Newly released data from the Centers for Disease Control and Prevention (CDC) show that US obesity rates are again on the rise. For the first time in three years, no state saw an improvement in its adult obesity rates in 2017, and obesity rates increased in six states—Iowa, Massachusetts, Ohio, Oklahoma, Rhode Island, and South Carolina.
Adult obesity rates are now at or above 35 percent in seven states. By contrast, as recently as 2012, no state had an adult obesity rate of more than 35 percent.
While national obesity rates continue to climb—nearly four in ten Americans have obesity, rates are even higher in Black and Latino communities, in low-income neighborhoods, and in rural areas. Such locations are more likely to be “food deserts,” where only unhealthful foods are readily available and affordable. These neighborhoods are also more likely to lack accessible and safe places for physical activity.
The increase in child and adolescent obesity is even more striking. Three decades ago, children with obesity were rarely seen. Today, almost 26 percent of Latino children, 22 percent of Black children, and 14 percent of White children have obesity. If current trends continue, more than half of today’s children will have obesity by the time they are age 35.
Obesity increases a person’s risk of heart disease, diabetes, and hypertension. It drives an estimated $149 billion annually in directly related health care spending, and—according to research completed at the Harvard T.H. Chan School of Public Health—an additional $66 billion annually in lowered economic productivity. Dollars invested in obesity prevention programs will be money saved on health care spending in the long run.
According to an October 2018 Mission: Readiness report, obesity also poses a national security vulnerability: one in three young adults is ineligible for military service because of being overweight.
Funding And Multisector Collaboration Needed
What does this return to increasing obesity rates suggest? Recognition of the obesity crisis is not enough. What’s needed is increased and sustained funding for obesity prevention programs.
The Obama administration, particularly through former First Lady Michelle Obama’s work, sent the right messages about healthy eating and exercise, including her Let’s Move initiative. However, during those same years, as obesity rates continued to rise, funding for obesity prevention programs was relatively stagnant and was tiny as compared to spending by the food industry on marketing unhealthy foods. (In September 2018, we learned good news about a small increase in funding for the CDC in the FY19 final budget, including a restoration of a portion of the recent budget cut to the REACH program funding). Racial and Ethnic Approaches to Community Health (REACH) is a federally funded, grants-based program to help local partners plan and execute initiatives to address obesity and other health issues in their communities.
What’s particularly frustrating to public health officials is that we know what is needed to reverse the alarming growth in obesity rates. The answer lies in policies and programs that allow people to make healthy food choices and be physically active. There have been substantial investments in such approaches by the Robert Wood Johnson Foundation (RWJF) and others in the philanthropic sector, including the W.K. Kellogg Foundation and the de Beaumont Foundation, and by the CDC and other government agencies at local, state, and federal levels. Where the investments have been sizable and strategic—for example, in the Live Well San Diego and Shape Up Somerville (Massachusetts) models—obesity rates have been positively affected. Such approaches and others need to be sufficiently funded and implemented in more places and sustained beyond the ins and outs of annual budgeting cycles.
I don’t mean to imply that the solution to the obesity problem is a simple one. To get obesity rates going down (they have been on the rise for forty years), everyone will have a role to play from individuals and families, to schools, the food industry, and local and federal policy makers. Solutions will require many sectors working together to shape an environment in which the healthy choice is the available, convenient, and affordable choice for all residents.
The CDC is tracking the promising impact of multisector initiatives in its innovative Childhood Obesity Research Demonstration (CORD) Projects, which are funded in a few states. The model used now needs sufficient funding to ensure that it can be more widely implemented.
Surveys show that most Americans recognize that their food and exercise habits affect their health. They are striving to make the right choices. Unfortunately, for many, where they live creates serious barriers to those healthy choices, and that’s particularly true in low-income communities.
How To Overcome Barriers To Healthy Choices
How do we knock down these barriers? A multiplace, multisector approach to reversing obesity trends includes the following:
- Meals served in schools should be healthful and taste good. (Some students consume up to half of their daily calories in school.)
- Students should have regular time periods that are reserved for physical education and/or active recess.
- Roads should be complete streets, meaning they should include safe places for walkers and people riding bicycles, as well as for cars.
- Government programs designed to provide food security to low-income families should be continued with additional incentives for healthful food consumption. Food insecurity often forces people to make the low-cost food selection, which is often the unhealthy selection.
- Medicare should encourage eligible beneficiaries to enroll in obesity counseling as a covered benefit, and the effectiveness of such enrollment should be evaluated.
- Food and beverage companies—or regulators—should eliminate children’s exposure to advertising and marketing of unhealthy products.
- All communities should have easily accessible and safe places to exercise and play.
- Hospitals should take a leadership role by no longer selling or serving sugary drinks on their campuses, by improving the nutritional quality of the meals they serve, and by promoting breastfeeding, which has been shown to reduce the likelihood of obesity in children.
These are some of the more than forty recommendations included in The State of Obesity 2018: Better Policies for a Healthier America, a report released in September 2018 by Trust for America’s Health and the RWJF.
As this year’s return to rising obesity rates demonstrates, we can’t be complacent.