When was the last time that you paid attention to a news story or headline that did NOT include the name “Trump”? I mean serious news reports about important issues, not stories like those about saving a horse from the middle of a frozen lake or how the donkey adopted a kitten? Probably not recently and probably not often. One of the important consequences of having a bloviated narcissist in the White House is that there remains little room in the news cycle, or even in our brains, to consider all of the rest of the world that continues to move forward. Many of these problems, though, have important, even critical, consequences to the country and the world.

One of the most important public health problems in the US and the developed world is obesity. Data released in 2018 shows that obesity rates have begun to rise once again after leveling off over the last few years. Unfortunately, the rates are alarming in both adults and children – 39.6% of adults and 18.5% of children in the US were considered obese according to national surveillance data collected in 2016. In 48 states, more than 1 in 4 adults were obese with the rates varying by state and region of the country. In some counties of the south, adult obesity rates approached 50%, meaning that half of their citizens were obese.

Although obesity impacts all strata of society, increased obesity is strikingly affected by socioeconomic factors. Adults with a college degree had a rate of obesity of 22.2% (9.6% for their children) versus a rate of 35.5% for those with less than a high school education (21.6% for their children). Income also affects an individual’s likelihood of being obese. Higher income adults had an obesity rate of 29.7% (10.9% for their children) while lower income adults were obese at a 42.5% rate (19.0% for children).

As most of you are aware, obesity is linked to a wide variety of adverse health outcomes, many quite serious. Diabetes, breast cancer, hypertension, strokes, prostate cancer, heart disease, myriad other diseases, and a diminished quality of life have all been repeatedly associated with obesity in peer-reviewed research. With obesity rates in the US once again on the rise, the incidence and prevalence of many of these conditions may be expected to also increase over the next few years.

So, how do we fight this epidemic (and obesity does qualify as an epidemic)? Before you can hope to control a disease, you must understand the underlying causes. As with most diseases, obesity is multifactorial in origin. Certainly, as our society has developed from agrarian to industrial to technological our lifestyles have become more sedentary resulting in less calories burned per day. Our diets are replete with high calorie/ high carbohydrate, processed foods with less intake of natural foods. However, and this is bound to surprise you, today’s diets are not generally higher in calories than diets of 40 years ago. Although a comparison is difficult to quantify (people do not accurately report their food consumption – surprise), most data seem to indicate that people today take in less overall calories that we did in the mid-1970’s.

For years, the intervention that was promoted to solve the obesity problem was relatively simple and straight forward. To reduce the weight of an individual (and by extension, the population) you had to reduce the calories taken in and increase the calories burned. The resulting drop in calories would/should lead to weight reduction. Problem solved. Everyone happy. Unfortunately, the data show that equation as simplistic and unsuccessful.

Everyone is familiar with the many popular diet programs that are advertised in the media with stories of dramatic weight loss experienced by semi-famous spokespersons. Although most of these for-profit companies guard their data zealously, when they have been independently evaluated over time they show an approximate 98% failure rate. The reason for the failures are many. Some dietary changes are so draconian that people just cannot follow them for a long period of time. Some people revert to their old eating habits as soon as the support structure of the program is removed. Then, there is the very complicated factor of metabolism in the weight loss issue.

In a study by Duke University, researchers assessing the metabolism of individuals who had recently lost large amounts of weight (over 100 pounds) found a much lower rate of metabolism than would have been expected for a person of their new weight. For example, a person who had dropped from 275 pounds to 175 pounds, in the months after shedding the weight had a lower metabolism than a normal 175 pound person. Meaning, of course, that if that person then consumed the calories that a normal 175 pound person consumes, they would gain weight. They wouldn’t know why they were gaining weight, but they would gain the weight back. The reason for this anomaly is not clearly understood, but the impact of this finding on understanding the well-known difficulty of people to maintain their new weight after losing weight is huge. It is very possible that metabolism changes may be the reason for the failure of so many diets and the yo-yo effect that we’ve seen with so many dieters.

As with many public health problems, there are no fast and simple solutions to the obesity epidemic. The good news is that we know a lot more about weight loss and healthy living than we did even 10 years ago. Also, the latest data seem to show that among the youngest children, obesity levels are decreasing. Of course, as a society we can ask ourselves why we have ANY obese 2-3 year olds in this country and how proud we should be to see that obesity rate among these innocent down to less that 15%.

To effectively begin to deal with the problem of obesity and its concomitant health issues, the US needs to make a commitment to reduce the rates in all segments of society. The best programs include efforts of organizations from both government and private sectors and focus on making good food choices and physical activity less expensive and easier to access. We also need to address the social and economic barriers that are associated with increased rates of obesity on a significant segment of our population.  Interventions can work. A study published in 2018 found that states that implemented a CDC program of nutrition and physical activity from 2000 to 2010 decreased obesity in adults between 2.4% and 3.8%.

There’s hope, but we need to start dealing with the real problems that our population faces without making up false ones based solely on campaign rhetoric. We have our hands full with the real ones.