Running Head: Obesity in America 1

Obesity in America

Rachel Fishkind

University of Maryland

"I pledge on my honor that I have not given or received any unauthorized assistance on this

assignment/examination."

Rachel Fishkind
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Introduction:

Obesity is a disease that impacts the lives and families of millions of people in the United

States, even though it is highly preventable. The World Health Organization attempts to define

the broad phrase of obesity: “an abnormal or excessive fat accumulation that presents a risk to

health” (Obesity , n.d.). They also describe that obesity is measured using a person’s body mass

index; body mass index is a person’s weight divided by their height squared. Weight is measured

in kilograms, and height is measured in meters. The World Health Organization states that if a

person has a body mass index that is over thirty, they are in the category of obese. Swan states

that obesity has many causes including inactivity, genetics, excess food consumption, and lack of

education. She discusses that many people argue that obesity is not a disease; however, it clearly

impedes the mental, physical, and even social health of an individual. Although obesity is

prevalent in many countries, it is most prominent in the United States. The CDC states in the

article, “Adult Obesity Facts”, that within the United States, 39.8% or 93.3 million people were

considered to be obese from 2015-2016. They also state that obesity is a serious detriment to the

economy; 147 billion dollars were spent on obesity in 2008. Totura and other researchers (2015)

found that 81% of people attribute obesity as the largest health problem the United States is

facing. Improving obesity in the United States would change the lives of people living with the

disease while also providing a great return to the economy.

Background:
Obesity most definitely varies across different groups within the United States. Swan

found that from 2015-2016, within children, obesity was more prevalent in boys; however, in

adults over the age of twenty, obesity was more prevalent in women. This same study also found
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that obesity increases as age increases, being that 14.5% of youth are obese, and 30.5% of adults

are obese. Along with age and gender gaps associated with obesity, there are also racial and

ethnic gaps. Swan describes that in the United States, blacks and latinos have the highest rates of

obesity. Latino and black women have higher rates of obesity than their male partners, while

white women do not. Education is another huge factor in obesity in most populations: Swan

found that individuals with a college degree have an obesity rate of 22.7%, while individuals

without a high school diploma have an obesity rate of 35.6%. Swan describes that middle income

groups have the highest levels of obesity, compared to high and low income groups for men and

women across the United States. Regionally, obesity is the highest in the south at 32.4%, and the

midwest at 32.3%. Therefore, rural areas are much more affected by obesity than urban areas.

Within the United States, Obesity rates are constantly increasing due to many different

factors and lifestyle changes. Swan proves that urbanization, transportation, workplace, and

physical activity all contribute to the increase in obesity. Urbanization is causing an increase in

jobs that do not require manual labor, which was an easy access to physical activity for those

with very busy work schedules. New transportation such as uber and lyft are causing more

people to drive to places instead of walking. With the large emphasis on working in America,

there is very little time to exercise

Significance:

Obesity should be a focus of public health due to the fact that it is negatively impacting

the economy and the families affected. Spieker and Pyzocha (2016) describe that obesity

contributes to 20% of healthcare costs in the United States every year. Swan states that the

United States is spending almost one and a half trillion dollars on treating obesity every year.
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Spieker and Pyzocha also describe that obesity is leading to other diseases such as cardiovascular

diseases that are very costly to both the United States and the families affected. Since treatment

is so expensive, a lot of people may avoid treatment, or end up in debt if they do decide to seek

treatment. Treatment is also extremely unequal in the United States. Swan mentions that costs to

treat children with obesity on medicaid are 80% higher than costs to treat children on private

insurance. Therefore, children with a lower socioeconomic status are much more likely to have

issues with obesity; this is because they cannot attain affordable treatment. The sustainable

development goal that most relates to this issue is under goal ten: “to ensure equal opportunity

and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and

practices and promoting appropriate legislation, policies and action in this regard” (About the

Sustainable Development Goals, n.d.). This goal talks about reducing inequality and providing

equal opportunity; This would change the outcomes of millions of families in the United States

suffering from obesity. Obesity rates will not decrease in the United States until inequality within

healthcare is improved.

Economics is only one of the many issues that families in the United States face when

dealing with obesity. Obesity causes countless other fatal diseases. Swan states that obesity

directly contributes to diseases such as diabetes, cardiovascular disease, cancer, gallbladder

disease, reproductive diseases, and respiratory disease. She describes that all of these diseases

contribute to the economic downfall of families affected by obesity. Treatment alone for these

diseases will put countless families into debt. These diseases will also prevent many people from

attending work. If one parent in a family can no longer bring in a stable income, the children will

also be affected. They may no longer have money for essentials such as food, running water,
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education, or healthcare. Swan states that another issue that goes along with obesity is stigma.

Obese people may be too afraid to go to the gym because of the judgement they will face. Swan

concludes that obesity will absolutely impact the future generations of the family. Obesity causes

cycles of poverty that are very difficult to escape. Obese parents also tend to have obese children,

which continues the cycle of obesity throughout the generations.

There are many contributors to obesity from the individual level to the societal level.

Swan states that on the individual level, eating unhealthy, not exercising, and smoking can

absolutely lead to obesity. Families will contribute to obesity by overfeeding children at a young

age. This will cause bad habits in the future, and children will never learn to eat the right way.

Communities and institutions can also be a large contributor to obesity if school systems are not

providing healthy meals. Eisenberg and Burgess (2019) state that schools should be replacing

processed foods with healthy alternatives so children learn at a young age how to eat well. They

also describe that along with healthy options at schools, they must provide education on

preventing obesity. Many children do not know the consequences of obesity and educating them

from a young age is a great start to tackling obesity. Society is considerably the largest

contributor to obesity. Swan describes that norms in America such as eating fast food every day

and working all day greatly contribute to obesity. There are also poor healthcare policies in place

at the societal level, preventing many people from acquiring access to treatment. When obesity is

not treated, it leads to the fatal, costly diseases that are an economic burden.

More attention needs to be attributed to this issue due to the economic cost that goes

along with it. Since obesity contributes to 20% of healthcare costs each year, tackling the issue

would save an immense amount of money and boost the economy: “estimates of future direct
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(medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will

impose a significant economic burden to individuals and society as a whole” (Spieker and

Pyzocha, 2016). Therefore, individuals and society would benefit from treatment for obesity.

Families would not have to deal with the economic burden of obesity and society would save a

substantial amount of money that would be used for other non-preventable health issues.

Although obesity is a large issue in the United States, there have been prevention programs and

interventions put in place to help crack the surface of ending obesity.

Current effort:

Some interventions within the United States include cognitive behavioral therapy,

nutritious school lunches, monitoring of fast food chains, and offering increased access to

medicaid. These interventions have been proven to be helpful; however, some have been much

more effective than others, one of the most effective being improved nutritious practices in

schools.

One intervention that has been put in place in the United States to improve school

lunches is known as the CATCH eat smart program. The CATCH website describes that they are

targeting obesity at three different levels: In the classroom, in the cafeteria, and in physical

education. CATCH was created in 1988 as a research program to improve child health in the

United States. The program is targeting children in schools all across the United States in order

to prevent problems such as obesity before they occur. It is well known in the health world that

prevention is much more successful than treatment, which is why they are targeting children and

not adults with obesity. A study conducted from 1999 to 2005 by Nansel and other researchers
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found that programs similar to CATCH that implement a healthy lifestyle to children in schools

can significantly increase academic performance.

A study was published in 2008 by Nansel and other researchers to study the impact of a

nutritious diet and physical activity for young students. This research was a case study conducted

in Georgia at the Brown Mills elementary school from 1999 to 2005. They used standardized test

scores to operationalize the dependent variable. They took the average of the students

standardized test scores before the treatment, and then the average after each year of receiving

better physical activity and a more nutritious diet. They found a positive correlation between

their standardized test scores and receiving the treatment. Before the program was implemented,

standardized test scores averaged around 52%. After the program was implemented, standardized

test scores averaged around 65%. This clearly proves that improved nutrition and activity led to

students being more productive with their school work. Nansel and other researchers explained

that this program was targeting children in schools. Targeting children is a great way to attack

obesity because it will stop the cycle of ongoing obesity through the generations. Targeting

children also proves the important lesson that prevention is always better than a cure. If programs

target adults with obesity, they are only helping to treat the issues, but when they target children,

they are preventing the issues from happening.

Although there are challenges to fully integrating this program into schools, it is

definitely possible to do so. Nansel and other researchers describe that the only way this program

will succeed will be if all of the systems such as family, schools, public health workers, and the

community work together to promote change. This program is not costly which will allow it to

spread to areas that may not have great healthcare. One issue surrounding this study was that it
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did not study individuals and it could not control other historical factors that may have affected

test scores. This prevents the researchers from knowing the trends in test scores compared to

nutrition for each individual student. One important issue that this article leaves unaddressed is

about children who are not in school, and how they will fight obesity. At an individual level,

those children will to prioritize school and make the decision to show up every day. At the

societal level, laws need to be put in place to make sure that all children are attending school.

The CATCH website describes that this program will continue to spread across the United States

and to other countries: “CATCH has been expanded beyond elementary school and now has

programs and health education curriculum for early childhood through middle school, including

the after-school and childcare settings” (Catchglobal, n.d.).

There were many important lessons learned from this research study, most importantly

being that CATCH will not be possible unless all levels of the community work together to

implement it, “During development of the CATCH program, those who were going to use the

program (e.g., teachers, food service employees, administrative staff, students, parents) were

included in the planning and design. Their inclusion was essential to ensure program

acceptability” (Catchglobal, n.d.). In the future, CATCH needs to put more effort into integrating

all members of the community if they want their program to be as successful as possible. In the

research study, Nansel and the other researchers also mentioned that the principle, families, and

communities must all be involved for any program to succeed.

Discussion:

I personally believe that CATCH is a great start to solving obesity in America. CATCH is

a fantastic program because it helps to solve the issues of inequality within the treatment of
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obesity. This relates again to the sustainable development goal of improving inequality and

providing equal opportunity for treatment. Since everyone in the school will be impacted by

CATCH in the exact same way, it provides equal opportunity and equal treatment to elementary

school students. I think that CATCH needs to spread to more areas in the country so that more

children are given this amazing opportunity. The CATCH program believes that all sections of

the community need to work together to create change, and I completely agree with this. If the

schools were doing a great job at providing education and physical activity, but parents were

providing their children with fatty foods, change would not occur. Another issue that must be

solved has to do with the inequity in the healthcare system. Until treatment is accessible to all

people at a reasonable price, many people will continue to die due to the repercussions of

obesity: such as cardiovascular disease and diabetes. We should be focussing on providing

education, physical activity, nutritious meals, and treatment to all children affected by obesity. I

believe that it is important to target children because this attacks the issues before they even

begin. When children learn healthy lifestyles in school, they will be more likely to be healthy in

the future, and they will be more likely to raise healthy children. Although providing treatment

for obesity is important, prevention will be the only way to bring about large change in America.

Conclusion:

Obesity is a disease that is destroying the lives of millions of American’s each year.

Obesity must be a focus of public health due to the fact that it is preventable, and also having a

large negative impact on the United States economy. The best way to fight obesity is to target

young children in school, so that they gain important knowledge about preventing obesity from a

young age. The most important thing to remember when treating obesity is that prevention is
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better than a cure, and if American’s all work together to solve the obstacle it is absolutely

feasible to do so.
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References

About the Sustainable Development Goals - United Nations Sustainable Development. (n.d.).

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Catchglobal. (n.d.). Community Health Programs: Health Education Curriculum. Retrieved

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Eisenberg, D. M., & Burgess, J. D. (2015, July). Nutrition Education in an Era of Global Obesity

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Nansel , T. R., Huang , T. T., Rovner , A. J., & Sanders-Butler , Y. (2008, June 24). Association

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_case_study.pdf.

Obesity. (2014, September 5). Retrieved November 11, 2019, from

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Swan, J. (2019). Obesity in America Management and Treatment in Children, Adolescents, and

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implementation of evidence-based childhood obesity prevention strategies in schools.

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