MMS Physician Focus: September 2006
By Stuart R. Chipkin, M.D.
In December 2001, then U.S. Surgeon General David Satcher issued
a 'call to action' on overweight and obesity, saying that both
conditions "may soon cause as much preventable disease and death as
cigarette smoking." Two years later, his successor, Dr.
Richard Carmona, addressed Congress on "The Obesity Crisis in
America," calling it "the fastest-growing cause of disease and
death in America."
The situation is not improving. Today, obesity in America -- and
indeed throughout the world -- is a runaway freight train heading
down the track of public health. The question is whether we stand
still or do something to stop the train.
The National Center for Health Statistics says that more than 30
percent of U.S. adults -- some 60 million people -- are obese, and
another 35 percent plus are overweight -- the distinction
between the two determined by Body Mass Index, a physical
measurement using an individual's height and weight. (Check yours
at www.cdc.gov/bmi) The
Centers for Disease Control (CDC) says the percentage of overweight
young people has tripled since 1980: among children and
teens 6-19, 16 percent -- 9 million -- are considered overweight.
In Massachusetts, CDC estimates that 55 percent of adults are
overweight or obese and 24 percent of high-school students are
overweight or at-risk of becoming so.
The consequences of overweight and obese children are that
"adult" complications begin much earlier. Imagine patients in their
30's comprising more than half of the beds in an intensive care
unit for heart disease, standing at the pharmacy to get bottles of
pills for their diabetes, filling the roster of the cancer care
center, or lining up for injections to treat their arthritis.
Obesity is associated with more than 30 medical conditions,
including coronary heart disease, high blood pressure, respiratory
illness, low back pain, and cancer. It's a major cause of
joint-replacement surgeries, type 2 diabetes, and osteoarthritis,
the most common form of arthritis affecting about 21 million
Americans.
There's more. Studies show that overweight Americans are sicker
late in life and die prematurely, that women who are overweight or
obese at 18 are at greater risk of dying in middle age than women
who stay at a healthy weight in their teens, and that obesity is
even affecting infants, posing potential health problems in
children as they age.
Obesity has some troubling side effects as well. Radiologists
say that very obese people can't get full medical care because
they're too big to fit into imaging scanners or their fat is too
dense for x-rays or sound waves to penetrate. Hospitals are making
capital investments to care for such patients, paying for wider
doorways, beds and operating tables that hold up to 1,000 pounds,
and special lifting devices to move obese patients, to avoid
injuries to the staff.
The causes of obesity -- whether genetic, environmental, or
behavioral -- are being debated around the world. Nonetheless, we
find ourselves in a "perfect storm," consuming much larger numbers
of calories (a "supersize me" society) than we expend. Even small
amounts of physical activity are decreasing -- remote controls,
escalators, and now personal transport devices are all designed to
remove the need to put one foot in front of the other.
Our response to this crisis must be both personal and
societal. Individuals must think more about healthy eating and less
about convenience eating. Physical activity must become a part of
everyday life. The best parking space is farther away from the
entrance. Take the stairs for one or two flights. Dust off the
exercise equipment sitting in our basements. Imagine if televisions
could only be powered when we walked on a treadmill!
Businesses can provide on-site exercise programs. Buildings can
be built or renovated to encourage using the stairs. Communities
and government agencies can develop walking and biking trails and
provide safe places for exercise. Schools can promote physical
activity and healthy eating and create smarter consumers and
shoppers in restaurants and grocery stores. If we become more
informed and take action, we can influence the market place -- and
business and government and communities -- to create the goods,
services, and environment we need to maintain a healthy
life.
Stuart R. Chipkin, M.D., a physician with the Valley
Medical Group in Amherst, Mass., and a research professor in the
School of Public Health and Health Sciences at the University of
Massachusetts, Amherst, is chairman of the Massachusetts
Medical Society's Committee on Nutrition. Physician Focus is a
public service of the Massachusetts Medical Society. Readers should
use their own judgment when seeking medical care and consult with
their physician for treatment. Send comments toPhysicianFocus@mms.org.
