What’s the problem?
Obesity is one of the major public health problems in the United States. About 1 in 3 adults and 1 in 6 children are classified as obese. Obesity can expose people to one of the major causes of death in this country: cardiac disease, certain types of cancer, and stroke, as well as to high cholesterol, type 2 diabetes, sleep apnea, and to other negative consequences for physical and mental health. In 2008, the annual cost of medical attention for obesity rose to $147 billion dollars. The development of obesity is a complex process influenced by both individual and environmental factors. Some of the individual factors are: hereditary predisposition, physical inactivity, an unhealthy diet, medical problems, use of certain medicines and parental eating habits. There are also environmental factors that promote obesity because they affect personal decisions about physical activity and food; for example, lack of access to healthy and inexpensive food, great availability of high-calorie food and sugary drinks at low prices, and limited opportunities to exercise in safe places due to crime and environmental risks.
Who’s at risk?
A person is considered obese when he or she has an excess of body fat. In clinical and academic environments, body mass index (BMI: weight and height) and specific BMI percentiles by age and sex are generally used as indirect measurements of body fat in adults and children, respectively. Adults over 20 years old whose BMI is 30 or higher are considered obese (men who are 5’9” in height and weigh 196 pounds or more, women 5’4” in height who weigh more than 174 pounds). Children between the ages of 2 and 19 with an age- and sex-specific BMI percentile of 95 or higher are considered obese. Although there is a high obesity rate in the population at large, certain demographic groups, particularly racial/ ethnic minorities, are disproportionately affected by obesity. There are also significant differences in obesity according to sex, age, certain socioeconomic factors, and the place where people live.
Can it be prevented?
Moderate weight loss can prevent health problems associated with obesity. You can lose weight by following a healthier diet and nutrition plan, by increasing physical activity, or by changing your health habits. Preventing obesity is especially important for children. A key factor in lowering obesity risk for children is encouraging personal healthy habits, such as reducing intake of sugary drinks, limiting the time spent in front of the TV set and other sedentary habits, increasing physical activity and choosing foods that are low in fats, calories and sugar. Environmental support factors, such as promoting breast feeding, choosing healthy foods and engaging in physical activity at school and in childcare facilities can also be beneficial for children.
To sum up:
Obesity is one of the major public health problems in the United States, affecting one third of the population. Annual costs of healthcare related to obesity were over one hundred billion dollars in 2008. Obesity can cause a large number of diseases, among them some of the major causes of death in this country. There isn’t one single solution to prevent obesity or to reduce the number of persons who have it. A coordinated effort is needed to address this complex public health problem. Some examples are following a healthy diet and doing physical activity, on an individual level, and promoting an active lifestyle and offering opportunities for healthy eating in the communities where people live, work, study, and play.
Martha works as a nutritional adviser at the Crewmanton Clinic. Apart from the high risk derived from poor nutrition, Martha has noticed that most of the children she takes care of are overweight or obese. For the past three years, she has taken care of Angela, a single mother of two boys, ages 5 and 3. The older boy is overweight. Martha is always giving Angela strategies for nutrition and physical activity to reduce her son’s overweight; for example, increasing his intake of fruits and vegetables and the time he spends playing outdoors, as well as limiting fast food, sugary drinks and time before the TV. Angela had never worried about her son’s excess weight; in fact, having a son who is somewhat heavy is considered a sign of affluence and good upbringing in her community. Nevertheless, she is grateful to Martha for her suggestions and tries to follow them.
One day Angela spoke with Martha about how difficult it was for her to carry out the strategies she had recommended. Angela does not have a car and there is no public transportation near her apartment. Where she lives there are few grocery stores or markets she can walk to. There are several fast food places nearby, but she needs some means of transportation to reach the nearest supermarket, which is 10 miles away. Angela usually buys food at the corner store, where she can seldom find fresh, high quality food at affordable prices. Most of the food she can buy within her budget is not healthy. Furthermore, her son is a finicky eater who refuses to eat vegetables. Angela tends to buy food she knows her son will eat in order not to waste money.
Doing physical activity is also hard because she lives in a high crime neighborhood so there aren’t safe places for children to play, such as parks and playgrounds. Angela is a fulltime student and works part-time, so she is usually too tired or doesn’t have time to play with her children. It is easier for her to turn on the TV and keep them busy while she does her homework.
Dr. Robinson, her sons’ pediatrician, also knows that eating healthy food and staying physically active can be difficult for people who do not have the environmental support factors to make these decisions. Both Martha and Dr. Robinson work with Angela to apply culturally adapted methods in order to solve her son’s weight problem. Angela and her sons started ttending healthy cooking classes taught for free at the clinic. The instructors use food bought at local stores that she can reach easily. Angela also participates in a local community food garden. She and her boys do physical activity while helping to take care of the garden, where she can also get fresh produce. Dr. Robinson has also taken steps to promote a healthy medical environment for his patients, installing a water cooler in his waiting room and removing the soft drink vending machines.