Obesity is extremely common in America. But not every racial group or socioeconomic status experiences it at the same rate. And what’s even more unfortunate is that not every group in America has access to or will end up with the same quality of treatment for obesity. While the disease has its genetic components, it is also greatly influenced by a person’s environment and lifestyle, and some of these facets are out of one’s control. This epidemic has been getting worse for the last several decades, as adult obesity has risen from 30.5% in 1999 to 39.8% in 2016, and childhood obesity has risen from 13.9% in 1999 to 18.5% in 2016.1 America has an epidemic on its hands. In this essay, I will discuss the realities and possible causes of disparities in obesity prevalence in America.
The high prevalence of obesity is a public health crisis. Obesity is linked to a myriad of other diseases such as type 2 diabetes. high blood pressure, heart disease, strokes, certain types of cancer, sleep apnea, osteoarthritis, fatty liver disease, kidney disease, gout, congestive heart failure, and numerous pregnancy problems, for example high blood sugar, high blood pressure, and increased risk for cesarean delivery. It’s a chronic condition that requires extensive determination to cure and a lifetime of caution to keep it at bay. Beyond the detriment to one’s health, it is in the best interest of everyone in America to end this epidemic.
Estimates for the cost of obesity on American society range from $147 billion to $210 billion per year. The average obese person will have an emergency room visit cost 28% more than it would for a normal weight person.
These costs are greatly shared with taxpayers and insurance buyers. Uninsured obese people who seek necessary medical treatment but cannot pay put a financial burden on the hospital they go to and that hospital will charge every other patient more to cover the cost. Hospitals cannot turn people away and they budget for indigent patients by raising the costs of all other services. Even insured obese people raise health care costs for others, as the disproportionate amount of health care costs they bill to their insurance get spread through higher premiums for every insurance buyer.
Obesity isn’t just a product of someone’s conscious actions. A person is more likely to develop obesity if one or both of their parents are obese. This could be due to eating behaviors being taught by one’s parents or due to genetic factors. Hormones involved in fat regulation and metabolism may be disrupted in a person with obesity and a hormonal imbalance can be inherited from a parent. One genetic cause of obesity is leptin deficiency - leptin controls weight by signaling the brain to eat less when body fat stores are too high. Overeating leads to weight gain, especially if one’s diet high in fat.
Unfortunately, foods high in fat or sugar are often the most attainable and convenient things for a person to eat. Experts call area with an unusually high density of unhealthy food options a “food swamp.” Research has found that the “food swamp effect” was more pronounced in areas where income equality was greater and where mobility was lower, as in, fewer people with cars, less public transportation, and so on. And the communities that are already the most disadvantaged are also more likely to be food swamps. The other side of this coin is the presence of “food deserts,” areas with decreased access to grocery stores and especially fresh, affordable produce. Food deserts are also much more common among low income and low mobility areas.
The relationship between frequency of eating and weight is still debated but there many reports of overweight people eating less often than people of normal weight. Researchers have concluded that people who eat small meals 4-5 times daily have, on average, lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (2-3 large meals daily). One possible explanation for this phenomena is that small, frequent meals result in stable insulin levels while large meals cause large spikes of insulin after ingestion. Appropriate eating habits may be difficult to attain for someone with a demanding job. Along those lines, sedentary people burn fewer calories than people who are active - this lifestyle is also characteristic of much of the working class.
Besides eating habits and genetic inheritance, the medication a must take can also put them at risk for obesity. Medications associated with weight gain include certain antidepressants, anticonvulsants, some diabetes medications, certain hormones such as oral contraceptives, and most corticosteroids such as prednisone. Some high blood pressure medications and antihistamines also cause weight gain. It is known that certain populations experience depression at different rates, which could bring about obesity in several ways besides the use of antidepressant medication. People with depression are less likely to maintain active lifestyles and eat healthily.
For some people, general emotions influence eating habits. Many people eat excessively in response to emotions such as boredom, sadness, stress, or anger and about 30% of the people who seek treatment for serious weight problems have difficulties with binge eating.9 Just as obesity can lead to other diseases, there are certain diseases which can trigger obesity. Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing's syndrome are also contributors to obesity. In the next paragraphs I will discuss how these different causes of obesity affect different populations, then I will discuss the challenges different populations face in getting treatment for their obesity.
Obesity prevalence was at 13.9% among 2-5 year-olds, 18.4% among 6-11 year-olds, and 20.6% among 12-19-year-olds in 2016, but childhood obesity is more common among certain races. The prevalence of obesity among non-Hispanic black (22.0%) and Hispanic (25.8%) youth was significantly higher than among both non-Hispanic white (14.1%) and non-Hispanic Asian (11.0%) youth.
Of course, as children grow, they gain weight and as age increases we can expect to see more and more children gaining weight above their growth curve. As children move into adulthood their metabolisms slow down and they may also be less active as they forego recess, then PE class, and then go on to get a high education or join the workforce.
As one ages, they may need to change their eating habits to maintain a healthy weight because while they are growing it is necessary for them to eat more calories than their body needs to function at a baseline level. But the fact is that most of the time, especially when children are young, it is their parents who decide what a child will eat. When it comes to making kids eat healthily, it’s no easy task. Busy parents may choose unhealthy, quick, and cheap meals over meals that are healthy, balanced, more expensive, more time-consuming, and less appetizing for a child.
As of 2016, the total prevalence of obesity among U.S. adults was 39.8%. Overall, the prevalence among adults aged 40–59 (42.8%) was higher than among adults aged 20–39 (35.7%). No significant difference in prevalence was seen between adults aged 60 and over (41.0%) and younger age groups.
As mentioned before, as a person ages their metabolism slows down, and they require fewer calories to keep their body functioning. But many adults do not take this into account into consideration as they age, which could be a cause of obesity frequency increasing as age increases. Furthermore, and understandably so, as one ages it may be more difficult to be active.
Women had a higher prevalence of obesity than men across several races. In particular, more women than men were obese among non-Hispanic black, non-Hispanic Asian, and Hispanic adults, but not among non-Hispanic white adults. Among men, obesity prevalence was higher among Hispanic men compared with non-Hispanic black men, but prevalence was similar between non-Hispanic black and non-Hispanic white men.
These differences could be attributed to the biological childbearing role that many women undertake. Furthermore, women on average get less vigorous physical activity per day than men, leaving them at a higher risk for, weight gain, high blood pressure, and depression.
Women are also more likely to emotionally eat, which could contribute to this disparity.
The prevalence of obesity differs significantly among races in America for a variety of social reasons. The prevalence of obesity is relatively low among non-Hispanic Asian adults at 12.7%. Hispanic adults (47.0%) and non-Hispanic black (46.8%) adults had a higher prevalence of obesity than non-Hispanic white adults (37.9%). These patterns of obesity among women are similar to the pattern of the overall adult population. For women, the prevalence of obesity is 38.0% in non-Hispanic white, 54.8% in non-Hispanic black, 14.8% in non-Hispanic Asian, and 50.6% in Hispanic. Among men, the prevalence of obesity is highest in Hispanic adults (43.1%) compared with non-Hispanic white (37.9%), non-Hispanic black (36.9%), and Asian non-Hispanic men (10.1%). Non-Hispanic black men had a lower prevalence of obesity than Hispanic men, but there was no significant difference between non-Hispanic black and non-Hispanic white men.
These trends could be due to lack of access to affordable health insurance and health care, which disproportionally plagues people of color. It could also be due to the underlying racism that infiltrates many of society’s systems today, which could lead minorities to take less active roles in their health. These trends are closely related to that of education and socioeconomic status by race. Reflecting their limited median incomes and frequent lack of access to employer-sponsored health insurance, people of color are more likely to be uninsured compared to Whites.
A lack of insurance can increase one’s risk of developing obesity or diseases that cause obesity. Furthermore, minorities often experience worse health care treatment than whites even when income, insurance status, and illness severity are controlled for. (NCIB – Understanding and Addressing Racial Disparities in Health Care).
This could be due to unconscious bias in healthcare providers or patients perceiving bias in health care providers and trusting their providers less which could, in tur make that provider unconsciously biased against a particular type of patient.
Obesity tends to decrease with level of education. Adults without a high school diploma or GED had the highest self-reported obesity (35.6%), followed by high school graduates (32.9%), adults with some college (31.9%), and lastly college graduates (22.7%).
As one completes more schooling, they are more likely to understand the fundamentals of biology, metabolism, and nutrition. Educated persons may also have more secure and well-paying jobs, giving them more free time to take care of their health and more money to spend on healthy food, gym memberships, and health insurance. Racial and ethnic differences in obesity prevalence persist after controlling for differences in family income. However, the fact that Hispanic and Black minorities have lower median salaries than White and Asian Americans cannot be ignored.21 An inverse association exists between family income and obesity prevalence among white females of all ages and white males aged 20 years and older. These trends are closely related to educational status, a person born into a lower class is less likely to go to complete high school and even less likely to go to college.
It is worth noting that the South (32.4%) and the Midwest (32.3%) have the highest prevalence of obesity, followed by the Northeast (27.7%), and the West (26.1%).
Factors such as concentration of outdoor activities, foods available, populations in the area, quantity of specialists, and whether or not the states in that region expanded Medicaid could all contribute to the correlation between region and obesity prevalence.
The social determinants of health are countless, and any one negative aspect of someone’s social or physical environment in childhood or adulthood could cause them, directly or indirectly, to end up with obesity.22 What policymakers can do to close these gaps in obesity prevalence as well as decrease the total prevalence of obesity is offer increased access to health insurance, more affordable healthcare in general, build more grocery stores, make them sell healthy food, and improve racial sensitivity training for health care providers.
The CDC says it will accelerate its efforts to eliminate health disparities by focusing on surveillance, analysis, and reporting of disparities and the identification and application of evidence-based strategies to achieve health equity. It will also attempt to raise awareness and in and of the groups that experience the greatest health disparities. Their findings can help motivate increased efforts to intervene at the federal, state, tribal, and local levels to address health disparities and inequalities. Medicaid expansion would greatly benefit low income and uninsured person’s access to preventative health services and obesity treatments.
I believe that preventative medicine is the way to go in handling this health crisis. Prevention needs to start with our youth and their parents. Programs in the past have tried to get young children to be active and eat healthy, many seldom heard of programs like Healthy Kids, but we need to do more. We need school and club sports to be more affordable and more inclusive of all skill levels to encourage physical activity for the purpose of fun. We need schools to serve healthy snacks; while efforts in the past have increased whole-fruit consumption among children, vegetable consumption remains quite low, in fact, 9 out of 10 children don’t eat enough vegetables.
We need to give parents information about healthy eating habits and the risks associated with improper diet and obesity. Although a reasonable parent would never wish obesity or any other health problem on their child, we need to stress the importance of developing good eating habits in childhood. It is the responsibility of community service members, like medical professionals, teachers, coaches, and parents, to save our society from America deadliest diseases.
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