In Depth

America’s Disease: Obesity

Our Increasingly Overweight Nation Is Always a Story

It’s an enormous story, pardon the pun, that has made huge headlines in recent years. The number of Americans considered obese has more than doubled in the past 30 years, from 15% of the population to nearly 33% by some estimates, reaching epidemic proportions. In 1985, not a single state in the U.S. had an obesity rate of more than 14% of its population. By 2006, not a single state had a rate of less than 20%.

Obesity currently costs the American people about $78.5 billion a year, according to a recent report by the Centers for Disease Control and Prevention.

The shocking numbers have sent the media scrambling to cover myriad angles of an extremely complex health issue, starting with the big question—how and why did this happen—and the simple answer that people are eating more and exercising less.

At the same time, public health officials have worked hard to reframe the conversation so that obesity is viewed not just as an individual concern but as a societal problem that raises health care costs and increases the risk of long-term chronic disease. Studies show there is a serious health consequence to obesity: A person with too much fat is at higher risk for high blood pressure, diabetes, heart disease, osteoarthritis and stroke.

The dissemination of information on obesity starts with its definition. An obese individual is defined as someone with a body mass index (BMI) of 30 or greater. BMI is a ratio between height and weight and serves as an indicator of body fat. A BMI of 25 to 30 is considered overweight.

“A lot of people are confused, and it’s a bizarre formula, but it seems simple to the people doing it,” said AHCJ board member Andrew Holtz, an independent health reporter. “It’s useful, and any story that mentions it needs to explain what it is and how to calculate it. It prompts some curiosity, but it means more to experts than to individuals.”

For consumers, there are now easy ways to calculate BMI online rather than doing the math themselves.

But Mr. Holtz said that doesn’t get at the root of the issue, which often comes down to simply recognizing the problem. “There is a lot of evidence that overweight people don’t think they are, and doctors are very bad at telling their patients. They weigh you, but don’t tell you about the consequences. It’s an opportunity for one-on-one education being missed. For a journalist, it’s important to realize that many people think it doesn’t affect them.”

When journalists dig deeper into the numbers of people considered obese, they find major socioeconomic, racial, cultural and regional aspects of the issue.

“We try to get perspective on stories, and my goal is to give a bigger picture of health disparities and how culture and race influences health decisions. I like to do stories in underserved and minority communities that the mainstream public doesn’t hear,” said Kelley Weiss, health care reporter for Capitol Public Radio in Sacramento, Calif., who is moderating a panel on the obesity epidemic at the AHCJ conference.

“I don’t think we could do enough stories on obesity,” said Dr. Bruce Hensel, a Los Angeles-area emergency medical specialist who is the medical reporter for KNBC-TV. “It is America’s disease, and that is so obvious when you go to other parts of the world. It’s among the most important stories we can do.”

Medical and public health experts recognize that economics are crucial to understanding the epidemic, and they try to get that message across, with the goal of effecting positive change. Based upon government-issued dietary guidelines, they’ve worked with schools to improve the quality of school lunch menus, making sure children get balanced meals with lots of fruits and vegetables and minimizing the amount of processed foods and sugary soft drinks.

“There’s a real focus on the younger generation, and working with families and raising awareness,” said Ms. Weiss. “The government’s doing it, and there is movement on the national and state levels, but communities are taking a grass-roots approach as well.”

Yet the headlines are often about lazy, fat kids and individual diet plans, without delving into the deeper issues. Video in a news story may show overweight children without showing a street corner in their neighborhood with multiple fast food restaurants and no full-service grocery stores.

“What has been true with every successful public health movement, whether it’s drunk driving, tobacco, worker safety or pollution law, is that it has always included major changes in public health policy so the healthy choice becomes an easier choice, rather than making it a difficult choice,” said Harold Goldstein, executive director of the California Center for Public Health Advocacy. “If you’re living in a world surrounded by junk food and huge portion sizes, the healthy choice becomes difficult and inconvenient.”

Mr. Goldstein pointed out that major policy decisions are made that have huge ramifications in communities, like city planners deciding whether to bring in a supermarket or schools deciding to have large numbers of junk food and soda vending machines—decisions that are out of the hands of the people they directly affect. Yet these issues are often difficult for journalists to identify.

“Every reporter writes from the perspective they bring,” said Mr. Goldstein. “The changes overall in the obesity rates are a factor of environment, and looking at what it is that causes the statistics. Thirty years ago, McDonalds came out with the Big Mac and the Quarter Pounder, and those were the biggest. A large soda then was the size a small one is now. Now, you cannot get a small.”

The recommended daily allowance of fat is 60 grams, and there are huge amounts of hidden fat in fast food items that position themselves as healthier than hamburgers.

“If you go to Quiznos and buy a tuna melt, it has 175 grams of fat and 2,090 calories. That kind of product did not exist 30 years ago. Everywhere you go, you’re eating 50%-100% more without thinking about it, and we’re not the ones who decided this,” said Mr. Goldstein. “It’s a slow change that no one noticed. Fast food used to be considered as a treat, and now many people have it multiple times a week. If you look at the total calories consumed, it’s increased dramatically. Here we are as human beings, and we love the taste of fat, sugar and salt, and they’re available everywhere we turn. We’re going to be releasing a study showing the relationship between where you live and how the kind of retail food outlets you have around you has an impact on your health.”

There are also the societal factors that contribute to obesity rates, such as taking physical education out of schools because of a focus on student performance on standardized tests, or designing communities more for driving than for walking.

Even as experts agree that the world has changed in these regards, there has been an exponential increase in the popularity and availability of organic foods at mass-market supermarkets, the rise of specialized grocery chains like Whole Foods, the increased number of farmers markets that sell farm-fresh unprocessed food and the interest in celebrity chefs and their restaurants—along with the popularity of television programs like “The Rachael Ray Show” and “Top Chef.”

But again, these factors also point up the socioeconomic disparity in obesity rates among different populations.

“People who are struggling to pay the rent or mortgage are not going to Whole Foods, and those are the people with the highest rates of obesity,” said Ms. Weiss. “It is challenging when you go into communities that are so underserved, and see all the things people need to be healthy they don’t have, and then you hear they don’t even know about their own risks. That can be difficult when you have the information but you see that people don’t have the money and don’t have health insurance. That’s definitely hard to hear. People are rationing health care, and then it turns into a bigger public health issue, when they get very sick and need acute care, which is much more expensive.”

“What I would like to see in an ideal world is the media covering issues from a community perspective,” said Mr. Goldstein. “There is an overemphasis on the individual personal responsibility aspect of this, and there needs to be lots more emphasis on the community and the public policy piece: How can we support people in being able to make healthy choices.”