The Obesity Problem: The Americas
The economic costs of obesity in America reached 147 billion dollars annually in 2008 (Centers for Disease Control and Prevention 2016a). With nearly one third of the U.S. adult population diagnosed as obese, this affects both indirect and direct costs to society. Obesity impacts labor markets and job prospects (Devaux and Sassi 2015). Hence, the indirect economic cost of obesity has been associated with decreased work productivity, additional sick days, fewer working hours and less pay.
Compared to international peers, the U.S. has the shortest life expectancy rates. While there are various factors that affect longevity in the U.S., such as tobacco use, income inequality , quality health care, obesity and inadequate levels of physical activity, cardiovascular disease is still the primary cause of mortality for both men and women (Crimmins et al. 2010; Centers for Disease Control and Prevention and National Center for Health Statistics 2015). Obesity, alone, exacerbates a range of comorbidities that accelerate mortality. The direct economic burden of obesity has been linked to a range of treatments for such comorbid conditions including cardiovascular disease, cancer, gynecologic complications, sleep apnea, osteoarthritis and type 2 diabetes (DM2) (CDC 2016a; Mokdad et al. 2003; Must et al. 1999; Akil and Ahmad 2011). The American Society for Metabolic and Bariatric Surgery (ASMBS 2017) dubbed obesity and type 2 diabetes as twin epidemics. Diabetes type 2 incidence rates have increased with rising obesity levels. Obesity was noted as an independent risk factor for type 2 diabetes and 90% of people with this disease were diagnosed as overweight or obese (ASMBS 2017). Diabetes increases the risk of heart disease and stroke. The costs to treat people diagnosed with this disease increased by 41% in a five-year period from $174 billion in 2007 to $245 billion in 2012. Consequently, one in every four deaths in the U.S. occurs as a result of heart disease and obesity further escalates cardiovascular events such as high blood pressure, persistent hypertension and heart failure (CDC 2015; Akil and Ahmad 2011).
Obesity is measured according to Body Mass Index (BMI) and is defined as excess body fat (Sahoo et al. 2015). In the U.S., obesity is diagnosed in persons with BMI levels at 30 or higher and persons classified as overweight have BMI levels greater than 25 (World Health Organization 2017). None of the states in the U.S. had obesity levels less than 20% (CDC 2017). Southern states had the highest obesity levels compared to other states, followed by the Midwest, Northeast and the West at 31.2%, 30.7%, 26.4% and 25.2%, respectively. Obesity prevalence was 35% or higher in Alabama, Louisiana, Mississippi and West Virginia. Puerto Rico and 19 states had obesity levels between 25% and 30%. California, Colorado, Massachusetts, Montana and Utah and the District of Columbia had the lowest obesity levels, which ranged from 20% to 25%.
In 2006, the Body Mass Index (BMI) of both men and women in the U.S. far exceeded their international counterparts in Europe, North America and East Asia (World Health Organization 2005). Obesity prevalence was significantly higher and more severe among younger age groups compared to their international counterparts. Hence, the burden of obesity prevalence in the U.S. caused elevated risks for mortality and ultimately contributed to lower life expectancy rates (Whitlock et al. 2009; Preston and Stokes 2011). Obesity reduced longevity by 29% in U.S. women and 32% for men. According to Preston and Stokes (2011) eliminating the obesity problem in the U.S. would increase life expectancy by 25â40% in the U.S. U.S. life expectancy would then increase to a much higher rate than Canada and England, which also have obesity levels nearer to U.S. rates.
The neighborhood environment impacts overweight and obesity prevalence, particularly in low-income communities. Food deserts are defined as limited access to healthy foods in low income communities (Alviola et al. 2013). Constrained food choices affect consumer purchasing opportunities. With limited sources, low-income consumers paid higher costs for food and therefore were less likely to purchase fruits and vegetables compared to consumers who lived in non-food desert communities (Alviola et al. 2013; Pearson et al. 2005). Convenience stores were more prevalent in food deserts and often sold energy-dense foods. Corner stores were omnipresent in low-income communities and these venues were noted for maintaining unhealthy food supplies (Mui et al. 2015). Comparably, U.S. counties that experienced an increase in grocery stores or supercenters showed a marked decrease in obesity prevalence over a five-year period (Myers et al. 2016).
The Obesity Problem: Children
In the U.S., nearly one in six children were diagnosed as overweight or obese and childhood obesity rates tripled over the past three decades (Ogden et al. 2012). There have been significant declines in obesity levels among preschool children; however, their rates are still relatively high. Childhood obesity impacts social and physical inequalities (World Health Organization 2017; Sahoo et al. 2015; Centers for Disease Control and Prevention 2016b). For example, obese and overweight children were reported to have inadequate academic performance, experienced comorbid conditions such as insulin resistance, cardiovascular disease, musculoskeletal disorders, renal challenges, asthma, psychological problems (anxiety and depression), sleep disorders and type 2 diabetes. Researchers implicated the following underlying causes for increasing obesity levels in children:
Maternal Disposition
Researchers found a link between the etiology of childhood obesity to prenatal life. This implicates an association between maternal weight prior to birth, weight gain during pregnancy and persistent overweight and obesity throughout childhood, adolescence and adulthood (Hollis and Robinson 2015; PĂ©rez-Escamilla and Meyers 2014). This maternal life course approach to the obesity epidemic in children is likely to repeat in the next generation. Fetal overnutrition, which is defined as excess concentrations of maternal glucose and free fatty acids intake, has been implicated in lack of appetite control and energy balance in children (Hollis and Robinson 2015). Mothers who gained excessive weight during their pregnancy were 1.3 times as likely to have children diagnosed as overweight. In addition, childhood obesity was likely to be present by the time their children reached nine years old.
The scientific literature appears divided on the association between breastfeeding and the risk of childhood obesity. Authors from twenty-five different research studies suggested that breastfeeding, reduced the risk of childhood obesity by 22% among children followed in 12 different countries compared to non-breastfed children (Yan et al. 2014). In fact, these results were more prominent among infants breastfed for greater than seven months. Other researchers argued there was any association between breastfed children and childhood obesity levels given the moderate amounts of sugar, protein, and fat contained in breast milk and potential fluctuations in the motherâs diet over time (Burdette et al. 2006; Kwok et al. 2010). Consequently, baby formulas contain higher concentrations of these same ingredients, all of which were linked to adiposity.
Nutrition, Physical Activity and Environment
Nutrition and metabolic aspects contributed to the obesity problem in children (WHO 2017). In addition, obesogenic environments exacerbated childhood obesity in the U.S. Obesogenic pollutants occurred in the home and/or built environment. In the home, the BMI of parents was associated with parental monitoring of their childrenâs diet and physical activities (Williams et al. 2017). Families with parents who were not overweight or obese parent were likely to expose their children to a healthier home environment. T...