Jennifer Macaulay

Obesity is escalating worldwide. An alarming 64% of adults in the United States are overweight or obese. And 15% of children 6–19 years of age are estimated to be overweight—a doubling over the past two decades.

Those who are overweight or obese are at increased risk for several diseases, including hypertension, type 2 diabetes, dyslipidemia, metabolic syndrome, coronary heart disease, stroke, gallstones, sleep apnea, certain cancers, and osteoarthritis. In addition, obesity increases the risk of psychological disorders such as depression and eating disorders. According to the Centers for Disease Control and Prevention (CDC), a lack of physical activity and poor nutrition contribute to more than 300,000 deaths each year, and treating obesity cost $117 billion in 2000.

The increase in overweight and obesity is an extremely complex issue. Environmental, behavioral, and genetic factors play a role in the development of obesity. In general, overweight and obesity are a consequence of an energy imbalance. Weight gain results from excess energy intake and/or inadequate energy expenditure (through physical activity, basal metabolism, and thermal effect of food.) According to CDC, more than 60% of American adults do not engage in regular physical activity, and more than 25% are completely sedentary.

The role genetics might play is not fully understood. Some scientists even suggest that an overweight person can be physically fit and healthier than a thin sedentary individual. Technology continues to advance, providing numerous benefits but decreasing the need for physical activity. Elevators, cars, televisions, and computers provide convenient ways to operate with little human energy expenditure. Dietary habits have changed as well. Restaurants serve larger portion sizes. Food is more readily available and more often eaten away from home. All of these factors play a role in less energy expended and more energy consumed, resulting in weight gain.

The U.S. Dept. of Health and Human Services and the U.S. Dept. of Agriculture have implemented several programs, campaigns, and initiatives to promote better nutrition and physical activity, in an effort to reduce the incidence of overweight and obesity in adults and children. Congress appropriated $16.2 million in 2001 and $27.5 million in 2002 to focus on obesity, physical inactivity, and unhealthy eating. These resources have permitted CDC to provide funding for 12 states to implement programs that address the problems of chronic disease, particularly obesity. In July 2002, the Senate appropriated $50.6 million for CDC and $70 million for the U.S. Dept. of Education’s Physical Education for Progress program. State health departments, in conjunction with partnering organizations, are encouraged to use a social marketing approach in developing policy and environmental interventions.

One intervention being considered includes taxing products that are higher in fat and sugar content, or “unhealthy” snacks. At least 15 states and the District of Columbia tax soft drinks and snack foods. Last year, 11 states initiated legislation to raise taxes on “junk food” and soft drinks in vending machines or to prohibit schools from selling sodas and “high-fat foods.” Other proposals include reducing the types of food advertised during television shows geared toward children and calling for labels on “high-fat foods” to warn about the health risks of a diet high in fat. In addition, 18 states, three territories, and the District of Columbia have passed stricter legislation for school lunch programs than the existing USDA standards.

The Surgeon General’s 2001 report, Call to Action to Prevent and Decrease Overweight and Obesity, supported environmental and individual approaches to combat obesity. HHS’s proposed Healthy Communities Innovation Initiative, for which President Bush has proposed $20 million for FY 2003, would concentrate on preventing diabetes, asthma, and obesity. As a part of this initiative, CDC will also begin a $5-million campaign to teach Americans that small changes can make a difference. Last July, HHS launched a $190-million Youth Media Campaign, “VERB: It’s What You Do,” using television, radio, and Internet to promote physical and “prosocial” activities for 9- to 13-year-olds in an effort to reduce the incidence of overweight children.

Media attention has recently focused on lawsuits made against fast-food companies, claiming that their food resulted in individuals’ becoming obese and developing health problems. The restaurant and food industry argue that food choice is a person’s responsibility, not a corporation’s liability.

Obesity will most assuredly be an issue of national importance for the foreseeable future.

IFT Staff Scientist