Sound Family Medicine - Puyallup, Bonney Lake WA Medical Center - Sunrise Medical Campus Puyallup Washington

Just How FAT Are We?

We hear a lot of reports about the growing obesity epidemic, but what does it mean?
What are the costs? How did it happen?

Obesity is defined as a body-mass index (BMI) of 30 or higher. Interestingly, the rate of obesity is not equally distributed around the U.S. Check to see how your state lines up in the prevalence of obesity:

15 – 19% Fat	Colorado is ‘thinnest’ state and the only state to average less than 20% body fat.
20 – 24% Fat	Hawaii, California, Nevada, Idaho, Montana, Wyoming, Utah, New Mexico, Wisconsin, Illinois, Vermont, New Hampshire, Massachusetts, Maine, Rhode Island, Connecticut, New Jersey, Florida and Virginia.
25 – 29% Fat	Washington, Oregon, Alaska, North Dakota, South Dakota, Nebraska, Oklahoma, Texas, Minnesota, Iowa, Missouri, Arkansas, Louisiana, Michigan, Ohio, Indiana, Kentucky, New York, Pennsylvania, West Virginia, Delaware, North Carolina, South Carolina, Georgia, Maryland.
> 30% Fat	Tennessee, Alabama, Mississippi.

The World Obesity Epidemic

I know it may be hard to believe, but the U.S. isn’t the most ‘obese’ country on earth. In fact, we’re also not the most ‘overweight’ (defined as a BMI of 25-29.9). Have we yet ‘hit the ceiling?’ After a quarter-century rise, obesity prevalence has not increased since 2004. Still, 72 million adults (34%) are obese. Many health professionals would like this number to be less than 15%, a level not seen since 1980. Below are the top eight ‘obese’ countries and the top eight ‘overweight’ countries:

	Overweight Countries percent of population		Obese Countries percent of population
	62% Israel		29% Kuwait
	63% Bosnia		29% Bahrain
	64% Kuwait		34% United States
	66% United States		34% United Arab Emirates
	67% United Kingdom		36% Saudi Arabia
	67% Germany		41% French Polynesia
	73% Saudi Arabia		56% Tonga
	75% French Polynesia		79% Nauru

Where Do You Fit In? What’s Your BMI?

Underweight = <18.5 Normal weight = 18.5-24.9
Overweight = 25-29.9 Obesity = BMI of 30 or greater

BMI (kg/m2)	19	20	21	22	23	24	25	26	27	28	29	30	35	40
Height (in.)	Weight (lbs.)
58	91	96	100	105	110	115	119	124	129	134	138	143	167	191
59	94	99	104	109	114	119	124	128	133	138	143	148	173	198
60	97	102	107	112	118	123	128	133	138	143	148	153	179	204
61	100	106	111	116	122	127	132	137	143	148	153	158	185	211
62	104	109	115	120	126	131	136	142	147	153	158	164	191	218
63	107	113	118	124	130	135	141	146	152	158	163	169	197	225
64	110	116	122	128	134	140	145	151	157	163	169	174	204	232
65	114	120	126	132	138	144	150	156	162	168	174	180	210	240
66	118	124	130	136	142	148	155	161	167	173	179	186	216	247
67	121	127	134	140	146	153	159	166	172	178	185	191	223	255
68	125	131	138	144	151	158	164	171	177	184	190	197	230	262
69	128	135	142	149	155	162	169	176	182	189	196	203	236	270
70	132	139	146	153	160	167	174	181	188	195	202	207	243	278
71	136	143	150	157	165	172	179	186	193	200	208	215	250	286
72	140	147	154	162	169	177	184	191	199	206	213	221	258	294
73	144	151	159	166	174	182	189	197	204	212	219	227	265	302
74	148	155	163	171	179	186	194	202	210	218	225	233	272	311
75	152	160	168	176	184	192	200	208	216	224	232	240	279	319
76	156	164	172	180	189	197	205	213	221	230	238	246	287	328

Counting Calories

Obesity rates in Americans ages 12 - 19 have more than tripled since 1980! Not only are we consuming too much fast food, processed white foods and drinking too many liquid calories, but we are also way too sedentary. It only takes an extra 100 calories daily to manifest to a ten-pound weight gain in one year. That’s not that much food (maybe a couple of Oreos with some nonfat milk). Instead of, “Where’s the Beef?” How about, ‘Where’s the Fruits and Vegetables?’ It is our own responsibility to ‘provide’ and ‘enforce’ healthy eating principles. Adults need to eat right and expect the same of their children. Keeping a food record for a few days can be a real eye-opener to how many extra calories you (or your child) are consuming each day.

Children should consume around 1,300 calories a day, or about 430 calories per meal (on average). One typical kid’s meal provides 570 to 740 calories per meal. These extra calories are very cumulative and can really add up and contribute to the obesity epidemic in children and adults.

The USDA recommends the average adult consume only 2,000 calories daily. The average American adult consumes from 1,883 up to 5,649 calories daily, as estimated by the World Health Organization. It is also estimated that over 40% of our calorie intake comes from both fat and excessive sugar intake of any form (corn syrup, molasses, honey, high-fructose corn syrup, maltodextrin, etc.). What this means is that we are eating more calories, 24% more to be exact. Although, there has been some finger pointing, one single food group is not to blame. It’s the big picture of too many calories (regardless of sugar or fat content) and not enough exercise.

The Personal Cost Of Fat

Trouble At Work – Obese workers cost employers more in medical, disability, and workers’ compensation claims.
The Bill – The average firm with 1,000 employees faces $285,000 per year in extra costs associated with obesity.
Discrimination – In 1996 only 7% of American adults reported weight discrimination as compared to 12% in 2006.
The Hidden Toll

	1.	Overweight people earn less than the non-overweight in a comparable job.
	2.	Obese elementary-school children miss more days of school than their peers.
	3.	Obese adolescent girls are less likely to attend college than their non-obese peers.
	4.	Every year, there are nearly 112,000 obesity-related deaths in the U.S.

What Can We Do About It?

The likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fat. Confined to older adults for most of the 20th century, this disease now affects both moderately overweight and obese children even before puberty. Approximately 85% of people with diabetes are type 2, and of these, 90% are obese or overweight.

Effective weight management for adults and children at risk of becoming overweight and developing obesity involves a range of long-term strategies. These strategies include:

Nutrition and Lifestyle Changes
Food-Nutrient Timing and Portions Sizes
Diagnosis-Specific Nutrition Education
Physical Activity Education/Monitoring
Laboratory Assessment/Target Ranges
Nutrient Supplementation
Stimulus Control/Behavior Barriers
Personal Goal Setting
Self Monitoring via Food Record Keeping

Meeting with a Registered Dietitian can and should be part of a ‘face-to-face’ personalized nutrition education and awareness-based approach, which includes family and environmental support for healthier eating and regular physical activity. Ask your Sound Family Medicine physician if he/she thinks you are an appropriate patient to benefit from Medical Nutrition Therapy (a physician referral is usually warranted by insurance).

Brooke Douglas, R.D., C.D.
www.NutritionAuthority.com

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