Care Of The Obese Population

Care of the Obese Population

The problem of obesity has already been determined. Many solutions to the problem are on the rise, but how do we handle the here and now? Obesity is a complex health issue, of which no one solution or source can yet address. Brief historical and cascading events, definitions, cost, life expectancy, medical adversities and statistical information are offered in this paper to outline the disparities of how we are going to care for the obese population.

Obesity, as defined by the Institute of Medicine is, "an important chronic degenerative disease that debilitates individuals and kills prematurely." (Institute of Medicine, 1995) This very simplistic definition follows the medical model of health care and leaves no doors open for introspection of the problem or solution. A more holistic model would state that obesity is a complex process involving a variety of social, behavioral, cultural, environmental, physiological, and genetic factors that interact to affect an individual's body weight. Obesity specifically refers to an excess amount of body fat that is determined by the Body Mass Index (BMI) to be greater than or equal to 30. The BMI mathematical formula is based on a person's height in inches divided by weight in pounds squared, times 703. BMI correlates with total body fat content and has become the medical standard for measuring overweight and obesity (Matz, 1993). A BMI less than 18.5 indicates underweight, 18.5-24.9 represents normal weight, 25-29.9 represents overweight, 30.0-34.9 represents class I obesity, 35.0-39.9 describes class II obesity and a BMI greater than 40 describes class III and severe obesity (NIH, 2003).

Centrally distributed adipose tissue that is out of proportion to total body fat is an independent predictor of risk factors. The individual components of abdominal fat to overall risk indicate different risk factors. For example, the visceral fat component is strongly correlated with risk factors for cardiovascular disease. While others, such as the subcutaneous component is highly correlated with insulin resistance (Abate, Garg, Peshock, Stray-Gunderson, Adams-Huet & Grundy, 1996).

Nationally, the obesity rate is 24.5% compared to the Omaha MSA of 22.7%. Nearly 1 in every 4 Nebraska adults (23.9%) is obese while 3 in every 5 (60.9%) is either overweight or obese. Less than half (44.5%) engage in a recommended level of physical activity of 30+ minutes per day on 5+ days per week. Nebraska adult's rank 17th lowest out of the 54 U.S. states and territories in percentage that engage in recommended physical activity. Less than 1 in every 5 Nebraska adults (17.8%) consumes the USDA recommendation of five or more servings of fruits and vegetables per day. Nebraska adults ranked 5th lowest in 2003 out of the 54 U.S. states and territories for the 5+ a day consumption of USDA recommendations (Nebraska Health and Human Services, n.d.).

In 2000, obesity contributed to the deaths of 400 million people worldwide, compared to 435,000 who died from smoking-related illness, 85,000 from alcohol related, 43,000 from car accidents and 29,000 from gun related deaths. Obesity has been projected to overtake smoking as the leading preventable cause of death in the very near future (NIH, 2004; Samuelson, 2004). An estimated 65% of Americans are overweight and 31% are obese, along with 16% of children and adolescents. Obesity has doubled in adults and tripled in adolescents since 1980 (NIH, 2004). Only 3% of all American meet at least four of the five federal Food Guide Pyramid recommendations for the intake of grains, fruits, vegetables, dairy products, and meats. Less than 1/3 engage in at least 30 minutes of moderate physical activity at least five days a week, and 40% engage in no leisure time physical activity at all (Anonymous, 2002).

The estimated $117 billion societal cost of overweight and obesity is composed of $61 billion in direct costs and $56 billion in indirect cost. Direct cost includes medical expenditures for preventative, diagnostic, and treatment services. Indirect cost includes lost wages resulting from people being unable to work because of illness, disability, or premature death. Indirect cost estimates, however, leave out the well-being of people outside the paid labor force, including homemakers, the retired elderly, and the infirm. The direct cost alone equals 4.7% of total U.S. health care expenditures in 2000. The estimated annual direct and indirect cost of tobacco use is $100 billion, which is $17 billion less than for obesity (Kuchler & Ballenger, 2002).

The relation between poverty and obesity is well documented in the medical literature; although, affluency of our society has changed and so has the causes of obesity. People are incurring debt and working longer hours to pay for the high-consumption lifestyle, consequently spending less time with family, friends, and community organizations. Americans devoted a fifth of their disposable incomes to food in 1950 and less than a fifth of that to eating out. In 2004, a tenth of disposable income went towards food and almost half of that was for eating out (Samuelson, 2004). As our population and high stress life styles has increased, a culture that worships choice has been created. The consumer demand for convenience has been the major driving force to the dilemma we face today. Weight status involves personal choices, and these personal choices tend to impose fewer external costs than other major health concerns. Together, these factors suggest that finding cost-effective interventions will be challenging.

The following is a partial list of some cascading events that are shaping our future and affecting our health. Increased reliance on automobiles means more pollution and traffic. Producing eight ounces of beef requires 6,000 gallons of water, 95% of world soybean crops are consumed by farm animals, and 16% of the world's methane, a destructive greenhouse gas, is produced by livestock. Most of the enormous quantities of manure produced become toxic waste rather than fertilizer, and soil runoff threatens nearby streams and bays. Animals are maintained under crowed conditions to satisfy the high demands of the consumer. These crowded conditions can lead to the spread of disease among the animals. To prevent this, antibiotics are included in their feed. The widespread use of antibiotics in the livestock industry is breeding antibiotic-resistant microbes, complicating the treatment of disease in people (Mayell, 2004). In essences, the above listed cascading events contributes to damage to the greenhouse/atmosphere, contaminated water supply, antibiotic resistant diseases, allergies and lung disease from pollution, stress from traffic, obesity from decreased actively and other various disease conditions.