A commentary in the special issue of JAMA on obesity argues that the nation has reached a point where therapy can no longer undo the damage of poor diets and lack of exercise, and a reckoning of policy change is needed.
US obesity rates, which the CDC reports at 35% for men and 40.4% for women,1 suggest the nation has reached “a tipping point beyond which technological advances may no longer compensate,”2 according to a commentary that appeared Tuesday in a special issue of JAMA on obesity.
The CDC data were widely reported: obesity prevalence continues to climb, as does Class 3 obesity, which includes those with a body mass index (BMI) of 40 kg/m2 or higher. (CDC defines those with a BMI of 30 kg/m2 or above as obese.)1 Class 3 obesity now affects 5.5% of men and 9.9% of women; levels of high-risk obesity are rising quickly among women but not among men, and, unlike men, obesity in women is not concentrated among those who smoke.
In his commentary, “Lifespan Weighed Down by Diet,” David S. Ludwig, MD, made the case that poor eating is undoing the medical advances of the 20th century, reversing trends that have held since the end of the Civil War. Age-adjusted death rates for the first 9 months of 2013 increased significantly compared with the same period of 2014, he notes. While there have been other explanations for this—Princeton researchers Angus Deaton, PhD, and Anne Case, PhD, have describe the “deaths of misery” due to increased suicides and drug and alcohol abuse, overeating and eating poor quality food cannot be excused, Ludwig argues.
He points out that US counties with an absolute or relative decline in life expectancy corresponded with those affected the most by the nation’s obesity epidemic; what’s worse, he asserts that the trend will continue as today’s overweight child grow into adulthood.
“Modern medical care may prevent premature death among adults who develop obesity at age 45 years, diabetes at 55 years, and heart disease at 65 years,” he writes, “but the public health implications are likely vastly greater if this sequence of events were initiated in childhood.”
Ludwig blame the “confluence of science and special interests,” pointing to new findings that show how certain foods affect genetics and hunger. All calories, he writes, are not alike, and public policy must reflect this. It is not reasonable to blame individual eaters for a nationwide epidemic when poor quality food is plentiful, and a second commentary concurs.
“Balancing work, family, and other obligations means few parents have time to prepare meals a at home regularly,” write Jody W. Zylke, MD, and Howard Bauchner, MD, in “The Unrelenting Challenge of Obesity.”3
“Fast food and prepared foods are part of life in 2016. Although some aspects of obesity prevention are a matter of individual responsibility, families need help,” they write.
Yet policy change has proven difficult. First Lady Michelle Obama’s decision to champion an overhauled school lunch program has been lampooned by some commentators and blasted by lunchroom administrators when students refused to eat the healthier food.
Perhaps taking a lesson from that reaction, FDA called for a graduated process when it presented voluntary sodium limits last week. Regulators called for 2-year and 10-year goals, which would allow American palates to adapt to new tastes and manufacturers to reformulate products.
The food industry previously reduced the amount of added sugar in some classic products in advance of a new Nutrition Facts label, unveiled in May, which segments out “Added Sugar” for the first time.
1. Fiegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden DL. Trends in obesity among adults in the United States, 2005-2014. JAMA. 2016;315(21):2284-2291.
2. Ludwig DS. Lifespan weighed down by diet. JAMA. 2016;315(21):2269-2270.
3. Zylke JW, Bauchner H. The unrelenting challenge of obesity. JAMA. 2016;315(21):2277-2288.