Welcome to Running: A FEVER. My name is Michael Davis. This is a podcast about fitness, diet, and medicine. My goal is to live a long, healthy, happy, active life right up to the very end. And I’ll do it by loving my life enough to make it last as long as possible. If you’re down with all that, stay tuned, and we’ll get there together.
The topic I am addressing today is near and dear to my heart because I have been obese for most of my adult life. It is also such a large topic with a volume of information that makes it impossible to address in a single episode. Perhaps a short series may be a better way to address it at some point in the future. But for now, I want to give an overview of the situation as best I can, and I hope to hear some feedback from you on what areas you would like to hear more about. Please comment on this video and I promise to read every one.
Perhaps you did not know that obesity is an epidemic. It is, officially so. In 1997 the World Health Organization published a 268-page document entitled “Obesity: Preventing and Managing the Global Epidemic.” In it, obesity is described as “a global problem,” “a reflection of the massive social, economic and cultural problems currently facing developing and newly industrialized countries,” “…not just an individual problem. It is a population problem and should be tackled as such.”
So obesity is a disease and a serious one. How is it defined and diagnosed? According to the WHO, BMI is the best method, at least the most useful. Although I really like that they call it “crude” and state that it may not be accurate in some individuals and populations. It admits that “BMI does not distinguish between weight associated with muscle and weight associated with fat.” An example of the differences between populations is that Polynesians have a lower fat percentage than Caucasian Australians at the same BMI. However, it is widely accepted that a BMI of 30 or more indicates that a person has the disease called Obesity. For the WHO, this is mainly based on the association of BMI with mortality. There is a sobering thought right there. Diagnosis is very simple. Look at a BMI chart where your height and weight intersect. If it shows a BMI over 30, you are obese. There is a link to a BMI chart in the show notes at http://RunningAFEVER.com/384. My BMI is currently between 37 and 38.
But the epidemic started much earlier. For most of history, being overweight was a sign of prosperity. Subsistence was the main goal of most humans, so those who had a lot of fat lived in a state of food abundance only afforded to the most fortunate in society. Obesity dates back at least to the Graeco-Roman period. However, it was only recognized as a problem by insurance companies in the early 20th century. Actuaries discovered a higher morbidity rate among the obese. Before 1950, drug treatments were already available.
According to a 2022 NIH paper by Norman J. Temple, obesity became an epidemic sometime between 1976 and 1980. It started in the United States but soon spread across the developed Western world—yay, USA. Starting in 1980, the occurrence of obesity started a 20-year run of rapid increase, from 15% in 1980 to 30% in 2000. This was true across all age groups, ethnic groups, and both sexes.
According to Temple, the causes of this change arise not from a decrease in activity but from a change in the American diet. I’ve said before that I believe the idea that I read somewhere that weight loss is 70% diet and only 30% exercise. Although manual labor decreased throughout the 20th century, at the time of the birth of the epidemic, there was an increased interest in exercise, including jogging and aerobics. I wonder how many of you are old enough to remember leg warmers?
So diet was the culprit. What caused the change in the 1970s and early 1980s? According to one article, fast food was and is the culprit. 34% of children and adolescents consume fast food on any given day, and 80% of children say McDonald’s is their favorite place to eat. This is in line with a 2012 study that concluded that “The most significant trend is clearly the continued shift of our energy intake from home to away-from-home sources.”
According to Temple, increased consumption of sugary soft drinks and ultra-processed foods is to blame in large part for the epidemic. There was a big drop in the cost of sugar after 1980. However, much of the sweetener intake comes from high-fructose corn syrup, which is generally cheaper than sugar. When the Coca-Cola company switched its marketing from “New Coke” to “Classic Coke” in 1985, “Classic Coke” was actually made with high-fructose corn syrup, whereas what you might call “Old Coke” was made with sugar.
Ultra-processed foods, which include sugary soft drinks, contain very little food of any nutritional value and contain lots of additives. They also usually contain a lot of salt and fat. Some examples are white bread, sweetened cereals, cookies, cakes, candy, ice cream, margarine, sausage, and pizza. Some surveys indicated that consumption of these foods as a proportion of energy intake as much as tripled between 1977 and 1996. One theory of why consumption of UPFs increased was an increase in government farm subsidies in the early 1970s. It’s also a fact that nutritional meals cost more than UPFs.
So, what is the situation today for the obesity epidemic?
I recommend going to the Trust for America’s Health (TFAH) website and having a look around. TFAH is a non-profit aimed at addressing the social determinants of health and correcting health inequities through public health policy, research, and advocacy. Obesity is one of their ten top-priority issues. And for the last twenty years they have produced an annual “State of Obesity” report. Their latest report, from 2023, reveals some stunning and perhaps even frightening information. But they also offer some recommendations to address the epidemic.
So here’s the bad news. In the U.S., 41.9% of adults have obesity. Black and Latino adults have the highest rates at 49.9% and 45.6% respectively. Rural communities are more impacted by the epidemic than urban and suburban areas. Rates for children and adolescents have tripled since the 1970s, and as of 2023, that rate is 20% for ages two to nineteen. One of the exciting exhibits on the website is a map that shows obesity rates by state. And guess what? I live right smack in the middle of the region with the highest obesity rates, over 35%. This 22-state area covers the entire South except for North Carolina and Florida, the entire Midwest except for Illinois, and more. Ten years ago, no state had a rate of 35% or higher. West Virginia is the big winner, with 41%. Washington, DC, has the lowest obesity rate, with 24.3%.
If you’re obese like me, all of this should make it clear that we are not alone in our suffering. But that just isn’t much help, is it? Not very comforting at all. We really want a cure for this disease. Much of the scholarly material I’ve presented is aimed at the big picture. Public policy figures large. Prevention is key. However, there is some constructive advice for individuals. Temple recommends reducing the intake of ultra-processed foods. The evidence about away-from-home eating suggests that we should eat more meals at home, which I’ve been trying lately. One article concluded that consumers should be encouraged to eat more fruits and vegetables and fewer high-fat mixed-grain-based dishes.
Of course, we know that advice on how to lose weight is perhaps more abundant than any advice, and as obesity rates increase, there will likely be increased advice for years to come. In this podcast, I have tried to share my own experience and let you be the judge. My advice has always been to become an expert at your own health and make small changes based on what you know about yourself.
There is so much to read and absorb about the epidemic of obesity. The show notes include a number of references, but there is so much more out there. I’d like to hear what you think of this episode and what more, if anything, you’d like to address on this topic. I am sure it will come up again and again.
I hope you’ve learned something from listening or watching today. I know I learned a ton from researching it, and it has piqued my curiosity to learn even more, especially about the root causes of the changes in society, which were just touched on in the sources I used today.
Here’s some unrelated good news. If you haven’t noticed, all new video episodes of Running: A FEVER are now available in Ultra High Definition 4k and Quad HD 2k. And when you watch the videos, don’t forget to like and subscribe!
As always, if you’ve got the fever, keep it burning, and if you don’t, catch the fever, and I will see you next time on Running: A FEVER.
References:
https://onlinelibrary.wiley.com/doi/10.1038/oby.2002.51
https://en.wikipedia.org/wiki/Fast-food_restaurant#:~:text=Arguably%2C%20fast%2Dfood%20restaurants%20originated,with%20outlets%20across%20the%20globe.
https://iris.who.int/handle/10665/42330
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9611578/
https://www.worldobesity.org/what-we-do/our-policy-priorities/obesity-as-a-disease
https://www.tfah.org/report-details/state-of-obesity-2020/#:~:text=The%20U.S.%20adult%20obesity%20rate%20stands%20at%2042.4%20percent%2C%20the,by%2026%20percent%20since%202008.
Photo by Polina Tankilevitch:
https://www.pexels.com/photo/fast-food-in-close-up-shot-4109256/