CW: talk about body weight, obesity, weight stigmatization.
While I was busy grading last December, a report came out in the New England Journal of Medicine that predicted an almost 50% obesity rate in the US by 2030. The report also predicted that almost 25% of Americans would, by that time, be “severely obese” (a term I’m not going to use again, but which means a BMI of at least 35).
This is certainly not good news. However, some people are more worried than others. Jane Brody of the New York Times calls it “dire” and compares it to global warming:
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.
Brody interviews experts who point to increased snacking, consumption of sugar-sweetened beverages, eating out more, and increased portion sizes as contributing culprits of the trend.
They make the usual policy recommendations, including taxes on sweetened sodas and other sugary beverages (which, in this recent study, found a reduction in sales after being implemented, but may mean that people purchased them in other places); working to create policies to promote reduced meat consumption, reduced portion sizes, and lower-calorie foods. These are the standard responses, and I think old news.
Reading through the original article, though, a number of things struck me that Jane Brody didn’t mention at all. I’ll share them with you, and I’d love to hear what you think as well.
First takeaway: the projected distribution of increased average BMI is not uniform throughout the US. We see it graphically displayed below, with darker colors indicating higher percentages of BMI30+, and BM 35+, respectively.
And what do we see? As an American, I see poorer states, states whose citizens get less good healthcare, states whose legislatures refused to expand Medicaid under the Affordable Care Act. The US is a country with severe health care inequality, and that shows in these graphs and in the tables in the article.
Second takeaway: the NEJM article talks about increase in “severe obesity” (I promised I wouldn’t use it again, but this is really the last time) but that term just means BMI 35+. We know that not all BMIs 35+ carry the same medical risk profiles. The authors of the article mention the need for more information across the BMI spectrum, but their analysis represents a shift only from BMI 30+ to adding BMI 35+. It’s also important to know the distribution BMIs 35–40, 40–45, 45–50, and so on. Why? Because they represent different health needs, and mandate different approaches to health promotion. I’m talking not only with respect to medical conditions that often go along with say, BMIs 50–55, but also with respect to responses that help citizens of those sizes navigate life, work, medical, educational and other public spaces. Which gets me to my next point.
Third takeaway: if we expect many of our citizens to be much larger in the next 10 years and we want them to be healthier, we need for them to be able to be active and present in the community, not barred from participating in ordinary activities of life. Yes, I’m talking about literally making space for larger and heavier populations (from restaurant chairs to hospital gowns), but not just that. We need a variety of ways to make physical activity accessible, easier, and safer for larger people. This means exercise machines that obviously handle larger weights, wider yoga mats, bikes with higher max weights. This also means more outdoor spaces tailored to physically accessible and satisfying activities (e.g. shorter nature trails with benches, railings, surfaces with less steep grades, etc.).
Last takeaway: the NEJM article acknowledges that medical research hasn’t been successful in developing weight-loss methods that will be able to reverse this trend on a nationwide level. The authors suggest turning to prevention as the most important strategy for health. I disagree. I think the most pressing agenda item is reducing weight stigmatization, especially in health care. Health care workers are the second-most common source of weight stigmatization, and the effects on people are a real hazard to their health. We know that stigmatizing weight doesn’t motivate people to lose weight, but instead reduces self-esteem, increases depression and anxiety and social isolation, and often results in increased body weights among those stigmatized. The Lancet published a series in 2015 (I wrote about it here in the Conversation) in which they made a number of recommendations for reframing obesity. One of them was to treat obese patients better. Yes, that sounds right. Let’s do that.
What do you think about these takeaways? Do you have other thoughts about this news? I’d love to hear from you.