A public health emergency is shortening our lives and supersizing our health-care costs. Here’s everything you need to know:
How serious is the crisis?
Americans are collectively gaining weight at an alarming rate, with the average adult weighing about 15 pounds more than 20 years ago. In defining obesity, nutritionists focus on body mass index: A healthy person has a BMI of 18.5 to 24, while an obese person has a BMI above 30. Today, about 40 percent of U.S. adults and nearly 20 percent of children are obese, a surge reflected worldwide, with more people now overweight or obese (1.9 billion) than underfed (800 million). In 1985, no state in the U.S. had an obesity rate above 15 percent; now every state’s is higher than 20. Excess weight is a major factor driving runaway medical costs. Obesity-related diabetes alone “will break the bank of our health-care system,” said University of Colorado nutrition expert James Hill. “Obesity may be the toughest social issue that we have ever faced.”
What’s making us fat?
Simple: eating too much and exercising too little. Despite constant debate over which dietary villain to blame — fat, carbs, sodium, sugar — obesity is primarily a problem of calorie intake. The average adult is eating about 300 more calories per day than in the 1970s. In 2015, for the first time, Americans spent more money eating away from home than they did on groceries, and research indicates people eat 20 to 40 percent more calories at restaurants, where portion sizes have quadrupled since the 1950s, according to the Centers for Disease Control. American calories are also largely “empty” ones — highly processed foods such as chips, white bread, and sugary cereals account for almost 60 percent of U.S. calorie consumption. Those foods, plus artificial sweeteners, may disrupt nerve signals between the gut and the brain, causing us to keep eating long after we’ve had enough. As Yale University neuroscientist Dana Small explains, it’s as if “the brain doesn’t really know the food is even there.”
Who’s most at risk?
Children, and it’s getting worse. “Addressing childhood obesity is like playing whack-a-mole,” said Harvard nutritionist Erica Kenney. Kids are spending more and more time indoors looking at screens, where they’re bombarded with advertisements for unhealthy foods. Black children see twice as many soda and candy ads as white kids do, which is just one reason why childhood obesity is racially skewed: A 2017 study showed that about 26 percent of Hispanic youth and 22 percent of black youth were obese, compared with 14 percent for white youth and 11 percent for Asian youth. Children are gaining weight faster than adults, with the obesity rate for U.S. kids ages 5 to 9 projected to hit 26 percent by 2030.
What’s wrong with weight gain?
Having a high BMI doesn’t necessarily mean a person is unhealthy. Still, the correlations are strong: As obesity surged over the past three decades, U.S. diabetes rates tripled, and now more than 100 million adults have diabetes or pre-diabetes. Research suggests that obese people are between 1.5 and 2 times more likely to die of heart disease. Other illnesses linked to obesity include high blood pressure, arthritis, Alzheimer’s disease, gallbladder disease, sleep apnea, sexual dysfunction, and at least 13 types of cancer. Excess body fat is associated with higher insulin levels, which may spur cell growth and, in turn, increase the probability of cancer; the American Cancer Society believes excess weight is linked to about 7 percent of cancer deaths, and obesity will soon overtake smoking as the top preventable cause of cancer.
How does it affect health-care costs?
Obesity adds between $147 billion and $210 billion to annual U.S. health-care expenses, increasing an average adult’s medical costs by 42 percent — an estimated $200,000 over a lifetime. This burden hits low-income households hardest, creating a vicious cycle of poverty leading to poor dietary habits leading to costly weight-related illness. Expenses range from basics like insulin, which is used to treat diabetes and costs up to $900 a month, to the increased need for expensive interventions such as heart surgery. Medicaid now covers bariatric surgery, because doctors believe a roughly $25,000 stomach-shrinking procedure is cheaper than a lifetime of chronic-disease treatments.