Every measurement of America’s waistline says we’ve eaten our way into a big, fat national crisis that compromises our health, shortens our lives and costs us billions. If Tennesseans want to feel even slightly better about the Volunteer State’s shape, it’s going to be hard because only a few states are worse off — and not by much.
Tennessee’s rank varies among studies, but it’s never good. At best we’re among the five fattest states, at worst only two states have higher obesity rates. What is clear is that we’ve gotten fatter faster than the country as whole. In 20 years, Tennessee has slid steadily from the middle of the national pack (26th) with 12 percent of residents being obese, to 48th with only Mississippi and Louisiana having higher obesity rates, 35 percent and 34 percent to our 33 percent, according to America’s Health Rankings.
Another study, the Robert Wood Johnson’s County Health Rankings, puts Tennessee’s adult obesity rate slightly lower at 31 percent. In that study, Washington County is slightly below the state average at 29 percent, but Carter, Johnson and Unicoi counties are at or above the state rate.
In 1990, the national rate was the same as Tennessee’s 12 percent. By 2010, the national rate had more than doubled to 27 percent, while Tennessee’s had nearly tripled. A 2003 estimate showed obesity cost Tennessee $1.84 billion in direct medical expenses. Nationally, the cost was $117 billion in 2000, according to the National Conference of State Legislatures.
Unlike other public health crises, the obesity epidemic doesn’t have a straightforward behavioral message like “don’t smoke” or “don’t drink and drive” or “get your kids vaccinated.”
“As others have said: you can’t just stop eating, it’s a hard habit to break,” said Dr. Randy Wykoff, dean of the College of Public Health at East Tennessee State University. “The obesity epidemic is complex, and it isn’t just the ‘use of hamburgers’ or the ‘use of video games’.”
The abundance and low cost of fast-food, neighborhood design, sedentary jobs, sedentary recreation, ethnicity, education, economic and social standing and the “thrifty gene” that got our ancestors through famines are just a few of the pieces in the obesity puzzle.
Obesity has been a fact of life for centuries, but until the 20th century the condition wasn’t linked to health issues and wasn’t remotely common enough to be considered a public health threat.
That had changed by the turn of this century, when enough people were suffering from obesity to warrant the term “epidemic.” In 2001, U.S. Surgeon General David Satcher issued a call to action, saying: “Overweight and obesity may not be infectious diseases, but they have reached epidemic proportions in the United States. ... Many people believe that dealing with overweight and obesity is a personal responsibility. To some degree they are right, but it is also a community responsibility.”
As Wykoff and others say, the causes of the epidemic are many. But at its most basic, it comes down to the calorie equation that determines weight, calories consumed vs. calories expended.
“The human body is designed to maintain a healthy weight in conditions that were present through most of human history — that is limited, unpredictable food supply and with relatively high activity levels,” Robert Pool wrote in his book “Fat: Fighting the Obesity Epidemic.”
“Living in a world of high-calorie, high-fat foods, always in plentiful supply, and with labor-saving devices that keep us from having to exert ourselves too much, sometimes our finely tuned internal machines fail us. They tell us to eat more than we need for a healthy, normal weight, and if we listen to their advice, we get fat,” Pool wrote.
Once we have that extra fat, our bodies fight to protect the stored energy for the famine part of the feast-or-famine cycle most previous generations experienced, said diabetes expert Dr. Charles Stuart of ETSU’s College of Medicine.
Stuart calls the epidemic a “social problem with medical consequences” caused by decreasing activities coupled with advertising — especially for soft drinks — and the social rituals that revolve around eating and drinking. We’re bombarded, Stuart says, with the message that to be happy we need to eat or drink advertisers’ products. “Food is the centerpiece of our socializing and an indication of our ability to be a good host,” he said. “And the portions have gotten bigger.”
The causes and cures for obesity are sometimes beyond our control. “There’s no room for villains in this epidemic,” Wykoff said. “Some things that happen before you’re able to make choices can affect you for life,” Wykoff said, underscoring the importance of preventing childhood obesity.
Childhood obesity has more than tripled in the past 30 years, the Centers for Disease Control and Prevention reports. The prevalence of obesity among children ages 6 to 11 years increased from 6.5 percent in 1980 to 19.6 percent in 2008. The rate of obesity among adolescents ages 12 to 19 years increased from 5 percent to 18.1 percent.
This paints a particularly bleak picture for the future because children who grow up obese are more likely to become obese adults and the obesity is likely to be more severe with worse health consequences.
Stuart says studies have shown that children whose weight is within the normal range at 8 years may become obese by age 12, but the reverse is never true. “Obese kids will become obese adults without significant interventions,” Stuart said.
Changing behavior on a societal level is never easy and hardly ever fast. Wykoff points to the 45 years that elapsed between the first surgeon general’s cigarette warning and the time the U.S. smoking rate was cut in half, and that was with two precise, simple messages: stop smoking and don’t start smoking. And unlike smoking, eating isn’t something we can give up.
There is hope and some data suggests the crisis may be leveling off or at least slowing, Wykoff said, “We can change this, nothing is fixed or inevitable ... we can change this or at least make it better.”