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Adam Fratto Introduction Overweight and obesity are major causes of morbidity and mortality in the United States.

Obesity is the second leading cause of preventable deaths in the U.S. (Get Fit Foundation, 2012), contributing to approximately 100,000 400,000 deaths annually (Blackburn & Walker, 2005). Obesity-related conditions include heart disease, stroke, hypertension, osteoarthritis, type-2 diabetes, and certain types of cancer (CDC, 2012). The United States has the highest rate of obesity of all the countries in the world. Obesity rates have risen from 15% in 1962, to 24.5% in 2004, to 33% in 2008 (CDC, 2012). In 2006 it was estimated that in the U.S., 66% of adults are overweight and 32% are obese (Ogden et al, 2006). In addition to health problems, medical costs associated with obesity are estimated at $147 billion (Finkelstein et al, 2009). Roughly half of all obesity related costs are financed by Medicaid and Medicare. It has been estimated that obese people have medical spending that is $1,429 greater than spending for normal-weight people (Finkelstein et al, 2009). There are also indirect costs associated with overweight and obesity, including decreased productivity, restricted activity, absenteeism, and bed days (CDC, 2012). These alarming statistics show how dangerous overweight and obesity is in America. In this paper, I will argue that overweight and obesity is the most dangerous epidemic in America. Overweight & Obesity The CDC defines overweight and obesity as labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems (CDC, 2012). These ranges are determined by using weight and height to calculate the 1

Adam Fratto body mass index, or BMI. Although BMI does not directly measure body fat, for most people it correlates with their amount of body fat. An adult to who has a BMI between 25 and 29.9 is considered overweight and an adult who has a BMI of 30 or higher is considered obese (CDC, 2012). Other indicators of potential health risks associated with being overweight or obese include waist circumference, high blood pressure, and physical inactivity (National Heart, Lung, and Blood Institute, 2012). Body weight is the result of genetics, behavior, culture, and socioeconomic status; with behavior and environment playing the largest role (CDC, 2012). For the majority of individuals, overweight and obesity are a result of excessive calorie consumption and/or inadequate physical activity (Office of the Surgeon General, 2001). The CDC states that overweight and obesity result from an energy imbalance which involves eating too many calories and not getting enough physical activity (2012). Currently, 78% of Americans are not meeting the basic activity level recommendations (Get Fit Foundation, 2012). Diet It has been proven that dietary choices can have profound consequences for health (WHO, 1990). Dietary guidelines recommend balancing calories with physical activity to manage weight. It is also recommended to consume nutrient rich foods, such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood (health.gov, 2011). Currently, only 3% of all individuals meet four of the five recommendations for the intake of grains, fruits, vegetables, dairy products, and meats (HHS, 2000). The current American diet consists of hamburgers, french fries, donuts, highly processed and packaged foods, and other foods that are low in nutrients and high in calories.

Adam Fratto Currently, 10 15% of American individuals daily calories come from food eaten away from home, or fast food (CDC, 2012). In fact, the percentage of individuals food budget spent on food away from home and fast-food has been gradually increasing since the mid-1970s, and in 2006, Americans spent approximately 49% of their food budget and take in 32% of their calories on fast-foods (USDA, 2007). Less cooking at home and more eating out means nutrition is most likely compromised because foods ordered away from home and fast-foods contain less fruits, vegetables, and nutrition while delivering more saturated fat and calories (Keystone, 2006). Portion size also is contributing to Americas overweight and obesity problem. Larger portions not only contain more calories, they encourage people to eat more, making it hard for individuals to regulate their intake (Young & Nestle, 2004). The average serving size of a pasta meal ordered at a restaurant exceeded USDA standards by 333%, and a steak exceeded the standard by 224% (Young, & Nestle, 2004). That means that Americans who eat away from home are getting a huge helping of food, which comes with a huge helping of calories. Restaurants use larger dinner plates; sell larger muffins, gigantic pizza slices with cheese stuffed crusts, super-size drinks, and extra-large french fry orders (Young & Nestle, 2004). Formal mealtimes have also disappeared. More parents are in the workforce, leading to increased snacking and no nutritional meal provided at the end of the day (Condrasky & Hegler, 2010). When families stop eating together, members eat on their own, and feed themselves whatever they want; this can be especially detrimental to children. Solitary eating can also be uncontrolled eating, including snacks, sweets, and fast-food (Kluger & Gorman, 2004).

Adam Fratto A recent survey suggests that people with a greater knowledge of nutrition eat a healthier mix of vegetables than people with less nutrition education (Guthrie, Lin, Reed, & Steward, 2005). But unfortunately, many Americans lack the knowledge to purchase and prepare foods for healthy meals (Keystone, 2006). Some research also suggests cooking skills are declining, thus impairing individuals ability to prepare nutritious meals (Short, 2003). Food is also a strong part of American culture and socialization with food present at parties, sporting events, movie theaters, and malls. A professor was cited in the New York Times (2004) as saying, Interaction over food is the single most important feature of socializing." It is clear that the combination of insufficient vegetable and fruit consumption, increased frequency of fast-food meals, poor food preparation skills, and increased portion size have all contributed to the rise in obesity and related chronic diseases (Condrasky & Hegler, 2010). Exercise It is no secret that there is a lack of physical activity in America. In 2011, the CDC announced that less than 2 out of 10 Americans get the recommended levels of exercise. More astoundingly, 25.4% of adults get NO exercise at all (CDC, 2011). Physical activity is one of the most important things an individual can do for their health. Physical activity can control weight, reduce the risk of cardiovascular disease, reduce the risk of type 2 diabetes, strengthen bones and muscles, improve mental health and mood, and increase the chances an individual will live longer (CDC, 2011). People who are physically active for about 7 hours a week have a 40% lower risk of dying early than those who are active for less than 30 minutes each week (CDC, 2011).

Adam Fratto Physical activity is anything that gets your body moving. 2008 Physical Activity Guidelines for Americans state that individuals need to engage in two types of physical activity each week to improve their health; aerobic and muscle-strengthening. It is recommend 2 hours and 30 minutes, or 150 minutes of moderate-intensity aerobic activity every week and musclestrengthening activities on 2 or more days a week that work all major muscle groups (CDC, 2011). Or individuals can engage in 75 minutes of vigorous-intensity aerobic activity every week and muscle-strengthening activities on 2 or more days a week. The Solution Weight management requires a complex series of interactions of individual choices, behaviors, and environments (Frable, Dart, & Bradley, 2006). With four of the top ten causes of American deaths (heart disease, cancer, stroke, and diabetes) being related to poor nutrition, it is crucial to improve Americas eating habits. Also, with only 20% of American engaging in physical activity, Americans need to increase levels of physical activity. Behavior In order to combat overweight and obesity, every American needs to take action with themselves, their families, and their communities. The first step Americans can take is to assess whether or not their current weight is healthy. Individuals need to be aware of their weight, and the threat their weight may be posing to their health in order to make necessary changes. The CDC encourages everyone to know their BMI, and provides a BMI calculator on their website: (http://www.cdc.gov/healthyweight/assessing/BMI). Individuals should also assess whether or not they are meeting the daily and weekly recommendations for physical activity. If individuals see that they are not meeting these

Adam Fratto recommendations, they should take steps to increase their physical activity. Physical activity helps to maintain weight, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and several forms of cancer. Physical activity also reduces arthritis pain, osteoporosis, associated disabilities, and falls. It can also reduce the symptoms of depression and anxiety (CDC, 2012). It doesnt matter what age you are, your ethnicity, your size or shape, everyone should get moving and everyone can gain the health benefits of physical activity. The CDC (2012) also encourages everyone to view their food intake as a lifestyle not a diet. The CDC states that, The key to achieving and maintaining a healthy weight isn't about short-term dietary changes. It's about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories you consume with the number of calories your body uses. Staying in control of your weight contributes to good health now and as you age. If individuals do need to lose weight, it is important for them to know that even a modest weight loss of 5% to 10% of their total body weight can improve their blood pressure, blood cholesterol, and blood sugars (CDC, 2012). Those who lose weight and maintain the loss experience better physical health, increased energy levels, physical mobility, improved mood, and self-confidence (CDC, 2012). The foods we eat every day and the activities we engage in (or dont engage in) are within our control. Every day, there are choices presented to us. What to have for breakfast? What to have for lunch? Take the stairs or the elevator? Watch a favorite TV show or take the dog for a walk? Hit the gym or go to a movie? What to have for dinner? Grocery shop or eat out? All of these decisions add up and contribute to the obesity epidemic America is currently experiencing. We are each in control of our decisions and our health.

Adam Fratto Environment In this technology age, Americans work in offices, sit at desks, and ride in cars and buses. Some individuals still have to do physical labor to earn a living, but not many. Children play electronics instead of kickball. Some individuals dont have access to safe spaces to exercise and recreate in. Public health policies should be in place to ensure the American obesity epidemic is conquered. Environmental and policy strategies can be used to combat overweight and obesity in America because they benefit everyone living or exposed to the impacted environment. Environmental and policy strategies can be used to supplement individual behavior changes and lifestyle modifications. Research has shown that access to facilities, such as walking trails, swimming pools, and gyms, has a positive correlation with physical activity behavior in adults (Schmitz & Jeffrey, 2000). Community strategies for preventing overweight and obesity may include increasing availability of healthier food and beverage choices, restricting less healthy foods and beverage, and improving availability of affordable healthier foods and beverage choices in food service venues. Other strategies include instituting smaller portion sizes in food service venues, improving geographic availability of supermarkets in underserved areas, and providing incentives to retailers to offer healthier food and beverage choices. Another way to decrease overweight and obesity is to improve mechanism for purchasing foods from farms, and providing incentives for the production, distribution, and procurement of foods from local farms. It is also a good idea to limit advertising for less healthy foods and beverages, and discourage the consumption of sugar-sweetened beverages (Siega-Riz & Gianni, 2009).

Adam Fratto Other environmental strategies include appropriating public funds to build community health centers, bike paths, and safe neighborhoods. Other things that can affect overweight and obesity include incentives promoting physical activity during the workday and policies requiring comprehensive school health programs, and zoning requirements that include walking and biking paths (Brownson, Baker, Housemann, Brennan, & Bacak, 2001). The goal of implementing environmental and policy overweight and obesity strategies is to create healthy communities that provide health-promoting opportunities and social support to enable people to develop healthier lifestyles. Conclusion In sum, obesity is the second leading cause of preventable deaths in the U.S. (Get Fit Foundation, 2012), contributing to approximately 100,000 400,000 deaths annually (Blackburn & Walker, 2005). Overweight and obesity causes heart attacks, strokes, diabetes, cancer, and takes individuals away from their families prematurely every year. With overweight and obesity contributing to serious morbidity and mortality in the United States, it has been shown that obesity is currently the most dangerous epidemic in America. This epidemic must be addressed through individual personal behavior, such as eating healthier and engaging in more physical activity. The epidemic must also be addressed through the environment we live in, such as providing citizens with community health centers, and easy access to grocery stores.

Adam Fratto References Blackburn, G. L.,Walker, W.A., (2005), Science-based solutions to obesity: What are the roles of academia, government, industry, and health care? The American journal of clinical nutrition, 82: 207210. Brownson, R.C., Baker, E.A., Housemann, R.A., Brennan, L.K., Bacak, S.J., (2001). Environmental and Policy Determinants of Physical Activity in the United States. American Journal of Public Health, 91: 1-12. Brownson, R.C., Schmid, T.L., King, A.C., (1998). Support for Policy Interventions to Increase Physical Activity in Rural Missouri. American Journal of Health Promotion.12:263266. Centers for Disease Control and Prevention, (2012). Overweight and Obesity. http://www.cdc.gov/obesity/. Accessed April 18, 2013. Condrasky, M.D., Hegler, M., (2010). How Culinary Nutrition Can Save the Health of a Nation. Journal of Extension. 48: 1-6. Frable, P.J., Dart, L., Bradley, P.J., (2006). Healthy Weigh (El Camino Saludable) Phase 1: A Retrospective Critical Examination of Program Evaluation. Public Health Research, Practice, and Policy, 3: 1-11. Franck, K., Vineyard, M., Olson, A., Peterson, A., (2012). Experiential Cooking Programs for Low-Income Adults: Strategies for Success. Extension Journal, 50; 1-5. Get America Fit Foundation, Accessed April 19, 2013. http://www.getamericafit.org/statisticsobesity-in-america.html Guthrie, J .F., Lin, B. H., Reed, J., & Steward, H. (2005). Understanding Economic and Behavioral Influences on Fruit and Vegetable Choices. United States Department of Agricultural Economic Research Service. Keystone Center. (2006). The Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and Obesity. http://www.keystone.org/spp/documents/Forum_Report_FINAL_5-30-06.pdf. Accessed April 20, 2013. Kluger, J., Gorman, C., Park, A., (2004). Americas Obesity Crisis: Eating Behavior, Why We Eat. New York Times. Office of the Surgeon General. The Surgeon Generals Call to Action to Prevent and Decrease Overweight and Obesity. Office of the Surgeon General: Rockville, MD, 2001. Ogden, C.L., Carroll, M.D., Curtin, L.R., McDowell, M.A., Tabak, C.J., Flegal, K.M., (2006). Prevalence of Overweight and Obesity in the United States, 19992004. Journal of the American Medical Association, 295: 15491555.

Adam Fratto Sallis, J.F., Hovell, M.F., Hofstetter, C.R., (1989). A Multivariate Study of Determinants of Vigorous Exercise in a Community Sample. Preventative Medicine, 18:2034. Schmitz, M.K., Jeffery, R.W., (2000). Public Health Interventions for the Prevention and Treatment of Obesity. Medical Clinics of North America, 84: 491512. Siega-Riz, A.M., Giannini, C., (2009). Promoting Healthy Weight in Women: What the Physicians Can Do to Help. North Carolina Medical Journal, 70: 449 453. USDA (2010). Dietary Guidelines for Americans. U.S. Department of Health and Human Services. www.dietaryguidelines.gov, accessed April 22, 2013. U.S. Department of Health and Human Services. Healthy People 2010. US Government Printing Office: Washington, DC, 2000. U.S. Department of Health and Human Services. Health, United States, 2011. Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/data/hus/hus11.pdf Accessed April 25, 2013. Young, L.R., Nestle, M., (2002). The Contribution of Expanding Portion Sizes to the US Obesity Epidemic. American Journal of Public Health, 92, 246-239.

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