The Weight of the World

When I was a young child, I was a very picky eater. I would often refuse to eat the meals my parents put before me, even if it was something that I’d eaten and enjoyed before. Some kids are so-called “selective” eaters because of a medical problem like gastroesophageal reflux disease, gluten intolerance, or some other nutritional or sensory disorder, but my picky eating was a result of sheer stubbornness.

Like most mothers, mine resorted to all sorts of inducements, incentives and threats to get me to eat, including using the age-old remonstration about starving children in India or Ethiopia. My usual retort was to offer to pay the postage out of my allowance so that she could send the food there.

What a change 40 years can make. The rebellious five-year-old boy who would go a whole month eating nothing but buttered noodles is now a very adventurous eater. I have even sampled such exotic foods as snake, spiders, jellyfish and grasshoppers while traveling overseas. Even more surprising, although there is still a massive problem of hunger and malnutrition in India, Ethiopia and even in the United States – as many as 1 in 7 Americans go to bed hungry – there are now more people who are obese than who are malnourished globally.

According to a new study published in the medical journal The Lancet last week, the number of people in the world who are clinically obese has increased six-fold over the last four decades. Using a measure of body fat composition known as the body mass index (or BMI, which is calculated as an individual’s weight in kilograms divided by their height in meters squared), researchers compared historical rates of obesity among 20 million people from 186 different countries.

Clinically, a person is usually considered to be obese if they have a body mass index of 30 or higher. By this standard, an American man who is an average 5’10” in height and weighs 210 pounds would be obese. While the use of BMI as an individual measurement of body fat does have its flaws – it doesn’t distinguish between fat and lean muscle, for example, so an extreme body builder might also be classified as “clinically obese” despite a body fat level of less than 5% – the body mass index does works well when examining obesity at the population level.

What the study in The Lancet reported was this: the number of people worldwide who are clinically obese has increased more than 600% during the past 40 years, from 100 million in 1975 to almost 650 million in 2014. Globally, ten percent of men and 15 percent of women are now considered to be obese, the bulk of whom (pun intended) live in industrialized countries like the United States, Great Britain and China. By contrast, only 450 million people worldwide are considered to be malnourished. Most of those individuals live in impoverished regions of the world.

Should this trend continue unabated, over one-fifth all adults worldwide will be obese by 2025. Another two-fifths of the world’s adult population will be considered overweight. The public health and economic implications of this are staggering.

According to the World Health Organization (WHO), obesity is linked to as many as 60 life-threatening and costly illnesses, including heart disease, high blood pressure, stroke, cancer, and diabetes. Nearly 3 million people each year die as a result of preventable weight-related illnesses, making obesity directly responsible for about 5 percent of all deaths worldwide.

The human toll aside, obesity-related health care expenses total approximately $2 trillion annually. As a relatively fat nation, both in terms of our waistlines and our wallets, we Americans shoulder about one-tenth of these costs: about $200 billion a year in medical bills alone. Only war and smoking make bigger but equally preventable dents in the world economy.

Small wonder then that the WHO has set the ambitious goal of reversing rates of obesity by 2020. This is, however, a goal that the World Health Organization and other public health agencies will never be able to meet. This is because obesity is not a medical problem. Rather, it is a social problem with medical consequences.

It’s not that so many people worldwide are deliberately eating unhealthy foods. Rather, they increasingly lack access to healthier choices. For example, the urban poor have some of the highest rates of obesity globally. This is in part because they do not have the money or opportunity to buy healthy foods. In many urban communities, from New York’s Spanish Harlem to the Kibera slum in Nairobi, the only stores that sell food are often small corner bodegas that stock little in the way of fresh and affordable produce.

Similarly, our growing urban and suburban cityscapes are rarely designed to provide residents safe opportunities for exercising out-of-doors, whether by providing sidewalks on busy streets, by building walking and biking trails, or by creating and maintaining public facilities like parks and basketball courts.

Quite simply, the global obesity epidemic is a complex social problem with no single quick fix solution. The various public health proposals that have been proposed — free and healthy school lunches for all students, nutritional labels on restaurant menus, taxes designed to reduce the consumption high-calorie foods and drinks, government-sponsored wellness programs, and educational campaigns – all have their merits. Taken alone, however, each of these efforts will be largely ineffectual in reversing current trends.

This isn’t to say that we shouldn’t try, but we need to do more than set lofty goals and promote quick fix policies. This crisis didn’t happen overnight, and it won’t be resolved overnight. We need to develop a holistic and concerted plan that addresses all of the factors contributing to the obesity epidemic, be they medical, psychological, social, political or financial. Only then can we hope to achieve a happier, healthier and lighter future.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on April 21, 2016, and is available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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