Preventing obesity

General Information on Obesity  

Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though. It increases your risk of diseases and health problems such as heart disease, diabetes and high blood pressure.  Source

About one-third of U.S. adults (33.8%) are obese. Source

Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. Source

Adults with a BMI of 30 or greater (obese and morbidly obese) are more likely to die at an earlier age than adults with a BMI of 20 to 25 (normal weight). Most of the increased risk can be attributed to obesity-related heart disease and stroke.  People who are obese or overweight are more prone to develop hypertension, elevated blood cholesterol, and diabetes. Obese people are also at an increased risk of colon, uterine, and postmenopausal breast cancer; gall bladder disease; liver disease; sleep apnea; respiratory problems; and osteoarthritis.  Obesity and overweight also affect mental health and are associated with decreased emotional well-being. (The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Approximately 300,000 deaths per year may be attributable to obesity (Office of the Surgeon General)

Obesity also poses a tremendous financial threat to our economy and our health care system. It’s estimated that the obesity epidemic costs our nation $117 billion per year in direct medical expenses and indirect costs, including lost productivity. Childhood obesity alone carries a huge price tag—up to $14 billion per year in direct health care costs. Source

Risk Factors
Obesity occurs when you eat and drink more calories than you burn through exercise and normal daily activities. Your body stores these extra calories as fat. Obesity usually results from a combination of causes and contributing factors, including:
-    Genetics. Your genes may affect the amount of body fat you store and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. Even when someone has a genetic predisposition, environmental factors ultimately make you gain more weight.
-    Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn off through exercise and normal daily activities.
-    Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.
-    Family lifestyle. Obesity tends to run in families. That's not just because of genetics. Family members tend to have similar eating, lifestyle and activity habits. If one or both of your parents are obese, your risk of being obese is increased.
-    Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to a weight gain of as much as several pounds a week for several months, which can result in obesity. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke.
-    Pregnancy. During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
-    Lack of sleep. Not getting enough sleep at night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
-    Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
-    Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't control what you eat as you age, you'll likely gain weight.
-    Social and economic issues. Certain social and economic issues may be linked to obesity. You may not have safe areas to exercise, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight — you're more likely to become obese if you have obese friends or relatives.
-    Medical problems. Obesity can rarely be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function.

Childhood Obesity

Television advertising influences children to prefer and request high-calorie and low-nutrient foods and beverages and influences consumption among children between the ages of 2 and 11 years (IOM. (2007). Nutrition Standards for Foods in Schools: Leading the Way toward Healthier Youth. Washington, DC: The National Academies Press)

Between 1977-78 and 2000-01, milk consumption decreased by 39 percent in children ages 6-11, while consumption of fruit juice rose 54 percent, fruit drink consumption rose 69 percent and consumption of carbonated soda rose 137 percent.  
(Cleveland L. U.S. Department of Agriculture; National Food Consumption Survey, 1977-78; What We Eat in America, NHANES 2001-02)

According to a national study, 92 percent of elementary schools do not provide daily physical education classes for all students throughout the entire school year.  (School Health Policies and Programs Study. Journal of School Health 2001;71[7])

Obesity-associated annual hospital costs for children more than tripled between 1979 and 1999.  
(Wang G, Dietz WH. Economic burden of obesity in youths aged 5 to 17 years: 1979-1999. Pediatrics 2002;109(5):E81-E86)

Overall, from the early 1970s through 2002, the percent of U.S. children who were overweight (BMIs greater than the 95th percentile) tripled; the percent who had BMIs greater than the 99th percentile quadrupled.  

The U.S. Institute of Medicine’s report for Preventing Childhood Obesity describes factors contributing to the increasing rates of overweight among children. These factors include:
-    fewer opportunities for physical activity
-    fewer meals eaten at home
-    media and marketing that target children with food advertisements
-    increased portion sizes
-    increased amount of time in sedentary activities including watching television and using computers
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

The rise of obesity in children and youth because obesity may lead to the following health problems:
-    Heart disease, caused by:
            high cholesterol and/or
            high blood pressure
-    Type 2 diabetes
-    Asthma
-    Sleep apnea
-    Social discrimination - Obese children and adolescents are targets of early and systematic social discrimination.  The psychological stress of social stigmatization can cause low self-esteem which, in turn, can hinder academic and social functioning, and persist into adulthood. Source

Obesity Disparities

A 2002 study of more than 200 neighborhoods found that there are three times as many supermarkets in wealthy neighborhoods as in poor neighborhoods, and four times as many supermarkets in predominantly white neighborhoods as in predominantly African-American ones.  
(Morland K, Wing S, Diez Roux A, Poole C.  Neighborhood characteristic associated with the location of food stores and food service places. Am J Prev Med 2002;22[1]:23-9)

Communities with higher percentages of African-American residents tend to have fewer available parks and green spaces, places to play sports, and public pools and beaches.  
(Powell LM, Slater S, Chaloupka FJ.  The relationship between physical activity settings and race, ethnicity, and socioeconomic status.  Evidence-Based Preventive Medicine 2004;1[2]:135-44)

Ethnicity and Race:
-    Non-Hispanic blacks have the highest rates of obesity (44.1%) compared with Mexican Americans (39.3%), all Hispanics (37.9%) and non-Hispanic whites (32.6%). Source

Gender and Income:
-    Among non-Hispanic black and Mexican-American men, those with higher incomes are more likely to be obese than those with low income. Source

-    Higher income women are less likely to be obese than low-income women. Source

How to Prevent Obesity?

The latest research shows that the environments we live in and the public policies our leaders enact directly impact the foods our children eat and how much activity they get. When schools have healthy foods and beverages in their cafeterias and vending machines, students eat better. When communities have parks and bike trails in their neighborhoods and vigorous physical education programs in their schools, children are more active. When neighborhoods have supermarkets and farmers’ markets that sell affordable healthy foods, families eat more nutritiously. But when communities are dominated by fast food, with few places to play, our children eat worse and are less active, and their health suffers. And we all pay a price—in higher health care costs and lost economic productivity. Source

Strategies to Decrease Obesity 
Source for all data

-    Ensure that all foods and beverages served and sold in schools meet or exceed the most recent Dietary Guidelines for Americans. Junk food has no place in our schools, whether it’s served in cafeterias; sold in vending machines, school stores or through fundraisers; or given away as classroom treats or rewards.

-    Increase access to high-quality, affordable foods through new or improved grocery stores and healthier corner stores and bodegas. Research shows that having a supermarket or grocery store in a neighborhood increases residents’ fruit and vegetable consumption and is associated with lower body mass index (BMI) among adolescents. Local governments can increase access to nutritious foods by working in partnership with the business community to bring new grocery stores and healthier corner stores and bodegas to underserved areas.

-    Increase the time, intensity and duration of physical activity during the school day and out-of-school programs. Schools can increase students’ physical activity by requiring active participation in daily physical education classes and by finding ways to add physical activity throughout the day. After-school programs located in schools, parks and recreational centers also can find innovative ways to help children be active.

-    Increase physical activity by improving the built environment in communities. Communities can increase opportunities for physical activity by building new sidewalks, bike paths, parks and playgrounds or by improving those that already exist. To encourage families to use these resources and facilities, they also can implement traffic-safety measures and crime-prevention strategies, so children are safe when walking, biking or playing outside.

-    Use pricing strategies—both incentives and disincentives—to promote the purchase of healthier foods. Food prices influence consumers’ purchasing decisions, and revenue generated by user fees, taxes or other price increases on unhealthy foods can be used to help meet the health and nutrition needs of children and families.

-    Reduce youths' exposure to the marketing of unhealthy foods through regulation, policy and effective industry self-regulation. Unhealthy products are heavily marketed to children, and research shows that exposure to food marketing messages increases children’s obesity risk. Some studies suggest that marketing restrictions are among the most powerful and cost-effective interventions available

Local Information on Obesity

Race and Ethicity:
Asians and Pacific Islanders had the lowest prevalence of obesity followed by whites and people of Hispanic origin. Blacks and American Indians and Alaska Natives had the highest prevalence.
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Income and Education:
Higher obesity rates are associated with lower levels of income and education. Washington adults with annual household incomes of less than $20,000 were nearly 50% more likely to be obese than those in households with annual incomes of $50,000 or more. College graduates had lower obesity rates than those with less education.
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Morbid Obesity and Gender:
Morbid obesity, defined as a BMI of 40 or higher, has become an issue with major health and economic impacts.  Studies have shown that the risks of death and illness are greatly elevated among morbidly obese people, regardless of gender or race.  In Washington for 2003-2005 combined, 2.8% (± <1%) of adults were morbidly obese.  However, women had significantly higher rates of morbid obesity than men in every age group.
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Overweight among Children and Teens:
Based on self-reported heights and weights, the 2006 Washington Healthy Youth Survey (HYS) found that 11% (±1%) of Washington adolescents in grade 10 were overweight and 14% (±2%) were at risk for being overweight.
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Pregnancy and Obesity:
Washington birth certificate data for 2003-2005 show that while 45% of all women in Washington gained more weight during pregnancy than recommended, women who were overweight before pregnancy were more likely than normal weight or obese women to gain more than the recommended amount.
(The Health of Washington State, Obesity and Overweight, Washington State Department of Health updated: 08/31/2007)

Steps to Help Prevent and Decrease Overweight and Obesity by Location

In the Home
•    Reduce time spent watching television and in other sedentary behaviors
•    Build physical activity into regular routines

•    Ensure that the school breakfast and lunch programs meet nutrition standards
•    Provide food options that are low in fat, calories, and added sugars
•    Provide all children, from prekindergarten through grade 12, with quality daily physical education

At Work
•    Create more opportunities for physical activity at work sites

In the Community
•    Promote healthier choices including at least 5 servings of fruits and vegetables a day, and reasonable portion sizes
•    Encourage the food industry to provide reasonable food and beverage portion sizes
•    Encourage food outlets to increase the availability of low-calorie, nutritious food items
•    Create opportunities for physical activity in communities


Healthy food in all neighborhoods