Overweight and Obesity Epidemic in America – Part XI: Where Have We Been, Where Are We Now, Where Do We Go From Here And How Do We Get There?

Suggested Citation: Garko, M.G. (2011, August). Overweight and obesity epidemic in America – Part XI:  Where have we been, where are we now, where do we go from here and how do we get there? Health and Wellbeing Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.

 

Overweight and Obesity Epidemic in America – Part XI: Where Have We Been, Where Are We Now, Where Do We Go From Here And How Do We Get There?

Michael G. Garko, Ph.D.
Host – Let’s Talk Nutrition

 
Introduction

 “Knowing is not enough; we must apply. Willing is not enough; we must do” (Goethe). When it comes to the overweight and obesity epidemic, Goethe’s words have significant meaning in that much is known about the causes and risk factors of the epidemic and many healthcare professionals, government and private agencies, as well as individuals (overweight or obese or not) are willing to prevent and treat it.

Knowledge and willingness are necessary conditions to help resolve the obesegenic crisis befalling the United States and other nations around the globe. However, they are not sufficient conditions to solve the obesity epidemic (and some would say pandemic) or prevent and treat it on an individual or societal level. Turning knowledge into action and applying that knowledge in a strategic and successful fashion are an important part of the prescription to prevent and treat the overweight and obesity crisis.

This August, 2011, issue of Health and Wellbeing Monthly explores the overweight and obesity epidemic from the standpoint of prevention and treatment and in terms of where we are now nationally and internationally, where we do go from here and how do we get there. Attention will be devoted to key issues in the prevention and treatment obesity such as the difficulty in treating it, why prevention might be a better option, the role of prevention policies, laws and regulations and specific recommendations to prevent and treat overweight and obesity.

 Where We Have Been and Where We Are Now?

 American society and other cultures have been taken somewhat by surprise in the upward surge of the prevalence of overweight and obesity. Globally and historically, the rise of obesity prevalence rates remained relatively small and static. But then about 20-30 years ago there arose on a global level an upward modulation of the prevalence of obesity in children and adults (see Swinburn, 2008). For example, the prevalence of obesity has doubled in England since 1980. Similarly, in the United States the prevalence of obesity increased steadily among both men and women, all age groups, all racial/ethnic groups, all educational levels and all smoking levels. Specifically, in the United States from 1960–2 to 2005–6, the prevalence of obesity increased from 13.4% to 35.1% among adults age 20-74, with 68% of the adult population being either overweight or obese. Less than one-third of adults (31.6%) in America are at a healthy weight, with 36.5% and 26.6% of women and men, respectively, being at a healthy weight. With respect to children, about 12.4% 2-5 years of age and 17% 6-11 years of age were overweight. Approximately, 17.6% of adolescents 12-19 years of age were overweight in 2003–2006 (Centers for Disease Control and Prevention, 2011).

According to the International Union of Nutritional Sciences (IUNS) (2002) and its International Obesity Task Force (IOTF), the worldwide prevalence of obesity ranges from less than 5% in rural China, Japan and some African countries to as high as 75% of the adult population in urban Samoa. The prevalence of obesity is increasing throughout the world, affecting the health and wellbeing of adults and children. It is not just a medical and social concern for developed countries, but for developing countries as well (see International Union of Nutritional Sciences, 2002).

The World Health Organization (WHO) (2011) reported that since 1980 worldwide obesity has more than doubled. According to the WHO, 1.5 billion adults, 20 and older, suffered from being overweight in 2008, with over 200 million men and nearly 300 million women suffering from obesity. Overall, better than one out of ten adults in the world was obese in 2008. Swinburn (2008) describes the global obesegenic state of affairs with the observation that “surveys from around the world now confirm that obesity has reached pandemic proportions, with many developing countries now struggling under the doubled burden of continuing high rates of infectious diseases and rising rates of cardiovascular diseases, diabetes, and obesity (Swinburn, 2008, p.1)

There was a time when overweight and obesity were considered a health problem for developed, high-income countries. Now they are on the rise and plague low- and middle-income countries, especially urban areas.  Sixty-five percent of the people in the world live in countries (including all high-income and most middle-income countries) where overweight and obesity is responsible for more deaths than there are underweight people. With respect to children, almost 43 million of them under five years of age were overweight in 2010. Close to 35 million children who are overweight live in developing countries, while eight million live in developed countries (See World Health Organization, 2011).

In terms of some of their health consequences, the WHO (2011) reported that globally overweight and obesity are:

  • The fifth leading risk factor for global deaths
  • Responsible for 2.8 million adult deaths annually
  • Account for 44% of the diabetes burden, 23% of ischemic heart disease burden and between 7%-41% of certain cancer burdens

Since about the 1980s, a heightened and unprecedented sense of urgency has emerged worldwide among healthcare professionals and policymakers within and outside of government to learn more about what is known about the causes and consequences of and corrections for obesity and to take that knowledge to develop prevention programs and treatment protocols to take nations (including the United States) out of the obesegenic quagmire in which they finds themselves. The success of this effort is questionable because the worldwide prevalence of overweight and obesity continues to rise unabated, with very little success in reducing the burden of the obesegenic pandemic on developed and developing countries. So the questions remain, “Where do we go from here and how do we get there?” 

Where Do We Go From Here and How Do We Get There?

Clearly, the overweight and obesity epidemic is among the most serious health problems facing America in the 21st century and many other developed and developing countries around the world. It is a pandemic crisis. According to the World Health Organization (2009), there will be approximately 2.3 billion overweight adults and at least 400 million obese adults by 2015.

Public Health Approaches

Some believe that public health approaches to prevent overweight and obesity have been successful (e.g., Chan and Woo, 2010). However, given its prevalence, geographical scope and continued debilitating, chronic and life-threatening impact on the health of people in the United States (see Garko, 2010, October; Garko, 2010, November) and other developed and developing countries (see World Health Organization, 2011; World Health Organization, 2009) , there are those who do not hold this view (e.g., Swinburn, 2008).

Success and failure of public health approaches. On the one hand, in their review of the literature on the effectiveness of public health strategies to reduce the risk for and prevention of obesity, Chan and Woo (2010) identified studies in which success was achieved in risk reduction and obesity prevention by changing food, physical activity and socioeconomic environments, influencing eating and physical activity behaviors and supporting health services and clinical interventions. On the other hand, Swinburn (2008) believes public health approaches have not achieved any real measurable success in preventing people from becoming overweight or obese. According to him, “No country has managed to reduce the burden of obesity using public health approaches” (Swinburn, 2008, p.1). Both Chan and Woo (2010) and Swinburn (2008) are illustrative of whether or not public health approaches or strategies have been successful in preventing or otherwise reducing the burden of obesity.

So how can it be that there are studies to show that there are successful specific public health strategies to reduce the risk of and prevent obesity, while at the same time no compelling evidence to demonstrate a real reduction in the burden of obesity using public health approaches? These are not necessarily mutually exclusive issues. Both are true and their resolution causes them to be inextricably connected. The facts are there are individual public health strategies supported by research which have the potential to prevent obesity (see Chan and Woo, 2010) and there has not been much success in individual countries preventing obesity.

Changing unhealthy diets and physical inactivity. The important piece which has been missing is the widespread support, agreement and commitment relative to resources, policies, laws and regulations among government, the private sector, civil society and the general public to institute changes in diet and physical activity on an individual, group, organizational and societal level. Notwithstanding the fact the overweight and obesity are a multi-factorial problem involving any number of non-modifiable and modifiable risk factors (see Garko, 2011, February; Garko, 2011, March), unhealthy diets and physical inactivity account for a large portion of the variance in the emergence and unrelenting upsurge of obesity worldwide. Following the WHO, unhealthy diets and physical inactivity are … among the leading causes of the major non-communicable diseases and contributing in a major way to the global burden of disease, death and disability, generally, and overweight and obesity, specifically (World Health Organization 2004).

Changing dietary habits and patterns of physical activity will require a serious effort and  the involvement and combined efforts of many stakeholders, public and private, over several decades (World Health Organizations, 2004). Furthermore, according to the WHO, “[a] combination of sound and effective actions is needed at global, regional, national and local levels, with close monitoring and evaluation of their impact” (World Health Organization, 2004, p. 6) to create meaningful and lasting changes in diet and physical activity to prevent overweight and obesity.

References

 

Centers for Disease Control and Prevention (2011). Overweight and obesity statistics. Retrieved July 4, 2011, from http://win.niddk.nih.gov/statistics/.

 

Garko, M.G. (2010, October). Overweight and obesity in America – Part I: Prevalence and trends among adults. Health and Wellbeing Monthly. Retrieved July 4, 2011, from www.letstalknutrition.com.

Garko, M.G. (2011, March). Overweight and obesity in America – Part VI: Modifiable Risk Factors. Health and Wellbeing Monthly. Retrieved July 4, 2011, from www.letstalknutrition.com.

Garko, M.G. (2011, February). Overweight and obesity in America – Part V: Non-Modifiable Risk Factors. Health and Wellbeing Monthly. Retrieved July 4, 2011, from www.letstalknutrition.com.

Garko, M.G. (2010, November). Overweight and obesity epidemic in America – Part II: Prevalence and trends among children and adolescents. Health and Wellbeing Monthly. Retrieved July 4, 2011, from www.letstalknutrition.com.

International Union of Nutritional Sciences (2002). The global challenge of obesity and the international obesity task force. Retrieved July 4, 2011, from

http://www.iuns.org/features/obesity/obesity.htm.

Swinburn, B.A. (2008). Obesity prevention: The role of policies, laws and regulations. Australia and New Zealand Health Policy, 5(12), 1-7. Retrieved July 4, 2011, from http://www,anzhealthpolicy.com/contents/5/1/12

 

World Health Organization (2011). Obesity and overweight. Retrieved July 4, 2011, from http://www.who.int/mediacentre/factsheets/fs311/en/.

World Health Organization (2009). Unhealthy diets and physical inactivity. Retrieved July 4, 2011, from www.who.int/entity/nmh/publications/fact_sheet_diet_en.pdf

World Health Organization (2004). Global strategy on diet, physical activity and health. Retrieved July 4, 2011, from http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf

Suggested Citation: Garko, M.G. (2011, August). Overweight and obesity epidemic in America – Part XI:  Where have we been, where are we now, where do we go from here and how do we get there? Health and Wellbeing Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.

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