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The elephant in the room--pandemic obesity.

Headlines abound--professional journals, local and national news, the Centers for Disease Control and Prevention (CDC), books and magazines, television commercials, online advertising--the risks of obesity and the benefits of weight management. Many of us battle obesity professionally and personally. Count calories, cut carbohydrates, eat more or less fat, eat more or less meat, avoid sugar, avoid artificial sweeteners, stop eating processed foods, stop drinking alcohol or drink red wine, eat more nuts and seeds. There is really no consensus. Vegetarian diet, vegan diet, raw diet, Mediterranean diet, gluten-free diet, Paleo diet. Do any diets really work long term? Businesses make millions from our weight loss obsession. I wrote an editorial in 2012 on obesity and health care. So how are we doing three years later?

As it turns out, not so well. Obesity is ubiquitous. In 2013, the American Medical Association adopted a new policy recognizing obesity as a disease. In 2014, the European Court of Justice ruled that if obesity could hinder full and effective participation at work, it could be considered a disability. Lancet published an obesity series update earlier this year noting little progress has been made since an earlier obesity series published in 2011. In 2013, 2.1 billion people, one-third of the world's population, were overweight (BMI 25 to 29.9) or obese (BMI greater than 30). In 1980, that number was 857 million (Ng et al., 2014). The 2012 documentary Globesity: Fat's New Frontier (Journeyman Pictures, 2012) takes a troubling look at the rise of obesity and associated problems in China, Mexico, Brazil, and India. World obesity is a bigger problem than malnutrition today. Obesity is one of the top three global social burdens generated by human beings, falling slightly below smoking and armed violence and terrorism, and well ahead of alcoholism, drug abuse, and climate change. Obesity is responsible for about 5% of all global deaths--3.4 million deaths annually (Dobbs et al., 2014; Lancet, 2015).

In 1980, no state in the United States (U.S.) had an obese population greater than 15%. By 1995, no state had an obese population less than 21%. By 2011, Colorado, the leanest state, had an obesity rate of 21.19% (Chen, 2013; Trust for America's Health & Robert Wood Johnson Foundation, 2014). In 2014, 42 states had obesity rates of 25% or more, 30 states had rates greater than 30%, and two states (Mississippi and West Virginia) had obesity rates greater than 35% (Trust for America's Health & Robert Wood Johnson Foundation, 2014). Two-thirds of Americans are overweight or obese now. For a disturbing visual of U.S. obesity from 1995 to 2011, check out Chen's "Overweight and Obesity (BMI)" interactive infographic and the CDC's (2014c) obesity prevalence maps.

If obesity rates continue on the current trajectory, more than 51% of Americans will be obese by 2030. In Europe, predictions are as bad or worse. Rates of severely obese U.S. adults (BMI greater than 40) have risen 350% from 1.4% to 6.3% since 1985. Our children are getting fatter with us; among children and teens (2 to 19 years of age), more than 5.1% of boys and more than 4.7% of girls are now severely obese (Ng et al., 2015; Trust for America's Health & Robert Wood Johnson Foundation, 2014). In 2012, a group of retired military officers released a study reporting that 75% of young Americans are too overweight to join the military (Mission: Readiness. Military Leaders for Kids, 2012).

Annual U.S. health costs related to obesity total over $200 billion. Nearly 21% of medical expenses in the U.S. can be attributed to obesity. Direct and indirect health care costs related to obesity lead to decreased productivity, absenteeism, and more sick days (Campaign to End Obesity, 2014). Obesity is linked to more than 60 chronic diseases, including coronary artery disease, gastroesophageal reflux and ulcers, hypertension, dyslipidemia, liver and gallbladder disease, stroke, sleep apnea, diabetes mellitus type 2, dementia, osteoarthritis, depression, back pain, dermatitis and skin infections, cancer (endometrial, breast, and colon), sexual dysfunction, and urological and gynecological problems (CDC, 2014a; Loaf & Walach, 2013; World Health Organization [WHO], 2015).

While this looks like a bleak picture, there are glimmers of hope. The CDC (2014b) reported declines in obesity in low-income preschool children 2 to 5 years of age from 14% in 2004 to 8% in 2012. Childhood obesity rates have stabilized in the past decade and have declined in several communities nationwide from Anchorage to Philadelphia and New York City (Trust for America's Health & Robert Wood Johnson Foundation, 2014).

First Lady Michelle Obama launched the Let's Move! campaign in 2010 to provide broad support and programs to prevent childhood obesity. We Can! (Ways to Enhance Children's Activity & Nutrition) is a national education program initiated in 2005 by the National Institutes of Health (NIH) as an obesity prevention program that is now partnered with more than 40 national health organizations. The Robert Wood Johnson Foundation funds a number of programs to reverse childhood obesity nationwide. Just for Kids! is a 5- to 10-week health education program for children that uses cognitive, behavioral, and affective techniques to encourage positive change to their diet, exercise, and communication.

What can we do to stop the global epidemic of obesity? The chronic diseases associated with obesity are largely preventable. The WHO's Global Action Plan for 2013-2020 includes a goal to halt global obesity rates to those of 2010 (WHO, 2015). McKinsey Global Institute's report, "Overcoming Obesity," noted: "No single solution creates sufficient impact to reverse obesity ... is likely to require commitment from government, employers, educators, retailers, restaurants, food and beverage manufacturers, and a combination of top-down corporate and government interventions and bottom-up community-based ones" (Dobbs et al., 2014).

The WHO (2015) recommends a comprehensive approach to reversing obesity (we all need to be accountable and step up our game):

* Individuals can limit intake of fats and sugars; eat more fruit, vegetables, legumes, whole grains and nuts; and participate in regular physical activity (1 hour a day for children; 2.5 hours a week for adults).

* Societies can support individuals in following the guidelines above by sustained political commitment and collaboration of public and private stakeholders; and make regular physical activity and healthier dietary choices available, affordable, and easily accessible to all, especially the poorest individuals.

* The food industry can promote healthy diets by reducing the fat, sugar, and salt content of processed foods; ensuring healthy, nutritious choices are available and affordable to everyone; practicing responsible marketing especially to children and teenagers; ensuring availability of healthy food choices; and supporting regular physical activity practice in the workplace.

The Blue Zones Project initiated in Albert Lea, Minnesota, in 2009, was an experiment designed to jump-start a community toward healthier living. The project posted some amazing results in just 10 months:

* 4,000 people or one-quarter of all adults in Albert Lea signed the pledge and participated in the project.

* 1,400 children (100% of students in grades 3 to 8) were reached through school programs.

* More than 50% of Albert Lea's employers participated by creating healthier workplaces, affecting more than 4,300 employees.

* At least 800 people joined 70 walking groups and logged more than 37,500 miles together.

* More than two-thirds of the 34 locally owned or operated restaurants made changes to help customers eat healthier.

* Community gardens increased from 70 to 116.

* More than 80 children at five different schools went to and home from school as part of a walking school bus.

Since 2009, Albert Lea has made steady progress toward healthy lifestyles on many fronts. Blue Zones Projects continue to foster healthy transformation in communities across America, proving that we can regain our national health and vitality (Buettner, 2015).

As health care professionals, we often avoid talking with our patients seriously about obesity. We have time constraints, or we think we cannot have a positive or lasting impact. Sometimes our own obesity prevents us from bringing up the topic in clinic. The stigmatization of obesity in both health care and society is very real and creates another barrier to solving the problem. Weight bias contributes to the vicious cycle of unhealthy behavior * obesity * health consequences * increased medical visits * stigma in health care * negative feelings * avoidance of health care * unhealthy behavior * more obesity. We can individually work on decreasing weight stigma by being more sensitive, recognizing the complexity of obesity, encouraging our patients, offering simple and concrete advice (start a realistic exercise program, eat at home ... not just "lose weight"), and emphasizing that even small changes can lead to big health gains (Puhl, 2014). If the average adult BMI could be reduced by just 5%, not only would millions of Americans avoid serious medical problems and preventable diseases, but the country would save nearly $30 billion in five years (Trust for America's Health & Robert Wood Johnson Foundation, 2014).

Reversing the obesity pandemic by changing our approach to food, drinks, and physical activity is one of the most important health care challenges facing us today. There is no magic bullet, no big or little pill, no simple solution to obesity. It took years for more than two-thirds of the adults in this country to get fat. For many of us, it has been a lifetime. But we can recognize the scope of the problem. We can think about it, talk about it, and work individually and together--as families and friends, as communities, and as a nation to move more, eat less and healthier, and teach our children to do the same. We can face the elephant in the room and make change happen one step and one bite at a time.

doi: 10.7257/1053-816X.2015.35.4.161

Kaye K. Gaines, MS, ARNP, FNP-BC, CUNP Urologic Nursing Editorial Board Member


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Campaign to End Obesity. (2014). Obesity facts and resources. Retrieved from http://obesity campaign, org/obesity facts.asp

Centers for Disease Control and Prevention (CDC). (2014a). Adult obesity facts. Retrieved from http://www.

Centers for Disease Control and Prevention (CDC). (2014b). New CDC data show encouraging development in obesity rates among 2 to 5 year olds. Retrieved from http://www. p0225-child-obesity.html

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Author:Gaines, Kaye K.
Publication:Urologic Nursing
Article Type:Editorial
Date:Jul 1, 2015
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