Attack the Overweight/Obesity Problem at Its Root Cause

In early 1991, Saddam Hussein famously and notoriously described the upcoming war with The United States as “the mother of all battles.” Hyperbole aside, we in the medical community who are informed and sensitive to the topic might conclude that being overweight and obese is “the mother of all diseases.” Indeed, these two conditions—overweight, meaning a body mass index (kg of weight divided by height in square meters) of 25 to 30, and obese, body mass index of 30 and above—puts you at risk for a host of bad things. These include high blood pressure, sleep apnea, type 2 diabetes, arthritis, asthma, stroke, heart attack, gastro-esophageal reflux…the list goes on.

What is as scary as this is the fact that the incidence of overweight/obese people in our country has doubled since 1970. The causes are not hard to figure out: cheaper “bad for you calories” (fast food, highly processed foods full of a lot of sugar, “refined” carbs and saturated fats) combined with a more sedentary populace is the perfect recipe for this trend. A casual perusal on any given busy street, mall or public venue proves the point. A startling 70% of Americans are either overweight or obese, and the numbers are still climbing. A telling fact is that in the mid 1960’s, an average American male weighed about 150 pounds. Today, that number is 200 pounds. This excess body mass, almost always the result of more fat in the body, has led to epidemic proportions of the diseases and conditions listed above.

This disturbing trend adds billions of dollars in cost to our health care expenditures each year, as well as overwhelms the same delivery system we increasingly depend upon. And the peripheral costs are staggering as well. Absenteeism from work, disability costs, increased insurance premiums, premature death, as well as increased fuel consumption and CO2 emissions (the heavier you are, the more fuel required to transport you—and the more we all pay for airline tickets!) all add up to billions more in waste and needless expense.

Part of the problem, I feel, is what I call the “normalization of obesity.” The portrayal of the average American in film, commercials, print and general media as overweight to obese has become more common as we all get larger. Food ads celebrating the relative cheapness of an enormous amount unhealthy of calories, particularly marketed to young-to-middle-aged men, has done much to fuel this problem. Food itself as a kind of object of lust, desire and commerciality rather than nutrition and sustenance (see eating contests, celebrity chef shows and the like) has contributed to what I feel is a near “pornification” of what used to be merely something to eat. As well, the attitude that you could always take a pill to treat all the problems that being overweight/obese might entail (see the ad for GERD medicine of the obese construction worker who eats chili-dogs and has as much as he wants because he can take a proton-pump-inhibiting antacid) is all too common in American life.

Until we attack the overweight/obesity problem at its root cause, as former First Lady Michelle Obama tried to do with her children’s initiative on the subject, we will not make a dent in the problem. And, as we have seen, a serious health and economic problem it is. We, as a society, need to take this problem very seriously, for as this issue gets out of control in our country, as it is in many emerging economies of the world, the morbidity, mortality and sheer dollar costs will exact a heavy toll.

In light of this, I suggest:

1. Public activism in restoring mandatory physical education in our schools.
2. Political activism in what advertisers can say and portray in the public arena about their health-wrecking products.
3. Education and training in health plans and private physician practices to further the cause of better eating and exercise.
4. Public subsidies that allow lower income people to be able to afford organic fruits and vegetables.
5. Parents’ limiting screen time for their children, and instead engaging in family walks, bikes or other physical pastimes.
6. More nutritious school lunches.
7. A change in the medical community that places prevention and lifestyle modification over pharmaceuticals.
8. Most importantly, an adoption of a personal attitude that overeating is a destructive physical and economic force in our country

I have no delusions that we can make even modest changes in this dangerous trend. After all, human nature has proven me wrong as the incidence of this problem reaches new heights with each passing year. However, if we as a society don’t get a handle on this issue, we will, I feel, (as in climate change) reach a point of no return. And that is good for no one, especially the chili-dog eating construction worker who takes the purple little pill.