Is obesity an epidemic? Is it even a disease? Semantics aside, it’s huge and growing burden.
I’m writing this in an airport, and a couple of hours ago as a line of passengers filed past me in the airplane aisle, I noticed, as I often do, that some of them were not just overweight—many are that—but obese. I remembered from yesterday’s news that some airlines are considering charging such people for two seats. It seems unfair, and yet…
Believe me, I understand the downside of talking about this. I understand that chubby children hurt inside, and they need to accept themselves. I once was a chubby child, and the humiliation of following my mother into the “husky” section of the boys’ clothing store, not to mention having the nickname “baby fat” in the Boy Scouts, stays with me, even in the body that has been fairly thin (with the exception of one decade) from age 16 to 62.
I understand about body image, about self-acceptance, about the (modest) risks of yo-yo dieting, about much greater risks of anorexia and bulimia. I understand that diets usually work but are almost always reversed, by a rebound that overshoots the original level of excess weight. I understand that mental health matters too. I understand all that, and more, but I still have to say what I think about the rapidly worsening problem of obesity.
According to the Centers for Disease Control, 30 percent of children ages 6 to 19 and more than 60 percent of adults in the U.S. are overweight, with overweight being defined as a Body Mass Index of 25 or higher. Fifteen percent of children have a BMI over 30, as do about a third of adults; although the CDC refrains from using the term, this is widely considered the definition of obesity. These percentages have doubled since the late 1970s, and they continue to increase year after year.
BMI is not an ideal measure, since short, muscular people like weight lifters and wrestlers meet the criteria for overweight and obesity but are solid muscle. Ideally, we should measure body fat, and use the cutoff of 25 percent for men and 30 percent for women—women normally have more body fat—as the defining characteristic of obesity.
But we know that our population is not becoming more muscular, and in the absence of more accurate measurements, BMI is an acceptable proxy. It’s your weight in kilograms divided by the square of your height in meters; or, your weight in pounds divided by the square of your height in inches, all multiplied by 703. Alternatively, use one of the many charts available online.
No one doubts that the increase is real. In fact, it is not just an American problem but a worldwide one, although we are out ahead of most countries. The health authorities in France, for example, have acknowledged it and have said in effect: We must not continue down the path taken by the Americans. Paradoxically and sadly, starvation and rising obesity coexist in most countries in the developing world, probably because as soon as the level of poverty rises above that of the starving, low food quality and lingering food anxiety lead to obesity.
Is it really a disease? I don’t care. Is it something very bad? Beyond a shadow of a doubt.
The most direct consequence for health is type 2 diabetes, which is largely caused by overweight and which relentlessly and reliably increases wherever people are becoming fatter. (The connection is close enough that someone coined the word “Diabesity.”) Diabetes is the disease of the future, and its consequences include heart disease, blindness, kidney failure, and nerve damage leading to infections and amputations.
Type 2 diabetes used to be called “adult onset” but now it rivals “childhood-onset” (type 1) diabetes in many pediatric clinics. The steadily growing numbers of diabetic children are condemned to lifelong chronic illness. Only a little more controversially, high levels of body fat have been shown to lead to hypertension, some cancers, joint diseases, and heart disease and stroke independent of the effect on diabetes.
A few years ago, the CDC said that 400,000 excess deaths are caused by overweight in the U.S. each year. This number was challenged, and reduced several times due to methodological considerations. It now stands at 140,000, and vocal opponents of the notion of an obesity epidemic consider this revision a triumph for their viewpoint.
Whew. What a relief. Only 140,000. Only ten times the number of deaths from AIDS.
And rising. Is it an epidemic? I don’t care. It depends on your definition of epidemic. There are two: an infectious disease spreading rapidly through a population; or, a disease that now occurs at much higher rates than expected in the past. Neither obesity nor diabetes meets the first criterion, but diabetes at least certainly meets the second.
More importantly, you can graph the proportion of people at given BMIs from 17 up as far as you like, draw a vertical line anywhere, and you will find more Americans to the right of the line every year. Put whatever label on it you please, it’s an incontrovertible fact with ominous implications for our future.
(In the future I’ll explain why this problem exists, and say more about my own so far successful struggle.)