US Obesity at an All-Time High

And Wisconsin's health statistics highlight the consequences.

According to recent statistics from national and international health organizations, Americans are among the fattest people on earth. The National Centers for Disease Control and Prevention (CDC) reports that in the United States, obesity has risen at an epidemic rate during the past 20 years. Dr. Jennifer Zebrack, Assistant Professor of Medicine (General Internal Medicine) at the Medical College of Wisconsin, reports that 34% of all Americans are overweight – defined as having a Body Mass Index of 25.0 to 29.9 – and 30.5% are obese, defined as having a Body Mass Index of 30.0 or higher. Dr. Zebrack points out that it’s not just adults who are becoming problematically heavy, but children and adolescents as well; about 13% of children and adolescents in the US are now seriously overweight.

Why Worry?
According to former US Surgeon General David Satcher, obesity counts for 300,000 premature deaths per year. Obesity raises our risk for heart disease, diabetes, stroke, high blood pressure, cancer and other chronic diseases. In Wisconsin, where lifestyle-related diseases are prevalent, our health statistics are worrisome. "Death rates from cancer, heart attacks and stroke are higher than those of most places in America," says a 1999 article in the Milwaukee Journal Sentinel. "The death rate from cancer in Wisconsin, for example, is 32% higher than the national average; it is 13% higher for heart disease and a staggering 54% higher for stroke. The percentage of all deaths in Wisconsin due to chronic disease - heart, cancer, lung and diabetes - was 73% here, the 18th highest percentage among the 50 states."

“Obesity is the most common nutritional disorder in the developed world,” emphasizes Dr. Zebrack, “and the second most preventable cause of death after smoking.” Health and wellness risks include, but are not limited to, the following:

• High blood pressure and high blood cholesterol
• Coronary heart disease, stroke, congestive heart failure
• Type 2 diabetes
• Osteoarthritis
• Gallstones
• Low back pain
• Heartburn
• Gout
• Obstructive sleep apnea and other respiratory problems
• Some types of cancer, including endometrial, breast, prostate and colon
• Complications of pregnancy
• Poor female reproductive health such as menstrual irregularities, infertility
• Bladder control problems (e.g., stress incontinence)
• Psychological disorders including depression, eating disorders, distorted body image and low self esteem

What is a Body Mass Index Score?
Body Mass Index (BMI) is a common measure used in adults that shows the relationship of an individual’s weight to height. Your BMI equals your weight in pounds, divided by your height in inches, divided again by your height in inches, multiplied by 703. For example, an adult weighing 210 pounds and 6 feet tall would divide 210 pounds by 72 inches, divide again by 72 inches, and multiply that number by 703, for a BMI score of 28.5

"In some cases," Dr. Zebrack says, "a waist-circumference measurement is an important and possibly stronger predictor of health risks than BMI." For children, overweight and obesity is determined using growth charts for age and gender and is best interpreted by a pediatrician.

Why Are We So Fat?
There are many factors contributing to the “growth” of Americans. Americans are eating out more than ever before and restaurants, fast food and fine dining establishments alike, are serving much heftier portions of food than they did in the past. We eat more between meals as well, and consume more sugary sodas and fruit drinks. Advertising also plays a part – who can resist the juicy double cheeseburger that looks so appetizing on TV, or the two-for-one specials advertised at our local pizza parlor? And forget about going to the gym – no one seems to have the time.

Interestingly, genetics also seem to play a part in determining our weight. Dr. Zebrack reports that over 250 genes and chromosomal regions are associated with obesity and that scientists have developed a "human obesity gene map." Two hormones – called leptin and ghrelin – are also being studied extensively by researchers who want to know more about America’s epidemic weight gain. But despite all these reasons, it seems that many Americans are simply eating more and exercising less.

Even a Little Helps a Lot
"Even a modest weight loss of 5-10% of body weight decreases blood pressure, cholesterol and blood sugars," says Dr. Zebrack. Her advice? Basic common sense. "A combined therapy has proven to be most effective for weight loss: dietary therapy, physical activity, and behavioral changes." She recommends first seeing your health care provider for an assessment. He or she can tell you how much, if any, weight you need to lose, as well as help you set goals and make a plan. Your provider may also have you see a dietician who can help determine your daily calorie requirements for weight loss.

"Regardless of the composition of your diet, the primary predictor of weight loss is calorie balance - in other words, calories eaten versus calories burned," says Dr. Zebrack. "Current recommendations of the American Heart Association, National Institute of Health and American Dietetic Association say that the composition of your diet should be about 30% or less fat, about 15% protein and about 55% carbohydrates." As far as fad diets go, Dr. Zebrack cites several reasons to avoid them. Many programs are difficult to maintain, lack basic nutritional requirements such as fiber, iron and calcium, and are not supported by any national health organizations. "We don't know the long-term effects of extreme diets," Dr. Zebrack emphasizes, "and we need to look toward life-long, healthy dietary changes, not a quick fix." > >

Herbal Supplements and Prescription Drugs
What about prescription weight-loss drugs? "Drugs must only be used as an adjunct to the combined therapy and are only indicated in select patients," states Dr. Zebrack. "Weight loss from drugs alone without other measures will typically be less than 5% of body weight, so dietary changes, physical activity and behavior modifications are necessary to reach weight loss goals." In addition, unless they have made significant lifestyle changes, patients typically regain the weight when the drug is stopped.

As for the various herbal supplements on the market today, Dr. Zebrack reminds us that they are not regulated by the Food and Drug Administration and in general we do not have well-designed trials to support their safety or efficacy. Ephedra, for example, has been taken off the market in Canada and is currently being investigated for a possible connection to heart attacks and strokes in several people taking the supplement for weight loss.

Physical Activity, Behavior Changes are Fundamental
Physical activity is vital to weight loss and a healthier body, says Dr. Zebrack. “Building muscle mass helps to burn more calories,” she points out. She advocates choosing an activity that you enjoy and can fit into your daily life. And little things add up, she says. “Take a walk around the block. Park farther than usual from work or shopping. Take one or more flight of stairs instead of the elevator. Reduce sedentary activities like TV, video games and computer use.” Your goal for physical activity should be at least 30-45 minutes per day, 5-7 days per week, although some experts are now recommending we raise that goal to an hour per day.

Behavioral changes play a necessary part in any weight-loss program, and Dr. Zebrack recommends the following:

• Eat your heaviest meal in the morning or at lunch
• Drink a glass of water before eating
• Eat more slowly
• Eat smaller portions
• Limit the number of meals eaten out, especially fast food
• Keep healthy snacks easily at hand around the house and at work
• Get social support from friends and relatives, or from established programs like Overeaters Anonymous or Weight Watchers

In general, a trimmer body is a healthier body. Seeing your health care provider for information that’s tailored to your individual needs might give you the motivation you need to get a healthy start. As Dr. Zebrack points out, if we eat a little less, add some physical activity to our routine and modify our behaviors, the loss of just a few pounds can make a dramatic difference in our health.

This article also includes information from:
Harris Interactive Health Care Research

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.