For the past seven years, the lazy, hazy, crazy days of summer have rolled out with the non-profit and non-partisan Robert Wood Johnson Foundation's release of F as in Fat alongside the soda, pretzels and beer. This year it could be renamed F as in Even Fatter. July 2010's report had only one bright spot: the District of Columbia showed a significant decline in obesity. However, 28 states had a significant increase. (D.C. is included because the Center for Disease Control (CDC) provides funds for a survey to be conducted in the district in a way equivalent to the states). Sixty-eight percent of adult Americans reported as obese (BMI > 30) or overweight (BMI >25-30). You can calculate your BMI here.
The data, according to the Robert Wood Johnson Foundation, are "based on telephone surveys conducted by state health departments with assistance from the CDC, and involve individuals self-reporting their weight and height. Researchers then use these statistics to calculate BMI to determine whether a person is obese or overweight. Experts feel that the rates are likely to be under-reported because individuals tend to under-report their weight and over-report their height." Amazingly, 68 percent is a best-case scenario.
Considering all of the weight loss fads, liquid diets, and diet pills that have been around for generations, it's difficult to believe that we weren't a weight challenged country until very recently. But, in fact, we were not. In 1980, no state had an obesity rate above 15 percent, and the combined obesity/overweight statistic for the country was at about 25 percent. By 1991, four states (Louisiana, Mississippi, West Virginia and Michigan) had obesity rates above 15 percent, and none above 20 percent. At that point in time, 33.3 percent of Americans were classified as obese or overweight, and scientists began to speak of a serious health problem and dangerous trend. Currently Colorado, at 19.1 percent, is the only state left that hasn't crossed the 20 percent borderline. We are at a point where a state with one out of five obese adults is the thinnest in the union. We are, as a nation, reporting an obesity level of 34 percent. In contrast, for all of the articles written about how the French and Italians are getting fat, the rate for both countries, according to the latest data from the Organization for Economic Co-Operation and Development (OECD) is still at about 10 percent.
This American obesity epidemic can either be just a blip on our timeline -- a few decades of wrong decisions by lobbyists, food processors, politicians, educators, and us -- or an inevitable glide into a future like the one depicted in WALL-E, with a population too heavy to walk, and too apathetic to care.
It takes a lot of streams and currents to collide and become an epidemic. For example, an infectious disease like the flu requires some combination of three things: an external agent (the virus), a host (you or me), and an environment eager to connect us (the guy with a cough on your flight). This is called an epidemiological triad.
A similar triad has been applied to obesity. The external agent includes the separate elements of increased portion sizes, technologically driven lifestyle changes that require less movement, and the 24/7 availability of fast and convenience foods. As hosts, this time we do more than breathe in when we're in the wrong place at the wrong time. Lack of education about good nutrition and/or basic cooking skills, health-positive behaviors, and human physiology; lack of adequate exercise, and lack of a sense of responsibility and forethought about health all contribute to the epidemic. The environmental factors that connect the "virus" to the "host" stem from the systematic support of the problem -- including political, economic and social influences.* And like a virus, obesity can be "caught," because we mirror the activities of those around us. In other words, it's contagious.
How do we stop the epidemic? We take control back. We use the equivalent of hand-sanitizer inside the shopping cart when we go to the supermarket, and eliminate processed foods, sugary cereals, and sweetened beverages. We read labels and learn, for example, that a 20 ounce bottle of something that sounds reasonably "healthy," like Tropicana's Tropical Fruit Fury Twister, has 340 calories and 64 grams of sugar, and leave that particular virus on the shelf. We drink tap water. We get back to the kitchen and make the effort to cook simple things, so we can eat real food. States with high rates of fruit and vegetable consumption have low rates of obesity -- it can't be any clearer than that -- so we buy and consume more fresh produce. We vote with our pocket books and avoid fast food, and if we have to eat at a fast food place, we eat a salad.
We put an end to being perfect hosts by demanding our kids get good quality physical education in school, and we keep moving ourselves. We insist on wholesome school lunches, and teach our kids right from wrong when it comes to food. We set a good example by what we eat ourselves. We fight to eliminate the "food deserts" prevalent in poorer urban areas, so everyone has reasonable access to healthy ingredients. We spend a greater portion of our money on quality food, and less on unnecessary objects like the latest video game or flat screen. If we live in a state that hasn't passed a sugar sweetened beverage tax, and 18 have not, we're vocal about demanding to know why.
We have to take control of the unhealthy environmental factors too. Because we're not just fighting our own appetites and ingrained habits, we're also battling pervasive Big Food, Big Pharma, and Big Weight Loss, with their Big Budgets. They're the major environmental links between virus and host, but they'll stop selling if we stop buying.
Next year the nation's report card on obesity can be even worse, it can plateau, or it can begin to reverse itself. It will take more than a village, it will take every single one of us to be part of the solution and to turn the obesity triad into a straight line heading downhill.
* For a more complete explanation of the obesity triad, see: Hu, Frank B., ed. Obesity Epidemiology, New York: Oxford University Press, 2008.