Overweight and Obesity - A Global Epidemic
Overweight and Obesity - A Global Epidemic
Being overweight and obese is a growing problem globally. According to the World Health Organization, the definition of the term overweight is an individual who has a Body Mass Index (BMI) exceeding 25. Obesity has three classes, but it all begins with a BMI exceeding 30, with the highest class, class III, a BMI of 40 or more (Flegal, 1999). Grundy et al. (1999) estimate that the rate of obese adults in the United States today is approximately 55% and steadily increasing. They also have evidence that trends show that the increasing rates are found in both genders and all racial groups, although the increase is more predominant in non-Hispanic black women, Mexican American women or men, and in individuals with lower education and household incomes (1999).
Grundy et al. (1999) define exercise as “planned, structured, and repetitive bodily movement done to improve or maintain one or more component of physical fitness” (pg). They further define physical activity as “bodily movement that is produced by the contraction of skeletal muscles and that substantially increases energy expenditure” (pg). Physical activity can be planned and done in set leisure time during the day, or it can subconsciously be achieved by the simple activities that are a part of our daily routine. This being said, the small amount of energy we expend from our daily activities is not enough in today’s society to be effective, without the added leisure time physical activity for most people. The exception to this would be individuals with professions or lifestyles that demand high amounts of energy.
It has been found that obesity increases with age. For women, the prevalence of obesity increases 8% at age 16 to 24, and approximately 23% by age 55 to 64. For men, at age 16 to 24, the rate of obesity increases by approximately 6%, and when they reach age 55 to 64, the rate increases approximately 22% (Jebb and Moore, 1999). This clearly shows that the prevalence of obesity is apparent more in woman than men. This decrease in physical activity as people age could be a possible result of the idea that as individuals get older they are simply unable to participate in the recommended amounts of physical activity. Hill and Melanson (1999) believe that “becoming obese is a natural response to our current environment and without changes in the environment, obesity will likely become a characteristic of our species” (pg). Society is reacting to the environment we have created. This environment unfortunately is promoting bad habits, which are leading to the obesity epidemic we are faced with. If this lifestyle is not altered to one that promotes healthy living then obesity rates will just continue rising. If this issue is not addressed with great stress soon, it will be too late to fix.
An individual’s surrounding environment can impact the type of lifestyle they adopt. The increasing prevalence of overweight and obese people is no exception. Grundy et al. (1999) explain that there are many environmental factors contributing to the overweight and obesity epidemic. They also believe that trends of today’s society, which promote high-energy consumption and reduced energy expenditure from physical activity, are key environmental influences on obesity (1999). Rates of obesity have increased in American children and adults by approximately 10%, and these rates are still rising (Flegal, 1999). Hill and Melanson (1999) believe that as an environment becomes more “obesity-conductive”, the population of this environment will increase accordingly in average weight and fatness.
As technology improves, in all aspects of life, sedentary lifestyles become more predominant, ultimately reducing an individual’s daily energy expenditure. Simple advancements, such as the computers, dishwashers, personal vehicles, and technological improvements in the workplace, all contribute to a decrease in daily physical activity in some way. Hill and Melanson (1999) along with Pratt et al. (1999) also believe that technologies contributing to a sedentary lifestyle, especially televisions are the reasons physical activity levels are decreasing. Although the reduction in energy output is very small with each of these improvements, the compiled overall energy savings can have a huge impact on an individual’s total daily energy expenditure (Hill & Melanson, 1999). In other words, the energy saved in using these improved technologies is minimal when looked at individually, but collectively as a whole, it has great influence. In the past people have done much work themselves, and their jobs demanded high levels of energy. Today, more people are surrounded by many conveniences, and most of their time is consumed by jobs that require low energy expenditure. Regardless of research and studies, it is easy to see that the advancement of the computer and the Internet is an important factor in the rise of obesity rates. A person can accomplish almost anything by computer; shopping, banking, playing, and working, are at one’s fingertips. This added convenience has made society lazy, and it is this laziness that is contributing to the raise of obesity.
According to Skidmore and Yarnelle (2004), it isn’t just the energy savings that reduce the amount of physical activity an individual participates in daily, it is also a simple matter of time. They believe that today, more time is spent in sedentary workplaces, daily traffic, and in front of computers or TVs, among other things that require little use of energy, resulting in decreased time spent partaking in physical activity (2004). The research of Pratt et al. (1999) has shown that only 28% of adults engage in the recommended levels of physical activity, and 29% report no leisure time physical activity at all. They recommend at least 3 sessions of vigorous physical activity a week, a minimum of 20 minutes each, or at least 5 sessions weekly of moderate physical activity, a minimum of 10 minutes per session, to equal a minimum total of 150 minutes(1999). These are only recommendations to aid an individual in receiving the health benefits of an active lifestyle. There are numerous people who partake in daily physical activity but it is surprising to see that those who do 43% do no meet the recommended amount to be rewarded with the associated health benefits (Pratt et al., 1999). The high percentage of those who are not maximizing the health benefits suggests that the set recommendations are not being promoted enough and society is not as informed about physical activity as it should be. Imagine if all those people who are physically active just not enough, knew that they were not meeting recommendations. There would be a substantial decrease in the overweight and obesity rates.
Decreased levels of physical activity are not only an escalating issue among adults, but are evident in children and adolescents as well. Skidmore and Yarnelle (2004) compared children’s transportation methods to school in the 1980’s to those in the year 2000. They found that the number of children who walk to school has decreased from 67% to 55% respectively, and the use of a car as transportation increased from 20% in the 1980’s to 35% in 2000 (2004). This shows that fewer children are using the simple act of walking to school as a form of physical activity. Furthermore, the same study also found that one third of US teens watch more than, or equal to, five hours of television per day (2004). Thus, these hours not spent being physically active. Enrolment rates in gym class have also seen a decline, suggesting that adolescents are choosing to participate in physical activity less and less. In 1991, 42% of teens enrolled in a physical activity class, and in 1997 that rate dropped to only 27% (Pratt et al., 1999). To increase these rates and help reduce the development of childhood obesity physical education should include information classes that explain and promote a healthy lifestyle. These classes should be a mandatory throughout their education career so that the option for children to make a choice in weather they are physically active or not is removed. Children, like adults, are not being informed enough about the repercussions of physical inactivity and therefore are not realizing what their choices to not partake in physical education can result in until it is too late.
Even though enrolment in physical education is low, it is surprising to see that approximately 50% of adolescents are involved in school sports, and 38% play on teams outside the school environment (Pratt et al., 1999). Although, overall, 64% of teens, mainly boys, participate in vigorous physical activity for at least 20 minutes three to four times per week, (Pratt et al., 1999), this is simply not enough to fight the ever growing issue of obesity.
It has been found that participation in physical activity declines with grade, but also, budget cuts within school systems provides fewer physical education classes and less time in physical activity participation (Pratt et al., 1999). Skidmore and Yarnell (2004) noted that changes in the family atmosphere are also contributing to the increased obesity-conductive environment for children. With more time spent in front of the television, and the replacement of family meals at home with fast food and eat-in restaurants, physical activity is decreasing, and energy input is exceeding that of energy expenditure (2004). This energy imbalance is the key to why the prevalence of obesity is increasing as well as why it is being maintained. In order to maintain healthy lung and heart function, the American Heart Association recommends that children age 2 or higher participate daily in 30 minutes of moderate physical activity, along with 30 minutes of vigorous physical activity three to four times per week (Skidmore and Yarnell, 2004). Overall, it has been shown through various reports, and backed up by an abundance of evidence, that the environment to which individuals are exposed influences their lifestyle, and as a result physical activity levels have been decreasing among both children and adults.
Why is this decrease in physical activity participation, through daily routine or in leisure time, so important? This is because physical inactivity, although not the sole cause, is more related to increasing rates of overweight and obese individuals, than anything else (Jebb & Moore, 1999). Studies have been found to show that even when energy input is decreased, there is still the issue of obesity as a result of increased weight and fatness, further suggesting that obesity is related to the decreased levels of physical activity and not the increase of calorie consumption (Jebb & Moore, 1999). Hill and Melanson (1999) claim that the balance of daily energy input and output, along with the balance of the intake and oxidation of macronutrients, are the key aspects of maintaining a healthy weight. The intake and oxidation of macronutrients involves several biochemical processes and in terms of this paper will not be discussed. Energy input however is defined as the energy in calories consumed by an individual, whereas daily energy expenditure is a bit more complicated as it consists of resting metabolic rate, the thermic effect of food and energy expended by physical activity, with the energy expended by physical activity being the most influential (Hill and Melanson, 1999). The development of obesity is the consequence of the maintenance of a positive energy balance as a result of higher energy consumption than energy expenditure (Grundy et al., 1999). If this balance could be altered to have constant negative energy, only then will individuals see a decrease in weight and therefore obesity rates. Once the desirable weight is achieved the maintenance of this weight is accomplished by an equilibrium between intake and output of energy. Jebb and Moore (1999) found that those who suffer from obesity are more inactive, and participate in less physical activity than those who are of normal weight. This suggests that the physical inactivity is what is offsetting the energy balance, making it more positive. As stated before a constant positive energy balance results in obesity making this finding yet another piece of evidence that proves physical inactivity is a key contributor to the obesity epidemic we face today.
Although the prevalence of obesity is more strongly related to physically inactive individuals, and evidence shows that the decline in physical activity has an important contribution to the increase in obese individuals (Grundy et al., 1999), Hill and Melanson (1999) believe that it is crucial to consider both the increase in energy consumption, along with the decrease in energy output. Although either, physical activity or diet, may protect against obesity, Hill and Melanson (1999) believe that high levels of physical activity, combined with a low fat, low energy diets, are more likely protect against the development of obesity than diet or physical activity alone. It is important to remember that the key is not the type of physical activity, but the amount in which an individual participates (1999). In summary, when looking at the issue of obesity, it is better to evaluate both energy input and output together, although there is a possibility that both decreased energy input or increased physical activity independently may protect against it.
It can be argued that if levels of physical activity contribute to obesity, it can indirectly or directly contribute to health risks and economic costs of obesity as well. According to Bray and Champagne (2005), physical inactivity increases the risk or early mortality. This is further emphasized by Grundy et al. (1999) who have found that there is a linear relationship between the increased risk of mortality and increasing body mass index. They have concluded that more leisure time activity has a positive effect on lowering premature mortality (1999). Obesity contributes to numerous health conditions, some which include insulin resistance, arthritis, cardiovascular problems, and glucose intolerance. Obesity has an especially strong correlation with levels of coronary heart disease, diabetes mellitus, and gallstone disease (Grundy et al., 1999). According to statistics, the direct economic cost of physical inactivity consumes 2.4% of the total US health care expenditure, which equals a total amount of 24 billion dollars. The direct economic cost of obesity is even greater, with a total amount of 70 billion dollars. Furthermore, the costs of both inactivity and obesity combined engross approximately 9.4% of the total National Healthcare expenditure (Grundy et al., 1999). These economic costs stem from increased health care services needed to treat the health issues related to obesity, increases social services which aid those who are unable to perform daily tasks due to obesity related health problems, and other costs placed on society to care for those who suffer from obesity. The economic costs of physical inactivity and obesity are astonishing, and the health risks that accompany obesity are devastating.
In contrast to the many negative repercussions of physical inactivity, being physically active has many positive heath benefits. According to Grundy et al. (1999) when an individual is physically active and fit, there is a reduction in the chances of obesity related disease and early mortality. Physical activity has such a strong influence on an individual’s health, that an active and fit overweight individual has lower health risks than an individual who is of normal weight but leads a sedentary lifestyle (Grundy et al., 1999). Pratt et al. (1999) also agree that physical activity is substantial to the maintenance of a healthy lifestyle and the prevention of chronic disease. Education concerning proper nutrition is crucial, as it could influence healthy eating habits. The promotion of healthy eating habits, combined with the promotion of physical activity, plays a significant role in the protection against obesity, along with the onset of type 2 diabetes (Skidmore & Yarnell, 2004). The incorporation of physical activity into the daily routine of an individual is important, but as stated earlier, it is also important to look at diet and energy consumption. It has been estimated that 30% of the reported cases of obesity, and 43% of the new cases of type 2 diabetes, could have been prevented if the implied individuals engaged in an active lifestyle (Skidmore & Yarnelle, 2004).
Physical activity does not only play a role in the prevention of type 2 diabetes, it can also increase the action of insulin, which ultimately reduces insulin resistance. This is a key health issue related to obesity. (Grundy et al., 1999). There is also strong evidence that the participation in physical activity can reduce blood pressure, and if there is an associated weight loss of 4.5 kg or more, high-density lipoprotein (HDL) levels can increase (Grundy et al, 1999). HDL is the good cholesterol and decreases as an individual becomes more obese. This decrease allows low-density lipoprotein (LDL) levels, the bad cholesterol, to increase and that is the main factor that causes cholesterol problems in those who are obese. Overall, an increase in physical activity has been proven to be strongly associated with the prevention of many health conditions that result from obesity. Comorbidities including insulin resistance, hyperglycemia, and dislipidemia are just a few that physical activity assists in preventing if an active lifestyle is maintained (Grundy et al., 1999).
If an individual simply incorporates daily physical activity into their daily lives, the health issues seen today as a result of obesity will start depleting. The economic costs will decrease and be better used in other sectors of health care where it is needed so much more. The rates of premature deaths will decrease, which anyone would agree is a wonderful thought, as it is never nice to loose a loved one at any age. It’s amazing to think that all these health issues can be reduced and even prevented by the simple act of physical activity. It’s a wonder why more people are not active.
In conclusion it is plain to see that there is strong evidence that shows today’s physical activity levels are decreasing and this decrease is a key contributor to today’s obesity epidemic. The rates of obesity are increasing across the board; no nation is safe from this issue. Changes in our environment and advancements in technology are what we have to thank for altering a once healthy lifestyle to one of laziness and sedentary behaviour. The lack of physical activity is making the energy balance we should maintain one of fiction, when it should be promoted. Most individuals are blind to the repercussions of physical inactivity and obesity, with almost half not even aware of the recommended levels of physical activity. The outstanding economic costs, health issues, and premature death should be brought into light in order to raise awareness and make people realize their reality. The issue of obesity is ever growing, and if action is not taken now the healthy lifestyle that once one, will become unattainable.