood and to develop obesity-related health problems.[22]

Newborns [edit]

Some newborns may be born big but this is more often a problem associated with a medical disorder. Unlike adults, newborns do not develop obesity. The number one cause of big babies is diabetes but this is not considered to be an obese baby.

Children and teens [edit]

From 1980 to 2008, the prevalence of obesity in children aged 6 to 11 years tripled from 6.5% to 19.6%. The prevalence of obesity in teenagers more than tripled from 5% to 18.1% in the same time frame.[23]

Data from NHANES surveys (1976–1980 and 2003–2006) show that the prevalence of obesity has increased: for children aged 2–5 years, prevalence increased from 5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5% to 19.6%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.6%.[24]

In 2000, approximately 19% of children (ages 6–11) and 17% of adolescents (ages 12–19) were overweight and an additional 15% of children and adolescents were at risk to becoming overweight, based on their BMI.[25]

Analyses of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999–2000, 2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall, in 2003-2006, 11.3% of children and adolescents aged 2 through 19 years were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile[26]

Trend analyses indicate no significant trend between 1999–2000 and 2007-2008 except at the highest BMI cut point (BMI for age 97th percentile) among all 6- through 19-year-old boys. In 2007-2008, 9.5% of infants and toddlers were at or above the 95th percentile of the weight-for-recumbent-length growth charts. Among children and adolescents aged 2 through 19 years, 11.9% were at or above the 97th percentile of the BMI-for-age growth charts; 16.9% were at or above the 95th percentile; and 31.7% were at or above the 85th percentile of BMI for age.[27]

In summary, between 2003 and 2006, 11.3% of children and adolescents were obese and 16.3% were overweight. A slight increase was observed in 2007 and 2008 when the recorded data shows that 11.9% of the children between 6 and 19 years old were obese and 16.9% were overweight. The data recorded in the first survey was obtained by measuring 8,165 children over four years and the second was obtained by measuring 3,281 children.

Elderly [edit]

Although obesity is reported in the elderly, the numbers are still significantly lower than the levels seen in the young adult population. It is speculated that socioeconomic factors may play a role in this age group when it comes to developing obesity.[28]

In the military [edit]

An estimated sixteen percent of active duty U.S. military personnel were obese in 2004, with the cost of remedial bariatric surgery for the military reaching US$ 15 million in 2002. Obesity is currently the largest single cause for the discharge of uniformed personnel.[29]

In 2005, 9 million adults of ages 17 to 24, or 27%, were too overweight to be considered for service in the military.[30]

Prevalence by state [edit]

The following figures were averaged from 2005–2007 adult data compiled by the CDC BRFSS program[31] and 2003–2004 child data from the National Survey of Children's Health.[32][33] There is a significant correlation between higher obesity rates and location in the U.S. South.[34]

Care should be taken in interpreting these numbers, because they are based on self-report surveys which asked individuals (or, in case of children and adolescents, their parents) to report their height and weight. Height is commonly overreported and weight underreported, sometimes resulting in significantly lower estimates. One study estimated the difference between actual and self-reported obesity as 7% among males and 13% among females as of 2002, with the tendency to increase.[35]

State and District of Columbia Obese adults Overweight (incl. obese) adults Obese children and adolescents Obesity rank
Alabama 30.1% 65.4% 16.7% 3
Alaska 27.3% 64.5% 11.1% 14
Arizona 23.3% 59.5% 12.2% 40
Arkansas 28.1% 64.7% 16.4% 9
California 23.1% 59.4% 13.2% 41
Colorado 21.0% 55.0% 9.9% 51
Connecticut 20.8% 58.7% 12.3% 49
District of Columbia 22.1% 55.0% 14.8% 43
Delaware 25.9% 63.9% 22.8% 22
Florida 23.3% 60.8% 14.4% 39
Georgia 27.5% 63.3% 16.4% 12
Hawaii 20.7% 55.3% 13.3% 50
Idaho 24.6% 61.4% 10.1% 31
Illinois 25.3% 61.8% 15.8% 26
Indiana 27.5% 62.8% 15.6% 11
Iowa 26.3% 63.4% 12.5% 19
Kansas 25.8% 62.3% 14.0% 23
Kentucky 28.4% 66.8% 20.6% 7
Louisiana 29.5% 64.2% 17.2% 4
Maine 23.7% 60.8% 12.7% 34
Maryland 25.2% 61.5% 13.3% 28
Massachusetts 20.9% 56.8% 13.6% 48
Michigan 27.7% 63.9% 14.5% 10
Minnesota 24.8% 61.9% 10.1% 30
Mississippi 34.4% 67.4% 17.8% 1
Missouri 27.4% 63.3% 15.6% 13
Montana 21.7% 59.6% 11.1% 45
Nebraska 26.5% 63.9% 11.9% 18
Nevada 23.6% 61.8% 12.4% 36
New Hampshire 23.6% 60.8% 12.9% 35
New Jersey 22.9% 60.5% 13.7% 42
New Mexico 23.3% 60.3% 16.8% 38
New York 23.5% 60.0% 15.3% 37
North Carolina 27.1% 63.4% 19.3% 16
North Dakota 25.9% 64.5% 12.1% 21
Ohio 26.9% 63.3% 14.2% 17
Oklahoma 28.1% 64.2% 15.4% 8
Oregon 25.0% 60.8% 14.1% 29
Pennsylvania 25.7% 61.9% 13.3% 24
Rhode Island 21.4% 60.4% 11.9% 46
South Carolina 29.2% 65.1% 18.9% 5
South Dakota 26.1% 64.2% 12.1% 20
Tennessee 29.0% 65.0% 20.0% 6
Texas 27.2% 64.1% 19.1% 15
Utah 21.8% 56.4% 8.5% 44
Vermont 21.1% 56.9% 11.3% 47
Virginia 25.2% 61.6% 13.8% 27
Washington 24.5% 60.7% 10.8% 32
West Virginia 30.6% 66.8% 20.9% 2
Wisconsin 25.5% 62.4% 13.5% 25
Wyoming 24.0% 61.7% 8.7% 33

Epidemiology [edit]

According to the NHANES data, African American and Mexican American adolescents between 12 and 19 years old are more likely to be overweight than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14% respectively. Also, in a national survey of American Indian children 5–18 years old, 39 percent were found to be overweight or at risk for being overweight.[36]

A 2007 study found that receiving Food Stamps long term (24 months) was associated with a 50% increased obesity rate among female adults.[37]

Looking at the long-term consequences, overweight adolescents have a 70 percent chance of becoming overweight or obese adults, which increases to 80 percent if one or more parent is overweight or obese. In 2000, the total cost of obesity for children and adults in the United States was estimated to be US$ 117 billion (US$ 61 billion in direct medical costs).

Food consumption has increased with time. For example, annual per capita consumption of cheese was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg) in 2000; the average person consumed 389 grams of carbohydrates daily in 1970; 490 in 2000; 41 pounds (19 kg) of fats and oils in 1909; 79 pounds (36 kg) in 2000. In 1977, 18% of an average person's food was consumed outside the home; in 1996, this had risen to 32%.[38]

Contributing factors to obesity epidemic [edit]

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Obesity levels per county 2004–2009.

According to Cleveland Clinic, cultural, social, and environmental factors, among others, all affect eating behaviors in the United States.[39] The United States’s cultural habits relating to food may be the most significant factor in the obesity of its people. Many of America’s favorite foods, including hamburgers, french fries, and doughnuts, are high in carbohydrates content. These foods are relatively easy to make and many are deep fried.[40] Adolescent children frequently demand that these foods be included in their diet. This trend reflects the fact that inexpensive, pre-packaged and high-calorie foods have become a major part of the country's diet.[41] Major United States manufacturers of processed food, aware of the possible contribution of their products to the obesity epidemic, met together and discussed the problem as early as April 8, 1999; however, a proactive strategy was considered and rejected. As a general rule, optimizing the amount of salt, sugar and fat in a product will improve its palatability, and profitability; reducing those elements for the purpose of public health had the potential to decrease both.[42]

As American families have become absorbed with other activities, formal meal time disappeared, leading to increased snacking all day without a nutritional meal. While other cultures will have a formal, planned meal with the family, Americans have lost this tradition. Along with other traditions of having certain foods for a special occasion and while some still remain such as the Thanksgiving turkey, mostly Americans have started having what they want when they want to have it because of how easy it has become to prepare packaged foods.[citation needed]

Americans are generally social which carries over into their eating habits. As Sidney Mintz, professor of anthropology at Johns Hopkins University said, "Interaction over food is the single most important feature of socializing."[43] The business world typically transacts business deals over food. Along with other activities, such as when people get together to catch up, food is served. At parties, there is food everywhere, at sports gatherings, food concession stands are ubiquitous. Funerals become wakes where mourners eat as part of mourning.[44]

The country has many labor-saving devices. This may contribute to obesity with people eating similar amounts of food while physical demands have diminished.[45]

In 2011, researchers assessed the causal relationship between recent increases in female labor force participation and the increased prevalence of obesity among women and found no such causal link.[46]

Sweet drinks [edit]

Three studies published in the United States shows a link between sweet soda and fruit drinks to obesity.[47] The consumption of sweet soda and fruit drinks has more than doubled since the 1970s.[47] The first study showed that "drinking sugary drinks was affecting genes that regulate weight and increased the genetic predisposition of a person to gain weight."[47] The other two studies showed that "giving to children and adolescents calorie-free drinks like mineral water or soft drinks sweetened with artificial sweeteners resulted in weight loss."[47]

One of the other two studies was conducted by Children's Hospital Boston who examined two groups of adolescents.[47] The group who were encouraged to consume water or light sodas for a year gained 0.68 kilograms (1.5 lb) compared to the other group, who consumed sugary drinks, gained 1.5 kilograms (3.3 lb).[47] The third study was conducted by Vrije Universiteit in Amsterdam, Netherlands.[47] They studied 641 children ages four to eleven over 18 months.[47] They were split into two groups. One group drank sweet and fruity drinks and the other group the same drank the same drink with sugarless sweeteners.[47] The group that drank the drink that had sugarless sweeteners gained only 6.39 kilograms (14.1 lb) on average compared to 7.36 kilograms (16.2 lb) on average by the other group.[47]

A proposed New York City ban on large soft drinks was found to be unconstitutional, although the Mayor has said that will be appealed.[48]

Other foods associated with weight gain [edit]

Consumption of red meat and processed meats, mashed potatoes, french fries are associated with weight gain. Consumption of potato chips has a strong association.[42]

Total costs to the US [edit]

There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability.[12] In particular, diabetes has become the seventh leading cause of death in the United States,[49] with the U.S. Department of Health and Human Services estimating in 2008 that fifty-seven million adults aged twenty and older were pre-diabetic, 23.6 million diabetic, with 90–95% of the latter being type 2-diabetic.[50]

Obesity has also been shown to increase the prevalence of complications during pregnancy and childbirth. Babies born to obese women are almost three times as likely to die within one month of birth and almost twice as likely to be stillborn than babies born to women of normal weight.[51]

Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year[11] (including increased morbidity in car accidents)[52] and has increased health care use and expenditures,[12][13][14][15] costing society an estimated $117 billion in direct (preventive, diagnostic, and treatment services related to weight) and indirect (absenteeism, loss of future earnings due to premature death) costs.[16] This exceeds health-care costs associated with smoking or problem drinking[15] and accounts for 6% to 12% of national health care expenditures in the United States.[17]

The Medicare and Medicaid programs bear about half of this cost.[15] Annual hospital costs for treating obesity-related diseases in children rose threefold, from US$ 35 million to US$ 127 million, in the period from 1979 to 1999,[53] and the inpatient and ambulatory healthcare costs increased drastically by US$ 395 per person per year.[14]

These trends in healthcare costs associated with pediatric obesity and its comorbidities are staggering, urging the Surgeon General to predict that preventable morbidity and mortality associated with obesity may surpass those associated with cigarette smoking.[13][54] Furthermore, the probability of childhood obesity persisting into adulthood is estimated to increase from approximately twenty percent at four years of age to approximately eighty percent by adolescence,[55] and it is likely that these obesity comorbidities will persist into adulthood.[56]

Anti-obesity efforts [edit]

Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias.[57] State legislators in California, for example, passed laws banning the sale of machine-dispensed snacks and drinks in elementary schools in 2003, despite objections by the California-Nevada Soft Drink Association. The state followed more recently with legislation to prohibit their soda sales in high schools starting July 1, 2009, with the shortfall in school revenue to be compensated by an increase in funding for school lunch programs.[58] A similar law passed by the Connecticut General Assembly in June 2005 was vetoed by governor Jodi Rell, who stated the legislation "undermines the control and responsibility of parents with school-aged children."[59]

In mid-2006, the American Beverage Association (including Cadbury Schweppes, Coca Cola, and PepsiCo) agreed to a voluntary ban on the sale of all high-calorie drinks and all beverages in containers larger than 8, 10 and 12 ounces in elementary, middle and high schools, respectively.[60][61]

Non-profit organizations such as HealthCorps work to educate people on healthy eating and advocate for healthy food choices in an effort to combat obesity.[62]

The American First Lady Michelle Obama is leading an initiative to combat childhood obesity entitled "Let's Move". Mrs. Obama says she aims to wipe out obesity "in a generation". Let's Move! has partnered with other programs.[63]

In 2008, the state of Pennsylvania enacted a law, the "School Nutrition Policy Initiative," aimed at the elementary level. These “interventions included removing all sodas, sweetened drinks, and unhealthy snack foods from selected schools, 'social marketing' to encourage the consumption of nutritious foods and outreach to parents.”[64] The results were a “50 percent drop in incidence of obesity and overweight”, as opposed to those individuals who were not part of the study.[65]

For two years, Duke University psychology and global health professor Gary Bennett and eight colleagues followed 365 obese patients who had already developed hypertension. They found that regular medical feedback, self-monitoring, and a set of personalized goals can help obese patients in a primary care setting lose weight and keep it off.[66]

Food labelling [edit]

Ultimately, federal and local governments in the U.S. are willing to create political solutions that will reduce obesity ratings by “recommending nutrition education, encouraging exercise, and asking the food and beverage industry to promote healthy practices voluntarily.”[67] In 2008 New York City was the first city to pass a “labeling bill” that “require[d] restaurants” in several cities and states to “post the caloric content of all regular menu items, in a prominent place and using the same font and format as the price.”[68]

Due to a visible calorie label, individuals became more inclined to purchase products with substantially lower calories than those with higher calories. Restaurants continued to label the amount of calories per meal. As a result, portion sizes were substantially reduced. Portion sizes have psychologically threatened an individual’s ability to make healthier choices.[citation needed]

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