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Can it be true that over half of all Americans are obese? And an additional 30 percent are overweight? 

These are staggering statistics from the National Health and Nutrition Examination Study (NHANES), a division of the U.S. Centers for Disease Control and Prevention (CDC). Obesity is not a matter of cosmetics and style. It’s a matter of health and is a huge factor leading to such illnesses as hypertension and other cardiovascular diseases, diabetes, respiratory compromise such as sleep apnea, fatigue and depression. Poor physical and psychological quality of life creates a downward spiral and health issues continue to worsen. 

According to the NHANES 2017-2018 survey, published in December 2020, 42.5 percent of all adults in the United States aged 20 and above have a body mass index (BMI) of 30-39.0. This constitutes clinical obesity. Nine percent are severely obese with a BMI of 40 and higher. And 31 percent are overweight with a BMI of 25.9-29.9. 

According to American Heart Association (AHA), cardiovascular disease is the leading cause of death of men and women in the United States. More than 870,000 people die of heart diseases every year, and many of these illnesses are directly related to obesity. Being overweight or obese impacts cholesterol levels, inflammatory markers, various hormones and other cellular processes which can lead to illness. 

Obesity is a direct precursor to Type 2 diabetes. Diabetes is the sixth leading cause of death in the United States. The complications can debilitating to fatal. High blood glucose levels can cause damage to all the organs in the body. Diabetic retinopathy affects 4.1 million people each year. Gum and tooth disease is more common in people with diabetes. Diabetes is the leading cause of kidney failure and many people require dialysis. Nerve damage can lead to the loss of feet and legs. Over 60% of non-traumatic amputations of the legs or feet occur in people with diabetes. Nerve damage can also impact the digestive system, causing nausea, vomiting, and bowel problems. Most people (65%) with diabetes die of stroke and heart disease. Almost 75% of adults with diabetes have high blood pressure. The rate of heart disease deaths is 2 to 4 times higher in diabetics than in those without the disease. People with diabetes have a two to four times higher risk for stroke.

Obstructive sleep apnea is a disorder in which a person stops breathing for 10 or more seconds during sleep. Oxygen levels are reduced and the sleep awakens with a startle and usually a loud snore. This repeats several times and the stress on the heart can be tremendous and cumulative as it slows down during apnea episodes and speeds up to breathe again. Heart attacks, strokes, and other cardiovascular diseases have been attributed to sleep apnea—and what is the most common cause of sleep apnea in adults? Obesity. 

U.S. Army Lt. General Mark Hertling gave a TED talk describing obesity as a national security issue. He cites many reasons for the obesity epidemic and noted that 75% of military recruits are disqualified for service due to their weight.

A September 2019 U.S. News and World Report article noted that obesity has become a public health crisis and cited the American Journal of Public Health data that 20% of all deaths in the United States can be attributed to obesity.

The obesity rates in adults and children are increasing every year. The financial toll is impressive, too. According to the CDC, “the estimated annual medical cost of obesity in the United States was $147 billion in 2008” and the National Institutes of Health Pub Med reported $149.4 billion in 2014. A Harvard study predicted that these costs will increase by $48-$66 billion per year by 2030 if the obesity trend continues. If that isn’t a starling enough fact, how about $208 billion in lost productivity due to premature morbidity and mortality.

While there are a few serious medical conditions that can predispose a person to being overweight, the bottom line is that we eat too much and exercise too little. We eat too much of the “wrong” foods. Supersized sugary drinks, fried and fatty meats, processed junk foods all taste good because we have trained our senses this way. 

Fresh fruits, vegetables, lean protein, complex carbohydrates and more water every day can retrain our brains to enjoy the healthier options available. 

The argument that it is too expensive to eat the healthier diet is usually not true. Compare the cost of a bag of apples to a bag of potato chips. Most communities have farmers markets and grocery outlets with huge selections of fresh and frozen vegetables. And as consumers, we need to address the fact that a greasy burger costs a dollar and a healthy salad costs a lot more. 

Living in our high-tech age means we need to pull away from computer games, internet, and television. We need to teach our children by example and get outside to walk, run or swim, play physical games, and work in the yard.

Primary care health care providers (PCPs) are on the front lines of the obesity epidemic. To not talk about weight management does patients a disservice and neglects a very important part of their health care. The PCP needs to establish a relationship, set realistic goals for weight loss and not be judgmental. 

Nutritional and exercise counseling and lifestyle change options should be done in such a manner that a patient comes up with their own plan and goal. Positive reinforcement at every visit will hopefully keep a patient on track. 

This is time consuming and many health care providers still do not consider this a primary focus issue; hopefully medical schools will catch up with nursing education in teaching nutrition, exercise and mind-body connections in health and disease.

We are an obese nation. Can we reverse the trend? 

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