Obesity has become a serious health problem in the United States (US): nearly 35% of Americans have obesity. Obesity is not just a problem of “girth control”; it is now considered a chronic disease by the American Medical Association, the American Association of Clinical Endocrinologists, the American College of Endocrinology, The Endocrine Society, the Obesity Society, the American Society of Bariatric Physicians, and the National Institutes of Health (NIH). It is, in fact, a national epidemic according to the Centers for Disease Control and Prevention (CDC). And it is not just a weight problem: it can have serious effects on a person’s physical, metabolic and psychological health. Overweight and Obesity Defined Overweight and obesity are defined by the body mass index (BMI), which is calculated by dividing the weight (in kilograms) by the square of the height (in meters). A BMI of 25 to 29.9 kg/m2 indicates that an individual has overweight; a BMI of 30 kg/m2, or more indicates that a person has obesity. People with a BMI greater than 40 kg/m2 are considered to have stage 3 obesity, and at one time were said to have “morbid obesity”. However, BMI is not a perfect measurement; it does not distinguish lean mass from fat mass, nor does it take into account racial or ethnic differences. Other factors to be considered include waist and neck circumference, overall fitness, and lifestyle. And importantly, the concept that patients may develop “sick fat”, or adipose tissue disease (adiposopathy), as introduced into the medical literature by Dr. Harold Bays, now makes it a treatment goal to return adipose tissue function to normal. In children, obesity is assessed differently. Since a child’s body composition varies as he or she ages, it is measured as an age- and sex-specific percentile for BMI. In children and adolescents aged 2 to 19 years, a BMI at or above the 85th, but lower than the 95th, percentile indicates overweight; a child with a BMI at or above the 95th percentile is considered to have obesity. How Prevalent Is the Problem? Obesity is widespread, according to the CDC. Using data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) database, the CDC reported that more than one-third (34.9% or 78.6 million) of US adults have obesity. As of 2013, according to the CDC, not one state had an obesity prevalence of less than 20%—and the national goal is 15%. The lowest rates (20-25%) were in California, Colorado, Hawaii, Massachusetts, Montana, Utah, Vermont, and Washington, DC. The highest (35% or higher) were in Mississippi and West Virginia. Regionally, the South had the highest prevalence (30.2%), while the West had the lowest (24.9%). One independent study of metropolitan areas in the United States revealed that the Provo-Orem, UT area had the lowest incidence of obesity (on a score of 1 to 100, with 1 being the lowest) and the Shreveport-Bossier City, LA area had the highest. The New York metropolitan area is in the middle, with a score of 54. At the greatest risk for obesity are Hispanics and non-Hispanic black women (30.7% and 41.9%, respectively). Obesity is more prevalent in middle-aged adults, aged 40 to 59 years (39.5%) than in those aged 20 to 39 years (30.3%), or those aged 60 years or older (35.4%). Women with higher incomes are less likely to have obesity than those with lower incomes. Although no correlation has been found between obesity and education in men, women with college degrees are less likely to have obesity than those with less education. What Is the Impact of Obesity on Society? Obesity has taken a toll on health care costs across the country—estimated between $147 billion and $210 billion in direct and indirect health care costs, as of 2010. • Medical costs for individuals with obesity were calculated to be $1429 higher in 2006 than for those of normal weight. • Lifetime medical costs for a 10-year-old child with obesity are staggering: about $19,000 compared with a child of normal weight. • When multiplied by the number of 10-year-olds with obesity in America, lifetime health care expenses are estimated to be $14 billion. In the Workplace In the workplace, decreased productivity and increased absenteeism due to overweight and obesity is a huge economic burden on our society. Absenteeism related to obesity costs an estimated $4.3 billion per year, and lower productivity on the job costs $506 per employee with obesity each year. The greater an individual’s BMI, the higher the number of sick days and medical claims—and a worker’s medical costs also increase with obesity. In addition, employees with obesity have higher workers’ compensation claims. Costs More than Financial If the incidence of obesity continues to climb, combined health care costs associated with treating obesity-related diseases could rise by $48 billion to $66 billion per year by 2030; the loss in productivity could total between $390 billion and $580 billion per year. The cost is more than just financial, however. Obesity can lead to early mortality and increased susceptibility to other diseases, and can have an incalculable impact on quality of life, as well as on the family. We’ll take a look at causes and related health problems in separate articles.
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