Climate change is not the only source of dire projections for the coming decade. Perhaps just as terrifying from both a health and an economic perspective is a predicted continued rise in obesity, including severe obesity, among American adults.
A prestigious team of medical scientists has projected that by 2030, nearly one in two adults will be obese, and nearly one in four will be severely obese. The estimates are thought to be particularly reliable, as the team corrected for current underestimates of weight given by individuals in national surveys. In as many as 29 states, the prevalence of obesity will exceed 50 percent, with no state having less than 35 percent of residents who are obese, they predicted.
Likewise, the team projected, in 25 states the prevalence of severe obesity will be higher than one adult in four, and severe obesity will become the most common weight category among women, non-Hispanic black adults and low-income adults nationally.
Given the role obesity plays in fostering many chronic, disabling and often fatal diseases, these are dire predictions indeed. Yet, as with climate change, the powers that be in this country are doing very little to head off the potentially disastrous results of expanding obesity, obesity specialists say.
Well-intentioned efforts like limiting access to huge portions of sugar-sweetened soda, the scientists note, are effectively thwarted by well-heeled industries able to dwarf the impact of educational efforts by health departments that have minuscule budgets by comparison. With rare exceptions, the sugar and beverage industries have blocked nearly every attempt to add an excise tax to sugar-sweetened beverages.
Claims that such a tax is regressive and unfairly targets low-income people is shortsighted, according to Zachary J. Ward, public health specialist at Harvard and the lead author of the new report, published in The New England Journal of Medicine in December.
“What people would save in health care costs would dwarf the extra money paid as taxes on sugar-sweetened beverages,” he said in an interview.
Yet, in a city like Philadelphia, where a soda tax of 1.5 cents an ounce took effect three years ago, total purchases declined by 38 percent even after accounting for beverages people bought outside the city, his co-author Sara Bleich told me.
However, she quickly added, piecemeal changes like this are not enough to make a significant difference in the obesity forecast for the country. Rather, nationwide changes are needed in the ubiquitous food environment that has fostered a steady climb toward a weight-and-health disaster. As the new report clearly demonstrated, Americans weren’t always this fat; since 1990, the prevalence of obesity in this country has doubled.
People who choose to blame genetics are fooling no one but themselves, Mr. Ward said. Our genetics haven’t changed in the last 30 years. Rather, what has changed is the environment in which our genes now function.
“Food is very cheap in the United States, and super easy to access,” said Dr. Bleich, a professor of public health at the Harvard T.H. Chan School of Public Health. We eat out more, consuming more foods that are high in fat, sugar and salt, and our portion sizes are bigger.
As Mr. Ward noted, “You don’t even have to leave home to eat restaurant-prepared food — just call and it will be delivered. If you have a smartphone, Uber Eats will bring fast food to your door in minutes.”
As a society, we also snack more, a habit that starts as soon as toddlers can feed themselves. My dog knows all too well that the bottoms of strollers are a rich source of snacks.
“People are snacking throughout the day,” Mr. Ward said. “Snacking is the normal thing to do in the United States. In France, you never see anyone eating on a bus.”
We also eat more highly processed foods, which have been shown to foster weight gain, thanks to their usually high levels of calories, sugar and fat.
A recent study showed that even when controlling for weight, consuming lots of processed foods raises the risk of developing Type 2 diabetes.
“It doesn’t take that many extra calories to result in weight gain,” Dr. Bleich said. “Through marketing, we’re constantly being sold on foods we didn’t even know we wanted. We’re all about immediate rewards. We’re not thinking about the future, which is why we’re going to see more than half the population obese in 10 years.”
Unless something is done to reverse this trend, Mr. Ward said, “Obesity will be the new normal in this country. We’re living in an obesogenic environment.”
“While there’s no one thing to throw at the problem,” Dr. Bleich said, “if I could wave a magic wand, I’d make a tax on beverages a federal mandate because they’re the largest source of added sugar in the diet and are strongly linked to weight gain and health problems. When people drink their calories, they don’t feel as full as when they consume solid food, so they end up eating more.”
This may also be true for calorie-free sweet drinks. Although the jury is still out on cause and effect, the link between beverage consumption and greater intake of calories may also apply to drinks flavored with no-calorie or low-calorie sweeteners.
With a third of meals now being eaten out, Dr. Bleich suggested that prompting restaurants to gradually, surreptitiously reduce the amount of fat, sugar and calories in the meals they serve could help put the brakes on societal weight gain. “Menus could make healthier, lower-calorie meals the default option,” she said.
Controlling portion sizes is another critically important step. “Big portions are especially motivating for low-income people who reasonably want to get more calories for their dollar,” she said. Low-income groups already have the highest rates of obesity and, the new projections show, they are the groups most likely to experience a rising prevalence of obesity and severe obesity.
Another policy-based approach that could reverse rising obesity projections might be to partner with climate control advocates, Dr. Bleich suggested. “If we pull more meat out of the American diet, it would help both the environment and weight loss,” she said.
“From a policy perspective,” Mr. Ward said, “prevention is the way to go. Children aren’t born obese, but we can already see excessive weight gain as early as age 2. Changes in the food environment are needed at every level — local, state and federal. It’s hard for individuals to voluntarily change their behavior.”
He said health-promoting changes in the food packages provided to low-income women, infants and children since 2009 have helped to reverse or stabilize obesity in the preschool children who receive them. Evaluations are currently underway to assess the impact of healthier school meals.
