US obesity epidemic still rising as are the associated healthcare costs, but what do we do about it? Well, it’s really complicated, but also perhaps simple.

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The News:

Obesity is more common in rural areas than in cities in the United States, two new studies have found. The two analyses, one of adults and the other of children, used data on weight, height and where people lived that was gathered in a series of nationally representative surveys from 2001 to 2016. They were published online together in JAMA, according to The New York Times.

The adult study included 10,792 men and women 20 and older. In the 2013-16 survey period, 39% were obese–defined as having a body mass index of 30 or above–including 8% who were severely obese, with a BMI of 40 or more. Prevalence of obesity was 36.5% among men and 40.8% among women, including severe obesity of 5.5% for men and 9.8% for women. In the study of 6,863 children 2 to 19 years old, 17.8% were obese, including 5.8% who were severely obese.

“I want to emphasize that this survey–the National Health and Nutrition Examination Survey–is the gold standard” in accuracy for obesity rates, said Cynthia L. Ogden, an epidemiologist with the Centers for Disease Control and Prevention and an author on both studies. “When people report their own measurements, they exaggerate their height and minimize their weight,” she said. “This survey has measured heights and weights.”

About 38% of women living in urban areas with a population greater than a million were obese, as were 42.5% of those living in urban areas smaller than a million. But in rural areas, the obesity rate for women was 47.2%.

Rates for men showed a similar, although not identical, pattern–31.8% in large urban areas, 42.4% in small metropolitan areas, and 38.9% in rural regions.

These differences could not be explained by age, education level, race, ethnicity or smoking status. There was no difference in obesity rates between non-Hispanic blacks and white men, but Hispanic men had significantly higher rates than either group.

Non-Hispanic black women had much higher rates of obesity than white women–55.9%, compared with 38.1% for whites. More than 48% of Hispanic women were obese, but only 13.6% of Asians.

Still, Dr. Ogden said, “The basic differences in demographics between rural and urban regions do not explain these differences in obesity rates. We need to look into this more to understand it better.”

Steve’s Take:

Hard as it is for me to grasp all the implications of the brutally ominous data above, another recent study confirmed that obesity rates in the United States have tripled since the 1960s and doubled since the 1980s. Nearly 70% of Americans are now overweight or obese. And as the JAMA studies make clear, it’s a national epidemic that contributes to chronic disease, disability, and death, and places a mammoth financial strain on our healthcare system.

While a healthy diet and regular exercise are key to obesity prevention, the causes of obesity are varied and complex–with economic, social, and environmental factors. This means the disease is not only difficult to pin down but it’s also unevenly experienced. Black women, for example, are more likely to be obese than any other demographic group, while Asian men and women have the lowest body mass index ratings.

Below, is a chart that examines the scope of this health issue, including who is most affected and how much it is costing us as a nation. The data are compliments of my alma mater’s online MPH program from the Milken Institute School of Public Health at the George Washington University.

As the chart below signifies, in addition to its serious health consequences, obesity has real economic costs that affect all of us. The National League of Cities says the estimated annual healthcare costs of obesity-related illness are a staggering $190.2 billion or nearly 21% of annual medical spending in the United States. Childhood obesity alone is responsible for $14 billion in direct medical costs.

Obesity-related medical costs in general are expected to rise significantly, especially because today’s obese children are likely to become tomorrow’s obese adults. If obesity rates were to remain at 2010 levels, the projected savings for  medical expenditures would be $549.5 billion over the next two decades.

The direct and additional hidden costs of obesity are stifling businesses and organizations that stimulate jobs and growth in US cities, says the NLC. In the 10 cities with the highest obesity rates, the direct costs connected with obesity and obesity-related diseases are roughly $50 million per 100,000 residents. If these 10 cities cut their obesity rates down to the national average, the combined savings to their communities would be $500 million in healthcare costs each year.

In addition to growing health care costs attributed to obesity, the nation will incur higher costs for disability and unemployment benefits.  Businesses are suffering due to obesity-related job absenteeism ($4.3 billion annually).  These costs also will continue to rise.

Bottom Line:

Please allow me to try to reduce all these data to some sort of fundamental understanding of the exact nature of the obesity dilemma, focusing on just two cohorts. Thus, I pose the apparently straight-forward question, why do Asian-Americans seem to have a lower threshold for what’s considered overweight, and yet experience even more health problems at lower BMIs?

Get ready for the hopefully straight-forward answer.

“It’s complicated,” says cardiovascular disease epidemiologist Stella Yi, an assistant professor in the New York University School of Medicine’s Department of Population Health who studies Asian-American health disparities.

(Oh well.)

For one, she says, the population tends to have more body fat than people of other racial and ethnic groups with the same BMI. So, just as BMIs can wrongly label people who are muscular as overweight or obese, they can deceivingly categorize people with unhealthy amounts of fat as normal. That appears to be especially true among Asian populations, says US News.

“It kind of ties together all with the fact that BMI is a faulty measure–it doesn’t account for the proportion that someone is of lean muscle mass versus fat,” says Yi.

Yi, whose paper published last year in the journal Preventive Medicine points out that obesity prevalence statistics of Asian-Americans aren’t derived from WHO-adjusted BMI cutoffs; they don’t differentiate between subgroups of Asian-Americans; and they don’t account for the constantly growing and changing nature of the Asian population in the US.

Where Asians carry their weight matters, too. While Caucasian and Hispanic populations often get bigger all around or on their hips and legs before developing belly fat, Jensen says, Asians tend to collect excess weight around their middles–a well-documented risk for obesity-related complications such as heart disease, diabetes, cancer and early death.

Steve's Take: Being simply #obese is not as bad as collecting excess weight around your middle called metabolic obesity Click To Tweet

The “model minority” stereotype–or the perception that Asian-Americans are highly educated, wealthy and, yes, thin–may also play a role in Asian-Americans’ rates of what researchers call “metabolic obesity”–aka skinny on the outside, fat on the inside.

“Because of…the idea that Asian-Americans are healthy, wealthy and wise…even when parents see their children kind of getting chubbier, they kind of ignore it,” Yi says. “They’re like, ‘Well, we’re the model minority, my child is fine.’”

I’ve been fighting the battle of the bulge for about the last 10 years. As a runner, I exercise about an hour a day and nearly two hours each Monday when I jog with a long-time marathon partner. What motivates us to “torture” ourselves, at least in the minds of many of our friends? It’s watching what happens to those friends who hang up their running shoes and repair to the TV room and ever-present snacks.

If we didn’t have each other to goad the other to show up on Mondays for the torture ritual…? Honestly? Well, I can still squeeze (barely) into jeans I bought 20 years ago. That’s my possibly lame, but distinctly simple approach.

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