How to adress obesity in the United States - Essay Example

How to Address Obesity in the United s A Review of Literature: Carmen R. Franklin CLRPS II, Taskstream Online May 29, 2007 Recently, in the United States, scientists, dieticians, nutritionists and other people in the health profession have been concerned at the alarming health risks due to obesity. While most agree that the issue deserves special attention, finding solutions to the problem is causing much debate. This literature review investigates the problem of Obesity – its causes, possible prevention strategies and cure. It also points out the limitations of some proposals and explores a comprehensive solution that involves public, private, and political approaches to this complex problem. How to Address Obesity in the United States? A Review of Literature There is drastic increase in obesity in the United States during the past 20 years. Current health care and social systems in the United States are in dire need of improvement, to halt the spread of the epidemic of Obesity. Sadly, it is one of the most rampant public health threats in the US, overlooked for centuries and affecting more and more people. Obesity leads to many other health problems, such as diabetes, heart disease and stroke, and cancer, to name just a few. So far, efforts in prevention are futile, as awareness of the problem is not well-disseminated. It is important that communities, local governments, along with the federal government and the state health department take action to implement long-term obesity prevention and treatment solutions, instead of ‘short term fixes’. Many believe that prevention of Obesity begins at home, as each individual family member is responsible in practicing healthy habits such as having good nutrition and enough exercise. Others advocate that schools and school districts need to feed students the healthy way. However, the dilemma lies in the great influence of media –the extensive advertisement of super- sized meal deals, or dietary programs from the food and pharmaceutical corporations. It seems to give out the message that “it feels good to eat whatever you want, as much as you want, anyway, there are dietary supplements that can take care of your nutrition or burn the calories you take in so you don’t get fat.” In the study of Obesity, this literature review aims to address the following concerns: 1. What are the Differing Points of View in Obesity? 2. What are the claims and corresponding evidences for such claims on Obesity? 3. What are the possible solutions to the problem and the limitations of such, based on the evidences? 4. What may be the most effective recommendation in the prevention or cure of Obesity? What Are the Differing Points of View Regarding the Problem of Obesity? Obesity in the United States is not a new issue and the American public is influenced “under the prevalence of overweight characterized by a body mass index (BMI)1 which continues to rise each year” (Frieden, 2003). Looking at ‘obesity’ etiologically, it seems to be a multifactor problem caused by poor diet and physical inactivity. Poor diet refers to poor dietary habits, such as eating junk food, consuming high calorie fast food, using excessive sugar, or high fats in our diet. Instead of buying and eating fresh food, or produce in the everyday diet, preference for preserved and frozen food overrides due to its convenience to acquire. Buchholz states in his article, “Fast food is not the primary cause of obesity states that our eating habits have changed dramatically. The addressed fast food industry is not the culprit; instead we should focus on the restaurant food and snacks we eat in between meals in front of the TV” (Buchholz, 2003). Another widespread reason for rapid increase in obesity among the U.S population is the rising trend of selling convenience through modern technology such as dial-up or internet delivery. Hence, the need to walk to a store or a food place becomes unnecessary. People prefer to use any mode of transportation in order to travel even short distances. Another possible cause of the rise in Obesity is the suburban landscape. “The structural features of the urban built environment - its enormous size, its large and densely clustered population, its social institutions, its psychosocial stressors, its economy, its rapid pace, its violence, the configuration of its streets, parks, schools, and play spaces all affect health, growth, and development of individuals” (Frieden, 2003) The landscape is almost always conducive to riding cars. Sidewalks are non-existent or disconnected, crosswalks are absent or poorly marked, and the speed and volume of vehicular traffic is overwhelming, which makes walking or biking either impractical or dangerous. So people who might otherwise walk are forced to drive even short distances and children who could easily walk to school need to be chauffeured (Engler, 2003) and some family activities such as going to the park to run, play, catch Frisbees, and other indulgences in physical activity – these are not as emphasized as typical family bonding activities anymore. Modes of entertainment have likewise changed. Gone are the days when parties and social gatherings were considered to be entertaining and filled with physical activity. Today, entertainment comes through watching television, playing video games and sitting for hours in front of the computer. Hence lives are driven by a sedentary lifestyle escorted by technological advancements. Still, there is no reason to blame technology for being overweight, or obese. Furedi says, “Note TV, junk food, or the lack of exercise does not cause obesity. Obesity is caused by far too much food eaten unconsciously throughout the day” (Furedi, 2006), coupled with inactivity that does not help burn the calories ingested. Another dilemma of Obesity is the economic reality in the United States where healthy and nutritious foods are more expensive and less accessible than junk or fast foods. Willet (2001) claims that “canned fruits and vegetables, which tend to have more salt and sugar, are much less expensive than fresh fruits. Leaner cuts of meat tend to cost more.” In addition, today’s fruits and vegetables have been bred to contain much higher levels of sugar and starch than their counterparts found in nature. “For example a tomato called the ugly tomato, is an “heirloom variety beefsteak style tomato. Heirloom means that the variety at least is 40-50 years old, is open-pollinated and has been preserved and kept true to its purest form. Heirlooms are not hybrid tomatoes which are grown for commercial purposes and tend to lose both flavor and color after several generations of breeding” ( Santa Sweets Inc., 2006). Individuals and families purchase fast food due to convenience and lack of time. An additional cause is that the local government, awards more commercial building permits for fast food and junk food places, than for supermarkets, or food vendors, and farmers markets, making such unhealthy foods more accessible to people. “Yet with more than 30% of Americans obese and fully two-thirds overweight, we continue to consider obesity a lifestyle choice rather than the public health disaster it has clearly become” (Ruppell Shell, 2002). Is the public still in doubt and vague when it comes to define obesity? Being overweight and obese are known risk factors for physical health problems, such as diabetes, stroke, and heart disease. So, how does one define overweight and obesity? Overweight refers to an excess of body weight compared to set standards. The excess weight may come from muscle, bone, fat, and /or body water. Obesity does explicitly refer to an abnormally high proportion of body fat. How is being overweight and obesity measured? One is based on the relation between height and weight, the other is based on the measurements of body fat, the body mass index (BMI) (WHO). WHO, recommended a classification for three “grades” of overweight using BMI cut off points of 25, 30, and 40 (WHO, 1995).” The International Obesity Health Task Force (IOHTF) for instance, suggested the BMI cut off point should be 35. Looking at the assumed BMI of 28.09 and following WHO cut off point of BMI 29, the person would be slightly overweight, with the tendency to obesity and the health risk for diabetes, heart disease or stroke. Following the IOHTF, the person would be of normal weight and no health risks (WHO, 1998). Will this implication being overweight, obese impact the decision on what the best solution is? It should be because reflecting on the information, given about BMI cut off point’s classification. The different cut off point classifications of the BMI used by WHO and the IOHTF for statistics, tables, or researches, will mislead and falsify results. On the other hand, the same classification (cut off point method) used is factual important evidence. Another implication of uncertainties and ambiguities is the established food pyramid from the Food and Drug Administration (FDA). The FDA calculates and recommends the following amounts of daily food, nutrition and liquid: six to eleven small servings per day, eating liberally whole grains daily, continued by three to five servings’ large amounts of fruits and vegetables with three to five servings daily, the body will be rewardingly full of energy and restlessness for all daily activities. Next, intake moderately the dairy groups, ranging from non-fat or low-fat milk, over yogurt, to fresh cheese, while being cautious consuming legume, nuts, seed’s, and meats as well. The body does not need meat every day to function. Lastly, the bad vegetable fats, oils, sweets, and salts should be consumed very sparingly, because these items create most of the diseases we struggle with today. It needs to be understood that today’s civilization was created in less than a 100 years, with not enough time for the human genes to catch up. As a matter of fact, the human body in comparison to a cockroach is extremely non adaptable to changes of any kind. The genetic makeup of the human body can not evolve to catch up to process fats in the amounts consumed today. These fats are devastating and make us suffer under various sicknesses such as obesity. What are the claims and corresponding evidences for such claims on Obesity? Obesity is a demoralizing problem from two sites, the individual and the public perspective. “There are two answers to the question, and they should be considered separately. First, we’ve vastly expanded the concept of public health to include government intervention into nearly every sphere of our lives” (Balko, 2005). Does that mean we need to consider government intervention to prevent and reduce the public health threat obesity? Second, does the public health care system undermine its responsibility because it assumes the public health costs on private behaviour? According to Ellen Ruppel Shell (Shell, 2003) obesity is more of a public health disaster than a problem. More than 30% of Americans are obese and overweight and every year, obesity claims more than 300,000 American lives. This statistics corresponds to a heightened health care cost to about $120 billion per year. Considering these facts, USA as a nation has done nothing to fight obesity and continue to believe that obesity is a lifestyle choice and not a problem. She argues that the government must take action--through regulation and education--to counter the powerful negative influence that the food industry has on peoples’ eating habits. She cited for one that there is a need to counter advertisements that mislead peoples’ choices. She argues that public service messages to eat healthy food lack the persuasiveness and convincing power of advertisements of processed foods. These processed foods contain generally more fats, sodium which if matched with the prevalent sedentary lifestyle of this generation would lead to obesity. The government by regulating food advertisements and subsidizing the production of fruits, vegetable and other unprocessed foods can combat the cycle, which leads to obesity. Shell has aptly seen the problem as a problem of the nation as a whole and not as an individual’s problem. She saw the need for government intervention but she failed to recognize that an individual has a decision sphere of his own which cannot be affected by governmental action. The State health department should insist that its food pyramid guidelines are enforced in communities and local governments to implement programs for healthy nutrition in schools. Guidelines must be set and disseminated and incorporated into school policies. Is there any substantial proof, which shows, that this kind of action backs up the claim that it would prevent and reduce obesity? Unfortunately, not. There is no proof, which provides scientific data, that regulating food advertising for children and subsidizing fresh produce for lower income individuals and family, providing better nutritional meals in schools, will prevent, or reduce obesity. Any external assistance will not be effective if the individual himself is not internally motivated to cooperate. Hanna Rosin (Rosin, 2004) proposes a solution similar to Shell’s. Rosin proposes to increase the taxes on junk foods; this may encourage people to purchase healthy fruits and vegetables instead of high fat, sugary snacks. According to Rosin, researchers have conducted experiments that tested whether people would choose low-priced healthy foods over regular-priced junk foods in vending machines. In each experiment, she contends, sales of low-calorie snacks, fruits, and vegetables increased, and sales of unhealthy foods decreased. These experiments suggest that increasing the cost of junk foods may promote healthy food choices. This however does not ensure that the choice would likely go to healthier food rather than lower priced junk food. On the other hand, Robert E. Wright (Wright, 2003) disagrees with the idea that government regulation is the answer to the problem of obesity. According to him, an individual’s food choice is solely under his control and it is unwise to use government regulation to influence such choices. According to Wright, while Shell calls for government to use its police power to influence Americans eating habits and she fails to show understanding of political economy. Experience has taught us that government regulation does not influence consumption patterns such as in alcohol and other drugs, sin taxes has not deterred consumption. He, also argues that Shell has a limited understanding of human behaviour. He asserts that Americans are passive victims of two forces beyond their immediate control, their genetic makeup and the "obesegenic" environment in which they live. He argues that while Americans cannot change their genes the government can make the environment less conducive to obesity. Americans decide whether they will be overweight, just as they decide whether they will use tobacco, alcohol, or other drugs. The last thing that Americans need is more government intervention in their eating habits. Americans need to be told to forget everything they have "learned" about diet and health over the last few decades and to search out the diet that best suit their individual needs. Individuals should be encouraged to find what works best for them. Wright says, “Instead of making the government responsible for our doing, we should be thankful for our human abilities, to think, reason and the ability to make the right or wrong decisions” (Wright, 2003). However, leaving the public health problem in the hands of civilians seems to be the problem - eating what is wanted, instead of eating what is needed. Wright’s assumption, that each individual should be responsible for his or her rights, does not mean that the government’s noble intentions and notable efforts are not to be considered and if accepted, would take privileges away from the individual. His claim, that governmental food regulation is unwise, unneeded and is not substantiated. The Food and Drug Administration only recommends and does not mandate, which food, or beverages each person should consume, to live healthily. Still another argument is that communities and local governments should come up with more efficient community logistic designs because the role of urban planning is subservient. According to Engler (2003), land developers built suburban communities in areas, which are of a good distance from shopping malls and food centre and schools. At first glance, it seems that governments should redesign their zoning plans, with enough facilities to prevent obesity. However, rather than making the assumption that it is the responsibility of the communities and local governments to ensure public health and to prevent and reduce obesity, we should ask what the individuals’ and families’ role is in this fight. Again, it all redounds to one’s accountability to his own health. There is no study, which shows that building smarter communities will prevent, or reduce obesity. Communities could do their share in the fight against obesity. Members can suggest community development plans that take health and fitness of the constituents in consideration, encouragement of healthy eating practices, banning of soda pops and fast foods in vending machines, community education on the awareness of risks associated with Obesity and other health related information, implementing taxes on junk foods and many more. ‘Obesity in America: A Growing Threat by Eileen Salinsky and Wakina Scott talks about the nature and causes of the obesity in America and also gives a summary of existing programs and policies to address the issue of obesity. According to Eileen Salinsky, many factors have contributed to the rise in obesity. Some of the factors are behaviour, genetics, culture, environment etc. But in America, over consumption of food is one of the most important reasons. While average calorie intake is increased, there is a decrease in physical activities. They have also suggested methods for tackling obesity. Some of the methods are improving access to healthy foods, educating people through information dissemination, researching pharmacological and the metabolic dynamics of weight control, improving access to physical activities and providing medical and behavioural interventions for individuals.(Salinsky, 2003) What are the possible solutions to the problem and the limitations of such, based on the evidences? There are a number of proposed solutions, which are available to combat the problem of obesity. The plan for communities and local governments to implement smarter community designs, building homes closer to commercial areas and schools, seems good; as long as sidewalks and bike paths are planned. Doing so however would mean that the communities and local governments would need public or private funds. Obtaining these funds, often seem impossible, due to budget cuts, or justification of taxes. Another constraint is that the required property is privately or commercially owned, and highly- priced. Another solution is that the FDA and the USDA need to implement newer policies and guidelines addressing obesity. The recommended intake of nutrients needs to be upgraded, to higher standards. The FDA food pyramid needs to have lower carbohydrate food items, and also higher demands for nutritious food. Then again Schools and School districts are focusing on minimum nutritional USDA standards, instead of concentrating on high nutritional standards on food and beverages, relying on revenue from the vending machines. School food suppliers and providers do not agree with higher nutritional guidelines, due to costs not being covered by the school districts. Junk foods, fast foods and candies are less expensive than nutritional, healthy fresh produce. The State health department should acknowledge publicly, the need for obesity prevention and reduction. Active information dissemination could be implemented by organizing well-researched educational public talks on the topic given by nutritionists, instructors, parents and students. This would be difficult because often, obesity- related information is unsuitable and confusing for the common people. Schools and school districts should be encouraged to introduce obesity preventive physical programs because. The State health department must intervene with the upgrading of information dissemination to educate the students. The Federal government may also rely on its powerful position, against the food and pharmaceutical corporations that market unhealthy food and drugs (dietary food supplements like slimming pills, etc.) and mandate new marketing tools, to prevent and reduce obesity. However, the food and beverage and pharmaceutical industries are not amenable to losing money on such profitable businesses. The industries’ interest is not to prevent obesity but to advertise dietary supplements, meals, and programs, even surgical procedures. What may be the most effective recommendation in the prevention or cure of Obesity? “ Public Health is the science and practice of protecting and improving the health of a community, as preventive medicine, health education, control of community diseases…”(American Heritage, 1995). Personally, the meaning of public health is formed within the micro level of a society. To regain control over the epidemic of obesity, long-term prevention programs need to be implemented. The federal government needs to initiate the updating of its programs and guidelines on public health by making the public more aware of their calorie intake, by printing the list of calories and nutrition on the menu, or on the wrapper; subsidising sport programs and treatments, by educating and informing the society about risks involved with Obesity, by moderating industries’ power to influence the public health sector, by mandating and issuing special taxation on unhealthy foods and beverages, if not compliant, with the federal guidelines. The government needs to make everyone aware that obesity is not only a personal battle to win or lose, but also a public battle to face and conquer head on. This solution is not devoid of limitations; government action alone is not enough, as Wright has aptly pointed out that individual’s freewill is an important factor in the formation of food and consumption choices, which lead to obesity or the eradication thereof. References Balko, R. (2005). Does obesity justify big government? The Freeman, retrieved October 16, 2006, from http://www.cato.org/pub_display.php?pub_id=5226 Buchholz, T. G. (2005). Fast Food is not the primary source of Obesity. Retrieved 06/31/2006, from http://galenet.galegroup.com/servlet/OVRC?vrsn=230&slb=SU&locID=wgu&srchtp=basic&c=3&ste=17&tbst=ts_basic&tab=1&txb=obesity&docNum=X3010311203&fail=0&bConts=79 Engler, Y. (2003). Much of the responsibility for obesity lies with Corporations. The obesity epidemic: the business opportunities in obesity., from http://galenet.galegroup.com/servlet/OVRC?vrsn=230&dcoll=ovrc-vpnts&locID=wgu&frmml=1&c=4&ste=30&docNum=X3010380228 Frieden R. T. & Galvez P. M. & Landrigan J. P. (2003). Obesity in the 21st Century in “Environmental Health Perspectives”. Volume: 111. Issue: 13. Obesity1, Retrieved from: www.worldfoodprize.org/assets/YouthInstitute/05proceedings/EldoraNewProvidenceHighSchool.pdf Furedi, Frank (2006). Television is not to blame for the obesity epidemic. Retrieved January 21, 2007, from http://galenet.galegroup.com/servlet/OVRC?vrsn=230&slb=SU&locID=wgu&srchtp=basic&c=30&ste=17&tbst=ts_basic&tab=1&txb=obesity&docNum=X3010379217&fail=0&bConts=79 Ruppel Shell, E. (2002). The Government should take action to help reduce obesity... Big food has become a big problem: Politicians and Health officials must address pandemic obesity., from http://galenet.galegroup.com/servlet/OVRC?vrsn=230&dcoll=ovrc-vpnts&locID=wgu&frmml=1&c=1&ste=30&docNum=X3010380226 Salinsky, Eileen, Scott, Wakina ‘Obesity in America: A Growing Threat, NHPF Background Paper, The George Washington University, Washington DC, 2003. WHO, (1998) Obesity: Preventing and managing the global epidemic. Report of the World Health Organization (WHO) Consultation on Obesity WHO, (1995) Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee World Health Organization: WHO Technical Report Series; 854). Wright, R. E. (2003). The Government should not rake action to reduce obesity. It just aint so! Retrieved from http://galenet.galegroup.com/servlet/OVRC?vrsn=230&dcoll=ovrc-vpnts&locID=wgu&frmml=1&c=2&ste=30&docNum=X3010380227 Read More