Obesity is an epidemic — why haven’t we responded accordingly?
The term “epidemic” derives from the Greek “epi” meaning “about” or “upon,” and “demos,” meaning “of the people.” The Centers for Disease Control and Prevention defines an epidemic as “an increase, often sudden, in the number of cases of disease above what is normally expected in that population in that area.”
The characteristic of urgency has also been attached to the term. For example, Dorland’s Medical Dictionary defines an epidemic as “an urgent or pressing need.”
Historically, epidemics have been caused by infectious agents. For example, Ebola and influenza are classic epidemics caused by viruses. But the opioid epidemic is caused by a medication, and the epidemic of lead poisoning in Flint, Michigan was caused by a heavy metal.
Beyond agency, popular usage also includes time, virulence and rapidity of spread. From 2014-2016, the Ebola epidemic infected approximately 3,800 people in Guinea and killed over 60 percent of those infected. The 2014-2015 flu epidemic was estimated to have infected 34 million people and killed 56,000. Deaths attributable to opioid overdoses accounted for 400,000 deaths in the U.S. between 1999-2017.
Obesity, a chronic disease, is held to a different standard, despite meeting most of the criteria popularly associated with other epidemics. Obesity affects 70 million adults and 14 million 2-19 year-olds in the United States, and nearly two billion people world-wide.
Almost 300,000 deaths annually in the U.S. are caused by obesity, well in excess of the number of deaths attributed to Ebola, recent epidemics of influenza or opioid overdoses. Obesity therefore meets the criteria of prevalence and lethality.
But the progression of the epidemic and the development of the consequences of obesity have been insidious, and have therefore generated less urgency. Until 1976-1980, the prevalence of obesity in the population was stable at approximately 15 percent in adults. But by 2015-2016, it had increased to almost 40 percent among men and women. Furthermore, the lethal effects of diabetes, cardiovascular disease, cancer and other diseases associated with obesity take time to appear.
Agency, bias and dispute over what constitutes a disease have contributed to the reluctance to see obesity as an epidemic and respond to it with the urgency that has characterized our response to other epidemics. In contrast to Ebola, influenza and opioids, obesity is not caused by a single agent, but by multiple environmental factors that reduce physical activity and increase caloric intake.
Despite the recognition that almost no one decides to develop obesity, many blame people with obesity for their disease, and consider people with obesity as lazy, unmotivated, sloppy, gluttonous and undisciplined. At its most fundamental, a disease is a state of ill health. Obesity certainly qualifies — it affects every system of the body, and is associated with diabetes, cardiovascular disease, cancers and over 240 other co-morbidities. Although in 2013 the American Medical Association declared that obesity is a disease, obesity is still widely perceived as a personal failing.
The prevalence of obesity, and its continued spread and lethal effects, clearly exceed those of recent epidemics like Ebola, influenza and opioids, and must be addressed with the same commitment of resources with which we address other epidemics.
For example, Congress allocated over $7 billion in 2018 to combat the opioid epidemic, and yet treatment for comprehensive treatment for obesity is not reimbursed by Medicare. Congress can start by passing the bipartisan 2019 Treat and Reduce Obesity Act, which will expand evidenced-based obesity coverage for Medicare beneficiaries. Passage of the bill would signal that Congress has begun to take obesity seriously.
But as with other epidemics, we must also invest in prevention. Policy initiatives should include increased support for community infrastructure that supports physical activities like walking and biking in the transportation bill, implementing pricing strategies that decrease consumption of ultra-processed foods, passing excise taxes on sugary drinks and sustaining the healthy standards set for school meals under the Obama administration.
The obesity epidemic is an epidemic of a long-term chronic disease, but this difference must not be allowed to temper the urgency of our response. Hundreds of thousands of lives are at stake. We must act now to end this epidemic.
Dr. William H. Dietz is the Director of the Sumner M. Redstone Global Center for Prevention and Wellness at the Milken Institute School of Public Health at The George Washington University. He is also the Sumner M. Redstone Center Chair.