Tuesday, June 23, 2015

Obesity In America... What Can We Do?

According to a 2011-2012 JAMA survey (Journal of the American Medical Association) approximately 69% or just over two-thirds of Americans are now considered to be Overweight or Obese. We've all heard the term "Obesity Epidemic" thrown around for quite a few years now, but what does it really mean, and why does it effect you and me? The truth is the Obesity Epidemic is widely considered by those in the medical field to be one of the most pressing issues facing our country. The ramifications of this epidemic are far reaching and have implications that can impact much more than just our healthcare system. In order to understand just how big of a problem obesity is, we must first understand a little bit more about this problem. How did we get here? Why does somebody else's weight effect your life? And most importantly what can we do about it?

In order to understand this pressing issue we must first look a little further into what exactly defines someone as being "overweight" or "obese". The system for calculating someone's ideal body weight range is based on the BMI (Body Mass Index) chart. BMI calculates your relative body weight compared to your height and spits out a number based on a charting system to tell you where you lie. According to the BMI scale a score of 18.5-24.9 qualifies as normal or "ideal" on the chart, while a score over 25 qualifies as "overweight" and 30 and above qualifies as "obese". But this system can be somewhat flawed. For instance I'm six feet tall and at the moment I weight 187 pounds, technically, according to the BMI scale, I'm overweight. However, I do intense weight training 4-5 days a week and I eat a high protein diet, my body fat is just around 10%, and most phyisicians would tell you I am very much not overweight. So where the scale may be flawed for athletes and people who train or are larger from excercise, for the most part it's a pretty good starting place to determine if you're within your ideal body weight range. So jumping back to the JAMA survey that means approximately two-thirds of Americans are above this recommended range, and that number has never been so high in our countries history. 


Though you could argue that there are more issues than these, for the purposes of this article I've broken down the obesity epidemic into four main problem areas, they are as follows:

1. The Systemic Problem
2. The Healthcare Problem
3. The Fitness problem
4. The Food Industry Problem

In this editorial I would like to examine each of these problem areas and what can potentially be done to help turn things around in our country. All of these problems are interelated and through this explanation you will see how they all intertwine with one another. The biggest thing to remember when dealing with the issue of obesity is that this is something that affects EVERYONE, and those who think because they live healthy lives that they are unaffected are dead wrong. Obesity has massive ramifications on the health care industry in this country which we are all a part of, it also poses a major threat to our economy. So like it or not we are all in this together. This article is not meant to put blame on anyone who may be facing issues with weight control, but rather to offer a glimpse into the reality of the situation, and how we all need to come together to make a real change. So while some of the language may be harsh, it is not meant to be detrimental towards individuals but rather to make us realize as a whole, we have failed eachother. The good news if we want it bad enough we can create a new environment of positive empowerment and work to overcome these issues, because if we don't the results will be dire. 


The truth is, it's easier, it's socially acceptable, and in the short term it's much cheaper to be unhealthy. You need to look no further than McDonald's "Dollar-Menu" to see it's much more affordable to go the fast food route, than it is to shop for locally sourced, organic, fair trade approved quinoa at WholeFoods. But what has happened in America is we've become one extreme or the other, it seems we have no middle ground anymore. Everyone is either a vegan or real life Burger King. Personally I try to opperate on a plan of 80/20, I eat well, or as well as I can 80% of the time, and the other 20% I pretty much allow myself to eat whatever I want. Mix that with regular exercise and you can enjoy the occasional cookie, ice cream, or a few beers, without feeling guilty about it. But with Americans in general it seems we are always about the extremes, and with the increase in technology, a decrease in overall regular exercise, and the availabilty and affordabilty of fast foods and unhealthy portion sizes, it's  simply easy to be fat in this country. 

This is why obesity is such a systemic problem in our country, quite frankly because now it's built in to our system. From an early age we are barraged with billions of dollars a year spent in advertising to keep us consuming high calorie, low value food and beverages. According to FastFoodAdvertising.org, fast food companies spent over $4.6 Billion in advertising in 2012, so it's no wonder when Americans want something cheap and easy, fast food always seems like a viable option. But as sizes get bigger and cheaper it's no wonder a typical large combo can exceed well over 1,000 calories and in many cases can break the 2,000 recommended calories per day mark, in just one meal (The Cheesecake Factory has quite a few items that break this threshold). 

If we want to break this trend we have to start holding these companies accountable for reality of what they're doing, slowly poisoning the American population. Alcohol and tobacco are regulated and taxed in this country at astounding levels yet fast food, which has been linked as a main contributor to obesity goes unpunished. It's true many companies have come under scrutiny in the last few years for substandard labor practices (McDonald's), and are now being held accountable for food quality in their establishments (Tacobell), but this is just the beginning. If we really want to change our attitude in this country towards obesity, I propose taxing these companies as what they really are, on the same levels as alcohol and tobacco.  According to the American Heart Association, Obesity results in $190 BILLION DOLLARS a year in weight related medical bills. It's time we passed some of this cost back onto the supplier. 

At the same time the government should be helping to fund and provide grants to companies willing to think outside the box. Companies who want to create affordable, healthy meal options that can perhaps help change the stigma associated with fast food. The other idea I would suggest would be programs to help underpriviledged and impoverished families with cheaper access to organic and healthy food options, think Food Stamps meets Trader Joe's. By making healthy options available and educating underprivileged familes on the importance of a proper diet, we can reach a population that is statistically even more affected by the Obesity Epidemic. This is not a change that can happen over night, but by creating a new set of ideas and societal morals, we can start the wheels of change in the right direction. 


Healthcare is always a touchy subject no matter how you approach it. There are some that believe "Obamacare" has been incredibly detrimental to our healthcare system, specifically privatized healthcare. While others claim the overall good created by these programs in making healthcare affordable for all ages and income brackets has outweighed any criticism. Personally I fall somewhere in the middle. This past year I did not opt into the new healthcare program and my insurance covered under my parents up to that point expired on my 26th birthday. For me healthcare has never really been an issue, I've always taken care of myself, I rarely get sick, and it seemed to me that paying for something I probably wasn't going to need was pointless. This is an extremely stupid belief system to have, trust me I know, but it's one also shared by many in my age bracket. Milllenials, specifically millenials who stay physically active seem to think that we are all invincible. The truth is, it's called insurance for a reason, it's meant to be there "just in case". But my issue is more with the setup of the healthcare system rather than the idea of offering it to everyone. 

As I stated earlier, the American Heart Association estimates obesity related healthcare issues account for an astounding $190 Billion a year in medical costs. That means the premiums that healthy individuals like myself and many other Americans are forced to pay for are a direct result of the medical costs associated with being overweight. To me this seems like a way to punish those who are literally costing the healthcare system almost nothing, compared to those who are crippling it with unnecessary medical bills. So here is my hypothetical solution to this problem. And though I know the reality of such a situation is very unlikely, unless I one day decide to run for President, I do think even minor shifts towards the drastic solutions I'm proposing would create a huge change in American culture and how we view health in this country. 


Let's look at a hypothetical scenario with two 26-year olds who are now required to cover their own healthcare expenses. Our first patient has no pre-existing conditions, his BMI falls right in the recommended range, he is extremely healthy and lives an active lifestyle. He is a non-smoker, who occiasionally has a drink or two, but by no means abuses any substances. His premium is $250/month. 

Our second patient has hypertension and is at huge risk of developing type-2 diabetes. He has a BMI well over 30, as well as smoking a pack a day, he drinks heavily and lives a mostly seditary lifestyle. His premium is $250/month. Now how is this fair? Instead of simply blanket charging people based on age and demographic, we need to create a system that rewards those who through proper diet and excercise alleviate the demands placed on the healthcare system. Now it's hard to work out all the logistics and create a fair a balanced plan that wouldn't simply ostracize those who are overweight without a chance to redeem themselves, so here is what I propose. 

Create base level costs in each age group and weight bracket, not simply using BMI as the across the board standard but also calculating in bf% and activity levels. No use of family history as this could pre-bias in both directions. If someone comes from a healthy family but is obese they should be punished more than someone with family medical history but extremely healthy lifestyle.

Create mandatory non-charged testing for first consultations when people are getting checked out for new plans. After that patients are allowed to apply for new testing twice a year with the option to be immediately downgraded to a lower payment bracket if they have shown significant improvements. 

After initial testing and bracket placement you will not be forced to go in for a new bracketing system except every 5 years, but you are always eligible twice a year to apply to go down in the bracketing system. This means if you choose to do nothing and continue to be sedentary, you have five years to do so, but in five years you could be forced to pay even more. However, when initially placed you have two opportunities each year to turn yourself around and go in to show improvement and pay significantly less. Same goes for older individuals but after say age 65 you only have to show up every ten years, but you can have the same two opportunities every year to show improvement. This will encourage people to drop down as the gap between the higher and lower brackets will be significant, for example healthy, non-smoking individuals ranging from 18-30 may pay as little as $50 a month for coverage, while obese, smokers could pay upwards of $1000 a month.

Now this may seem drastic, because it is, but really that's the point. By rewarding those who take care of themselves and put less burden on the healthcare system, you encourage all people to take an active role in turning their lives around. The other thing this would do is create a potentially enormous boost in healthcare related programs to stimulate growth in the economy. Think about all the new opportunities that would arise for businesses related to nutrition and exercise. You could even create tax breaks for those who are investing in these industries in order to better themselves. So for instance if you paid $5,000 over the course of a year for nutritionists and fitness services, but this resulted in drastic improvements to your health and wellbeing, those costs could be used as a tax write off. And by giving people multiple opportunites each year to enter a lower costing bracket, you are giving everyone a fair chance to take an active role in their personal well being. Whether or not they choose to do anything about it is up to them. 

The short term costs associated with this kind of total overhaul would be pretty drastic at first, but over the course of 10-20 years we could potentially see a huge change in the health culture of American Society, which brings us to our next issue.


When I was growing up in schools in the midwest in the 90's P.E. class or PhysEd, was just starting a major decline. Now you would be hardpressed to find a regular P.E. program at most schools in the country. With the GFC and school funding cut drastically over the course of the last two decades, programs like P.E. simply became a novelty, not a necessity. But I would argue that good real Physical Education classes from a young age are just as important if not more than many of the things taught to our young people in school. For instance I spent much of my 5th grade year learning of the importance of cursive writing, and I can't remember one time in the last decade when I used it for anything other than my signature. 


Physical education classes have seen a continued and drastic decline in our country. With school budget cuts across the board and the creation of NCLB testing standards, any available resources in schools have been put towards test prep and pulled away from programs deemed frivolous. According to a 2006 CDC report less than 10% of schools in all age levels teach the recommended amount of physical fitness or the equivalent to all students on a regular basis. So it's no wonder that childhood obesity has had such a dramatic rise. Schools are where we go to learn the fundamentals and building blocks of the things that will help us in the rest of our adult life. Since physical fitness is no longer a priority it's no wonder the foundation for a healthy lifestyle is so rare these days. 

In 1960 President JFK announced a program aimed at elevating the level of physical fitness in students across the country. The flagship school for this programs role out was La Sierra High School in California. As you can see from this short clip (http://youtu.be/fISgKl8dB3M), these programs were not only impactful, the results were incredible. There is now a growing movement in this country to revisit the importance of regular physical fitness in children in schools throughout the country. In 2008, La Sierra became one of the first schools in the country to role out a "Crossfit" program for it's students and once again the results have been extremely positive. Regular excersise has dramatic affects in improving not just the overall health of young people but also their academic capacity. With the increase of video games, and technology it's harder and less frequent to see children getting their recommended alotment of physical exercise, and for many students incorportating these programs into schools is the only way they will see any activity at all. 

It's widely known and accepted that physical activity increases brain function by opening capilaries in the cardiovascular system and increasing blood flow and oxidation, two things that are extremely important when people are tryinig to learn. In one study in May 2013 by the American College of Sports Medicine, reseachers found that fourth and fifth graders who ran around or otherwise exercised vigorously for 10 minutes or more prior to a math test, tested higher than thosee who sat quietly before the test. Another study pulbish in August of the samee year by the Journal of Pediatrics, found that out of 12,000 Nebraska school children, those with higher levels  of physical fitness were also linked with better scores in both English and Math testing. So by cutting out mandatory physical fitness in an effort to increase time for in classroom learning may actually be having a counter intuitive effect on improving students learning capabilites. 

All academics aside, it's also incredibly important to get our youth active from a young age. The pre-adolescent and pre-pubescent time frame is when most children learn the activities, social beliefs, and societal standards they will carry with them throughout the rest of their lives. If we can instill from this young age the importance of regular physical activity and proper nutrition then we are reaching children in their most moldable years. By simply teaching children to be active we are teaching them valuable life skills that can have huge ramifications on the socio-economic and financial impacts for future generations. 


As was stated earlier, fast food companies spend BILLIONS of dollars each year on marketing and advertising campaigns directed at children and the impoverished. While it is true that in recent years many of these companies have come under increased scrutiny there is still a daunting issue facing our country. Yes, companies like McDonald's specifically have come under fire recently, but even with all this increased scrutiny it seems they are simply trying to put a band-aid over a mortal wound. And as T-Swift so eloquently puts it, "Band-aids don't fix bullet holes"... preach T-Swift... preach. 

I don't have nearly the time, the space, the energy, or the statistical data to delve into the many problems with the food industry in this country, but I can outline some of the basics. Really what it boils down to is three interelated aspects that have put us on this downward spiral. The are cost, convenience, and lack of education. 

The past few years have seen rapid and expansive growth in the U.S. economy. Regardless of what your beliefs are about the current administration, the fact remains that the U.S. is once again at the forefront of the World's economies. As Europe continues to deal with it's own financial crisis and bailouts, the U.S. Dollar is the strongest it's been in quite some time. While it's good to be back on top, this in no way implies that we are out of the darkness just yet. Many people in our country are still struggling to make ends meat and the cost and availability of healthy nutritious food is part of the problem. It's time we started demanding higher quality products, not just from fast food companies, but from all food manufacturers. It seems every week there is a new recall in the states, whether it be contaminated chicken, beef, or even vegetables, and the reasoning for this is clear. In an effort to cut costs while maximizing profits, food suppliers are doing everything in their power to give us the most amount of food, for the least amount of money, but at what cost to our health? There are countless documentaries focused on the horrible living situations surrounding mass produced livestock in this country, but what really has been done to rectify these situations. When push comes to shove people without the funds to pay for "organic" "fair-trade" items are many times forced to simply buy what's affordable. 

It's because of this low costing structure that we need to make a fundamental shift in what we expect from our food suppliers. Instead of letting large food conglomerates control the will of the senate through lobbyists we need to create programs that start holding these companies accountable. The same way people get up in arms when they find out their favorite clothing brands are being made by 6-year olds working 14-hours a day, is the same way we should feel about food companies with substandard labor practices. This is not to say that children and chickens are on the same level, but simply realizing that when we sacrifice our consumeristic ingegrity we are sacrificing more by paying slightly less than we may think. We need to start holding our food suppliers accountable, demanding fair labor practices, not just for the livestock, but also for those producing it. By creating restrictions on corporations, we provide incentives to farmers, who then supply supremely better products. 

The next thing we need to do is something I touched on earlier. Providing higher taxation and restrictions on those companies providing shoddy products to the consumers. At the same time offering tax breaks and incentives to innovative companies and entrepreneurs that are willing to create healthy, convenient, alternatives to their corporate counterparts. For instance we could create a program that incentivizes opening healthy meal outlets. If you were to say open a salad and fallafel chain, where your most "unhealthy" item fell under the 1,000 calorie threshold, you could apply for government grants and loans to expand your business. Whereas if you wanted to open a chain of Chicken & Waffel restaurants, you wouldn't be afforded the same government incentives. You could even go one step further and offer larger grants and tax breaks to companies willing to opening healthy alternative businesses in areas of lower socio-economic status. This would not only provide business opportunities within these communites for residents of the communities but could also slowly start to shift the sterotypes related to different economic levels. Which unfortunately are there for a reason. But by offering incentives and breaking stereotypes we can slowly start to creating a change that branches outwards from the places most in need. 

This previous idea ties in with the last one, which is, lack of education. This is a broad and someone confusing category as it involves many aspects, including home life, public education, and advertising. There is not a lot of emphasis in this country on proper diet and excercise while you can find ads regularly depicting 99 cent Frosties, and the importance of milk. While I won't argue that milk is not an arguably important nutritional supplement, I find the lack of education regarding well-rounded diets appauling. 

I remember learning about the food pyramid as a youngster and not really caring that much, as long as I got to have some gushers every once in a while I was good. I was fortunate enough to come from a good home where putting food on the table was never an issue. Unfortunately for millions of Americans this is a daily struggle, and the amount of children in this country going hungry is alarming. There are government programs in place to help underprivileged students receive meals at school but what our country's schools are serving, while better than nothing, is not necessarily good. I grew up in a pretty affluent area but even the food at my school was mostly high preservative, deep fried mush. But when I was in school we also had recess everyday, and after school sports. So eating a couple of pieces of pizza for lunch was quickly burned off by the time the 3 o'clock bell rang. It's time our schools started making nutrition and education a priority, and just like the other proposed programs here, I think government incentive is a good place to start.

Let's start making fitness testing just as important as starndardized testing. Offering schools grants to create new and inventive programs that teach our students about proper exercise and nutrition. Maybe instead of "Home-economics" we can start offering classes from an early age about "Excercise Physiology" and "Nutritional Fundamentals". By replacing some age old "elective" classes we can at least begin to offer our kids a chance to learn about health and wellness. The key is starting young, and making education a priority when it comes to health and wellbeing. Yes, it's important to make sure our kids are learning educational fundamentals to help them in their quest for higher education, but shouldn't we also be worried about their long term wellbeing?


The truth is this problem can't be fixed over night, but it's something we need to start talking about. What will really make a change in this country is open candid discussions about changing our situation, people stepping forward with long term solutions, rather than short term fixes. This isn't something that can simply be implemented and enforced, people have to want it, and they should. By continuing to spread awareness, we can start to take this issue out of the realm of taboo, and into the main stream. Remember it's not just a small group of American's affected here, it's two thirds of the American population. The long term ramifications of this problem are startling and dire, and unless we start a change now, the end result will not be pretty. But what can you do to make a difference? For one, take an active role in noticing all these things. Demand more from your food suppliers and start supporting local, healthy food alternatives. If you or someone you know is affected with obesity, talk about it. For many people, obesity is not a disease, it's an addiction, and like many addictions it came as a result of lack of education about the long term consequences. There is an solution, we just have to be willing to work for it, to hold eachother accountable, and to understand that only together can we make a difference in this fight. 

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