It’s not just pets that are getting fatter. Humans are, too. And though the US ranks 49th in the world in lifespan, our nation is number one in body mass index, a major index of obesity.
Sixty eight percent of Americans are now classified as obese or overweight.
However, beyond the headlines of Finucane et al.’s useful study recently published in the Lancet, there are more interesting clues as to what is going on. Here are some results:
In 1980, 5% of men worldwide were considered overweight – as of 2008, 10% are.
In 1980, 8% of women were classified as obese; as of two years ago, 14% are.
The highest rate of obesity amongst women – South Africa, at 37%.
Countries that did not see an appreciable rise in body-mass index – Brazil, Taiwan, Belgium, Switzerland.
What the Study Did Not Show
- Body mass index is far from the end-all for explaining weight’s effects on health. Many studies show that waist to hip ratio, for example, is better for predicting who will have heart attacks (you want it lower.)
- Simple explanations for why the world is getting fatter in some places but not others are getting harder to justify.
- The study does not really describe the explosion of obesity in South and East Asia, especially amongst urban children. The number of obese children in Beijing has gone up around 10 times over the last twenty years.
- Different populations have different health results even if their BMI is similar. South and East Asian groups show high rates of eart disease and diabetes at much lower BMIs than western groups.
Why Are Some Places Getting So Much Fatter?
The answers are not clear. Usually, populations experiencing major economic growth tend to be able to eat more; eat more meat; become more sedentary as they move from rural regions to urban centers.
Clearly the trend towards obesity is not occurring everywhere. Brazil and Taiwan have heavily industrialized in the last 30 years without major changes in BMI.
The explanations may lie in the opposite direction – why some populations are not getting much fatter. Here the answers may lie in 1. Continuing levels of relatively high physical activity 2. Plant based diets 3. Protecting sleep and rest time : when people start sleeping 6 – 6.5 hours or less per night obesity rates ratchet up.
Why We Should Worry
As of 2008, the estimate is 1.46 billion people around the world are overweight or obese. Rates of so called “fat cancers” like breast and colon cancer, where the inflammation associated with weight gain appears to help cause more tumors, are rapidly increasing throughout the developing world. Soon we may see cancer winning over cardiovascular disease as the number one killer of humans.
Bad News for the World Economy
This is bad news for more than people’s health; it’s also bad news for the world economy. A healthy economy requires a healthy population. Weightier populations will have more diabetes, more tumors, more heart disease, and more chronic pain syndromes. Unhealthy populations cost a lot of money, and don’t allow an economy to grow nearly so well.
What We Won’t Be Able to Do About This
Lifestyle changes can markedly affect results everywhere. However, quick technical fixes beloved of industry and the media do not seem in the cards. The FDA has turned down three obesity drugs in rapid succession over the last several months. The ghosts of phen-fen remain; cardiovascular risk remains a concern for the approval panels. Most drug makers will not spend the money to see if drugs cause excess deaths a few years on – such costs are high, and meanwhile their patent protection will leach away. Moreover, influencing the extensive systemic biology necessary to treat obesity makes it difficult to create new drugs.
People keep coming to me asking more or less the same question – “Can you give me a drug which makes me lose weight, has no side effects, and makes me feel good?” Don’t expect a positive answer anytime soon.
What We Will be Able to Do
Clearly many places, like Switzerland, are not seeing major increases in obesity. Unsurprisingly, they tend to be places where there are national health care systems that are incentivized to keep their populations healthy.
Emphasis can then be placed on public health goals that matter, like having lots of greensward; supporting mass transit, which encourages people to walk and move on their own; and public health programs to promote exercise.
Social cohesion also matters. In Britain, death rates differences between the richest and poorest socio-economic
Group survival differences more than halve when there’s plenty of greenspace available to poorer populations.
That allows people to walk more, move more. Their sense of personal safety also appears to improve.
So the answers lie in national policies. Food policy is health policy. Making fast food cheap and subsidized, as we do through American agricultural subsidies, is a recipe for a fatter, shorter lived, more medically expensive politicians.
And lack of mass transit continues to dog us. New Yorkers live three years longer than the average American. It’s hard to believe “lack of stress” is the reason. In cities with mass transit, people without cars get around more under their own steam.
With American health care expensive and failing, people will need to rely on themselves, and regenerating their bodies to keep themselves healthy.
Simple measures will work. They will demand political and individual effort. We better start now.
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