An epidemic threatens the health of American children, and yet we've heard little about it. The prevalence of this medical condition has more than doubled among adolescents and nearly quadrupled among children ages six to 11 in the last 30 years, placing children at risk for a lifetime of chronic health problems. If an infectious disease spread at this rate, the headlines and sound bites would fill the news. What is this insidious health risk?
Poundage. Excess avoirdupois. In a word, obesity.
"Today we see a nation of young people seriously at risk of starting out obese and dooming themselves to the difficult task of overcoming a tough illness," said U.S. Surgeon General David Satcher in 1998 at the Conference on Childhood Obesity sponsored by the U.S. Department of Agriculture. In response to the trend, Satcher produced a report in 2001 called The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity.
The problem of obesity in America is not limited to children, of course. The Surgeon General's 2001 report estimated that 61 percent of American adults were either overweight or obese in 1999, while 13 percent of children and adolescents were overweight. Nearly 300,000 Americans die each year as a result of conditions associated with overweight and obesity. Rates of obesity-related chronic diseases such as diabetes, heart disease and asthma are on the rise and affect Americans at younger ages than ever before. And while Americans are getting bigger across all demographic groups, those with a lower family income are affected disproportionately.
Locally, the prevalence of obesity has risen, although our rates come in slightly below the national average. "The CDC states that about 14 percent of children two to six years old [nationally] are at risk for overweight and obesity," says Michelle Hagan, a registered dietitian with the Spokane Regional Health District who works with families in the WIC (Women, Infants and Children) program. "Our rate is now about 11.5 or 12 percent, so we're lower than the national average, but our rates are increasing."
According to the Health District's most recent Spokane Counts report, young people locally are more physically active than their counterparts in other parts of the country, Hagan says. "We're doing a bit better than the rest of the country, but I feel it's still an important health issue."
Why are Americans -- both adults and children -- getting fatter? The simplistic answer is that we're eating more calories than we're burning. But why have the obesity rates risen so rapidly in the last two decades after remaining nearly steady for so long? In his recent book Fat Land: How Americans Became the Fattest People in the World, journalist Greg Critser documents a perfect storm of cheap commodities, marketing savvy, overscheduled families and decreased physical activity. The combination of these factors leads Americans to tip the scales, Critser argues.
In the Oct. 12, 2003, issue of the New York Times Magazine, writer Michael Pollan (author of The Botany of Desire) echoes Critser's indictment of agricultural policies and agribusiness, starting with Richard Nixon's infamous secretary of agriculture, Earl Butz. According to Pollan, Butz "set about dismantling 40 years of farm policy designed to prevent overproduction," resulting in steadily declining prices for farm commodities like corn.
"Cheap corn, transformed into high-fructose corn syrup, is what allowed Coca-Cola to move from the svelte eight-ounce bottle of soda ubiquitous in the '70s to the chubby 20-ounce bottle of today," Pollan writes. "Cheap corn, transformed into cheap beef, is what allowed McDonald's to supersize its burgers and still sell many of them for no more than a dollar. Cheap corn gave us a whole raft of new highly processed foods, including the world-beating chicken nugget, which if you study its ingredients, you discover is really a most ingenious transubstantiation of corn, from the cornfed chicken it contains to the bulking and binding agents that hold it together."
Cheap commodities led to bigger portions of fast food and a plethora of inexpensive convenience snacks during the '80s and '90s. Consumption of soft drinks soared. Families, increasingly crunched for time, ate more meals away from home, while those eaten at home often relied on highly processed prepared foods. As a result, Americans consumed calories, fat and sugars at an increasing rate.
In the meantime, physical activity levels decreased. Sedentary recreation like television and video games became increasingly popular. Due to budget cuts, schools offered fewer opportunities for physical activity, particularly in after-school programs. And in many neighborhoods, parents regarded the streets as unsafe for children, leading to less time outside.
"Schools are one of the main areas where children gather, and as we cut back on physical activity there, that affects health," says the Health District's Hagan. After-school programs that include physical activity are particularly important for low-income students, she says, because such programs may be the child's only safe alternative for recreation.
Indeed, low-income Americans of all ages have a higher prevalence of obesity than the national average, according to the Surgeon General's Call to Action. Anyone who buys food with an eye toward health and nutrition, as well as economics, knows that eating healthy costs a lot of money.
"Realistically, foods that are higher in fat are cheaper," says Hagan. "Fresh fruit and vegetables tend to get downplayed because they are more perishable and they're more expensive at the supermarket."
Based on her experience working with and advocating for WIC families, Hagan concludes, "Lack of economic opportunity limits choice."
From The Surgeon General -- Many people believe that dealing with overweight and obesity is a personal responsibility. To some degree they are right, but it is also a community responsibility. When there are no safe, accessible places for children to play or adults to walk, jog or ride a bike, that is a community responsibility. When school lunchrooms or office cafeterias do not provide healthy and appealing food choices, that is a community responsibility. When new or expectant mothers are not educated about the benefits of breastfeeding, that is a community responsibility. When we do not require daily physical education in our schools, that is also a community responsibility. There is much that we can and should do together."
-- David Satcher, Surgeon General of the United States,
from The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity, 2001
Calculate Your BMI - Statistics on obesity rely on a measure called Body Mass Index (BMI), a measure of the ratio between a person's height and weight. For adults, the definitions of "overweight" and "obese" used by health professionals are based on the BMI. A BMI between 19 and 25 indicates a healthy weight; above 25 indicates overweight. A BMI of 30 or more is considered obese.
For example, an adult male or female who is 5 feet 6 inches tall and weighs 150 pounds has a BMI of 24, coming in at the upper end of the healthy weight range. If that person reaches 160 pounds -- and a corresponding BMI of 26 -- he or she would be considered overweight. A body weight of 190, for a BMI of 30, would mean a classification of obese.
To calculate your Body Mass Index, square your height in inches, then divide that number by your weight in pounds, then multiply by 703. (Or you can check out the Web site nhlbisupport.com/bmi/bmicalc, where you can simply plug in your height and weight and get a quick answer.)
For children, health professionals use the growth charts published by the Centers for Disease Control. Those whose weight places them at or above the 95th percentile for their height, gender and age are considered overweight.
Publication date: 11/20/03