Chapter 11 Energy Balance and Body Weight

“Obesogenic” is a word that has sprung up in the language of public health professionals in the last two decades. The Centers for Disease Control and Prevention (CDC) defines obesogenic as “an environment that promotes increased food intake, nonhealthful foods, and physical inactivity.” The CDC reports that in 2009 in the United States, 33 percent of adults and 16 percent of children were obese, a doubling and tripling of the numbers since 1980, respectively, while in Canada the obesity rate was 24.1 percent for 2007–2009. The health consequences of too much body fat are numerous, including increased risks for cardiovascular disease, Type 2 diabetes, and some cancers. The medical costs related to obesity are well over one hundred billion dollars and on the individual level, people who are obese spend $1,429 more per year for medical care than people of healthy weight.

Numerous obesogenic agents that contribute to this immense public health problem have become a part of everyday life in American society. The fast food industry has been growing for decades and continues to grow despite the latest economic slump. In America today there are over twelve thousand McDonald’s restaurants, while in 1960 there was one. Food portions have been getting bigger since the 1960s, and in the 1990s North American society experienced the “super-size” marketing boon, which still endures. Between 1960 and 2000 more than 123 million vehicles were added to the American society. Escalators, elevators, and horizontal walkways now dominate shopping malls and office buildings, factory work has become increasingly mechanized and robotized, the typical American watches more than four hours of television daily, and in many work places the only tools required to conduct work are a chair and a computer. The list of all the societal obesogenic factors goes on and on. They are the result of modernization, industrialization, and urbanization continuing on without individuals, public health officials, or government adequately addressing the concurrent rise in overweight and obesity.

With obesity at epidemic proportions in America it is paramount that policies be implemented or reinforced at all levels of society including education, agriculture, industry, urban planning, health care, and government. Reversing and stopping obesity are two different things. The former will require much more societal change and change on the individual level than the latter. The following are some ideas for constructing an environment in America that promotes health and confronts the obesity epidemic:

• Individual Level

  • Purchase less prepared foods and eat more whole foods.
  • Decrease portion sizes when eating or serving food.
  • Eat out less, and when you do eat out choose low-calorie options.
  • Walk or bike to work. If this is not feasible, walk while you are at work.
  • Take the stairs when you come upon them or better yet, seek them out.
  • Walk your neighborhood and know your surroundings. This benefits both health and safety.
  • Watch less television.

• Community Level

  • Request that your college/workplace provides more access to healthy low-cost foods.
  • Support changes in school lunch programs—this is happening now in 2011.
  • Participate in cleaning up local green spaces and then enjoy them during your leisure time.
  • Patronize local farms and fruit-and-vegetable stands.
  • Talk to your grocer and ask for better whole-food choices and seafood at a decent price.
  • Ask the restaurants you frequent to serve more nutritious food and to accurately display calories of menu items.

• National Level

  • Support policies that increase the walkability of cities.
  • Support national campaigns addressing obesity, such as America on the Move.
  • Support policies that support local farmers and the increased access and affordability of healthy food.

Some scientists predict that the childhood obesity rate will reach 100 percent by 2044. It is critical for the nation’s health to change our environment to one that promotes weight loss and/or weight maintenance. However, action is needed on multiple fronts to reverse the obesity epidemic trend within one generation.

In this chapter you will learn how to assess body weight and fatness. You will also learn that it is not only society and environment that play a role in body weight and fatness, but also physiology, genetics, and behavior—and that all of them interact. We will also discuss the health risks of being underweight and overweight, learn evidence-based solutions to maintain body weight at the individual level, and assess the current state of affairs of combating the obesity epidemic in the United States.