Obesity

Actually, it depends whom you ask. The American Medical Association formally designated obesity as a disease in June 2013. Advocates of this decision believe it will change how obesity is handled both by insurance companies, which may cover a broader range of treatments (including diet and exercise counseling), and by doctors, who may promote more surgeries and medications. Not everyone agrees with the label. Some express concern that calling obesity a disease not only categorizes one-third of Americans as ill but also could prompt some people to dismiss the benefits of lifestyle changes to combat the problem.

About 70 percent of Americans 60 and up are obese or overweight, with people in their 40s, 70s and 80s seeing the largest weight gains. This epidemic is putting a huge number at risk for medical problems like heart disease, hypertension, some cancers and type 2 diabetes. It’s also taking a tremendous financial toll. Reuters reports the annual health care cost for obesity in the United States is $190 billion, a higher price tag than for smoking. A recent study found obese men pay $1,152 more and obese women pay $3,613 more yearly for medical treatments than people of normal weight. Then there are costs we don’t think about: for example, more weight means vehicles burn more fuel—an extra 1 billion gallons of gasoline per year.

Body mass index (BMI) means how much fat you have on your body in relation to your height and weight. A BMI above 30 indicates obesity, 25-29.9 is overweight, 18.5-24.9 is normal and less than 18.5 is underweight. But BMI is not an undisputed measurement for obesity. For instance, it doesn’t differentiate between muscle mass and body fat. Because older adults lose muscle and bone mass, their BMI might be low while their weight is too high. The National Institutes of Health suggests doctors consider BMI in partnership with waist size (a “spare tire” can indicate a higher risk for diabetes), blood pressure, and cholesterol and sugar levels.

Obesity raises your chance of developing potentially fatal conditions, but being merely overweight could actually lower your mortality risk. A Centers for Disease Control and Prevention (CDC) analysis showed that during many studies, overweight people were 6 percent less likely to die than normal-weight men and women, regardless of age or even smoking. Researchers speculated this could be because overweight people get regular medical care to screen for health risks or because a slightly heavier body suffers less damage in health crises. But the studies show that the key is being just a bit overweight and maintaining that weight—not gaining a few pounds each year. Slightly overweight people in their 50s who kept their weight stable had better survival rates than normal-weight people who gained poundage. No matter what your age and starting weight, continual gain is likely to work against you in the long run.

According to the CDC, obese youth are likely to become obese grown-ups. Obesity rates have doubled for children—and tripled for adolescents—in the last 30 years. Obese children run a higher risk of prediabetes, sleep apnea, high cholesterol, high blood pressure, joint and bone problems and low self-esteem. They’re also four times more likely to develop hypertension as adults. Obese adults are prone to the same list of life-threatening health problems, and the risk can be even higher if the trouble started in childhood. It’s all too easy for American children to be overweight: too much time spent on electronics (average daily screen time for kids 8-18 is over seven hours); uneven access to healthy foods; giant, sugary drinks; and too few safe, outdoor places to play. Lack of support for breastfeeding may even share some of the blame—it has been proven to help protect against obesity.

Research has shown that obesity can contribute to feelings of sadness and that people suffering from depression have an increased likelihood of gaining weight. A study presented in 2011 looked directly at the correlation between older, obese adults and depression, and the results are disheartening. The Dartmouth Institute for Health Policy and Clinical Practice studied 1,000 older adults and found that “the likelihood of depression increased steadily with body mass index,” particularly for obese individuals age 60 to 74. While this doesn’t yet clarify whether obesity causes depression or visa versa, researchers are suggesting that the two issues should be considered in relationship to each other.

If your insurance company told you to step up or pay up, which would you choose? When Blue Care Network told its obese subscribers that they would have to pay up to 20 percent more for health insurance if they didn’t start exercising, 6,500 people enrolled in a fitness program. A year later, 97 percent of the participants had achieved the goal of walking at least 5,000 steps daily—and showed few signs of slowing down. After studying this program, researchers from the University of Michigan Health System and Stanford University suggested that monetary incentives could become more common among insurers and that they could motivate obese adults to be more physically active.

Digital fitness and weight management trackers can be allies in the quest for better health, according to research published in the Archives of Internal Medicine. Half of a 70-person group of overweight or obese adults were randomly chosen for “tech-based support tools” to supplement enrollment in a weight-loss program. The digital trackers recorded how many calories participants consumed and how much they exercised, transmitting the data to health coaches. In three months, the digital group lost an average of seven more pounds than those without the tech support. Not only that, but the tech group lost more body mass and had double the chance of maintaining weight loss after a year. Researchers believe mobile apps and websites can be effective tools—particularly when used in combination with a support group or health coach—because they don’t require too much time and offer good feedback on progress.

Recent studies show that people who believe diet is the path to weight control have lower BMIs than those who look to exercise first. Yes, exercise plays an important role, but when it comes down to losing significant weight—and keeping it off—diet is the key. Reducing portion size and eating a low-fat diet rich in greens, lean proteins and whole grains are the first steps toward losing weight. This doesn’t lessen the importance of daily exercise because it burns calories and also supports heart health, lowers blood pressure, strengthens muscles and joints, helps maintain bone mass and improves mood. You’ll get the best results by working with a doctor to find the combination of diet and exercise that’s right for you.

Too many white women (32 percent) and Hispanic women (41 percent) are obese, but nearly 60 percent of African American women are suffering from obesity. Research has often linked obesity in white and Hispanic women with lower education or socioeconomic levels, but that’s not true for African American women. Instead, geography—living in a neighborhood high in crime and with little access to healthy food and safe outdoor space—may play a role. Culturally, there may also be less emphasis on thinness as a marker of beauty and health in African American families. But dramatic weight loss might not be the answer for black women trying to shed pounds. A recent study published in JAMA Internal Medicine showed that weight maintenance through increased physical activity and better diet might be the most effective approach—as well as building community awareness of the issue.