Obesity: An American Epidemic

It strikes me that there are many people today whose disease - obesity and overweight - makes them feel they are taking the "walk of shame" each day. Their disease - and society's frequent judgment of its symptoms and manifestations - makes them feel that they are victim, even if no one is physically hurling objects or insults.

Obesity is a medical problem that we have been reluctant to address, even though it is becoming more and more common as two-thirds of Americans are either overweight or obese. It is such a stigmatized issue that, as I sat to write this, I was challenged by how I could address obesity as a clinician and as a compassionate human being. The best way to accomplish this is to explain obesity as a disease and to bring awareness to how important it is to help patients who suffer from it.

Are we really facing an epidemic? The answer is yes. Data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System reveal that obesity rates increased by 37 percent between 1998 and 2006. And with no signs of this slowing, many estimate that more than one-half of Americans will be affected by obesity by the year 2030. That's more than 180 million people in the U.S. alone - a staggering number.

Obesity is a gateway disease that almost always leads to conditions most of us recognize as life-threatening, including diabetes and heart disease. It can be linked to increased risk of stroke, liver disease, depression, and even cancers. The rapid rise in obesity is startling, especially when we recognize the potential for a corresponding increase in these other devastating diseases.

How significant are the repercussions? Recent estimates show that the annual direct medical burden of obesity alone is approaching 10 percent of all medical spending and likely amounted to $147 billion per year in 2008. One study found that obesity was responsible for 27 percent of the rise in inflation-adjusted health spending between 1987 and 2001. But you cannot calculate the full cost of obesity just in terms of dollars.

Despite what many people think, obesity is not a disease that people can stop by themselves. Nobody wants to be obese. The problem is that losing weight is not as simple as just pushing oneself away from the table or exercising more. There are a multitude of genetic, biochemical, and environmental factors that cause obesity, much the same way these exact same factors cause diseases such as depression or heart disease.

Additionally, when a person does lose weight, there are incredibly powerful bio-hormonal factors that immediately make him feel like he is in fact starving to death, and prompt him to eat more. We all have friends who have repeatedly tried to lose weight only to regain it. This is not a weakness but a series of powerful driving forces that result in a devastating disease.

Individuals affected by obesity are commonly shunned, and many feel they travel that walk of shame each day. What compounds the problem is society's propensity to categorize obesity as something within the control of the individual that is manageable; minimizing the complexities of the disease and its hold on the individual. Obesity's toll on our community - from the people who suffer from its devastating effects to the healthcare system managing it - is enormous and truly under-appreciated by most. The reality is that this disease cannot be marginalized or ignored.

What have we done about similar diseases? We declared war. That is what we did with cancer. In addition to stepping up research efforts to fight the disease, we focused on increasing awareness and education about cancer and its impact. Today, while we continue to struggle to eradicate it in all forms, the most common form of pediatric leukemia approaches a 100 percent cure rate. How can we not do the same for obesity?

The first week in November is National Obesity Care Week and it is during this week that scientists and healthcare providers will focus on the basic science, clinical application, surgical intervention, and prevention of obesity. By dramatically reducing and eventually eradicating obesity, we will eliminate the collective burdens this disease is placing on our society. Now is the time to declare war on obesity in this country.

Lawrence Herman, PA-C, MPA, DFAAPA, is dean and full professor in the College of Health Sciences, Physician Assistant Studies, Gardner-Webb University in Boiling Springs, N.C. Herman practiced in emergency medicine for nearly a decade, and most recently was the administrative medical director for a large multi-specialty practice. He served on the Board of Directors for the American Academy of PAs as president and chair of the board.