Obesity Rates: A Rising Threat To Public Health And Welfare

In recent decades, obesity has become one of the greatest problems facing the United States. Since the 1980s, the number of overweight and obese people has more than doubled, raising the likelihood of heart disease, stroke and Type 2 diabetes.

All this week, Here & Now will take a closer look at obesity in a new series, America On The Scale. We’ll explore its causes, the fight to prevent it and the cultural complications and biases that people living with obesity face on a daily basis.

Host Jeremy Hobson begins with the raw numbers with NPR’s Allison Aubrey and Dr. Bruce Lee of Johns Hopkins University. They discuss what regions and what demographic groups are most affected and how obesity in America compares to the rest of the world.

Interview Highlights: Allison Aubrey and Dr. Bruce Lee

What is obesity?

Aubrey: “Obesity is typically indicated or measured by body mass index. So your body mass index is a measure of body fat based on your weight in relation to your height. There are cut-offs given, so a BMI of 30 or greater is considered obese. Now to put that in perspective, a 5-foot-3 woman would need to weigh about 170 pounds or so to be classified as obese where as a 5-foot-10 person would need to weigh about 210 pounds to put them in the obese range.”

How much of a problem is obesity at this point in the U.S.?

Aubrey: “As a country, it seems we're kind of stuck. Overall, obesity rates have continued to inch up. The overall prevalence of obesity in the three-year period ending last year was just over 36 percent. This means about one in three adults in the U.S. are obese. This compares to 27 percent back in 1999. So, you know, this goes on given the drum beat that we've all heard to eat healthier and to get more physical exercise. Now, one note of optimism here is that the CDC has found in its most recent report issued last month that in the last two years of its analysis, the changes were so slight that they're not statistically significant, so a bit of a leveling off.”

How much of the world's population is considered obese?

Lee: “It's becoming an increasing problem worldwide. There's been a transition over the past decade where many countries where under-nutrition was a problem. Now, we're finding obesity is a problem as well. Many different countries, obesity rates are well over 20 percent, in some cases close to 30 percent. And it's been increasing in every part of the world.”

Is the U.S. still the most obese nation in the world?

Lee: “Depending on which statistics you look at, Mexico may be first or second, and other countries such as Australia, New Zealand, Canada, Ireland, there are a number of other countries that are close to the United States in terms of obesity rates.”

Why do some areas have these higher obesity rates while others do not?

Lee: “That's the question. There's a lot of thoughts and theories behind what are the systems that are leading to increasing obesity. Some of the possible causes are the change in food systems around the world. We're seeing more and more processed foods in different parts of the world – high-calorie, high-salt, high-sugar foods. There's been decreases in physical activity throughout the world. There's been questions about what role the environment plays in terms of affecting obesity. Studies have shown that different types of medications, such as antibiotics or ADHD medications, may be associated with increases in childhood obesity. So it's a very complex problem and we're seeing a complex set of factors that are changing throughout the world.”

Is there any place in the world that is doing a good job at preventing obesity?

Lee: “If you look at the statistics, there're some countries where obesity rates have been historically fairly low – parts of Southeast Asia, North Korea has a very low rate, certain parts of Africa. Now, that raises several questions: one is we’re not sure what the sampling has been in some of these locations. And also, even places where you see low obesity rates historically, they have been increasing. So there isn't an exemplary country where we can say ‘OK, yeah. They're really taking care of the obesity epidemic.' It seems like almost every place is affected or we need more information about how they're doing.”

If you could have the government do something that would make a difference, what would it be?

Lee: “I think it's not just a single – the government steps in and says ‘OK, we're going to take care of the obesity epidemic.' I think first everyone has to recognize that this is a major problem. It's not an individual behavior problem. It's not just telling people ‘OK, well you should eat less and exercise more.' There's a lot of things going around – the social milieu, the environment. One can also look at access to healthy foods versus unhealthy foods. And when I talk about access, I don't just mean geographic access, but I also mean social and economic access. That's one of the reasons why people have been talking about taxes on sugar-sweetened beverages and other types of unhealthy foods. There can be economic disparities in terms of how expensive or how costly it can be to eat healthy and people don't even realize it.”

Aubrey: “What's interesting about the kinds of solutions out there, if you look at the body of evidence that's growing, you see a couple of different things. I'm going to point to one, they are looking at how to prevent diabetes – Type 2 diabetes. So about 10 years ago, researchers recruited a whole bunch of people who didn't yet have Type 2 diabetes, but were at risk of it, either because of their body weight or because they had elevated blood sugar, and they put them in a group setting and they said ‘Hey, look. We're going to teach you a new way to eat, we're going to teach you some new tricks for physical activity, we're going to give you counseling. We're going to kind of make this a new lifestyle for you. We're not going to put you on a diet, but we're going to help you sort of gradually move to this new lifestyle.' And it was very successful. If you give people the right tools for changing their diet, the right tools for getting exercise into their life and you sort of put them in a group setting for support, those are the kinds of things that can be successful.”

Guest

• Allison Aubrey, health and food correspondent for NPR. She tweets @AubreyNPRFood.
• Bruce Lee, director of the Global Obesity Prevention Center at Johns Hopkins University. He tweets @bruce_y_lee.

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