Obesity is a growing public
health concern. Multiple studies have evaluated not only adverse health effects
caused by obesity but also direct and indirect medical cost associated with it.
In a ten-year period (1999-2010) one in three Americans were categorized as obese. The classification used to define (and grade)
obesity may vary between experts. The WHO (World Health Organization) uses a
1-3 grading system based on BMI (body mas index) whereas some experts define
obesity based on the percentage of body fat generally (greater than 25%). However
it is defined it is a health risk that is associated with - and can lead to - other
medical conditions form asthma to varicose veins, but is of particular
importance when the heart, brain or endocrine/metabolic systems are involved - more
on this later. Lifestyle modification is the first course of action and the
foundation of the treatment of obesity. The major components of the
modification (diet, exercise, and behavior therapy) have been documented to
significantly reduce weight and reduce the risk of developing diabetes (a major
complication linked to obesity). In one study the effects of weight loss and the
attendant glucose control lowered cardiovascular (heart) risk following the
modification and the benefits were still evident four years later 1.
It is little wonder that public health
experts spend so much effort trying to create public policy – requiring
disclosure of calorie counts in foods, and size limits of sugar containing
drinks - that will stem the tide of obesity. But should food and drink consumption be dictated by healthcare policy decisions?
This is a matter of public debate for policy and public health experts, but in
my opinion prudent restraints limiting excessive consumption can’t hurt. After
all you can be refused alcohol if you are visibly intoxicated.
Practically speaking life
style modification is much easier to advocate that to actually accomplish. Factors
including poverty, education, and socioeconomic status have been linked to
obesity. Although the research is not conclusive in this area, there is a
relationship between family income, food insecurity and obesity. And in certain
populations there is a direct link between poverty and obesity in children and
adolescents2. Is there really
a link between poverty, food insecurity and obesity? Food security is the
availability of safe, consumable, and sufficient food. Food insecurity is the
opposite where the possibility of hunger and even starvation may exist. The
recent financial crisis of 2008 resulted in a rise in food insecurity in the
U.S. One report sites up to 14.5% of households as food insecure in 2012 (four
years after the crisis) with households of single parents, and Black and
Hispanic households being higher than the general population 3. In poorer
neighborhoods it is easier to satisfy a calorie requirement with readily
available fast food that are cheap and maybe available 24/7 than higher nutritional
foods such as fruits, vegetables, and high value proteins, which may be in
short supply, and at a premium. Persons that derive their calories form high
calorie low nutritional value meals not only suffer the effects of the poor
nutrition but are also at risk for obesity. And the wonderful produce that comes
to the local farmers market once or twice a week is often not found in inner
city and if it is the cost of those foods may be prohibitive to poorer
populations. So the high calorie fast food though satisfying and relative
inexpensive is more the food of necessity and less of choice. These are
sociopolitical issues that go far beyond the scope of this post. These and
other questions both social scientist and medical scientist will have to work
through. For now public healthcare advocates will continue to advise on prudent
management of the modifiable risk (calorie consumption and exercise). We must
watch what we eat (within financial means) and we must also promote exercise
and healthy activities i.e. Get Active work out, popularized by the First Lady and
the NFL Play 60 that will help burn the calories. Hopefully the socioeconomic
issues will be addresses by our lawmakers in a judicious and equitable manner.
1- Circulation. 2012
March 6; 125(9): 1157–1170
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