Obesity, smoking, and substance abuse are the unholy trinity of self-inflicted health crises in the modern world. Obesity occupies a unique position among these three vices.
The Good – Smoking Declines
No one advocates taking up smoking to improve your health. According to the American Lung Association in my lifetime smoking rates in the US have declined from 42.6% to 11.6%. Even more promising, over the last decade rates among 18-24 year-olds dropped from 19.2% to 4.9%.
The Bad – Substance Abuse Worsens
According to the 2023 US National Survey on Drug Use and Health, one in six (16.7%) of Americans 12 and over struggled with substance abuse in the past year. Fentanyl has been the fastest-growing substance, but alcohol remains the most commonly abused drug. About half also suffered from a separate mental health disorder. While these numbers fluctuate, they have risen sharply in the last few decades.
The Ugly – Obesity
Labeling obesity as ‘the ugly’ has less to do with physical beauty and more to do with the propensity of the issue. In the span of a few lifetimes, Americans have flipped the script on hunger. Before anyone flips out, I’m not saying that hunger isn’t a problem in America (or the world). According to government statistics, 12.6% of Americans receive food stamps. That’s double the number from 2001, but only 80% of the record number in 2013. As worrying as that is, a potentially bigger problem (no pun intended) is our growing girth. Based on data from the CDC as many as 40% of Americans are overweight.
2019’s Childhood Obesity Intervention Cost Effectiveness Study projects that by 2030 almost half of American adults will be obese with a quarter severely obese. No wonder I’m inundated with advertisements for weight loss drugs, diets, and supplements. There’s (again no pun intended) big business in obesity.
Measurement Controversy
These statistics and projections rely on the Body Mass Index (BMI). The modern BMI (wikilink), a ratio of weight to height squared dates to 1972. While BMI is a simple easy-to-use metric, it doesn’t make any allowance for body type (long torso vs. long legs) or weight composition (muscle vs. fat). This limitation leads to some troublesome errors. As an aside, I recently dropped 35 lbs and now weigh 195 lbs. While I feel great, according to BMI, I remain overweight. In fact, at the peak of my collegiate swimming career, I weighed 190 pounds. At 6′ 1″ tall, my BMI score of 25.1 classified me as overweight.
Overdue Update?
With obesity a prime risk factor for conditions such as diabetes, heart disease, and high blood pressure, the medical community needs a better predictor than BMI. A recently proposed change adds waist circumference and general health conditions to the evaluation process. It sounds promising, but a complicated change to accepted practice will likely take years.
Map of Obesity rates in US states and territories courtesy of r/Infographics (reddit user)
As always thanks for reading.
Armen
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