This is the third is a series of articles on cardiovascular health and risk factors for heart disease.
We need to drop a few pounds. Most of us, after all, are now overweight or obese. Nearly 74% of adults in the United States have BMIs above the healthy weight range. 42% are considered obese. America is one of the fattest nations on the planet, and data from the CDC suggest the numbers will only continue to grow in the near future. Sometimes referred to as an epidemic, the obesity problem is the most significant public health crisis we face today. The scale is screaming at us, and we need to start listening.
Obesity is linked to a large number of negative health outcomes: type 2 diabetes, cardiovascular disease, even certain cancers. It worsens outcomes from COVID-19, possibly tripling the risk of hospitalization and severe illness. Obesity can also impair immune and lung function and contribute to poor mental health. With such a large percentage of Americans now living with obesity, the rates of these various related conditions are increasing dramatically. For example, from 2001 to 2017, the number of people under the age of 20 living with type 2 diabetes grew by ninety-five percent. Clearly the time to act is now. But in order to address the problems, we need to understand why this is happening in the first place.
What has caused obesity rates to skyrocket in the United States? Dr. Deeb Salem, cardiologist and Professor of Medicine at Tufts University School of Medicine, provides a succinct explanation: “Decreased physical activity, increased dietary sugar and fat, less sleep, and increased time watching a screen.” The data are in line with this. According to a study published in the scientific journal PLOS One, only 20% of today’s jobs require at least moderate physical activity, but in 1960, the number was closer to 50%. Americans now walk less than people in any other industrialized country. The CDC reports that 80% of us don’t get enough exercise.
As for increased sugar and fat, we know that the average American ate almost 20% more calories in the year 2000 than they did in 1983, in part because of increased meat consumption. Today the average American consumes an average of 195 pounds of meat every year, while in the 50’s that number was just 138 pounds. We started eating more added fats (about two thirds more) over the same period. Consuming more calories while moving less has the unfortunate consequence of packing the pounds on.
All of this puts a strain on our bones, our joints – and our hearts. Obesity can increase bad cholesterol and decrease “good” high-density lipoprotein (HDL) cholesterol. HDL cholesterol, according to Penn Medicine, “is important for removing bad cholesterol and working to reduce the risk for heart disease.” Obesity can also cause blood pressure to rise and may lead to diabetes. The American Heart Association reports that at least 68 percent of people aged 65 or older with diabetes also have heart disease, and that individuals with diabetes are two to four times more likely to be at risk for heart disease.
Reducing your risk of heart disease, then, may involve eating less and exercising more. There are medical conditions like PCOS and Cushing’s syndrome that may make it difficult for some people to lose weight, but for the vast majority of us, simple lifestyle changes can lead to weight loss and improved health. Yet obesity continues to be a major problem, and many attempted interventions, on federal and state levels, have failed. Michelle Obama’s Let’s Move public health campaign, for example, sought to reduce childhood obesity to 5% by 2030. Obviously there are still eight years to make good on this promise, but since the Obamas left the White House childhood obesity has only continued to increase. A 2011 study from BMC Public Health found that “[to] date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit.”
Dr. Salem suggests that “increasing physical activities for all school children at an early age would help,” and indeed P.E. classes have declined significantly over the past few decades. Social scientist Claire Nader found that today, only “4% of elementary schools, 7% of middle schools and 2% of high schools have daily P.E. the entire school year. 22% of schools have no P.E. at all.” Making daily P.E. a norm again could go some ways to combatting childhood obesity and have lasting effects as children get older. For adults struggling with obesity, meanwhile, new medications could have some benefit. Dr. Salem says “there is growing evidence that new drugs such as SGLT2 inhibitors can decrease weight (by appetite inhibition)” in people with morbid obesity. Unfortunately, these medications are prohibitively expensive.
There is no easy solution to the problem of obesity in the United States. A complex combination of policy and cultural changes may be in order, but exactly what those policy and cultural changes are no one has yet been able to say. In the meantime, most of us can make small changes to our daily lives to lose weight if we need to. As always, you should consult your doctor about any new diet or exercise changes you plan to make. But you should also plan to get moving, whether you need to lose weight or not – sitting, as Dr. Salem reminds us, is the new smoking, and your heart deserves better.
