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By Robert R. Larsen, M.D., CEO of MD Execs, Inc.
I weighed myself today. It's no surprise that I picked up about 4 pounds during the holidays. At 200 pounds, I weigh more than I ever have, and this is a situation I don't want to be in. My only consolation is that I'm not alone. In fact, my problem is probably mild, but I have established a trend that, left unchecked, could become dangerous.
According to the Centers for Disease Control and Prevention, more than 60 percent of adult Americans are overweight and of these, more than 30 percent are obese (having a BMI of more than 30). This number is increasing at an alarming rate. From 1960 to 1964, the percentage of overweight Americans increased from 13 percent to 23 percent. Yet Americans are not alone in this pandemic. Twenty percent of European adults are also obese, which means that 15 to 30 million people in the United Kingdom, France and Germany are at risk of developing the serious health problems that can affect people whose BMIs exceed 30. And the problem is not limited to those who live in the West. The incidence of obesity may be lower in some Asian countries, but the rate of increase in these countries is comparable to the rate seen here.
The causes of obesity
My family includes many farmers. From early in the morning until long after dark, they worked the fields or tended their animals. Seldom did they sit down. Today's successful farmers spend hours at their computers, balancing their ledgers and studying ways to improve their crop yields. Success has led to both a decrease in physical activity and an increase of food intake. The "good life", in short, has given us too much food and too much inactivity.
Looking at the problem a little more deeply reveals other important factors. Culture plays a major role in the genesis of obesity and can have an even greater influence than affluence. For example, obesity is a greater problem in Mexico than it is in Canada. In America, the cities with the highest percentage of obese individuals are New Orleans and Atlanta, whereas the city with the lowest rate of obese adults is Denver. (In fact, Georgia alone has seen a 101.8 percent increase in the number of obese adults during the last seven years - double the national average.) Cities with higher unemployment rates, a larger proportion of African-Americans, lower per capita incomes, higher annual precipitation levels and a higher number of food stores per capita tend to have higher numbers of obese individuals.
Another factor that contributes to obesity is genetics. After all, not everyone who indulges in rich foods and shies away from physical activity will become obese. Children with overweight parents are more likely to become overweight adults, and their odds are even greater if both of their parents are overweight. The prevalence of obesity in both parents of two-parent families doubled between 1969 and 1991.
The impact of obesity on health care costs
An overwhelming percent of obese adults (80 percent) have coronary heart disease, diabetes, gallbladder disease, hypercholesterolemia, hypertension or osteoarthritis. Additional problems directly related to obesity include gastric reflux disease, stroke and depression.
Clearly obesity is a health risk and an expensive one at that. According to the American Obesity Association, the cost of health care for the obese in America comes to $238 billion per year. This represents the cost of managing diseases such as diabetes, arthritis, depression and other illnesses that can result from an individual being obese.
The physician's responsibility
Physicians must play a key role in managing obesity. Assessment of the BMI should be part of any screening program, as should counseling and education about potential health risks and available treatments. Referrals should also be provided to patients to a clinic, group or physician (whichever seems most appropriate).
The patient's responsibility
In the long run, the ultimate responsibility rests with the patient. Changing behavior is very difficult under the best of circumstances and is virtually impossible without a strong commitment from the patient. Studies have shown that people who have lost weight successfully have had a trigger to their success. This can be a serious medical problem, such as diabetes, sleep apnea, low back pain or varicose veins, or an emotional trigger, such as a husband or wife leaving a spouse because the other was overweight.
We need to treat obesity as a medical disease. Success requires commitment to a lifetime of new behavior. There needs to be a multi-pronged approach that includes diet and exercise modification, pharmaceutical crutches, behavioral modification, counseling and feedback.
To paraphrase a quote from Mark Twain: Losing weight is easy. I've done it hundreds of times and have lost hundreds of pounds over the years.
Robert R. Larsen, M.D., is the president and CEO of MD Execs, Inc., which provides temporary medical management and consulting services to physician groups and health care organizations.
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External Sources
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Centers for Disease Control and Prevention
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American Obesity Association
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This article was reviewed and updated June 2007.
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