Question of Judgment: What is the best way to address obesity in the United States?
This requires a question of judgment because this is a subject for discussion and debate: obesity is the number one health problem in the United States today. We will be seeking the best answer within the range of possibilities on how to address obesity in the United States. From this standpoint, we can evaluate answers to such questions using universal intellectual standards set forth in dealing with questions of judgment. (Paul & Elder, 2002)
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There are various, logical ways to address this problem of obesity but are not properly implemented, or if they are, there are no right programs and policies from proper agencies and authorities concerned to back the implementations.
How can we address the problem? We can cite some possible remedies:
- Policies and programs should be focused on controlling obesity in the young and adults, and these should be backed with the right political will;
- Programs to encourage the young and the students to eat the right food and not resort to overeating;
- Physical education should be a part of all grades up to college;
- Physical exercise should be a part of the activities in government offices and private offices and businesses.
We have to address this problem and increase awareness in people over this growing disease. All government agencies and health workers and organizations should focus their resources to combat obesity.
Obesity is not just people going fat; it is a disease that causes maladies like type-2 diabetes, heart disease, cancer and strokes. Women and our teens are more susceptible to obesity. They suffer economic harm as they become more inactive when their body mass grow. People with a weight control problem have a real and identifiable physiological and medical condition, and obese people have shorter lives than non-obese people. Preventing and addressing obesity has cost billions of dollars for the government, estimated at $110 billion a year, equivalent to 1 percent of the U.S. Gross Domestic Product (Burd-Sharps et al., 2008, p. 64).
Along this line are the questions that need to be answered:
- What are the Americans doing to fight obesity?
- Are there enough programs and policies being instituted by the government, and are health workers doing it right to help people fight obesity?
I’m afraid these questions can all be answered in the negative.
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Policies are not geared towards eradication of obesity in the country. The government is spending a lot of money from the national budget, but the real answers to the problem are not being done.
We have gathered from statistics that one American dies every ninety seconds from obesity-related problems (Burd-Sharps et al., 2008, p. 64). Another fact is that 280,000 Americans die of overweight or obesity-related deaths every year (Allison et al., 1999). The proportion of Americans who are overweight and obese has increased dramatically within the past two decades, and increases in overweight and obesity cuts across all ages, racial and ethnic groups (Bailey, 2006, p. 24).
According to the Centers for Disease Control and Prevention, for the first time in history, there are more overweight and obese people in the nation than people of normal weight. An estimated 61 percent of U.S. adults are either overweight or obese. Obesity develops more rapidly in black men after approximately age 28 years. Worldwide, there are at least 300 million people obese and two to three times are overweight (Cooke and Wardle, 2007, p. 238). Researchers stipulated that if the prevalence of obesity continues to rise, especially at younger ages, the negative effect on health and longevity in the coming decades could be much worse.
What are the Americans doing to fight the disease?
Not much that we can cite here. Americans continue their way of life. Modern lifestyles characterized by inactivity are risk factors leading to diabetes and diseases with high mortality: insulin resistance, lipid disorders, hypertension, and vascular disease. Food is cheaper, particularly high-fat foods. There are also changes in the nature of work, time pressures in the daily living.
Survey studies conducted among patients and physicians uniformly demonstrate that physicians are failing to adequately identify the overweight and mildly obese patient, although there is greater recognition for the moderately to severely obese patient, particularly when accompanied by comorbid conditions. A great percent of the children’s population is succumbing to the disease.
In diabetes, there is energy imbalance: more energy intake with less energy expenditure. Therefore, early assessment of energy imbalance should be taken to help individuals counter obesity. Obesity is preventable like cigarette smoking if drastic actions are undertaken.
There are many steps to control the pandemic (as it is now because of its fast increase).
First is prevention, later cure. We all know the saying “An ounce of prevention is worth a pound of cure.” That is precisely the principle here.
Then, Body Mass Index or BMI should be measured on Americans who are perceived obese. This is for purposes of statistics; there has to be new surveys on the number of obese Americans, to know the right procedures in implementing the programs to fight obesity.
The American Medical Association considers one overweight when he/she has a BMI of 25 to 29.9. Obesity is divided into mild (BMI of 30 to 34.9), moderate (BMI of 35 to 39.9), and severe / extreme (BMI ≥ 40) classifications. A BMI of 30 is about 30 lb. overweight and equivalent to 221 lb in a 6’ 0” person and to 186 lb in one 5’ 6” (Bailey, 2006, p. 23). In children, the relationship between BMI and body fat varies considerably with age and with pubertal maturation; however, when adjusted for age and gender, BMI can point mass.
The U.S. Preventive Services Task Force along with multiple other societies and organizations has endorsed periodic measurement of height and weight for all patients. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) checklist for health recommends that all men and women have their body mass index (BMI) calculated to screen for obesity.
Communities can help address the problem. Physical education subjects should be required in all grades up to college, more healthy food for the students, and a healthy environment in school. Diet, exercise and enough sleep are the keys to a successful diabetic regimen.
But is this encouraged at home, school, or at work?
We doubt this is being done, except in a few government-run institutions. There must be full cooperation from the government and the private sectors, and from people suffering from this disease. Teamwork is essential. Sacrifice and care for one another are needed. Programs such as doing away from fat-filled foods, keeping on monitoring blood pressure, glucose, and following what the doctor and other health professionals say, can help fight obesity.
We often hear and read of promoting exercise among the youth, but are our youth doing it? There are tools that encourage them to be immobile or to just stay at home and surf the Net and be inactive. Technology is encouraging our young people to sit there in front of their computers, chat with their friends, browse the Web, and consequently acquire sickness and obesity in the long run.
We have to encourage physical exercise or aerobic exercise which is a planned and structured bodily movement resulting in increased oxygen consumption and calorie expenditure. There is substantial evidence demonstrating that 5% to 10% loss of initial weight is sufficient to reduce, at least in the short term, the risk of many health complications associated with obesity including essential hypertension, type 2-diabetes, and dyslipidemia.
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Obesity is a deeply stigmatizing attribute that prompts negative stereotyping and discrimination in others, which, in turn, causes depression and other negative psychological and social outcomes. Discrimination against obese people can lead to depression. Exposure to obesity stigmatization by others is associated with poor body image, low self-esteem and greater psychological distress. Depression is traditionally considered an outcome or effect of obesity. Eating and energy expenditure are often proposed as intervening constructs in the depression-obesity relationship. Depression indirectly causes behaviors such as emotional eating, eating calorie-dense food, and decreased physical activity.
“Prevention of Obesity”
Authors: W. Philip T. James and Timothy P. Gill (2008, pp. 155-175)
The article raises right arguments for combating obesity in the United States. Prevention is the key to fight obesity, but this must be done right here in the midst of obese adults. Adult obesity is the real problem.
The importance of adult interventions should be reinforced by a new analysis which models the potential gains that might occur if children or adult prevention are the primary focus of action. Overweight and obesity are a world pandemic, widespread and advanced that few regions of the world appear to have escaped its effects. Priority should be on the prevention of obesity and weight maintenance in preference to weight loss interventions.
James and Gill (2008) argue that the sharpest increase in the incidence of obesity is in adulthood; adults usually continue to gain weight at this age, and adult weight gain is almost always fat gain except in athletes in training. The relative risks for many diseases associated with obesity decrease with age but the absolute and population-attributable risks for disease increase with age. Adults and parents act as role models and have other responsibilities toward the diet and physical activity behaviors of children. Thus, the prevention of obesity in childhood is dependent on the successful engagement of parents.
Moreover, interventions in children and adolescents need to be maintained for many more years or decades to have a considerable effect on the number of new cases of type 2 diabetes mellitus and heart disease or cancer compared with interventions in older individuals.
James and Gill (2008) further argue that if the emphasis of obesity prevention efforts are focused solely on children and further deterioration in obesity levels are halted, this would have almost negligible impact on the disease burden over the next 40 years, while interventions that address adults have the potential for a much more profound effect. Preventing weight gain is likely to produce better returns than attempting to achieve population width loss, with the gain achieved by preventing those who are overweight becoming obese only slightly less than that produced by reduction of 4 body mass index (BMI) units in the population BMI.
The modeling of illness shows that the benefits of identifying and focusing preventive efforts on those who are most at risk of developing chronic disease indicates that it is a major mistake to focus only on those younger than 50 years, as immediate benefit comes from addressing those older than 50 years as well. Evidence discovered from epidemiological studies that the period of early adulthood has now become the new age group that is gaining weight the fastest and thus has the greatest incidence of overweight and obesity. In previous decades, the rate of weight gain began to rise slowly from the early 20s and peaked in the fifth or sixth decade of life.
In past generations, most adults attained excessive weight late in life only and thus limited the length of time that they were overweight and at increased risk of illness. The rapid development of obesity in young adults resulted in development of chronic diseases such as coronary atherosclerosis and cardiovascular disease, diabetes, fertility problems, and quality of life.
The authors further argue that:
- The current generation may be the first not to outlive their parents; and
- The decline in the age in onset of type 2 diabetes has been tied to early weight gain and development of obesity in early adulthood, and
There is the problem of mothers accumulating excess weight and developing obesity during pregnancy. A considerable variation has been noted in the amount of weight gained during gestation and this excess weight is often retained after giving birth. Some women experience extreme weight gains and others have cumulative increases in body weight after each pregnancy. Obese women have the propensity to produce large babies, and there’s a great possibility for these children to become obese.
A number of surveys revealed that the level of overweight and obesity begins to climb rapidly in early adulthood and reaches its peak in the middle age for both males and females. But the rates of overweight and obesity begin to decline from the seventies. The increases in body weight are accompanied by changes in body composition that result in middle-aged and older adults having a higher level of body fatness.
There is also the detrimental consequence of aging on the development of obesity-related illness which is the increase in central distribution of body fat that occurs in both men and women with age.
Adults have the tendency to develop abdominal obesity, which is now linked to an enhanced risk of comorbidities and is a key feature of a particular malady known as syndrome X or the metabolic syndrome. This is characterized by a relative excess of abdominal fat, hypertension, insulin resistance with glucose intolerance or diabetes, dyslipidemia, and micropretenuria. Men have have higher proportion of body fat stored centrally than women, and the level of abdominal fat increases gradually with age.
Women generally enter the middle years with a lower level of abdominal fat but it begins to accumulate rapidly within this period so that by the seventh decade of life, men and women have a more equal distribution of body fat. Recently, the Centers for Disease Control and Prevention (CDC)-based working group reaffirmed the importance of addressing abdominal obesity.
The authors state that no country, no matter how wealthy, has unlimited resources to apply to health care, and this applies even to the United States. However, with limited resources, countries should be able to make decisions about where to target interventions. They suggest a follow up of the report of the WHO Consultation on obesity which states that there are three different but equally valid and complementary levels of obesity prevention. They state that the logical approach is to consider identifying those who are on the borderline of obesity, or adults with BMIs of perhaps 28 to 29 kg/m2 and attempt to prevent them from gaining further weight and thus entering the obese category. Success would relate to maintaining a maximum BMI of 29 kg/m2 for individual adults.
The reasons for focusing on Weight Gain Prevention in adults are:
- Weight gain adulthood carries an independent risk of ill health
- Risk for chronic disease begins to increase from low BMI levels and significant weight gain can occur within normal limits.
- Extended periods of weight gain are difficult to reverse.
- Weight gain in adulthood is mostly fat gain.
- A focus on weight gain prevention avoids exacerbation of inappropriate dieting behaviors.
- The message is equally relevant to all sections of the adult population.
- It avoids further stigmatization and reference to poorly understood terms such as “healthy weight”.
Weight gain prevention is important in adults, James and Gill (2008) argue, therefore more effort should be applied to find successful intervention to achieve this outcome. Current obesity prevention efforts in adults are been limited and may have been inhibited by a number of factors including:
- lack of acceptance of the importance of obesity as a serious health problem,
- the setting of inappropriate or unachievable goals,
- lack of focus on weight gain prevention as the main outcome,
- a poor understanding of effective prevention strategies, underfunding of public health and obesity prevention research, problems identifying and targeting at risk individuals and groups, and inadequate public health and practical prevention skills within the health workforce.
James and Gill (2008) conclude that determining the most effective strategies for the prevention of obesity at the community level must be seen as a priority.
The Prevention of Obesity in Childhood and Adolescence
Author: Tim Lobstein (2008, pp. 1-25)
Lobstein (2008) stresses the importance of focusing on childhood obesity. He states that lifestyle patterns are learned at an early age, and unhealthy patterns can lead to a lifetime of increased risk of ill-health, and that the pathological effects of obesity are in many cases a product of the time the individual has been obese as well as the severity of the obesity. It is important to treat obesity while it is still beginning to grow because the root of the problem is not so difficult to treat. Prevention is the point here.
Lobstein (2008) states that multiple actions in school for children can have a sustainable beneficial impact than single actions. The more an environment is consistently able to promote healthy behavior, the greater the likelihood that such behavior will occur. In schools, we can help in instilling awareness in the children, and this can continue in their homes and as they grow up. Interventions that can be controlled can be done in schools where specific inputs can be measured and the experimental designs can ensure a degree of scientific validity to the results. The focus on the school creates a strong “setting bias” in the scientific evidence.
Interventions that can maintain or improve health behavior from an early age and that prevent long-term obesity are likely to be far more cost-effective over the longer period than managing and treating obesity and obesity-related diseases after they have developed.
WHO recommends population-based interventions and to tackle the determinants of food choices and physical activity levels. There is also the need to institute clear nutritional food labeling, and this must be done as a policy.
There is also the concept of investment paradigm where prevention initiatives are considered speculative ventures. An investment portfolio should carry a mixture of “safe” low-return initiatives and “risky” potentially high-return initiatives.
There are reasons why we should prevent obesity occurring in childhood or as a result of behaviors learned in childhood. Policy-makers are sensitive to prevention of obesity in children because children are generally not held responsible for their own health behavior, their behavior is assumed to be more open to influence than that of adults, and they can be more readily targeted than adults, for example, in school settings. Perhaps as a result of this perceived set of advantages, funding for research into childhood obesity prevention tends to be more easily obtained and the evidence base has consequently grown more rapidly. Prevention of obesity is preferred to be instituted at an early age because once children are overweight, successful weight loss is difficult to achieve.
There is strong evidence and this is common in almost all countries that obesity is prevalent among school-age children. An obese child faces a lifetime of increased risk of various diseases. Moreover, a child is also likely to experience excess body weight as a cause of psychological distress.
We have to shift focus because of the unavailability of more treatment options for pediatric services.
Lobstein (2008) stresses the classical framework for the development of health promotion strategies which is one that describes interventions in terms of “target groups”, the children for example. The target groups that we can discuss can be specified through reference to the life course, and this starts with maternal health and prenatal nutrition and proceeds through pregnancy outcomes, infant nutrition preschool and school-age children, adolescents, adults of reproductive age, and older people. WHO also recommends that this can be crosscut with gender and socioeconomic groupings, including racial and ethnic groups, migrant status, income and educational levels.
A limitation to the use of this analysis for identifying target groups is that it can be interpreted to mean that interventions should only act upon the group whose health is in question, for example, those for home improvement in diet or physical activity would be beneficial. This may be considered too narrow a target for tackling obesity as it does not consider how to tackle the determinants of individual behavior.
Lobstein (2008) argue that some interventions are designed to change dietary patterns while others are designed to increase physical activity, or decrease sedentary behavior, in order to increase energy expenditure. Many interventions are designed to tackle both energy intake and energy expenditure in a combined program.
There are many possible solutions to the question: What is the best way to address obesity in the United States? In fact all of the above facts and recommendations are possible solutions. What is only needed is a systematic approach and policy formulation that should come from the government in order for these solutions to become a way of life and something that should be followed by our children and adults.
For example, we can avoid the risk factors that contribute to diabetes from childhood up to adulthood. This we can do while at school and at home. We have to apply what we learn at school in our lifestyle.
We can focus on prevention, then on programs promoting exerciseo, diet, and points on ways of life in the American setting. Our two sources in the this essay state of interventions and policies that can be instituted by the government or health professionals and workers.
The best recommendations of diet, exercise, and enough sleep should be a part of our daily lives. Not only diabetics and obese people can do it but also everyone. In other words, everyone must have a change of attitude – from inactivity or full dependence on technology and robots to active lifestyle, full of energy and efforts to combat the disease.
Diet and exercise are two simple but effective solutions to the problem of obesity and overweight. This can be a part of the daily programs at school and at school. All the other sources that we have browsed and consulted point to diet and proper nutrition and exercise.
We have discussed in this essay the advantages of preventing obesity in childhood and adulthood. We focused on two sources but there were other sources we saw relevant to the topic that we have mentioned in the Introduction. Early intervention in children is important but more important and a lot of focus should be in adult intervention on obesity and overweight. Both sources provide an in-depth analysis on the menace of obesity. But adult intervention has some edge in arguments.
We cannot leave behind obesity intervention in children. It is of great importance that children learn how to control themselves in overeating or taking in energy without much mobility as they are so engrossed with computers and other indoor activities. But adult intervention of obesity has to be provided more focus. Health care policies should be geared on this. Obesity is much like smoking; it is preventable.
Bailey, E. J. (2006). Food choice and obesity in black America: creating a new cultural diet. Westport, CT: Greenwood Publishing Group, Inc.
Burd-Sharps, S., Lewis, K., and Martins, E. B. (2008). The measure of America: American human development report, 2008-2009. United States of America: Columbia University Press.
Cooke, L. & Wardle, J. (2007). Depression and obesity. In A. Steptoe, Depression and Physical Illness. Cambridge, UK: Cambridge University Press.
James, W. P. T & T. P. Gill, T. P. (2008). Prevention of obesity. In G. A. Bray and C. Bouchard (Eds.), Handbook of obesity: Clinical applications third edition (pp. 157-170). New York: Informa Healthcare USA, Inc.
Lobstein, T., (2008). The prevention of obesity in childhood and adolescence. In G. A. Bray and C. Bouchard (Eds.), Handbook of obesity: Clinical applications (third edition) (pp. 131-150). New York: Informa Healthcare USA, Inc.
Paul, R. & Elder, L. (2002). Critical Thinking: Tools for taking charge of your professional and personal life. Upper Saddle River, New Jersey: Pearson Education, Inc.