Weight Management Health Article

Demographics and statistics

Obesity has become a major public health concern in the United States in the last decade. As of 2003, obesity ranks second only to smoking as a major cause of preventable deaths. It is estimated that 300,000 people die in the United States each year from weight-related causes. The proportion of overweight adults in the general population has continued to rise since the 1960s. About 34% of American adults, or 58 million people, are overweight, compared with 25% in 1980. In addition, there has been a 42% increase in the rate of childhood obesity since 1980.

The prevalence of obesity in the United States varies somewhat according to sex, age, race, and socioeconomic status. Among adults, 35% of women are considered obese, compared to 31% of men. The rate of obesity increases as people get older; those aged 55 or older are more than twice as likely to be obese as those in their twenties. African American men have the same rate of obesity as Caucasian men; however, African American women are almost twice as likely as Caucasian women to be obese by the time they reach middle age. The same ratio holds true for socioeconomic status; people in the lowest third of the income and educational level distribution are twice as likely to be obese as those with more education and higher income.

From the economic standpoint, obesity costs the United States over $100 billion each year. This amount includes the direct costs of hospital care and medical services, which come to $45.8 billion annually, or 6.8% of all health care costs. Another $18.9 billion represents the indirect costs of obesity, such as disabilities related to overweight or work days lost to obesity-related illnesses.

Obesity is considered responsible for:

• 88–97% of cases of type 2 diabetes
• 57–70% of cases of coronary heart disease
• 70% of gallstone attacks
• 35% of cases of hypertension
• 11% of breast cancers
• 10% of colon cancers

In addition, obesity intensifies the pain of osteoarthritis and gout; increases the risk of complications in pregnancy and childbirth; contributes to depression and other mental disorders; and makes a person a poor candidate for surgery. Many surgeons refuse to operate on patients who weigh more than 300 lb (136 kg).

Although fewer people suffer from eating disorders than from obesity, the National Institutes of Mental Health (NIMH) reports that 10 million adults in the United States meet the diagnostic criteria for anorexia or bulimia. Although eating disorders are stereotyped as affecting only adolescent or college-aged women, as of 2003 at least 10% of people with eating disorders are males—and the proportion of males to females is rising. Moreover, the number of women over 45 years of age who are diagnosed with eating disorders is also rising; many doctors attribute this startling new trend to fear of aging, as well as fear of obesity.

The long-term health consequences of eating disorders include gum disease and loss of teeth, irregular heart rhythm, disturbances in the chemical balance of the blood, and damage to the digestive tract. At least 50,000 people die each year in the United States as the direct result of an eating disorder; anorexia is the leading cause of death in women between the ages of 17 and 25.

Description

To understand the goals and structure of nutritionally sound weight management programs, it is helpful to look first as the causes of being overweight, obesity, and eating disorders.

Causes of nutrition-related disorders

GENETIC/BIOLOGIC. Studies of twins separated at birth and research with genetically altered mice have shown that there is a genetic component to obesity. Some researchers think that there are also genetic factors involved in eating disorders.

LIFESTYLE-RELATED. The ready availability of relatively inexpensive, but high-caloric snacks and "junk food" is considered to contribute to the high rates of obesity in developed countries. In addition, the fast pace of modern life encourages people to select quick-cooking processed foods that are high in calories, rather than making meals that are more healthful but take longer to prepare. Lastly, changes in technology and transportation patterns mean that people today do not do as much walking or hard physical labor as earlier generations did. This sedentary, or inactive lifestyle makes it easier for people to gain weight.

SOCIOCULTURAL. In recent years, many researchers have examined the role of advertising and the mass media in encouraging unhealthy eating patterns. On the one hand, advertisements for such items as fast food, soft drinks, and ice cream, often convey the message that food can be used to relieve stress, reward, or comfort oneself, or substitute for a fulfilling human relationship. On the other hand, the media also portray unrealistic images of human physical perfection. Their emphasis on slenderness as essential to beauty, particularly in women, is often cited as a major factor in the increase of eating disorders over the past three decades.

Another sociocultural factor that contributes to obesity among some Hispanic and Asian groups is the belief that children are not healthy unless they look plump. Overfeeding in infancy and early childhood, unfortunately, makes weight management in adolescence and adult life much more difficult.

MEDICATIONS. Recent research has found that a number of prescription medications can contribute to weight gain. These drugs include steroid hormones, antidepressants, benzodiazepine tranquilizers, lithium, and antipsychotic medications.