Leading Preventable Cause of Death in America

Obesity is now the leading preventable cause of death in America by some estimates.  Others call the leading cause of death, “dietary,  lifestyle and metabolic risks” but this is really just a politically correct way to say obesity.   The prevalence of obesity in United States is skyrocketing.  It’s not clear why Americans are becoming increasingly obese, but it is perfectly clear that it’s happening.  Using the standard definition of obesity of a body mass index (BMI) greater than  30, in 1985 no state had more than 20% of adults with obesity, and by 2009 9 states in the SE US had obesity rates > 30% and only the District of Columbia and Colorado had obesity rates <20%.   Compare the maps from the CDC web site of obestiy rates by state in 1985, 1994 and 2009.

Many states had no data in 1985, so you may think maybe the worst states did not report.  Probably not. Look at the data in 1994 when all states reported data.

In 1994 still no states reporting over 20% obesity rates.  Now compare to just 15 years later in 2009.

The change from blue to red is not a change in political parties.  Its us Americans getting fat.  This is a truly shocking increase in obesity in just 24 years, really a single generation.  In 2001 Mississippi became the first state with >25% of adults with obesity.  By 2005 Louisiana, Mississippi and W. Virginia had obesity rates >30%.  In 2009 only 14 states and Washington DC had obesity rates less than 25%.

This is far more than a cosmetic problem.  By some estimates obesity passed tobacco use as the leading cause of death in 2010.  This is largely because over the time frame from 1993 until 2008 the incidence of smoking decreased by 18.5% while the proportion of Americans who were obese increased by 85%.

Medical problems caused or made worse by obesity include many of the most common causes of death in America including  coronary heart disease, diabetes and some types of cancer, and stroke.  In addition obesity, especially morbid obesity, is associated with significant morbidity.  Osteoarthritis, congestive heart failure, lymphedema lead to marked reduction in a person’s ability to accomplish even the most basic of the activities of daily living.  The estimated cost of obesity in the US in is estimated at just over 9% of the total health care spending, or about 147 billion dollars in 2008 according to HealthDayNews.

So what can you as an individual do and what can America do as a country, to reverse this trend toward increasing obesity?  We know a lot more about what does not work than about what does.  It’s clear that fad diets just don’t work.  It’s also clear that there is more to obesity than just calories in and calories burned, but the answer for individuals and the answer for communities and the country as a whole are likely related to lifestyle changes as an individual and inducements to lifestyle changes as a community.

As a family physician I deal with individuals.  I have patients who are dying of obesity and I feel relatively helpless when I try to help them.  Bariatric surgery, either gastric bypass, lap-banding, or whatever the next better version of procedure may be is coming into its own as an option.  I have a few dozen patients who are great candidates for bariatric surgery, but the cost of $30-50,000 of more and the exclusion of obesity as a covered medical problem by most insurers makes almost none of them able to have this surgery.  Exercise and reduced calorie intake are the obvious answers, but changing eating and exercise habits as an adult are not easy, and many of my obese patients just are not successful in sustaining this type of change.

As a community, in any way you define community, there are things that can be done to make healthier choices about walking places, biking places, and getting incidental exercise easier to make.  Lighted sidewalks on busy streets, bike lanes on more roads, and building communities so that more jobs are within walking distance of home would induce more people to get out of their vehicles and walk or bike about.  These changes are expensive, and will compete with other infrastructure challenges for funding  I’m not optimistic that many established communities will commit to this type of change, but maybe some cities and newly developed communities can be healthier places to live.   The Walmart and Michelle Obama obesity partnership may be the type of thing that will help to some degree, but it will take lots more than that I’m afraid.

This medical blog would love to have a lively discussion of your best ideas on personal and community changes you’d like to see or accomplish.  Leave a comment.

4 Responses to Leading Preventable Cause of Death in America

  1. Yes, overweight and obesity are the factors that contribute to the leading medical conditions that lead to early, preventable death: hypertension (heart disease), diabetes, and cancer. And what are the causes of obesity? Leading researchers at the NIH (National Institutes of Health), Institute of Medicine and Centers for Disease Control and Prevention are looking at multiple factors.

    There is a very compelling and informative 4-part documentary produced by HBO in conjunction with these research entities that will be aired in May 2012 and available for free download. See: http://www.theweightofthenation.hbo.com

  2. I absolutely agree that it is one of the leading causes of death – I am not quite as convinced it is “preventable” – at least not easily so. There are huge societal forces in play – from increased calorie density of food, computer/TV lifestyle issues, increased light exposure with subsequent decreased melatonin, suburban design and aversion to walking,…. The list is endless. I doubt there are any silver bullets.

  3. I looked at the articles. They definitely are “food for thought” but I think we are a long way from really understanding obesity. I think it’s going to be multifactorial, but my hunch is that in the truly morbidly obese there is often something more than just eating too much.

  4. I recently read a blog post by Dr. Julie O’Toole that obesity may be caused by gut microbiota:
    http://www.kartiniclinic.com/blog/Some-Weird-things-about-Fat-Obesity

    She links to several articles in her post that talk about the differences betweent the microbial populations of lean and obese people–and they are different.

    This article in the NY Times is readable and very interesting:
    http://www.nytimes.com/2006/08/13/magazine/13obesity.html?_r=1

    It pretty much blows my mind to think that obesity might be due to microflora, inflammation or exposure to certain infections.

    What do you think?

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