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by DAN REIDER
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Over the past several years, there have been numerous articles published in the IJS, Great Britain and other western countries discussing the alarming increase in people’s weights along with the percent of those considered to be obese. In those reports, obesity was not only viewed as a health issue that needed more immediate action but the damage to one’s health was compared to smoking several packs of cigarettes a day as was commonplace for more than 40% of the US adult population up through the early 1970’s.
The World Health Organization (WHO) reports that worldwide obesity has nearly tripled since 1975 with more than 4 million people dying each year as the result of this condition. They reported that in 2016, 1.9 billion adults, or 39% of the world’s population, were overweight and of these, 650 million, or 13% of the world’s population, were considered obese. The World Obesity Federation projects that by 2030, 1 in 5 women and 1 in 7 men will have obesity. Calcium Health is even more pessimistic estimating that obesity in the US could exceed 40% of all adults by 2030.
“Studies continue to seek causes of the worldwide obesity epidemic,” they noted. “There have been hundreds of papers written, conclusions reached, but unfortunately, the problem is getting worse.”
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As the results of numerous studies have shown, we have known of the health risks associated with obesity for several decades. In the mid-twentieth century, once smoking was recognized as the cause of many diseases including cancer, pulmonary disease, cardiovascular disease, and other health problems, there was a concerted effort by the U.S. government through a variety of advertising campaigns, public service announcements, newspaper articles, etc. over several decades (which continue even today) to try to educate the public about the health risks associated with smoking. The number of adults smoking was highest in 1954 where an estimated 45% of adults smoked. By 1977, that number had declined to 36%. By the late 1980’s, the rate had fallen to below 30%. And since 2016, the number of adult smokers has been less than 20%.
A large reason for this decline was the intense effort by the government to inform people of the ill effects of smoking. As obesity is the second leading cause of preventable death, per the CDC – second only to smoking – it is hard to understand why more attention has not been given to the consequences of obesity to the American public. With today’s technology, one would think that adults and adolescents alike would understand the causes of obesity, the Iong-term health issues associated with obesity, and what an individual could do, in many cases, to avoid this excessive weight gain. It would seem that the government and the various health agencies would be putting in at least the same effort to educate the public about obesity as they did with smoking more than 50 years ago. Maybe the reason lies in that there still are conflicting views by various medical groups and others about what is causing obesity and to what degree an individual can control their own weight.
The CDC, NIH, WHO and other well known, respected organizations list possible causes for excessive weight gain in humans. This list included an imbalance of calories consumed and calories expended, genetics, decrease in activity levels, decreased consumption of healthy foods, stress, disease, access to grocery stores, advertising from fast food restaurants, economics and the public’s general lack of health information. Although there is general agreement that there are multiple causes of obesity, there does not seem to be a general consensus on the primary causes of obesity – nor is there any consensus on how much responsibility that an individual has to prevent excessive weight gain. One of the contributing causes of excessive weight gain as stated by the CDC is the lack of consistent physical activity. Its recommendations include that adolescents, ages 6 to 17, should engage in some form of rigorous activities for a minimum of 60 minutes each day. They recommend that adults should participate in moderate activity at least 150 minutes per week or about 20-30 minutes per day. Harvard Health has estimated that fewer than 25% of adults meet the goal outlined by the CDC.
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Forbes Magazine (March 9, 2023) reported the findings of W. Timothy Garvey, MD, University of Alabama and Caren Mangarelli, MD, Northwestern University Feinberg School of Medicine.
“Like many chronic diseases, obesity is [caused by] an intersection between genes and environment,” Dr. Garvey is quoted as saying, adding that the environment is more likely to contribute to obesity today than 100 years ago. Dr. Mangarelli agreed and stated that “over the course of several generations, multiple changes in our environment have occurred that promote weight gain among people.” She added that this is the result of more time people spend in vehicles, at computers, the development of highly processed foods and stress.
Both Dr. Garvey and Dr. Mangarelli stated that the causes of obesity are complex, and people should not be blamed for their obesity. Stress can lead to weight gain and obesity. Dr. Mangarelli stated that “this [stress] includes the stress of chronic sleep deprivation, poverty or the threat of poverty and systemic racism or other trauma.”
“Short term and chronic stress experienced by all humans, including marginalized communities, can lead to changes in hormones and genetic material such that it promotes fat mass gain, obesity, as well as other chronic diseases,” she added.
In addition, Dr. Mangarelli explained that communities of color don’t always have access to healthy food due to the lack of grocery stores where they live.
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Healthline.com (May 4, 2018) listed what it understood as the 10 causes of obesity including genetics, junk foods, food addiction, aggressive marketing, insulin, certain medications, Leptin resistance, food availability, sugar and misinformation.
“Many people seem to think that weight gain and obesity are caused by a lack of will power,” the website noted. “That is not entirely true. Although weight gain is largely the result of eating behavior and lifestyle, some people are at a disadvantage when it comes to controlling their eating habits. Of course, people can overcome their genetic disadvantages by changing their lifestyle and behavior. Lifestyle changes require will power, dedication and perseverance.”
Another major problem the website cited was the availability of foods – that is the almost excessive access to fast foods and sometimes much more limited access to healthy foods.
“Food, especially junk food, is everywhere now,” it noted. “Shops display tempting foods where they are most likely to gain your attention. Another problem is that junk food is often cheaper than healthy, whole foods, especially in America. Some people, especially in poorer neighborhoods, don’t even have the option of purchasing real foods, like fresh fruits and vegetables. Convenience stores in these areas only sell sodas, candy and processed, packaged junk foods.”
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“Many people seem to think that weight gain and obesity are caused by a lack of will power. That is not entirely true.”
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More recently, on March 14, 2023, WION News in New Delhi, India discussed obesity – which is becoming a growing problem in their country as well. Its report stated that obesity is a lifestyle disorder and not a disease. Obesity did not exist 50 years ago presumably because people at that time led more active lives and did not have easy access to high caloric, processed foods. People now tend to eat more calories than their bodies require. Another reason that the current generation is dealing more often with obesity is the absence of physical activity- people becoming increasingly lethargic and lazy.
The World Obesity Organization has listed the causes of obesity as an imbalance in energy consumption and expenditure, genetic disorders and eating habits. In most cases, obesity arises from living in an environment that allows and encourages low levels of physical activity and plentiful consumption of foods rich in fats, oils, sugars and starches.
A number of organizations have listed economics as a primary cause of obesity. The reason for this was given that healthy foods cost a lot more than unhealthy foods available at either grocery stores or fast-food restaurants. It would have been good if at least one of the articles would have gone into a little deeper explanation on how they arrived at the economics behind their position. Many of items in a grocery store which are typically considered healthy choices – vegetables, fruits, eggs, grains, milk, etc. — are mostly less expensive than the foods that might be considered less healthy, including fatty meats, processed foods, soft drinks, etc. Unless there is some other explanation, if money, or lack thereof, was the driving factor between eating healthy or eating poorly, those persons on tighter budgets would be buying the less costly items, i.e., generally the healthier items, in the store rather than many of the more costly, less healthy items. They would also be avoiding the fast foods to a much higher degree than they appear to be doing.
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Another explanation given was that in some rural areas, access to grocery stores required a much longer travel distance than that required to get to a fast-food restaurant. According to the U.S. Department of Agriculture, an area is considered to be a food desert if there is not a grocery store selling fresh fruits and vegetables within one mile of where a person lives in a city and within ten miles in a rural area. As the fast-food restaurants were more convenient to the local population in areas considered to be a food desert, far more meals would be eaten at or from the fast-food restaurants. While there is no doubt that some or even many persons live closer to a fast-food restaurant than a grocery store, the explanation that a drive to the grocery store is so much further than the fast-food restaurant and that is why so many more meals are eaten from the fast-food restaurant just is not plausible in most instances. That is not to say that there are not instances here grocery stores are at a location where a person has to drive a considerable distance, but this would almost certainly apply to a very small percent of our population. It is hard to imagine that most people don’t have a grocery store within say less than a 20 or 30 minute drive from their home, apartment or place of work.
The real answer to why the rate of obesity continues to climb, to a large degree, is the lack of personal responsibility – or possibly the lack of understanding as to the cause of excessive weight increase. Or maybe some people don’t fully understand the long-term implications of gaining weight. Or maybe some just don’t care. To begin to correct this problem, there needs to be more information provided to the general public to help this segment of the population understand what needs to be done to maintain a body weight more in line with acceptable health levels. This needs to be at least to the same level as was provided by the U.S. Government many decades ago warning people of the health risks and real dangers from smoking. Once there is more understanding, there needs to implementation which requires lifestyle changes ranging from minor changes to major changes in one’s choices.
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“Some physicians explain that workplace stress or stress at home is often a contributing factor…”
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Explaining to someone that after a long day at work they need to come home and prepare a meal versus swinging through the fast-food pickup line is really the simple part. Getting people to follow through on that is the tougher part. Asking people to get off their couches and walk maybe 30 minutes a day before or after work also will be a challenge. Again, this is a relatively simple thing to explain to people but getting people to do this on a regular, consistent basis is the real challenge. We need to stop making excuses as to the real reasons why many persons become grossly overweight and obese over time. That is not to say that there are no medical reasons or possibly mental health reasons why some people struggle with weight issue.
Some physicians explain that workplace stress or stress at home is often a contributing factor. Some of that stress could be related to economic factors which would support the theory that some of the weight increases are at least partly due to economic factors — not the cost of healthy foods but the stress factor related to other financial concerns. However, we cannot keep telling people that they are not responsible for not trying to eat healthily (the majority of the time) and exercise (such as walking, etc.) to maintain a healthy lifestyle and acceptable body weight (BMI). By emphasizing those things, that will help address a significant percent of those experiencing significant weight gains and obesity and encourage them to lead more healthy lives.
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ABOUT THE AUTHOR…
Dan Reider was a consulting mechanical engineer for more than 30 years designing primarily educational and healthcare facilities. He is currently working as a Project Manager for the Construction and Planning Department at the University of South Carolina.
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