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body image, obesity, weight loss

More than two-thirds of Americans are overweight: the normalization of unhealthy

34% of the adult population in America (32% of men and 35% of women) is obese. While the rate of obesity (body mass index ≥ 30, or 30 lbs overweight for someone who is 5’4″) has remained constant over the past few years. The rate of obesity has more than doubled since 1985, when less than 15% of the population was obese. Now 68% of the population is either overweight (BMI of ≥ 25-29) or obese (JAMA, 2010).

Obesity rates comparing 1990, 2000, and 2010

We can argue about BMI being an imperfect tool, and it is. BMI only accounts for weight, not muscle versus fat, so a very healthy person with a lot of muscle mass could have a BMI of ≥ 25 and technically be a healthy weight. Likewise, a person can have a normal BMI (≥19-25) and actually be unhealthy if they have no lean muscle mass (that is why BMI is less accurate for elderly people as most people lose muscle mass with age). However, keep in mind if your BMI is over 30 it’s a pretty accurate reflection of obesity. And while my observations are clearly not evidence based medicine, I remember very few instances where I was surprised to find out a patient who I thought was a healthy weight actually had a BMI of 25 or more.

Being overweight is a health risk. It increases the odds of diabetes, heart disease, breast cancer, and arthritis just to name a few of the negative health repercussions. This is not a judgement, it is simply fact. If you are overweight you are more likely to die earlier than someone with a BMI of 19 – 25. Of course, not everyone who is overweight will die of a heart attack and not every smoker will get lung cancer. My grandfather smoked until he died, at the age of 99, but just because he beat the odds doesn’t mean it is a safe habit.

Seeing the color changes by decade on the CDC chart is heart breaking. That we are eating ourselves to death (never mind the economic burden due to the increased costs of health care). While there are many factors involved, such as poverty, education, and difficult access to better food choices, I wonder how much the normalization of overweight comes into play. Is there a tipping point where so many people around are overweight that it ceases to register as a health concern?

I’m not sure I know the answer, but I live in a county with the lowest obesity rate in California: 16%. And seeing healthy looking people out and about helps. It certainly helped trigger me into thinking that I wasn’t as healthy as I had previous thought. When I lived in areas where decidedly more people were obese, well, it just seemed more normal.

It’s a hard conversation for many to hear. So much body image and self-worth bound and wound together with each pound. But when we talk about healthy weight, about striving for a BMI of 19-25, we are not ascribing blame or wrong doing. We are not saying bad or good. We are talking about health. About reducing diabetes risk. About reducing the risk for cancer.   About preventing a knee replacement.

Normalization of what is common happens to all of us. It doesn’t mean we are bad people it’s just human nature. But it’s also one more reason why we need to keep talking about healthy weight. No matter how difficult the conversation.

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Discussion

5 thoughts on “More than two-thirds of Americans are overweight: the normalization of unhealthy

  1. Very true, it is heartbreaking. I live in one of those areas that is >30% obese. And I spend a lot of my day counseling and trying to help people lose weight and to understand the health risks associated with it. And what is even more heartbreaking is that about once a month a family will bring a child in for being underweight and wanting to know what is wrong, and the child is actually ideal for his height and weight. That is where you truly see the normalization of the obese patient. When a normal weight child is thought to be underweight and malnourished.

    Posted by Melissa Gastorf | January 30, 2012, 4:16 am
  2. I see it as part of an overall trend in dumbing-down everything in this country. We seem to be incapable of saying “that is wrong” or “your child won’t be getting a PhD”. Years ago I was friends with a woman who was helping to raise four granddaughters. All four kids came home with all sorts of awards, and my friend was very proud of her granddaughters. Except that the “awards” were for everything but academics, for the most part. One of her granddaughters was reading three years below grade — she was in 5th grade and read at the 2nd grade level. Another granddaughter, who was also in elementary school, wasn’t doing much better.

    I blame a lot of the obesity epidemic on medicine. My father, who passed away 3 years ago, had perfect blood tests. His cholesterol was great, his blood pressure was great, and his blood sugar was great. He also took a fistful of pills several times a day to make sure they all stayed “great”. As far as he was concerned, as long as his test results were “great”, he was also “great”.

    If you’d like to read an interesting article, try this one —

    http://www.gallup.com/poll/142736/obesity-peaks-middle-age.aspx

    The article doesn’t say this, but I suspect the reason obesity “peaks” in middle age isn’t because 40 and 50-something year-olds are getting religion and going on a diet, it’s because they are just plain dying. The way I see it, the doctors who lulled my father into a false sense of security with years of “great” blood tests killed him just as dead as the heart attack he had.

    Posted by Julie in Austin | February 12, 2012, 10:04 pm
  3. I think this normalization is real, and it’s powerful — where I live (one of those healthy, slim California counties), I look normal. Menu options at restaurants, seemingly limitless exercise/activity options, and what other people are having for lunch at the office all contribute to what our local “normal” is: generally a healthy BMI.

    But when I go to visit the fam in Texas, I’m usually the skinniest person in the room. Everything from portion sizes (dig those constantly-refilled 40-oz glasses of sweet tea at the chicken-fried-steak restaurant!) to what a healthy teenager looks like (the contrast between the pictures of my beautiful, popular cousins in my high school yearbook and what those cousins’ teenage sons and daughters look like is astonishing) serves to reinforce it. Twenty years ago, you didn’t really see a lot of obese kids or teens in my old hometown — those were the skinny years, and you were supposed to slowly add the pounds as you got older, right? So — at least by my anecdata — this is definitely a recent phenomenon. Not sure what could be done about it, other than, as you said, to keep having the difficult conversations.

    Posted by Gleemonex | February 14, 2012, 10:07 am
  4. It is sad but there is an answer. I have counseled my patients so many times on weight loss that I finally wrote a how to do it book, called : “A Visit with Dr. Mickey: the Serengeti Plan for Weight Loss” This simple plan (it’s a very short ebook on Amazon.com) is only 2.99 and it works. My patients are all losing weight. no pills, no special foods to buy. no new membership in a gym necessary. no hunger. It is working for my patients. My book is not full of testimonials, they are on my website. I kept it short and simple so that someone can read it in a day and start right away. I hope it can make a difference in those statistics

    Posted by drmaureenchevalierseawell | March 5, 2012, 1:35 pm

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