Obesity: The Hidden Epidemic

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The pandemic exposed some of the underlying inequities and inefficiencies in our healthcare system. But the single-minded focus on the coronavirus also took our attention away from other pressing challenges to our nation’s health. At the top of that list is obesity, a problem that had already reached epidemic proportions before COVID.

Obesity has a complicated relationship with the pandemic. Widespread obesity left certain communities, and our society in general, more vulnerable to the ravages of a once-in-a-century public health challenge. In turn, lifestyle changes triggered by lockdowns and other precautions have worsened the problem.

The pandemic is far from behind us. But it is time for us to start getting a handle on the obesity problem before it gets even further out of control.

A problem decades in the making

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As recently as the 1990s, no state in the U.S. had an obesity rate of more than 14%. By 2019, twelve states had obesity rates that exceeded 35%. Just a year later, four more states joined that group.

One reason these rising rates are so concerning is that obesity is more than just being fat or out of shape. As the Mayo Clinic puts it quite directly:

“Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.”

According to the School of Public Health & Health Services at George Washington University, society bears a high price tag for the health care costs and lost productivity associated with such large numbers of people being overweight or obese[1]. (Body Mass Index, or BMI, is an accurate shorthand for obesity. Those with a BMI of over 30 are said to be obese; those between 25 and 29 are said to be overweight.)

  • The medical cost of adult obesity in the U.S. may exceed $200 billion.
  • If obesity rates continue on their current track, medical costs associated with obesity are estimated to increase by $48 – $66 billion per year in the U.S., and the loss of economic productivity could be as high as $580 billion annually by 2030.
  • The costs for obese individuals are 15 times higher than total costs of overweight individuals, irrespective of gender and employment status.

In particular, obesity is closely linked to Type 2 diabetes. According to preliminary data from the CDC, over 100,000 Americans died of diabetes in 2020—the second year in a row that has hit six figures. “The large number of diabetes deaths for a second year in a row is certainly a cause for alarm,” says Dr. Paul Hsu, an epidemiologist at the University of California at Los Angeles. “Type 2 diabetes itself is relatively preventable, so it’s ever more tragic that so many deaths are occurring.”

Obesity makes us less resilient as a society

The connection between obesity and so many serious underlying health conditions is one of the things that prompted me to obtain an additional degree certifying me as an obesity specialist. And this connection with underlying health conditions made us as a society more vulnerable to the ravages of COVID.

As the CDC points out, obesity is linked to impaired immune function, decreases lung function, and can make ventilation more difficult. It is, therefore not surprising that obesity may triple the risk of hospitalization due to a COVID-19 infection. According to one model, 30% of COVID hospitalizations at the start of the pandemic could be attributed to obesity.

The CDC also estimates that higher obesity rates among Black and Hispanic adults significantly contributed to the pandemic’s greater impact on those communities.

There are many reasons why the United States, despite being the richest country on earth, has suffered a far higher mortality rate during the pandemic than other wealthy nations. But the high incidence of obesity is certainly on that list. The World Obesity Foundation reports that COVID-19 death rates are about ten times higher in countries where the majority of the population is overweight.

Given how it appears we may be in a cycle of new variants for some time to come, this sobering data is something to keep in mind. If anything, doctors at first underestimated just how profound a complicating factor obesity would be in the fight against COVID. And now, recent preliminary research finds that the virus infects fat cells and certain immune cells within body fat.

Pandemic weight gain

weight gain

In the early days of the pandemic, people joked about taking on a few extra pounds: about the “pandemic ten” or the “quarantine fifteen.” In fact, the extent of our national obesity problem has worsened much more considerably. A survey last year found that 42% of Americans experienced significant unwanted health gains during the pandemic—to the tune of an average of 29 pounds. And for 10% of those responding, their weight gain exceeded 44 pounds.

Weight gain amongst children and adolescents was “significant and alarming” in the words of one expert at the CDC. The percentage of obese children and adolescents rose to 22%. Annual weight gain for moderately obese kids went from 6.5 pounds to 12 pounds; in severely obese kids, from 8.8 pounds to 14.6 pounds.

This startling weight gain isn’t just due to changed habits and routines: less exercise, more stress eating and drinking. Stress itself triggers the body to store more fat.

Where do we go from here?

A recent report from the non-profit Trust for America’s Health (which has been issuing an annual report on the nation’s obesity crisis for eighteen years) outlines some of the measures that should be taken:

  • Increase funding for the CDC’s National Center for Chronic Disease Prevention and Health Promotion.
  • And, given the disproportionate incidence of both obesity and Covid within minority communities, also increase funding for the CDC’s Racial and Ethnic Approaches to Community Health.
  • Provide free healthy school meals to all students.
  • Close tax loopholes and deductions related to the advertising of unhealthy food and beverages to children.
  • Impose an excise tax on the sale of sugary drinks.
  • Ensure equitable access to safe and convenient walking and biking trails.
  • Expand access to health insurance, including the extension of Medicaid.

Jerome Puryear

Dr. Jerome Puryear Jr., MD, MBA, is a Health and Well-being coach and renowned Obesity in Medicine expert. With a holistic perspective on patient care, Dr. JP is dedicated to helping individuals maximize their health and well-being.