Obesity used to be thought of as a problem of a few states in Appalachia and the Southeast. It is now prevalent across the United States. In 1990, no state had an obesity prevalence rate greater than 20%, and only 4 states had an obesity rate between 15 and 19%. By 2000, 46 states had obesity rates of greater than 20%, and 17 states had obesity prevalence of over 25%.



The US is a leader in obesity, but rates are climbing around the developed industrial world. It is estimated that there are over 300 million obese people in the world. Rates in China, Western Europe and even Japan are increasing.

Morbid obesity, defined as a BMI (body mass index) of greater than 39%, afflicts 3% of all Americans, or about 9 million people. While the number of obese patients has grown by 24% from 2000 to 2006, the number of morbidly obese people has grown by over 50% during the same period.

Even children are not immune. Whereas childhood obesity was virtually unknown before 1990 in the US, the incidence of obesity has climbed to 13% amongst teens and pre-teens in 2006. Type-II diabetes, previously only an affliction of obese adults, has started to become a concern with children as well.

The statistics are incontrovertible. The key questions are: how does obesity affect the health of those who have it, what is causing this epidemic, and how can we reverse its effects?

Obesity leads to a series of problems. The main concerns with the obese are heart and circulatory diseases (including strokes and peripheral vascular problems) and diabetes. These two problems are interrelated, as diabetics have a much higher chance of contracting circulatory diseases. Even the incidence of some cancers, such as estrogen-dependent breast cancer, can be raised by obesity. Those diseases related to diabetes and overweight are also increased; these include blindness, neuropathy, congestive heart failure and valve calcification.

What are the primary reasons for this growth in the number of obese people in the US? While there was always an underlying level prior to 1990 due to problems with the thyroid, heredity or other hormone imbalances, the growth in obesity since then can only be attributed to the consumption of higher-calorie foods and lack of exercise.

High calorie consumption comes through a number of sources, but especially

"super-sizing." Compare the size of a McDonald's hamburger from the 1980's and one served today, it's three times bigger, on average, by weight.

The presence of sugar and fat in the foods we eat.

We eat out much more often than we did in the past. Restaurants tend to pour on the sugar and fats, and their portions are enormous.

Lower exercise comes from the proliferation of armchair activities we've seen since 1990. At that time, there were four or five main TV channels; there are now over 150 on most televisions. Americans are watching much more television today than they did 20 years ago. In addition, the attractions of the Internet have led to a sedentary existence, particularly for pre-teens and teenagers. The habits that these people form in their youth remain with them for the rest of their lives.

What can be done against obesity and morbid obesity? The usual 'saws' of "more exercise, less caloric intake" are always valid, but heeded less and less. Despite the proliferation of gyms, commercial diet plans and books on dieting, most diets fails.

For those who are morbidly obese, bariatric surgery is the best alternative. Although dangerous, four percent die during or after surgery, and ineffective in over 20% of the cases, bariatric surgery often represents the best opportunity for the morbidly obese person to escape the serious problems brought on by their overweight condition.

Since 2004, when the Medicare CMS approved reimbursement for bariatric surgery, we've seen an explosion in the number of such operations. Whereas there were fewer than 20,000 bariatric surgeries in 1998, that number expanded to nearly 200,000 in 2004. It is estimated that the rate will increase to 800,000 by 2008.

Obesity is a scourge on our modern populace. We should do what we can to address the underlying causes.