The obesity epidemic in America: Costly in food and lives
The obesity epidemic is a global catastrophe attacking the world in slow motion — moving fast enough to wreak havoc on health, but not rapidly enough for people to always recognize its devastating effects.
America — and the rest of the world — is getting heavier every year. Experts say food addiction is this generation’s tobacco addiction, with the same harmful results.
In the United States, nearly 2 in 5 adults are now considered obese, and 1 in 11 have severe obesity, according to the National Health and Nutrition Examination Survey. The number of individuals who qualify as overweight is harder to calculate.
The World Obesity Organization estimates that by 2035, more than 4 billion people — over half of the world’s population — will be overweight or obese, using a body mass index calculator.
The growing obesity epidemic raises some important questions in the U.S. and abroad, like should the federal government change its food and tax policy to make unhealthy food less accessible? And how does shame about weight play into a person’s decisions about nutrition?
There is clear evidence about what factors are driving the epidemic, including a person’s environment, whether they have affordable access to healthy foods, poor gut health and the too-slow pace of progress of prevention efforts, among other factors.
Calculating weight
Body mass index, or BMI, is determined using a somewhat complicated calculation using a person’s height and weight. Online calculators exist to help people determine their BMI.
If the BMI calculation is below 18.5, the person is considered underweight. The number considered a healthy weight is between 18.5 and 24.9, while the calculation above 25 is considered overweight. Anything 30 or above indicates obesity.
Excess weight has been linked to heart disease, sleep apnea, certain cancers, Type 2 diabetes, hypertension and a higher risk of stroke.
Food environment
As of March 2022, the World Health Organization reported that “more than 1 billion people worldwide are obese — 650 million adults, 340 million adolescents and 39 million children.”
The change has been fast: The World Health Organization separately said that in just the five years between 1995 and 2000 the number of obese adults worldwide increased by 100 million, to 300 million.
Dr. Tom Rifai, founder of health consulting company Reality Meets Science, told the Deseret News that the environment you live in is “arguably the strongest factor” in influencing your food choices. He describes himself as a “flexitarian” lifestyle medicine expert. A flexitarian diet is flexible, but emphasizes plant-based foods and beverages. His Flex5 Lifestyle based eating pattern emphasizes minimally processed plant-predominant foods.
The European Public Health Alliance said one’s food environment includes the physical, economic, political and sociocultural context of the area where a person buys and eats food.
An “obesogenic” environment — one that promotes weight gain — is one with a lot of fast food restaurants and that encourages people to use their car over walking, according to the Obesity Evidence Hub.
Rifai said part of the problem in the obesity and overall health epidemic is the lack of access to healthy foods, while it’s easier to access foods that are calorie-rich, refined and highly processed — which he calls CRRAHP foods, a trademarked acronym.
Processed foods dominate most Americans’ plates, especially within the last 20 years.
A study by Northeastern University’s Network Science Institute found that 73% of the food supply in the United States is considered “ultra-processed.” These foods are cheaper, full of additives and are linked to diseases such as obesity, metabolic syndrome, heart disease and sleep apnea.
A senior research scientist involved in the study, Giulia Menichetti, said the results shocked her and her staff.
“It surprised me how a considerable amount of highly processed food is mistakenly considered healthy because the public narrative still focuses on one nutrient at a time, instead of evaluating food as a whole,” she said.
Menichetti and her team are among researchers working to inform people about America’s food industry and the lack of guidelines on healthy eating.
Affordable food
The Supplemental Nutrition Assistance Program, or SNAP, is the U.S.’s biggest food and nutrition assistance program, and is managed by the U.S. Department of Agriculture. SNAP provides a monthly benefit to eligible households to buy food, the amount based on a family’s income and family size.
As of 2019, 38 million people were enrolled in the program, which is about 12% of the country’s population.
Although the program’s goal is to combat food insecurity with nutritious food, it does not necessarily contribute to good nutrition.
Angela Rachidi, a senior fellow and the Rowe scholar in poverty studies at the American Enterprise Institute, said she respects the argument that people of all income levels should have the autonomy to purchase whatever food they want. But since SNAP (formerly food stamps) is a tax-funded program, she believes food purchased with the benefit should have nutrition standards to encourage people enrolled in the program to have healthier eating habits.
She also believes that federal food programs need to challenge the food industry by promoting healthy food. “There needs to be a counterweight to this intense marketing around food and what is healthy and what is not healthy,” she said. “So if you have a niche, your largest nutrition assistance program is funding all of these purchases of foods that are not nutritious. That sends a very clear message suggesting that these foods are okay.”
Rachidi cited statistics from the 2016 Department of Agriculture report in an article she wrote for the institute: “SNAP households spend almost 25% of their food budgets on sweetened beverages, frozen prepared foods and prepared desserts alone.”
Diet culture and body image
In 2022, close to half of Americans’ New Year's resolutions were fitness-related and 40% were weight-loss goals, according to reporting by NPR. The U.S. spends an estimated $30 billion on the health and diet industry every year.
Body image researcher Nadia Craddock told NPR that diet culture is a group of social expectations “telling us that there’s one way to be and one way to look and one way to eat and that we are a better person, we’re a more worthy person if our bodies are a certain way.”
Michelle Lewis, a Salt Lake City weight counselor and licensed clinical social worker, said there is correlation between increasing obesity and diet culture — a pattern in history that when diet culture is popular, obesity numbers rise.
The reason, she said, is that unhealthy habits are promoted by diet culture. People will either lose weight unhealthily or ignore their weight in defiance, creating two extremes.
“When we feel bad about ourselves and our bodies, shame is a huge contributor to emotional eating. If you have decided not to eat something like sugar, but then do, you beat yourself up and feel shame. This is a big trigger for eating more to avoid feeling the shame,” Lewis said.
The shame that comes with weight stigma may mire a person in an endless cycle of weight loss and gain. Stigmas hinder progress for those who are overweight or obese and fail to address real solutions that can help people maintain a healthy weight, she said.
One of Sweden’s leading obesity researchers, Erik Hemmingsson, told the Deseret News, “Personally, I don’t think we will ever find solutions for the obesity epidemic until we get rid of obesity stigma. ... We need to find a balance in promoting a healthy body weight, but not at the expense of people’s relations with their bodies or other aspects of their mental health.”
Gender differences
Diet culture disproportionately affects women compared to men, starting at younger ages.
Larry Tucker, a professor of exercise science at Brigham Young University, said a big factor for weight gain in young women is childbirth. “Pregnancy usually carries with it weight gain — significant weight gain — and it takes an awful lot of effort to regain a lean body after,” he said.
A study of almost 14,000 randomly selected U.S. adults conducted by Tucker and Kayla Parker found that “women gained around twice as much as men over 10 years, on average 12 pounds for women and six for men. Including race in the analysis found that Black women had the greatest average weight gain over the 10-year study period, averaging 19.4 pounds. Conversely, Asian men experienced the least weight gain, at 2.9 pounds.”
“One of the best strategies to achieve a healthy weight is to focus on eating low-energy-dense foods, like fruits and nonstarchy vegetables,” Tucker said. “Foods, such as whole grains, with lots of fiber, are also good choices. Because most adults do not like the taste of non-starchy vegetables as much as sweet or high-fat foods, they should eat their vegetables first as a pre-load, which will help them feel full and consume fewer calories.”
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Gut health
Research has shown that people who immigrate to the U.S. often struggle with health issues related to weight gain.
Our stomachs contain about 300 trillion different microbes, which are bacteria designed to carry out proper functions and contribute to overall health. In a TED Talk on gut health, Dan Knight, who runs the Knights Lab at University of Minnesota, said his research found immigrants and refugees who reach the U.S. with healthy metabolic gut health quickly become at risk for obesity and other diseases due to processed foods in American diets.
“What we found is that when people come to the USA from these groups, they lose a large fraction of their microbiome, somewhere around 20%, and those who come to the USA and become obese lose about a third of their microbes. ... So we know that moving to the USA is sufficient to cause a dramatic change in your microbiome, probably not for the better,” he said.
According to the Centers for Disease Control and Prevention, certain minority communities have significantly higher obesity prevalence.
The CDC website lists the number of states with obesity rates higher than 35% among different races:
10 states had an obesity prevalence of 35% or higher among white adults.
27 states had an obesity prevalence of 35% or higher among Hispanic adults.
31 states for American Indian or Alaska Native adults.
36 states and the District of Columbia for Black adults.
“Racial and ethnic disparities in obesity underscore the need to address social determinants of health such as poverty, education, housing, health care access and to remove barriers to health,” per the CDC.
Social adversity, according to the National Institutes of Health, is an umbrella term that describes negative living situations like poverty, violent crime and poor parenting.
Hemmingsson was the lead author of an Obesity Reviews article that showed a correlation between social adversities, genetic makeup and obesity. He told the Deseret News by email, “There is no one magic bullet for stopping obesity. It will require multiple and prolonged changes to our societies to have any lasting impact. One of the major changes will need to be the promotion of greater socioeconomic equality (for example by helping families living in deprived areas) and some type of regulation of cheap ‘junk’ calories.”
Prevention efforts
A study in the National Library of Medicine found that “physicians with greater knowledge in obesity management were more likely to treat patients with weight-loss medications or bariatric surgery,” which is surgery on your digestive system to promote weight loss.
“Bariatric surgery remains the most durable option for people to lose weight and keep it off, particularly if someone has a significant amount of weight to lose or certain medical conditions. However, weight-loss surgery is not magic,” Elizabeth Hanna, a doctor of nursing practice and advanced practice registered nurse at St. Mark’s Weight Treatment Center, told the Deseret News.
A news release earlier this year by the American Academy of Pediatrics recommends health care providers’ treatment for teens with obesity include, “nutrition support, physical activity treatment, behavioral therapy, pharmacotherapy and metabolic and bariatric surgery.”
Hanna said maintaining a healthy lifestyle after surgery is challenging in an environment full of hyper-palatable foods.
Rifai said by “incentivizing and subsidizing healthier foods” to the public, the government can help reduce obesity numbers.
Peter Lurie, president of the Center for Science in the Public Interest, said in an interview with the Deseret News that the Washington, D.C.-based center pays special attention to helping design healthier food environments, especially for children.
Engineering retail spaces to place healthier food items in the open with high visibility, along with pushing restaurants to offer healthier food and beverage options for children, are two efforts in which Lurie’s team has made progress.
A study in the National Library of Medicine said that 52% of 448 women surveyed felt that their weight prevented them from getting appropriate health care, due to discrimination. To lower this percentage, the study said health care providers should try to communicate in a respectful and compassionate manner the seriousness of the disease to their patients who struggle with obesity. People who suffered from internalized weight stigma struggled more with binge eating and were much less likely to diet.
Lewis said addressing trauma is an important factor in tackling obesity.
“The biggest takeaway I hope your readers have is that weight and eating are so intrinsically tied to our emotional health that behavior is difficult, if not impossible to change without addressing the underlying emotional components that created their relationship with food or body.”
