Obesity in the United States - Research Paper Example

Obesity in the United s I. History of Obesity in the United s Obesity has become a major health issue in the recent decades. Overweight or obesity is a serious problem that can happen at any age. While most countries in this world are experiencing this problem at increasing rate, obesity rates are however highest in the United States. The Americans were considered as the most obese in the world till as recently as 2013 when Mexico surpassed the rate. According to 2013 statistics report, Mexico currently has 32.8 percent of obese adults while U.S. lags behind by just 1 percent at 31.8 percent of obese adults (FAO, 2013, p.79). Obesity is considered as a major problem in the United States for many decades. The rate of obesity prevalence has multiplied in the last few decades of the last century. However, in the past few years the percentage growth of fat people in the US has declined to some extent. Since obesity can give rise to several serious health problems and even can cause death, therefore it is very important that every year the obesity rate of Americans be monitored. Statistics from the Center for Disease Control and Prevention Every year the National Health and Nutrition Examination Survey (NHANES) studies the health conditions and nutritional levels of American people including both adults and children. To make proper assessment this program includes both interviews and physical diagnosis (CDC, 2014). According to NHANES conducted for the year 2009-2010 several facts came to light – 1) In 2009-2010, there were more than 33 percent of adults and almost 17 percent of the youth who were considered to be obese, 2) the prevalence rate of obesity remained constant with the previous year 2008-2009 in case of both adults and children, 3) the prevalence of obesity between men and women was not different in 2009-2010, 4) the older people are more inclined towards obesity than the young adults (Ogden et al., 2012, p.1). Table 1 shows the prevalence of obesity among adult men and women from 20 years to over 60 in the year 2009-2010. Table 2 shows the prevalence of obesity among boys and girls in the age range of 2-19 in the same year. Table 1: Men Women All 20 and over 35.5 % 35.8 % 35.7 % 20 to 39 33.2 % 31.9 % 32.6 % 40 to 59 36.6 % 37.2 % 36.0 % 60 and over 36.6 % 42.3 % 39.7 % (Ogden et al., 2012, p.1) Table 2: Boys Girls All 2 to 19 18.6 % 15.0 % 16.9 % 2 to 5 14.4 % 9.6 % 12.1 % 6 to 11 20.1 % 15.7 % 18.0 % 12 to 19 19.6 % 17.1 % 18.4 % (Ogden et al., 2012, p.2) Among adult Americans, in the year 2009-2010 there were 41 million women and 37 million men who were obese. However, among adolescents between 2 to 19 years, more boys (approximately 7 million) than girls (more than 5 million) were obese. Moreover, the study showed that in between 1999-2000 and 2009-2010, the prevalence of obesity had increased among men but there was no major change among women. In the year 1999-2000, 27.5 percent of men were obese and this figure increased to 35.5 in the year 2009-2010. Among women, there were 33.4 percent obese in 1999-2000 while in 2009-2010 there were 35.8 percent of obese women. Therefore, from 1999-2000 to 2009-2010 the obesity percentage difference between men and women decreased to become almost equal in 2009-2010 (Ogden et al., 2012, pp.1-5). Factors and trends There are various reasons that contribute to obesity and debates continue to occur on the issue of the degree of influence that any given factor has on increase in weight. As agriculture has become industralized, food is now available at low cost and in abundance. Intensive advertising promotes consumption of processed food. In America, agricultural policies are factors for obesity. When there was limited supply of food and oil in the early 1970s, efforts was taken to produce cheap corn and high fructose corn syrup. Then there is the Farm Bill that artificially lowers the price of food items like corn, soyabeans and meat making “unhealthy diets an economically sensible choice” (Giroux, 2012, p.86). Also, this oil crisis led many women to join the work force which had given rise to fast food industry – another major contributor of obesity. Food habit is one important factor of obesity and it is of special concern among adolescents since this group has the most energy and nutrient requirements than any other age groups (Ayranci, 2009, p.772). Genetic composition along with environmental factors like daily lifestyle plays a vital role in obesity although it is still not clear the relative contribution of genes and environment (Marti, 2004, p.S29). Reduced physical activity like walking can cause obesity and such decisions people may take due to their environment. For instance, lack of sidewalks may discourage people to walk to the store; therefore the need is to create facilities to increase physical activity like parks, fitness centers etc (CDC, 2011). In America, rising obesity among children and adolescents is major issue and the main reason is their lifestyle and food habits. Children are mostly influenced by advertisements which focus more on promoting fast food and these food are high in fat, sugar and calories. Moreover, watching television is a growing habit among adolescents and food intake becomes maximum during watching television (Green et al., 2012, p.916). Another important factor is smoking habit of pregnant women. Moreover, weight gain during infancy can lead to obesity in adulthood (Obesity causes, 2014). There are many other obesity contributing factors – longer work schedules giving less time for physical activity, excessive food portions available in gas stations, restaurants, movies theaters, supermarkets etc., lack of availability of healthy foods due to high costs or supermarkets not present nearby, excessive alcohol consumption, increased eating caused by depression or low self-esteem, lack of sleep and certain medications (What causes overweight and obesity, 2012; Obesity Risk Factors, 2013). II. Problems in Treatment of Obesity Patient compliance with regimens Treatment to reduce weight is very important since obesity can cause life-threatening diseases. There are certain difficulties that arise in the management of obesity and its treatment. Obesity treatment is often an unpleasant experience for the patients. One major part of the treatment is monitoring of weight and it becomes even more uncomfortable for the patient if weight remains unchanged after a phase of treatment or loss of weight is not according to expectation after treatment. This experience becomes even more humiliating for the patient if the weighing scale cannot accommodate the weight of the patient. It is required that patients coming for obesity treatment should be provided with user friendly equipments. Many patients report the problem of having to wear gowns that are unfitting for them. Also, many often chairs in the clinic are more suitable for leaner patients thus making obese patients uncomfortable which can be eliminated by providing them armless chairs. Moreover there are certain medications that can also lead to unpleasant side effects (Foster et al., 2005, p.233S). Obesity or excessive weight gain can lead to psychological problems in many people like reduced self-confidence, reluctance to socialize, pessimism, low self-esteem and embarrassment to face other people. Therefore, it is the duty of the physician to help patients to overcome these psychological hindrances by motivating them through an encouraging and sensitive approach so that they change their food habits and alter their lifestyles. Although the goal should be to reduce weight on long term basis, it is still necessary to establish short term goals to encourage patients to participate in weight reduction regimes. Also, there are some overweight people who feel confident about their weight and refuse to acknowledge their obesity. Such psychologies act as barriers since these people refuse to adopt measures to reduce their weight (Keegan, 1977, pp.77-78). Although much research has been done on understanding obesity problems and its negative impacts, the number of obese people in America is continuously increasing. There are now many effective treatments easily available, but still only few Americans seem to lose their weight. Previously, obesity was thought as something to be ignored to a large scale but now it is treated as an illness. Researchers now focus on the difference between calorie intake and energy expenditure; however it is still necessary to create awareness of obesity preventive programs for long term success. For many people, medication is the initial stage of treatment after failing to lose weight on permanent basis from dietary changes. Although diet sessions are most of the times successful in shedding weight of patients but after the sessions end they tend to revert to their old weights. Unlike any other kinds of illness, obesity is a clear physical manifestation and hence is known by everyone. This leads to additional social pressure which drives many patients to resort to drugs that will act as quick fix. At Washington University’s Weight Management Center, such quick fix drugs are not recommended before patients have participate in weight reducing programs for at least six weeks. By the end of this period, most of the patients become successful in losing their weight through proper diets and enhanced physical activities, and therefore they no longer remain interested in any kinds of obesity reduction drugs. The problem begins when the programs end and patients are released from dietary and physical activity sessions. For most of them, maintaining their reduced weight becomes a problem without medical and psychological support services. At this point, the Washington University recommends drug intake to help patients sustain their weight loss. However, since research on thus drugs is still at nascent stage therefore it is not yet possible to know the long term effects of such drugs. Samuel Klein, professor of medicine, suggests that just like patients with chronic diseases need to be on lifelong medication, similarly obese people must maintain a certain lifestyle forever. Since obesity is a chronic problem, therefore there is no quick fix solution (Obesity drugs not a quick fix, 2000, pp.6-7). Inherent factors in nature of treatment Physical exercise is a principle form of obesity treatment especially for children. It is necessary to develop lifestyle patterns in children and adolescents that will have long term impact on their adulthood. In order to maintain an ideal body weight, energy consumed in the form of food needs to be equal to energy expenditure in the form of physical activity. Therefore, to increase longevity of obesity reduction programs, the need is to reduce the intake of energy and increase energy output (Roberts, 2000, p.34). III. Ethical issues in society’s efforts to combat obesity Although obesity and growing weight is increasingly becoming matter of grave health concern, it is nevertheless required to consider the myriad ethical issues before implementing obesity prevention programs. The attitude of the society towards obesity influences both the psychologists and the general public. This can have negative impact on physicians who are responsible for providing effective and respectful help to patients especially women. It is important that psychologists remain aware of the biogenetic compositing in weight status of patients and that any kind of dieting can fail to have long term effect on weight loss. The natural tendency of professionals is to focus more on the negative impacts of obesity and ignore at large the harmful effects of dieting on physical and psychological constitution. Connors and Melcher (1993) have suggested that professionals should guide patients to stress on overall good health rather than to maintain society’s interpretation of ideal weight. The idea is to make patients less conscious of their weight so that the issue does not hamper their self-confidence level. Young women today live in a world where “looks are of utmost importance, social support is low, and pressure to achieve the cultural ideals of attractiveness is high” (Sheldon, 2010, p.277). Women today attempt to follow the fashion and style standards set by the society based on the fashion programs and the manner in which the models and television celebrities are exhibited. In today’s society women are often judged by their beauty and sensuality to the extent that women strive to alter their body images to achieve the practically unattainable thin body figures of the fashion program models. This can “increase women’s opportunities for shame and anxiety, reduce opportunities for peak motivational states, and diminish awareness of internal bodily states” (Fredrickson & Roberts, 1997, p.173). A woman’s physical attractiveness can be enhanced both by “facial and bodily features” (Singh & Singh, 2006, p.345), however, most research studies have proved the tendency of women to link attractiveness to faces. Although the body undergoes transformation as age increases, attractiveness is exclusively defined by the thinness of the body like thinner women are considered more attractive than overweight or even normal weight women. This is the criterion on which fashion models of television programs are also judged. According to Singh and Singh (2006, p.345) “such a unidimensional description of an attractive body is due to the lack of theory about the human body”. Yager (2007) in his article has mentioned the illusion created by media on the minds of women regarding body images and eating disorder. Magazine articles have always influenced the eating disorder patterns of women as they “seem to inadvertently associate the disorders with achievement and glamour and to make them seem more normal and more prevalent than they really are” (Yager, 2007, p.29). Magazines and televisions have the ability to create false impressions by presenting women with anorexia or bulimia nervosa as having slender bodies identical to models and celebrities. Without considering the fact that slim figures are result of negative impacts of eating disorder, common women begin to believe that since the featured women look same as models so eating disorder can result in glamorous body images which are otherwise unattainable by healthy measures. Such growing perspective among women that makes them believe that thinness is beauty often leads obese or overweight women to resort to obesity prevention programs. These women look for quick results and overlook the negative impacts of excessive dieting and physical activities. Mathe (2008) in her article focused on the influence of media on the eating disorder of women in America. This article has argued that society is responsible by large for the growing incidence of eating disorder among women by portraying ultra-thin models in television programs and promoting advertisements that encourage excessive weight loss. Such cultural standards of weight create dissatisfaction regarding body image among women even if they have normal body weight and shape. Today, there is ubiquity of television and women’s magazines filled with information about celebrity images and information which often supersede the other major world news. Majority of female celebrities are portrayed as extremely thin, which makes the average American women feel fat. Models who appear in television fashion programs exude power and status since they are highly visible in the society, and so the body image they exhibit influence young women who want to emulate them. The most vulnerable are those women who are already preoccupied with their body images; they become easily influenced by television models and soon develop eating disorders. The problem here is that average American women are not aware of the lifestyles of these models and the access these celebrities have to physical trainers and body perfection techniques. To increase sales of their products, advertisements promote thinness and weight-loss as healthy exercises and solution to many problems. This inevitably induces women to develop eating disorders in order to achieve the perfect body image as promoted by these advertisements. Such exploitation of women’s body images may be beneficial to companies that sell weight-loss products and beauty products, however it is very dangerous for women as eating disorders can also lead to death. This kind of tendency to emulate television models is even more dangerous for obese women since they resort to drastic dietary sessions that prove to be harmful for their physical constitution. Morris and Katzman (2003) in their article refer to the research evidences that have proved media’s influence on the adolescents’ perception of body image and weight. The growing incidence of anorexia nervosa and bulimia among adolescent girls has been due to their increasing concern regarding weight, shape and size of their bodies. In this modern technological world, the adolescent girls are exposed to all kinds of media including magazines and televisions. It has been observed that adolescents spend almost 5 hours every day for watching various programs on television. In the past 20 years, there has been a dramatic change in the cultural standards of body weight, shape and size as portrayed by television models. The growing trend to present models as thin to thinner has resulted in extreme underweight of models in recent years. About 75% of these models weigh less than 85% of their required ideal weight (Morris & Katzman, 2003, p.287). Such standards set by television programs influence the psychology of adolescents who consider such projections as ideal. This leads to dissatisfaction among adolescents regarding their body image and they resort to life-risking weight loss methods in pursue of the perfect body image. The core problem lies in the adolescents getting access to images conveyed by mass media. It becomes difficult for them to distinguish the distorted and manipulated images as portrayed by television programs. With the help of digital technology, the body images of the models are modified to portray them in an ideal manner that suits the program managers and advertisements. Although television has this negative impact like inducing dissatisfaction regarding body images among adolescents, it is also true that television can promote prevention strategies and health enhancing programs. Hence, the need is to create more programs that can pave the way for healthy development of children and adolescents. Body image dissatisfaction among women of all age groups is considered as normal at a certain level. Almost 50% of girls and undergraduate women consider their body images as inappropriate and this kind of assessment generates as early as 7 years of age (Grabe et al., 2008, p.460). Michael Bloomberg and the NYC ban on large size soft drinks The one best thing about obesity is that it can be controlled through personal choice made by people like type of food they consume or how many hours they provide for physical exercise (Clark, 2013, p.60). Since obesity is increasing becoming a threat for health welfare of the Americans, politicians are stepping in with policies that supposedly serve the best interests of the common people. Michael Bloomberg, the mayor of NYC is one such example of politicians who proposes policies to provide consumers with better information and choices, but ends up making the choices for the consumers. Bloomberg’s recent attempt to restrict the sale of large soft drinks has been subject to many criticisms. Bloomberg supported his decision by saying that “the correlation between the rise in obesity and the consumption of sugar is just up 100 percent.... no matter what the beverage companies think or say” (Bennet, 2012, p.68). He stressed on reducing the risks of obesity among children since according to research “one sugar-sweetened beverage per day can increase a child’s risk of obesity by 60 percent” (Richardson, 2011, p.88). According to critics, NYC’s Board of Health does not have the legal rights to ban the sale of large size drinks. For this reason, a NYC judge struck down this partial ban which stated that “a food service establishment may not sell, offer, or provide a sugary drink in a cup or container that is able to contain more than 16 fluid ounces” (Mariner & Annas, 2013, p.1764). Although the purpose of this rule is to reduce the fat from the bodies of American people, it is still largely inefficient and according to Sullum (2012) it puts a restriction of public freedom of food choice. If it is considered that it is government’s prerogative to look after the health of the American people, then it will give politicians the right to implement policies that will prove to be unfair and interfering in public rights. Hence, Bloomberg’s rule to ban large soft drinks will inevitable fail as anti-obesity measure and will only succeed as a “paternalistic precedent”. Bloomberg’s rule has minimum possibility to become successful since it is unlikely that the rule will induce people to consume less quantity of soda, and also there is always the possibility that people will intake the extra calories in other aspects of their diets which are not regulated by policies (Sullum, 2012, p.8). However, there are also views supporting Bloomberg’s policy which state that he is an urban innovator who establishes a new framework of public health measures. As major of NYC, Bloomberg has implemented various policies to combat obesity. In 2006, the city was regulated that food sold without sealed packages cannot contain more than 0.5 grams of trans fat. This policy in general received more positive response from the public in relation to other health related policies by the government. However, this too received criticisms from restaurants and human right advocates. Moreover, between the years 2002 to 2011, Bloomberg had launched several policies that regulated smoking tobacco in certain places which were successful in reducing smoking among adults and youth. According to Gostin (2013), public should give due credit to those who take steps to advocate healthier population and Bloomberg is one of those courageous politicians who focuses on the growing problem of obesity. Efforts to fight obesity by improving food choice in school lunch programs Childhood obesity is increasing at an alarming rate worldwide with America alone having 17% obese children and adolescent between the age of 2 and 19. Although genetic compositions are still regarded as major contributor, obesity among children has almost doubled in recent years indicating change in lifestyle as an important reason. Study has been conducted on a minimum of 30 students from 134 high schools of America classified according to region, size, ethnicity and curriculum. This study evaluated the influence of physical activities, sedentary activities and dietary habits on childhood obesity. Results as recorded by Dodor et al. (2010) in their article state that low physical activities and high sedentary lifestyle increase body weight and obesity in the adolescents. Also, greater intake of fruits and vegetable reduce obesity. CDC (Centers for Disease Control and Prevention) has found out that growing problem of overweight or obesity among American children has to be controlled or else future health problems will drastically reduce their life span or else the today’s children will become the first generation in America to live shorter lives than their parents. It is necessary to design anti obesity programs by emphasizing on children since food producing and processing chemicals have the most impact on this group of population. Children and adolescents also have the tendency to consume more food than adults thereby allowing “antibiotic and hormone residues” of food to accumulate in their bodies. Moreover, children are psychologically flexible and so any kind of change can be implemented on them to which they will more easily adapt than adults. Therefore, it is the responsibility of health care organizations to create health awareness among children and teach them to make proper choice of food. It is likely that what children learn now they will carry those into adulthood. Moreover, by positively shaping the food tastes and habits of children, it is possible to ensure sustainability of healthy production in the future. In order to affect the eating habits of children, the best place to start is school lunch programs (Cooper, 2011, p.76). For proper implementation healthy school lunch programs, few things need to be observed. Most foods that are ubiquitous in school cafeterias are not healthy for children. It is important that highly processed foods that are rich in sugar, salt, fat, preservatives and coloring should be removed from schools. Fried foods should also be banned from schools since it has been seen that children between 9 to 14 years who consume fried food on regular basis tend to put on weight faster than those children who avoid fried food. Also, whole grains should be promoted instead of refined sugars and flours because the former is healthier for children. Another important food stuff is salad which needs to be included in school lunch as this will encourage children to eat fresh fruits and vegetables (Cooper, 2011, p.77). The Social Stigma of Obesity The social stigma of obesity can have extreme negative physical and psychological effects on obese adults and children, college students and medical patients. Such stigma can start from childhood and remain lifelong, and is caused mainly by peers, parents, health care providers and even researchers who study the problem of obesity. As a result of this people who go through such stigma, face discrimination in their schools, colleges, workplaces and medical settings. The negative psychological impacts include low self esteem and also poor judgement of body image. Obese people experience same kind of social stigma like homosexuals, criminals and those suffering from AIDS and drug addiction. According to a study, children prefer making friendship with peers with disabilities other than obesity like those in wheelchair, missing hand, holding crutches or even having facial deformation (Latner et al., 2005, p.1226). Another study showed that adults from African American communities prefer obese people more than white people prefer. This is because more than the African American men, white men and women, African American women keep a positive attitude towards obese people (Latner et al., 2005, p.1229). Since recent years have witnessed steep growth of obesity among children and adolescents, therefore it is not surprising that obese children experience a high degree of stigmatization. According to study conducted by Latner and Stunkard (2003, p.452) on 458 children, “stigmatization of obesity by children appears to have increased over the last 40 years”. One important finding from this study is that children hold strongly unfavorable opinions regarding their obese peers, and this intensity was deeper in the 2001 than in the year 1961. Almost 77 percent of girls prefer peers who are nonobese over peer who are obese. It is however been observed that this kind of attitude is prevalent among all children irrespective of their ethnic backgrounds. Today, it is critical that extreme measures be taken to curb obesity among children and adolescents. However, to tackle this problem the need is to approach it with understanding the social stigma experienced by obese children especially from peers and parents since such stigma adversely affects the physical health and psychology of the children. Since obesity related discrimination is rampant and its negative impacts are inevitable, therefore solution lies in designing programs for reducing weight along with addressing the problem of stigmatization (Puhl & Latner, 2007, p.576). Effects of weight-loss reality TV shows (The Biggest Loser) Previously, researchers did not focus on television reality shows and their impacts on people’s perspective regarding health issues like obesity. However, a study conducted by Yoo (2013) has revealed that people who are concerned about their weight are more inclined to watch all episodes of television shows like The Biggest Loser where obese individuals make all kinds of efforts to reduce their weight. Moreover, participants of this show tend to lose their body weight which indicates that obesity can be control by personal endeavours. Therefore, it can be concluded that obesity can be attributed to personal responsibility (Yoo, 2013, p.294). Essentially media contributes towards obesity (advertisements promote fast food and fried food), it is still not known whether weight loss reality television shows have any impact on weight bias. Domoff et al. (2012) have investigated the impact of The Biggest Loser on weight bias. It was found that participants of the show harbor dislike for obese people, and they intensely believe that losing weight becomes easier after exposure. Moreover, people who watch this show tend to develop anti-fat attitudes. Michelle Obama’s campaign against childhood obesity One of the major contributions of Michelle Obama, the first lady of America, is her campaign against childhood obesity. She has titled her campaign “Let’s Move”. It was launched on February 9, 2010 and Michelle emphasized on its potential to curb childhood obesity as she said, “the entire health and the future of this country is at stake” (Bond, 2012, p.99). There are various measures taken by this campaign. Michelle and her staff has discussed with restaurant owners and food stores like Walmart to provide healthy foods. She has also stressed on making policies to control nutritional content. The campaign has already made positive impacts on childhood obesity and the result is that there has been improvement in the health of many American children (Bond, 2012, p.99). Racial, ethnic, and socio-economic inequalities as contributing factors Childhood obesity causes metabolic complications which can develop T2D and CVD. It can also lead to reduced insulin sensitivity and elevated blood pressure. A study was conducted on children belonging to different ethnicities like African Americans (AA), Hispanic American (HA) and European Americans (EA). The purpose was to evaluate the ethnic association of adipose depots on cardiometabolic outcomes. All the participants were selected by same dietitian. Their body composition and blood pressure were measured. Their glucose and lipids were analyzed. Their geographic and socioeconomic statuses were also considered. Result showed that AA children had greater lean mass, higher systolic blood pressure and lower fasting glucose than those of other ethnic groups (Casazza, 2009) Williamson et al. (2011) in their article have reported on cross-sectional studies that prove temporal increases in prevalence of childhood obesity in both genders and different racial communities. This rise has reduced in recent reports. Prevention measures for childhood obesity suggest that overweight children have the tendency to lose weight and vice versa. This was proved by a test which was participated by 451 children. Each child’s BMI percentile score was calculated. Results showed that over a period of 28 months the BMI percentile mean for AA girls increased while it remained stable for AA boys. This supports the theory that overweight children lose weight and non-overweight children gain weight. Research suggests that some minority groups like AAs will remain obese over time. 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