With shirt buttons bulging and my panniculus spilling like the top of an oversized muffin over my belt—which was essentially a tourniquet strangling my lower extremities—I examined my options.
After hours of grazing through the snack food pyramid and consuming significant portions of a dinosaur-size turkey, an acromegalic dollop of dressing, a bog of cranberries, and a field of mashed potatoes, I was faced with the proposition of shoveling in another 500 calories cleverly disguised as a heaping slice of pumpkin pie.
The intensity of the situation was palpable. My in-laws sat mouths agape, stunned by the amount and rate at which I forked thousands of calories into my gullet. They fidgeted as I stared with steely, miotic pupils and furrowed, sweat-beaded brow at my prospective ingestion.
The tension heightened as my lower two shirt buttons gave up the cause, careening across the table and striking, respectively, a deserted bowl of creamed corn and the forehead of a comatose relative who had long ago lost interest in watching my acute food intoxication. As my cousins brokered bets over the likelihood of my impending demise, I sat and deliberated, fork hovering over my sugary prey.
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Figure 1: Percentage of Adults Who Are Obese
Source: CDCclick for large version
Figure 1: Percentage of Adults Who Are Obese
Obesity Epidemic
As healthcare practitioners, we are well aware of the dangers of obesity, yet seem paralyzed to make change. However, hospitalists are perfectly positioned to help patients resolve to lose their weight.
A body mass index (BMI) of 30 or more indicates obesity; its slimmer overweight cousin weighs in with a BMI of 25-29.
Overweight or obese people are at increased risk of osteoarthritis, dyslipidemia, obstructive sleep apnea, hypertension, coronary artery disease, stroke, cancer, and diabetes. Obesity accounts for 300,000 excess deaths per year in the U.S., along with about 10% of all healthcare expenditures, according to the Centers for Disease Control and Prevention (CDC). It affects all ages, races, and professions—including physicians. It is perhaps the most significant health issue facing our nation.
Despite this awareness, we keep getting bigger. In the past 20 years we have seen an epic swelling of American waistlines. In 1990 the CDC reported that among adult residents, 10 states had a prevalence rate of obesity less than 10%, and no states had a rate more than 15% (see Fig. 1, above). By 2006, no state had a prevalence of obesity less than 10%, while only four states clocked in with a rate less than 20%. A whopping 22 states found at least 25% of their inhabitants obese. Since 2005 we’ve become so big the CDC had to create a new category for states with more than 30% of their residents being obese. When the BMI cutoff is dropped to 25 or more, 66% meet of U.S. adults meet this definition for being overweight or obese.
Recent CDC data reveal a glimmer of hope. There was no statistically significant increase in the prevalence of obesity in 2005-2006, compared with 2003-2004. In the earlier time period, 31.1% of men and 33.2% of women were obese, compared with 33.3% of men and 35.3% of women in the most recent time period.
Still, one of every three U.S. adults is obese. That’s 100 million Americans. More than 50% of non-Hispanic black and Mexican-American women age 40-59 are obese. Sixty-one percent of non-Hispanic black women older than 60 are obese.
A complex mix of components, including environment and genetics, determines weight gain. The rapid rate of weight gain in recent years is unlikely to be explained by genetics alone—the population’s genetic composition cannot change that quickly. Thus the bulk of the recent increase in obesity is likely related to cultural and environmental determinants. A 2007 paper by Christakis, et al., found that social networks play a large role in the spread of obesity.1 The study followed 12,067 people for more than 30 years. Those with a friend, sibling, or spouse who became obese over that period were 57%, 40%, and 37% more likely, respectively, to become obese. The authors hypothesize that obesity may become less stigmatized and more tolerable for those surrounded by obese associates. Another theory is that peer groups tend to adopt similar behaviors, such as smoking, eating fast food, and inactivity.