Obesity in America: are you part of the problem?

Meghan Musso, Susan Dudley, PhD, and Sarah Pedersen


Despite our country’s obsession with weight and appearance, most people who are medically overweight don’t realize it.  Although 39% of adults responding to a 2006 survey said they believe they are overweight, the actual number of overweight people in America, according to the National Institutes of Health (NIH), is much larger.  At the time of the survey, about 60% of Americans age 20 and older were overweight or obese.  According to the latest Center for Disease Control (CDC) National Health and Nutrition Evaluation Survey, 34.2% of Americans age 20 and older are overweight, 33.8% are obese (meaning overweight enough to be at high risk for health problems), and 5.7% are extremely obese (meaning that they at even higher risk of developing health problems).

What we’re talking about isn’t annoying “love-handles” or a body that doesn’t match the supermodels we see in magazines.  Instead, we’re talking about a condition that significantly threatens health, well-being, and longevity.  Our collective weight problem is so bad that only cigarette smoking causes more preventable deaths in America than obesity does.  That means that approximately 300,000 deaths each year are directly or indirectly related to obesity.

Certain groups are more prone to overweight and obesity than others.  For example, women-who often tend to gain weight as they get older-are at higher risk than men.  Black women are at higher risk than white women, and low-income minority women are the most likely to be overweight.  In general, middle aged women are at the highest risk for becoming obese.  Most troubling of all, children-even at very young ages-are more overweight and obese than ever before, setting the stage for lifelong weight-related health problems.

For more information on patterns of obesity and overweight in America, visit the CDC website.

Assessing Body Composition: BMI and Waistline Measurements

How do you know if you are medically overweight or obese?  Doctors use a formula that takes both height and weight into consideration to come up with a standardized measurement known as body mass index, or BMI.  The BMI is a reliable indirect way of measuring total body fat content.

Your health care provider can help you figure out your BMI, or you can use an automatic BMI calculator.

You can also calculate your BMI by hand:

1) divide your weight (in pounds) by your height (in inches) squared. Then
2) multiply the result by 703

For example, if you are 5′5″ (65″) tall and weigh 150 lbs:

[150 ÷ (65)2] x 703 = [150 ÷ 4225] x 703 = 24.96.

The interpretation of BMI is based on health risk, not on a judgment about physical attractiveness.  In general, the higher the BMI, the higher your health risks will be.

  • BMI for people at a healthy body weight falls between 18.5 and 24.9;
  • A BMI between 25 and 29.9 is considered overweight.  At this weight, your chances of dying early, especially from heart disease or cancer, are increased.
  • A BMI over 30 is considered obese.  Over 30% of Americans fall into this category, with dramatically increased risk of health problems and earlier death.

Even with a healthy BMI, however, white, black, and Latina women with a waistline measurement of 35 inches or more, and Asian women with a waistline of 31 inches or more, may still be at risk for serious fat-related medical problems.  This is because the accumulation of “visceral” fat can be especially harmful.  Measure your waist at the level of the points of your elbows when your arms are at your sides.  Keep the tape measure parallel to the floor, and don’t pull it so tight that it compresses your skin.

Causes of overweight and obesity

Why are so many Americans overweight?  At least three general factors contribute to adult weight gain: behavior, environment, and genetics. Although we can’t control our genetics, we do have some substantial control over behavior (our eating habits and physical activity) and of many aspects of our environment (things at home, school, and work that might affect our weight).

Behavior includes the personal decisions we make about diet and exercise. Many of us, perhaps tempted by appealing advertisements and the convenience of fast foods and take-out restaurants, eat more fattening and unhealthy foods than we intend to.  Americans tend to favor large serving sizes and high-calorie, high-fat, and high-sugar foods, which provide little nutrition and add many pounds.  This includes fast food, sodas, sugary cereals, and processed foods.  Too often we don’t even realize it.  For example, at some popular restaurants, one meal may have an entire day’s worth of calories and far more fat and salt than our bodies can process in a day.  Our favorite latte can have one-third of a day’s calories.

Our environments contribute to weight control problems in a number of ways.  The couch potato is a well-recognized stereotype of American life. And although most of us don’t think that stereotype applies to us, the fact is that two-thirds of adults don’t get the 30 minutes of exercise a day that is needed to stay fit.  With cars, remote-controlled TV’s (complete with frequent images of junk food), on-line shopping on home computers, and an array of labor-saving appliances at home and at work, many of us have become less active every year.  Regular moderate exercise can get rid of the unhealthy visceral fat that accumulates around the waistline, even before the scales start to show an overall weight loss.

Scientists are still learning about how genetics affect obesity.  The Center for Disease Control and Prevention (CDC) has found that some people are more likely to become obese, but they can’t explain exactly why.  One theory is that thousands of years ago some humans developed genes that allowed their bodies to store more fat and helped them survive when food was scarce. Today, we don’t need fat storage for survival, but some people still have the fat-storing genes passed down from their ancestors.  Such people would have a very high chance of becoming obese and would therefore need to work all the harder to avoid obesity.

Making a commitment to do something about being overweight

People don’t need to be extremely thin to be healthy and happy.  But being overweight or obese can diminish the quality and the length of your life. Some people can get their weight down on their own, and others can benefit from working with a health care provider, nutritionist, trainer, buddy, or proven programs like Weight Watchers®.  Everyone is different so do what will work for you.  The important thing is that you take steps to keep or get to a healthy weight.

Eating a healthy diet with the right foods can help you lose and manage weight.  It’s important to know that not all foods are created equal!  Some foods, such as nuts, are high in nutrients and essential vitamins, while others lack nutritional substance, such as products containing added sugars.Nutrient-dense food” provides substantial amounts of vitamins and minerals and relatively few calories, but leaves you feeling fuller while also supplying valuable fuel for your body.  A person is more likely to stick to a diet-while feeling better and healthier-if calories are nutrient-dense.

Empty calories from simple carbohydrates found in processed and refined sugars, such as candy, pasta and bread made from white flour, and foods with corn syrup, leave you hungry again soon after, craving more food.  This is because simple carbohydrates quickly turn into useless sugar, whereas complex carbohydrates, such as vegetables, whole-grain breads and cereals, and low-fat yogurt and milk, provide long-lasting nutrients, improve digestion, help stabilize blood sugar, and keep your energy at an even level.  Although foods such as fruit are also considered simple carbohydrates, they contain vitamins and nutrients that occur naturally, unlike those found in processed and refined foods.

A 2011 study in the respected New England Journal of Medicine found that certain foods were linked to weight change more than others. After following participants for an average of 17 years, researchers found that weight increase was most strongly linked to foods such as potato chips, sugar-sweetened beverages, and unprocessed red meats.  Foods such as vegetables, whole grains, nuts, fruits, and yogurts were closely linked to preventing weight gain.

Also, adding or increasing regular exercise to your daily routine can help gain control and maintain a healthy weight.  Research has shown very clearly that 30 minutes of moderately strenuous daily exercise is one of the most important requirements for disease prevention-even for people who are already at an ideal weight.  The exercise you choose doesn’t need to be elaborate, or to take place in a gym.  Walking, biking, swimming, or gardening can do the trick, and getting a friend or family member to exercise with you can turn this into a valued part of your daily routine.  Learn more about the health benefits of physical activity and how to get started from the CDC.

Pew Research Center. American See Weight Problems Everywhere But In the Mirror. April 2006.

Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults United States, trends 1976-1980 to 2004-2008. National Center for Health Statistics, Centers for Disease Control and Prevention. June, 2010.

Mozaffarian D, Hao T, Rimm, EB, et al. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. The New England Journal of Medicine. 2001;364:2392-404.