The following article provides excellent reasons why we have become obese as a nation. There are great graphics and videos about food and culture. The reasons reflect our current food supply that could lead us to some solutions that at least should be considered in order to curb the current trend.
Obesity is a major risk factor for the development of the most common form of diabetes mellitus, type 2, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system. It has now become a pandemic since it meets the definition: (of a disease) prevalent over a whole country or the world.
Globally: Source: Lancet
- Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
- Diabetes is fast becoming a major problem in low and middle-income countries.
- From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
- Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.
So what are some possible solutions for the future?
The standard American diet (SAD) is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .
Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half; In people over 60, the reduction was 70%.
Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why healthy foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high school levels by returning to a totally revamped and modernized home economics course in the curriculum. Involving students in their nutrition education is key.
A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.
Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program. If the medical community was more involved in increasing access to prevention programs or other options, more attention might be paid by individuals in seeking these treatments. In other words, people listen to their doctors.
There should be an increased number and access to professional treatments. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced.
We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.
Educate the public on food labeling, ingredient lists and marketing techniques. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling. For example they may include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.
Stop corporate-government partnerships and lobbying influences.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by a myriad of food companies including Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another annual fee. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may contain high levels of sodium. Researchers from the Harvard School of Public Health (HSPH) found that eating processed meat, such as bacon, sausage or processed deli meats, was associated with a 42% higher risk of heart disease and a 19% higher risk of type 2 diabetes. May 17, 2010
Bottom Line: It will take a concerted effort from government, politics, industry, communities, and other perpetrators of our obesigenic culture to begin to change this disturbing trend and prevention is the key. It may take decades; however, there has to be a beginning.
The most talked about topic concerning our obesity epidemic involves two major theoretical theories: the conventional theory of calories in -calories- out and the carbohydrate-insulin model. It is important for the population to have a basic understanding of these theories in order to deal with the obesity conundrum so prevalent in our current food environment. Determining which is predominant could help us to counteract the epidemic with the most effective dietary treatments. The following article provides us with a simplified understanding of both sides of the debate.
By Sally J. Feltner, PhD, RDN
In 2013, the American Medical Association House of Delegates approved a resolution classifying obesity as “a disease state with multiple pathophysiological aspects requiring a range of interventions.” We now accept the fact that obesity can lead to diabetes, heart disease, and cancer risks.
Today, 2.1 billion people – nearly 30% of the world’s population – are either obese or overweight, according to new data from 188 countries. The U.S. Centers for Disease Control and Prevention analysis said, “About 38 percent of U.S. adults aged 20 and older are obese as are more than 17 percent of children aged 6 to 11, federal data shows.”
“The global problem affects all countries, income levels, age groups and accounts for over 3-4 million deaths a year with estimated health costs of over $2 trillion a year.” (International Journal of Obesity).
There is no one cause. Many people still continue to blame the obese person’s lack of willpower and insist that if they just ate less and moved more, their weight would not be a problem. This may explain some cases of obesity, but how could more than 2 billion people worldwide begin to make poor choices about their food intake and allow themselves to become fat. Moreover, this upward trend earnestly began in the late 1980’s and has continued to the present. Obesity rates were just 13.4% in 1980 but reached 34.3% by 2008. So what happened to cause this sharp rise? – More than likely a lot of things.
In 2016, an article by Bruce Y. Lee, Associate Professor of International Health at Johns Hopkins Bloomberg School of Public Health succinctly describes his opinions on what factors changed to help create this epidemic. He states that obesity is a result of the breakdown of three major systems that include biological, social, and environmental factors.
Our metabolic systems have been affected to some extent by non-stop dieting. A plethora of fad diets and exercise gimmicks grew into a huge obesity industry. Diet books topped Amazon and best seller lists while the supplement industry went berserk over worthless and sometimes dangerous weight loss aids. Americans responded and when surveyed, a large majority of respondents said they were “on a diet.”
Even TV reality shows (The Biggest Loser) resulted in weight loss that lowered the metabolism of almost all participants gained back their hard-fought loss. As each weight loss attempt occurs, the cycle of weight loss/regain occurs over and over again. The body is threatened by a perceived starvation state and attempts to prevent it by putting forth metabolic and hormonal mechanisms to alleviate the threat. Obesity research has shown that nearly 95% of dieters regain their weight loss in a few years.
Social media, friends and family, cultural beliefs, TV advertising, and personal responsibility are all important in shaping our behaviors about eating, appearance, and body image.
Advertisements in the media have promoted the obesity epidemic by making claims that their products will magically transform your body into a svelte image and allow you to finally wear that bikini you bought years ago and that weight loss is easy. Most weight loss diets promise success by showing us before and after pictures of supposedly successful weight losers. What they do not say but disclaim in the small print that you usually can’t read is that results don’t always occur as presented. Most weight loss programs do not include an exercise component nor do they offer any behavioral counseling. Almost all have no disclosure about their success rates of weight loss and maintenance.
Determining what a healthy diet consists of is difficult enough – opinions abound and debates continue. This results in confusion and misinformation for the average consumer. They tend to give up on just what exactly is the best way to eat.
So many individuals are exposed to reliance on cheap foods found in the fast food industry. They may live in food deserts defined as parts of the country usually found in impoverished areas devoid of easy access to fresh fruit, vegetables, and other healthful whole foods. This is largely due to a lack of grocery stores, farmers’ markets, and other healthy food choices.
The food industry has been instrumental in developing ultra-processed foods that hardly resemble “real” foods. Snacking has become a national pastime and is dominating several of the inner aisles of the supermarkets. Snacks are abundant in every gas station, convenient store, or vending machine that tempt you to increase their profits.
Additionally, the food industry promotes the intake of sugar, fat and salt by attempting to reach what they call “the bliss point,” defined by the precise amount of sweetness that makes food and drink most enjoyable. You can find the results in the sugary cereals and sweetened beverage aisles in the supermarkets.
People do not cook anymore leading to procuring your meals outside the home. Restaurant portions have become gigantic compared to what they were in past decades. For example, a typical serving of theater popcorn was 270 calories (5 cups) in 1970 compared to now that is typically 630 calories (one tub). Some restaurant meals contain as many calories as we need in an entire day. The average U.S. intake increased 455 kcal/day, a 20% increase from 1970 to 2009. (Dr. Stephen Guyenet, The American Diet, 2012). From research studies we have found that the more food that is put in front of people, the more they eat. We now are familiar with the term “supersize” and the concept of “all you can eat buffets.”
The complexities of the obesity epidemic/pandemic are impossible to fully comprehend as well as their need to be “fixed” to reverse or at least slow down the trend. There are some solutions to accomplish this but they will require much cooperation between politics, community, medicine, research, government, and the public.
If America’s obesity trend continues at its current pace, all 50 states could have obesity rates above 44 percent by 2030, according to a new report from Trust for America’s Health and the Robert Wood Johnson Foundation. Although important, we need to stop just focusing on what we eat, but equally important on how we eat to fix what contributed to the epidemic in the first place.
It is becoming more apparent that the global obesity epidemic is due to many complex interactions between our genetic makeup, physiology and environmental factors such as availability of cheap food, an abundant food supply and the types of foods we eat. This interaction is referred to as epigenetics and discussed in a previous post HERE.
Two very thoughtful discourses on the causes, attitudes, treatment and prevention of obesity. As we know more about the complexities of obesity, some still seem to want to treat it with a simple solution: Eat Less, Move More. This approach does not seem to working very well and only appears to add to the bias against the obese patient.