Why You Should Care About the Obesity Epidemic – Even if You’re Not Obese

Unless you’ve been living under a rock the last 20 years or so, you know that the United States is in the midst of an obesity epidemic. If you HAVE been living under a rock, as you venture out into your new world, you may have noticed that we’re a little bigger than we used to be. Also, why were you living under a rock? Remember to wear sunscreen – you are super pale.

Now that we’re all on the same page. . .

You may be thinking to yourself, “I’m not obese. I’m not even overweight. Why should I care about someone else’s health?” Some people also have the attitude that obese/overweight people got themselves into that mess, so it should be up to them to get out of it, just stop eating, get up off the couch, etc. I’m here to give you some reasons why EVERYONE should care about obesity.

First: Some Background

Prevalence of Self-Reported Obesity Among U.S. Aduts BRFSS, 2011More than one-third of U.S. adults are obese, and almost 17% of kids and adolescents are as well (Ogden, et al, 2012). To put that in perspective, that’s about 78 million adults!  That’s about the entire population of Texas, California, and New York combined. The growth of obesity in the U.S. over the past 20 years is simply staggering.

Obesity is a very complex disease. There are multiple components to consider: environment, genetics, diseases, prescription drugs, etc. It is very unwise and foolish to assume that an obese person is obese simply because of something completely under their control, such as eating too much or exercising too little. I could write an entire dissertation (and many have been written) about the link between a person’s environment and obesity. Many components of obesity exist, and coupled with the fact that food intake is essential to living, obesity a very complicated disease indeed.

Let’s Talk About Fat, Baby

Before we get to the physiological changes that happen in the human body because of obesity, let’s talk about fat. Fat is essential to the human body–fat is needed. We couldn’t function without it. We use fat, or lipids, for:

  • Cell membranes
  • A source of energy (more on that later)
  • An insulator
  • Many other important functions

Where we run into problems with obesity is excess fat that is stored in fat cells in our body. This stored fat is basically energy that has not been used. Unfortunately, the human body does not rid itself of excess fat that easily.

Because of our baby-havin’ organs and hormones, women generally have a higher body fat percentage than men. We also tend to store our fat around our hips and waist in a “pear” shape. Men tend to store their fat in their abdomen, which is generally referred to as an “apple” shape.

So if fat is essential, why is too much a bad thing?

Storage Wars

Have you ever seen the A&E show Hoarders? Admit it–you have. Well, the human body sort of “hoards” that excess fat. Our bodies are designed to hang on to that fat, which is a result from thousands of years of our ancestors’ diets and the infrequency of meals. Now that food, especially high-caloric  meals, are abundant here in the United States, our caloric intake has increased while our physical activity has decreased. But what, exactly, does too much fat do the human body?

The short answer is it increases our risk for heart disease, diabetes, high blood pressure, stroke, and numerous other diseases with negative health consequences. The long answer is a little more complicated.

The Long Answer I Just Talked About

Let’s talk about the co-morbidities (diseases that “piggyback” onto obesity) I just referenced, starting with heart disease.

Heart disease

Heart disease, along with stroke, is the leading cause of death and disability in the U.S. As BMI increases, so does your risk for heart disease. But you also have to look at fat distribution, which I referenced earlier (the apple and pear shapes). If you are someone who is “apple” shaped, you have a higher risk of developing heart disease than someone who is “pear” shaped. Fat that gathers around your heart is especially dangerous.

Obesity lowers your HDL cholesterol, which is the “good” cholesterol. It also raises your triglyceride levels.

(Martin, S.S. et al, 2008)

Adipocytes, or fat cells, act as an endocrine organ. Increased levels of leptin, a hormone that controls food intake and energy metabolism, is related with cardiovascular disease. C-reactive protein may also play a role in the development of leptin resistance. Increased concentration of leptin has been associated with an increased risk of major cardiovascular events.

Blood pressure

Obesity increases the total amount of blood in your body and the amount of blood your heart pumps, which means that your heart has to work harder. When your heart is ready to pump oxygenated blood to the rest of your body, your left ventricle is the part of your heart that does the heavy lifting, er, heavy pumping. Because of the increased amount of blood and all the hard work your heart is doing, an obese person has a greater chance of developing left ventricle hypertrophy, or muscle enlargement.

Because of the increase in insulin in the blood, which I will discuss in the next section, your blood vessels have thickened. This causes the blood vessels to be harder and less stretchy, which increases blood pressure.  The higher your blood pressure, the higher your risk for heart disease, stroke, and other cardiovascular events.

Diabetes

Basically, if a person gains weight and becomes physically inactive, that person’s beta cells (which are located in the pancreas and store/release insulin) give an inadequate response to the weight gain and inactivity. Obesity causes your body to secret high levels of insulin in order to try and decrease the excess sugar concentration in the blood.

Stroke

Being obese can cause an increased risk of blood vessel blockages and blood flow issues, some of which were discussed earlier. This strain on the circulatory system, along with diabetes, increases a person’s risk of having a stroke.

We’ve talked about the physical changes that obesity can cause. Now let’s talk about how obesity affects every single American.

We’re All In This Together

Some people see obesity as an individual issue. “Why should I care about other people’s health status? How does this affect me?” As you’ll see, it affects all of us, even if you are not obese.

Here are just a few of the ways obesity affects ALL Americans:

  • Billions of dollars in annual health care costs
  • Billions of dollars in lost productivity
  • Increases in workplace absenteeism

I should also talk a little bit about the health care costs associated with Medicare and obesity. About 35% of adults 65 and older were obese from 2007-2010, which is about 8 million adults. That number has grown linearly since this type of data has been kept. If you think about the health issues that accompany growing older, think of how complicated and costly it get when you throw obesity into the mix as well. Also, when someone who is eligible for Medicare and is obese enters the Medicare system, the health care costs are immediate and are higher than someone who enters the Medicare system who is not obese. Because of this, Medicare has a much greater financial incentive to prevent obesity than the private sector (Finkelstein et al, 2008). If we can prevent obesity before someone is eligible for Medicare, the health care savings would be substantial.

Conclusion

As you can see, obesity affects us all, either through health insurance costs, health care system burden, and through loss of economic production. What is the solution? Well, it’s complicated. Stay tuned for an upcoming blog post about possible solutions and what our public health system is doing about this burgeoning* problem.

*Tee hee. See what I did there?

References

Finkelstein, E.A., Trogdon, J.G., Brown, D.S., Allaire, B.T., Dellea, P.S., and Kamal-Bahl, S.J. The Lifetime Medical Cost Burden of Overweight and Obesity: Implications for Obesity Prevention. Obesity, V16 I8 2008, p 1843-1848

Martin, S.S., Qasim A., Reilly M.P. Leptin resistance, J Am Coll Cardiol 52 2008,  1201-1210

Ogden, C.L., Carroll, M.D., Kit, B.K, Flegal, K.M. Prevalence of Obesity in the United States, 2009-2010  NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics. 2012.

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