We are fat

It is no secret that obesity in America is a huge problem. It should still be less of a secret though. We talk about terrorism constantly, people who die from car accidents, cancer, etc. But obesity kills well over 100,000 Americans every year. This happens through coronary heart disease, hypertension, stroke, type 2 diabetes, cancer, and other health risks. Obesity also drastically complicates recovery from medical procedures, dramatically increases overall health-care costs and has all sorts of quality of life issues.

According to figures from the CDC, 25 years ago, 8 states had obesity levels between 10 and 14 percent (the highest reported). Five years later the majority of the country hit that level (still the highest levels reported in any state). By 1995, the CDC had added a new category for states that had obese populations between 15-19 percent -- and half the country met that higher threshold. In just 5 more years (now 2000), the CDC had added yet another category for states where obesity levels were over 20 percent of the population. By then only one state in the entire country had less than 15 percent obesity. Another 8 years later (now 2008 -- the last year statistics were gathered), TWO more categories had to be added to reflect states where obesity now affected between 25 to 29 percent of the population and for states with over 30 percent obesity. The vast majority of states, five years ago, had obesity rates between 20 and 29 percent. Reports today put about 1 in 3 people as obese, though the CDC reports that the rate of obesity may finally be slowing. In summary, in the past 30 years, obesity has more than doubled in the United States.

Obesity is more likely to affect lower income people and minorities. Blacks are most likely to be obese, followed by Hispanics, followed by whites. People are more likely to be obese in the South and Midwest than the West or Northeast. Over 40 percent of blacks are obese in at least 5 states. Compared to whites, blacks have a 51 percent higher prevalence of obesity and Hispanics have a 21 percent higher prevalence.

Obesity is also a major concern for our youth. About 1/5th of America's children and adolescents is obese. Business Week recently reported that about 7.3 percent of boys and 5.5 percent of girls are classified as extremely obese in California -- as state with below average obesity. A 10-20 year lifespan reduction is expected for these children, helping contribute to the risk that the next generation may be the first in history to have a shorter lifespan than their parents.

While obesity can be dramatically impacted by genetics, metabolism, environment and culture, there must be some reason our country has seen the trends it saw in the last 30 years. Food consumption and exercise are certainly two large issues. But what does bother me is the emphasis of exercise as the government and food companies continue to make the problem one of personal choice. That is really a separate discussion but I for one believe that diet is far more to blame than less exercise.

What could have changed? For one thing we work more. Americans have consistently worked longer hours and moved towards a two-income household over the decades. For another we eat worse. Much worse. Papers in Phoenix show that readers consistently rank the best Italian restaurant as the Olive Garden, the best Chinese restaurant as P.F. Chang's and the best French restaurant as La Madeline. Really? Every day, about 1/4 of adult Americans will eat fast food. Over the period we saw obesity rates skyrocket, so did the availability of fast food. 40 years ago there were about 30,000 fast food restaurants in the U.S. Today there are about 250,000. About 15 percent of our schools have fast food chain outlets. Studies in California show a higher likelihood of obesity if a fast food restaurant is located within close walking distance of a school. At the same time we have seen a dramatic increase of so called fast casual restaurants and low-priced full service restaurants (some of which our friends in Phoenix so adore). The problem is that these types of places make their offerings appear healthy when they can contain more calories and fat than a typical fast food meal.

Of course access to fresh fruits and vegetables is also a large issue as I have written about before in this blog. Initiatives are underway to continue to incentivize grocery stores to enter lower income markets. Unfortunately, we still face a situation where calories about about 2x more expensive for produce than processed foods.

The solution is very complicated because it must be workable for low income and minority individuals. It must also be workable for our youth who are bombarded with advertisements for a largely impulse driven industry. But at the end of the day the solution will rest in increasing access to healthy foods, reducing availability of fast food options, decreasing consumption of soda, and emphasizing the need to be active. Just as credit card companies must now show you how long it will take to payoff your balance with minimum payments, I'd love to see a world where people understand just how much it will take to work off that Big Mac combo meal (1300 calories and 55 g of fat). (It's about 3 hours on a stairmaster.)