The greatest challenge to addressing obesity in the United States is changing America’s perspective on the disease.
What is obesity?
Obesity is a more extreme form of being overweight. Overweight individuals have excess body weight. A human’s weight comes from muscles, bone, fat, and water, but excess body fat is the greatest health concern.
The body mass index (BMI) calculator is a generalized tool used as an indicator of healthy or unhealthy body weight. The BMI calculator takes a weight-to-height ratio calculated by dividing a person’s weight by the square of their height. An individual with a normal weight will have a BMI of 18.5 to 24.9. Overweight individuals have a BMI between 25 and 29.9.
An obese individual will have more excess body fat than an overweight individual. Although obesity can be a contributing factor to other diseases, both the American Medical Association and the World Health Organization recognize obesity as a disease itself.
According to the National Health and Nutrition Examination Survey1,2, 68.8% of adults aged 20 and over are considered either overweight or obese, and 35.7% of adults are considered obese in the U.S. Of those, 6.3% are extremely obese. Obesity prevalence in women and men is about the same, around 36%, while slightly more men than women are overweight, and slightly more women (8%) than men (4%) are extremely obese. Globally, 39% of adults are overweight and 13% are obese, making Americans disproportionately heavier than the global population.
Why is this a problem?
Overweight is a risk factor for potentially life-threatening medical conditions such as coronary heart disease, stroke, diabetes, and cancer. Overweight individuals are more likely to experience breathing problems, such as sleep apnea and asthma, and reduced mobility due to a larger body size. Most of these conditions require medical attention, which costs the U.S. $190.2 billion annually3. Obese individuals are less likely to participate in the workforce and more likely to require excessive time off due to their condition. This phenomenon, termed obesity-related absenteeism, costs the U.S. between $3.38 billion and $6.38 billion each year4.
Finally, there are increasing infrastructural and societal costs for accommodating individuals with excessive body weight. In the near future, everything from sidewalks to elevators to turnstiles at subways stations will have to be widened to accommodate a heavier population.
Why aren’t we doing anything about it?
First, the United States has created a culture that encourages obesity. Long workdays, combined with little vacation time and a sedentary work desk culture have left many Americans inactive. Due to time constraints, many rely on calorie-dense fast- or prepackaged foods for their meals. Although relatively benign in moderation, the proliferation of ready-made convenience foods has likely contributed to America’s weight problem.
It is not lifestyle hurdles—but the American mindset—that is the greatest barrier to challenging the obesity epidemic in the US. Americans are adverse to preventative measures and treat health like credit cards and retirement: focus on the now at the expense of thinking about the future. Only when catastrophe happens is there a cause for concern.
Only 44 million Americans receive a physical each year, with most visiting a doctor only after something is wrong. The rising cost of healthcare might be a deterrent, but with the American Affordable Care Act enacted by President Obama, Americans can receive their annual physical—as well as preventative shots and screenings—free of cost. So far, there’s no evidence to suggest that the ACA has increased the number of Americans who receive physicals or wellness checkups.
Even if patients are treated for obesity-related diseases, most are very unlikely to believe that their body weight is a contributing factor to their medical maladies. According to the Center for Health Statistics5, over a quarter of overweight males and nearly half of overweight females do not perceive themselves as overweight. These results, recorded between 1988 and 1994, are corroborated by a 2016 Gallup poll6 that reports only 37% of Americans believe that they are overweight (compared to 68.8% who actually are, according to the CDC).
An average American’s weight has increased from 166 pounds in the 1990’s to 176 in the 2010’s. Interestingly, American’s ideal weight has also increased from 153 pounds in the 1990’s to 161 in the 2010’s. In a decade, both the average and the ideal weight have increased by about 10 pounds. The data suggests that as Americans become heavier, an ideal body weight has also become heavier, perhaps as a response.
Since being overweight is the new normal, it is small wonder why people have an exaggerated perception of a healthy body weight. New trends have validated this perception at the expense of addressing overweight as a real, potentially dangerous threat. Friends, family, and even medical professionals who comment on a person’s excessive weight are now “fat-shaming” instead of expressing concern. Vanity sizing in the US and the UK have now given single-digit size numbers to clothes that would have been double-digits only a few decades ago. There are now clothing stores that cater exclusively to larger clientele.
On the other hand, weight-loss or weight-management measures have been discouraged in the US. “Fat taxes” on heavier airplane passengers have been received very unfavorably, although additional body weight requires more fuel and weight limits on the plane may prevent other passengers from boarding as well. Many obese passengers cannot fit comfortably into a single seat. Most airlines strongly recommend an obese passenger to purchase a second seat, but many don’t require it.
In May 2012, former New York City mayor Michael Bloomberg pushed to limit the size of sugary drinks available in New York City to 16 ounces. In September 2012, the New York City Board of Health voted unanimously to adopt the proposed limit. After numerous legal proceedings, the New York Court of Appeals ruled that the ban was beyond the regulatory authority of the New York City Board of Health.
Failed legislation like this reminds one of why America may never become a normal weight again: Americans don’t like to be told what to do, even if it’s sound advice. Pregnant women are recommended (not told) to quit drinking during pregnancy, although alcohol has a scientifically documented, negative effect on developing fetuses. Hospital patients are recommended (not told) to stop smoking as an inpatient, although smoking is a risk factor for several health conditions.
Combating obesity in America requires changing a mindset. There is an idea that obesity is normal, and therefore healthy. There is a idea that because in a very small minority, obesity is caused by genetic or medical conditions, that all obesity should be left unaddressed. There is an idea that people don’t want the government telling them how they should live. These opinions do not account for the rise of obesity in America due primarily to lifestyle changes—not genetic or medicinal causes—or that those who don’t want the government to create a healthier society still want the government to help cover healthcare expenses when obesity-related disease sets in. These opinions do not account for the fact that although obesity is a serious health condition, one still expects society to accommodate and embrace this disease as something normal and positive.
America doesn’t necessarily have an obesity problem—it has a mentality problem.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. Journal of the American Medical Association. 2012; 307(5):491–97. Link
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. Journal of the American Medical Association. 2012; 307(5):483–90. Link
Cawley J, and Meyerhoefer, C. Medical care costs of obesity: An instrumental variables approach, Journal of Health Economics. 2012; (31): 219-30. Link
Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes, metabolic syndrome and obesity : targets and therapy. 2010;3:285-295. doi:10.2147/DMSOTT.S7384.
U.S. National Center for Health Statistics, unpublished data covering 1988–1994.
Gallup Poll. “Fewer Americans in This Decade Want to Lose Weight”, 26 November 2016