New York City’s public health enemy number one
The World Health Organization (WHO) defines obesity and overweight as an accumulation of excess body fat; to an extent that may impair health. The WHO uses Body Mass Index (BMI) to measure excess fat. To get a person’s BMI, a person’s weight (in kilograms) is divided by their square of their height (in meters). A BMI of 25 or more is considered overweight while a BMI of 30 and more is considered obesity.
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(www.who.int/topic/obesity/en/). Obesity is a condition that results from eating more calories than one can expend and as a result this is stored as energy reserves in the form of fat. Obesity predisposes one to diabetes, cardiovascular conditions, arthritis and some cancers. (National Institute of Diabetes and Digestive Kidney Disease, (NIDDK)). Obesity therefore is a condition that leads to great strain of the country’s health budget and is in fact already doing so.
Energy imbalance over along period of time will usually result in obesity. The cause of energy imbalance for every person is usually due to interplay of several factors. Body weight is influenced by genetic makeup, behavior, culture, environment and socioeconomic status. In causation of obesity, behavior and environment are the most significant factors. This means that these are the areas that should be targeted by prevention and treatment programs (US Surgeon General, 2001)
The Center for Disease Control (CDC) reports that the approximately 65% of the adults in US are either overweight or obese (CDC, 2004) children and adolescents are also affected by the same trends. The CDC further reports that about 16% of children and adolescents from the ages of 6-19 are overweight, a number that is three times what it was in 1980. (CDC, 2004). This trend is one that should cause a lot of worry because overweight and obese youth are likely to become overweight and obese adults who will develop severe health problems.
New York State reflects a similar trend. More than half, about 56% of adults in New York are overweight (CDC, 2004). The rate of obesity has doubled between 1990 and 2002, New York state adolescents are also affected in a similar way, with about 28% of adolescents being overweight or being at risk overweight as reported by the New York State Department of Health (USDA, 2004).
The Trust for America’s Health in a report ranks New York 34th in the US in the highest rate of adult obesity at 21.2 percent (Trust for America’s Health, 2007). The report states that about 16% of active duty US military personnel are obese making obesity the leading reason for discharge from the military (Trust for America’s Health,2007).
Obesity is definitely a crisis in America as can be elicited from the surgeon-General’s statement that about one out of every eight deaths in America is caused by an illness that is directly related to overweight and obesity. The condition is actually the fastest growing cause of morbidity and mortality despite the fact that it is preventable (Carmona, 2003)
The causes of obesity may not be specifically identifiable but several factors work together to cause someone to be obese. Among these, are genetic factors, often obesity tends to run in families. There are certain people who remain thin no matter what environment they stay in. Research has proved that obesity can be hereditary. This has been demonstrated by results of twin studies and children who have been adopted. Obesity-related genes may affect how food is metabolized or stored. In addition, they may affect a person’s behavior such that the person is predisposed to lifestyle choices that increase the risk of becoming obese. Some genes control appetite making it difficult for the individual to sense when they are full, others make one more responsive to taste, smell, sight or food, others give an individual preference for high fat foods while putting off healthy foods, while other genes make it less likely for one to participate in physical activity. (Alters, 2005)
This however does not mean that an individual with obese-related genes is destined to be obese; it simply means that they are at a greater risk of becoming obese. They therefore need to put more effort in maintaining a healthy body weight.
The environment is one of the major causes of obesity as far as public health professionals are concerned. Changes in the foods available have contributed to peoples poor eating habits which cause obesity. Nowadays, food has a better taste, has more variety, and is less expensive especially processed foods. With bigger portions of food and more people choosing to eat pre-packaged foods for convenience obesity is high on the increase. Most of these fast foods are high calories, high on fat, high sugar and also high in salt. All these foods when advertised become even more attractive more so to children who may not be fully understand the concept of nutrition. (Cancer Research UK, 2007).
Most people have sedentary lifestyles as a result of such things as use of vehicles and public transport instead of walking or cycling, jobs that involve sitting at a desk rather than moving around, physically inactive hobbies and pastimes like watching television surfing the internet, playing play station for children rather than playing in the playground. With such inactive life styles it becomes difficult to expend all the calories consumed in high fat foods.
Behavior affects calories balance through such things as diet programs which are short term solutions to a problem. These are driven by our instincts and unfortunately fail most of the time. This is because it is only long-term lifestyle decisions in which an individual combines healthy eating with physical activity that an individual can truly lower one’s chances of becoming obese. (Cancer Research UK, 2007).
Psychological factors also have some relationship with obesity. Binge eating when stressed or depressed is a characteristic of about 29% of obese people, as revealed by research. (Blackburn and Stephanie, 1994). Eating large amounts of food when stressed apparently reduces the stress of negative feelings, however, a person who engages in binge eating commonly feels ashamed, guilty and may be even more depressed once they have indulged themselves. Often, the individual will make resolutions to stop compulsive overeating and stick to a diet, however the resolution is broken with time, leading to feelings of guilt and depression, causing the person to over eat compulsively again. (Blackburn & Stefanie, 1994).
Physical factors for example medical conditions may also cause obesity. Some of these conditions include hypothyroidism, a condition in which metabolism is slowed down causing fat deposition to occur at a higher frequency than normal.
Aging also leads to decreased metabolism and usually the elderly, due to a sedentary lifestyle have a lower chance of losing weight once they have accumulated it.
Edward Sondik, Director of the centers for Disease Control and Prevention’s National Center for Health Statistic, asserts that the consequences of the obesity crisis are severe and will continue to become worse. To place emphasis on how big a problem this is, Dr. Sondik pointed out that obesity in 2000 cost the US upwards of $100billion. 4 out of ten of leading causes of death are associated with obesity. These are coronary heart disease, stroke, type 2 diabetes and some types of cancer, hypertension. Obese people also undergo a lot of psycho-social trauma as they face discrimination and prejudice causing depression to be a common feature of most obese persons. (Sutton, 2005)
Obesity is more of a public health issue in America than other countries (www.who.int/topic/obesity/en). This is because America has a higher number of individuals within the low socio-economic bracket as compared to most other developed countries.
The immigration of various communities into these neighborhoods where the income bracket is low has contributed much to the prevalence of obesity in the country. This is true because most studies reveal high obesity levels in African American communities and Hispanic communities.
Members of these communities are the ones most likely to be on food stamps. Research studies have proved that there is a higher prevalence of obesity among individuals on food stamps compared to those not on food stamps (Trust for America’s Health, 2007). The children of parents living in these communities are likely to develop childhood obesity since they are eating the same low nutritive value foods their parents are eating. In addition they have less physical activity than their parents did increasing their risk for obesity resulting in a greater population of people with obesity as compared to other countries.
The general inclination of people in certain other countries like China and Japan is to be naturally slender and of small stature, as a result most of them are not likely to develop obesity. Most Americans of Hispanic and African-American origin and even some white Americans have a generally bigger frame of body and predisposition towards being obese.
The level of industrialization in the country (America) makes pre-packaged foods more available and also the fast pace of life and the fact that most individuals are busy makes fast foods and pre-packaged foods a more convenient option compared to preparing fresh foods for a meal (Sutton, 2005). This will definitely contribute to higher obesity rates.
Developing countries are more likely to report lower rates of obesity than America due to the differences in industrialization; the exposure to pre-packaged foods and fast foods is less leading to lower obesity rates even in the urban centers. In addition manual labor is still used in some areas as compared to America where manual labor is not used much and most people’s jobs do not have much physical activity.
World Health Organization statistics indicated that countries like Australia, Finland, New Zealand, and Canada among other are behind the US in obesity rates. These countries have adopted a more firm approach in dealing with the issue of childhood obesity; Australia for example has firmer regulations for advertisement directed at children. The Scandinavian countries have stricter regulations concerning what foods can be sold to children at school; as a result children eat higher nutritive foods as opposed to foods with minimum nutrients as is the case in most American states. In addition, the countries in the EU have greater amount of resources at their disposal for combating the problem of obesity, meaning that their obesity rates are likely to come down faster than those of the US (http://ec.europa.eu/research/)
The Healthcare system of Canada provides health insurance for the entire population which means that socio-economic levels do not affect significantly access to medical care. This makes it easier for the health system to carry out obesity-screening tests and preventive measures resulting in lower incidence rates of obesity (www.worldpress.org/). The American healthcare system on the other hand makes it difficult for low-income workers who are in and out of employment to access medical-care thus they are at a higher risk of developing obesity it is even more difficult for them to access the necessary information concerning obesity and obesity-related illnesses.
Even though most countries have a lower rate of obesity than America, the obesity trends are similar with obesity being on the increase worldwide.
Obesity in childhood has similar effects to that in adults with short-term medical consequences being adverse effects on blood lipids, blood pressure, growth and metabolism of glucose. Respiratory complications such as asthma and obstructive sleep apnea are other potential negative consequences. (Thorn et al, 2004). The more serious complication however is the long term effects which for children and adolescents seem in adulthood. This means that children may not be able to reach their full potential because as adults they will be plagued by illnesses related to obesity.
The link between obesity and poverty cannot be ignored. Research reveals that differences social economic status contribute to disparities in health. Drewnowski argues that “obesity in America is an economic issue, to a large extent”. (Drewnowski, 2004). High rates of obesity in the US are found in those areas where poverty levels are high and education levels are low. Though the rise in obesity is steady in both genders, across different income levels, ethnicities and ages, it is still more prevalent among those who are in the low income bracket. (Drewnowski, 2004).
Research by public health professionals revealed that while children in families with lower income had higher chances of being obese compared to those from higher income families. (Alaimo et al, 2001).
Findings from a study reported by TFAH show that federal obesity programs do not have a significant impact on control and reduction of obesity as they are too few and silo-ed (TFAH, 2007). The report also indicates that obesity is made worse by absence of significant policies that address issues of community design for example suburban sprawl increased accessibility and affordability of healthy food options (TFAH 2007). This latter point is best illustrated by the example of people receiving food stamps having higher levels of obesity compared to those who are not participants of the food stamp program (TFAH, 2007).
The New York Times reports that in New York the greatest increase in weights occurred among women in the Bronx. Those with the highest weight live in the poorest communities where healthy fresh food and medical cure are difficult to access and afford. (Santora, 2005). Inability to gain access to healthy food that is nutritional (especially fresh fruits and vegetables) is an issue that affects mainly lower income people. As a result they are more likely to become obese. Food insecurity, defined as inability to access nutritionally healthy food, is directly correlated with obesity as revealed by a study of women of child-bearing age where Body Mass Index was found to be higher (significantly) in women who experienced food insecurity in comparison with women from households where food insecurity was not a problem (Sutton, 2005).
A poor person is more likely to purchase food energy dense’ food made up of refined grains, high sugars, high fat as this presents the lowest cost option to the poor person. Dry foods with a long shelf life and fast foods generally cost less than fresh foods and most people in the low income bracket state that they have enough food, ‘but not the type of foods they want to eat’ (Sutton, 2005)
Accessibility to fresh foods is a factor that contributes to obesity in low income areas. Neighborhoods where the occupants are predominantly black low-income people have about five or more fast food joints compared to white neighborhoods (Block, 2004). White neighborhoods on the other hand have more supermarkets which are likely to have more fresh fruits and vegetables than neighborhood grocery stores. As a result the people in a low-income neighborhood have less of a choice and are more likely to eat what is readily available to them which are nutritionally deficient.
Other issues associated with poor food access leading to poor diet and in effect risk for obesity include lack of transportation to supermarkets, with fresh food, convenience and inadequate time to prepare fresh foods. (Sutton, 2005).
It is not only adult obesity that is on the increase, childhood obesity is also rising to alarming levels. New York City has high levels of obesity among public elementary school children with about 100,000 students with weight conditions which will increase their risk for medical, psychological and social consequences (Thorpe et al, 2004). The obesity rates are particularly higher in black and Hispanic children (Thorpe et al, 2004). This can be tied to the issue of food accessibility and food affordability which is determined by social economic status most of these children come from poor neighborhoods and will therefore most likely eat the same fast foods that their parents are eating predisposing them to obesity.
School meal programs have not been effective in arresting the development of obesity in children mainly because most of them have their focus on delivery of ‘minimum versus maximum nutrition’ to students physical education programs do not receive much priority. (THAF, 2007) children as a result continue to be inactive both in school and at home. Many states do not enforce the requirements for physical education for children and adolescents; South Dakota does not even have physical education requirements for students. New York lacks nutritional standards for foods sold in schools. (THAF, 2007)
What this two issues do (poor nutrition standards and lack of effective physical education programs) is they work together to perpetuate lifestyle choices for children that will be hard to change. Sedentary lifestyles coupled with poor diet are a sure way of increasing the risk for children to develop obesity. Once such behavior becomes part of their lifestyle it becomes very difficult to change resulting in a nation of obese children who later become obese adults. Childhood obesity becomes really expensive when the child becomes an obese adult, the average cost of healthcare per obese child is about $15 compared to $4,289 on average for an obese adult. An obese adult will most likely live as a diabetic, have a heart attack at say 40 years and end up running a hospital bill of about $50, 000. (Ulrich, 2007).
According to the World Health Organization around 1.2 billion people in the world are presently classified as overweight. This shows that the alarming trend is not only in North America, rather other parts of the world are adopting a similar trend. The government of China reports that for every ten children living in the city, one is obese. The rates of obesity in nine year old children in Japan have tripled while an estimated 20% of Australian children and teenagers are overweight or obese. Sir John Krebs of the Food Standards Agency in the UK asserts that failure to stop the trends in child obesity will lead to a reversal in the health gains, with life expectancy decreasing, something that has not happened in the last century. (www.worldpress.org/Africa/1961.cfm). Research by the FSA, the food watchdog in Britain shows that advertisements have an influence on the eating habits or children would like some food packaging to healthy warnings.
In Beijing the government owned Xinhua New Agency reports that official statistics point to an eight percent yearly increase in children with obesity to the current 10 percent of obese children. (www.worldpress.org/Africa/1961.cfm). Big cities like Beijing and Shangai have even higher prevalence of obesity in children with one child out of every five being obese. The main underlying reasons for obesity in this country are decreased involvement in outdoor activities and indulgence in television viewing and playing games at home, both passive activities.
The problem of obesity is not just a problem of industrialized countries, but it is also occurring in developing countries. Approximately 115 million people in developing countries suffer from problems related to obesity. In the US the increase in child obesity is by more than 4 percent in the last ten years, leading to approximately 99 billion dollars in health care costs in the future. (www.worldpress.org.)
The reason behind obesity incidence in developing countries is the shift to eating industrialized foods and a decrease in physical activity levels with non-manual labor increasing together with sedentary lifestyles.
In Australia, parents will receive tips on the food types that children should eat and the amount of physical exercise that will be needed by the children. This is part of a $100million strategy to deal with childhood obesity. Around 10% of the children with a weight problem will remain in school for exercise sessions three times a week. The Australian Medical Association, Bill Glasson states that educating parent on nutritionally healthy foods and physical exercise is important since children are more likely to follow their parents, because often fat kids have fat parents. (www.worldpress.org/).
Jamie Dollahite, associate professor for nutritional sciences at Cornell University asserts that ‘the parents are gatekeepers for children’ as result parents need to be helped to improve parenting skills where selection of food and physical activity are concerned especially those parents with pre-school and elementary school children. This is because at this age is when children are likely to develop lifelong habits (Ulrich, 2007).
The obesity crisis has led to various acts within the European union to combat obesity, the European commission set up the European platform for Action on Diet and Physical Activity which brings representatives from the food, retail, catering and advertising industries together as well as those from consumer organizations and health NGOs.(http://ec.europa.eu/research/leaflets/combating-obesity/article-2766). The platform has been involved in various activities such as labeling, education, promoting of physical activity, marketing, advertising that targets children, product reformulation (a process that involves changing the recipe for a product that has large amounts of unhealthy substances such as sugar and salt so as to make the product healthier).
Most programs that have been set up to deal with the problem of obesity in the US and world over have focused on the diet and physical activity of individuals; and rightly so since these are the main influencing factors in development of obesity. The US government has made various attempts aimed at combating obesity in 2004, the Department of Health and Human Services and the Food and Drug Administration launched programs, one of these the Calories Count has such components as inclusion of recommendation that would strengthen food labeling, education of consumers regarding importance of maintenance of a healthy diet and weight loss, and urging restaurants to provide information about the nutritional value an the calorie content for foods served.
The NHS campaign was an advertising campaign that aimed at educating Americans concerning taking steps though small but achievable ones to make their health better, promote loss of weight and reverse the effects of obesity (www.obesityinamerica.orga/govinitiatives.html)
These campaigns are commendable especially because of their focus on behavior changes which is the most effective tool for dealing with obesity, since for most people behavior and environmental factors are the major contributors to obesity.
Many governors in the United States have taken innovative steps with regard to reduction of obesity and control programs for employees of the state. These have however mainly been limited to public information campaigns as reported by Trust for American Health (TFAH, 2007). The danger of public information campaigns is that they may have the effect of jut providing a lecture where people listen to information but do not apply it to benefit them. This party explains how come obesity, despite measures being taken to reduce it is still a growing epidemic with most states reporting increases in rates of obesity.
It is more important for people to learn that it is imperative for them to make choices and be in charge of their own health. This means that people have to participate rather than just be recipients of information. A good illustration of this is a program done in cooperation with Head start and the women, infants and children program in Herkimer country, where a series of workshops were held in spring 2006 for nine Head start families. There were six weekly sessions that gave practical exposure of preparation of healthy meals, educated on food choice, cost effective food shopping and physical activity. After each session parents and their children participated in a family play activity, each parent also got a fit W/C kit of activities aimed at promoting active play with children at home, together with a p2s gift card on condition that they attended all the six sessions. Evaluations of the seven parents who graduated from the program were very positive. This program was interesting and encouraged participation besides empowering families and parents to continue making positive lifestyle changes even after the workshops ended. An effective program should be able to do this.
In order to combat the obesity crisis that affects the low income neighborhoods it is necessary to involve the community so as to give people access to affordable fresh healthy foods. This can be achieved through Community Supported Agriculture where local farmers can sell their product directly to consumers enabling the small scale farmers to sustain themselves and increasing access of low income communities to fresh-food and vegetables. (Sutton, 2005).
Focus on the two major reasons for obesity should not be the only approach in battling with the problem of obesity since there are factors that lead to people taking up sedentary lifestyles and also taking poor diets.
The TFAH puts across some suggestions that policy makers can include in policy actions. They have an effect on the amount of physical activity people get and availing a healthy diet to them. The emphasis is on prevention, which is in the long run cheaper for both the government and the individual. Some of these include placing greater emphasis on preventive care through employers and Medicaid running obesity-risk screening and providing benefits for preventive care and encouraging activities that achieve fitness.
Another strategy involves the federal government using its role as the major buyer of food to put more requirements on nutritional value as a condition for granting food contracts in public-assistance programs, military meals and contracting for cafeterias. (TFAH, 2007).
School districts ought to change their position and focus on maximum nutrition rather than minimum nutrition. Using this is as a criterion in the bidding process will ensure students get healthy nutritional food. Physical education requirements also ought to be taken more seriously and given much more priority in the curriculum.
Provision of information to the public cannot be over emphasized since it helps to sensitize the public concerning obesity and as a result the public is more willing to participate in obesity-reduction efforts. The information provided needs to be uniform, constructive and provided as much as possible in an interesting to the public. Forging of partnerships with the private industry is essential to providing healthy options to consumers.
Research into other causes of obesity is also necessary since so far most campaigns have focused on diet and physical activity. While this are of vital significance in the fight against obesity, other causes need to be evaluated so that issues relating to obesity can be brought to the forefront and addressed to ensure the epidemic is curbed.
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