Fat Americans 

The subject of obesity among Americans is a frequently discussed subject.  We begin with an extensive quote from an article by Dr. Susan Davis: 

The rich are thin, and everyone else is getting heftier, at least in the United States. Here, as is well known, income inequality has increased dramatically over the last thirty years, and more than a quarter of American children live below the federal poverty line. At the same time, 60 percent of adult Americans are overweight, and nearly 18 per cent of Americans are categorized by public health officials as obese. Even more concerning, the proportion of obese children is now 25 percent. Obesity and poor nutrition are implicated in a host of serious diseases, including one that used to be called adult onset diabetes. It's now so common among children that doctors can't call it that anymore. It's now "Type II Diabetes."

Here in Illinois, the size of people is astounding. Midwesterners are notorious for consuming high-fat, high cholesterol meals. A cluster of eight states in the Midwest and the upper south --Missouri, Oklahoma, Tennessee, West Virginia, Arkansas, Ohio, Kentucky, and Indiana -- are among the ten with the highest mortality rate for coronary heart disease. Together, they make up a region dubbed "Coronary Valley," actually the ancient southern Mississippi River plain. Historically, black and white people in the upper south raised pork and corn, and often fried their food. 19th-century settlers from Europe brought sausage, pastry, and beer to the Midwest, reinvigorating the high-fat, high calorie pattern.

These dietary habits made sense when men and women labored in farm or factory for 12 and 14 hours. But today these preferences persist in the context of sedentary work, lots of driving, and reliance on processed foods. Recently, I took my son out to dinner at a family-run Italian restaurant. Like a lot of kids, the only thing he'll order is chicken fingers. He got them, but since this is the Midwest, the deep-fried slivers of chicken came with a side of pasta, a plate of french fries, and "for free," a plate of fried cheese. I'd never seen fried cheese before, but it's very popular in this part of the country.

It isn't just outgrown habits that are causing the American body to expand. It's new habits, too. Most families eat more than seven meals a week away from home, and because they eat on the run they are inhaling more restaurant and processed foods. Poor and working families are more likely to eat at fast food restaurants where nutritional values are lower and calories higher. Food manufacturers have increased the calories in their products over the last decade, making them sweeter in an effort to get people to buy and eat more. Sugar is incredibly cheap and it seems to have as much of a stimulating as a satiating effect on eaters. Sodas and french fries are where the profits are in the fast food business. Putting two and two together, the hot "rollout" in the frozen food locker this season is cinnamon sugar-sprinkled french fries.

For several years, I've been pondering portion sizes -- the very image of the lethal platter. Why is it that when you go out to eat, they try to stuff you instead of feed you? Why has a plate of spaghetti or roast beef or Chinese food gotten bigger and bigger, until we leave restaurants lugging a week's supply of leftovers back to the fridge?

It turns out that this is a deliberate restaurant strategy, or so my students who have studied "food service marketing" tell me. Restaurant managers believe that customers go home feeling more satisfied if their guts are aching, because being overfed makes Americans feel they've gotten a real bargain. The managers are convinced that if you eat two of their meals, one in the restaurant and one at midnight in front of the TV, you have them in mind twice a week instead of once. This is eating as advertising.

Overfeeding is used in all price ranges except the most expensive, where the reverse principle operates and you pick lightly at a few slivers of belly of tuna comforted by a caper and an asparagus spear. In most restaurants, profits are made when the volume of inexpensive foods or "sides" increases on the plate. Commodity prices for most vegetables, starches and legumes are so low that restaurants have been able to double serving sizes with out doubling prices. Portion sizes have gotten so large that one can easily consume 2200 -- 2400 calories in a single mid-price restaurant meal, more than the total an adult needs for a day. How can this be possible when an uncounted number of people in United States don't get enough daily calories?

The super-sizing strategy gets extreme in the fast food industry, the part of the restaurant business that markets most heavily to kids. Here you really have to step back and marvel at the magic of capitalism. The fast food folks figured out how to make it more profitable to sell highly processed, mechanically shaped, frozen, artificially flavored and deep fat fried segments of potato, than it is to sell a plain baked or boiled potato. The key is volume. As Eric Schlosser shows in Fast Food Nation, McDonald's has driven potato prices so low that they can sell a pound of cooked French fried potatoes for twenty times what they pay for it frozen.

There are multiple data sources on obesity among Americans.  Here, we will cite some survey data from the 2002 MARS survey.  This is a mail survey of 22,097 adults living in the 50 states conducted during the first quarter of 2002.  Within this survey, 7.9% of the survey respondents said that they had been diagnosed as being obese, either professionally or by themselves.  We note that this is not necessarily an objective classification (such as with the use of body mass index).  However, we can take these answers to mean that 7.9% of the people recognized that they are in an obese condition.

In the next chart, we show the incidence of obesity by age/sex groups.  Obesity can occur at any age in either sex.  There is a significant difference between the sexes.  In women, obesity is liable to occur after pregnancy and at menopause. During, pregnancy, a woman can gain about 20 to 25 pounds in weight.  Part of this is an increase in the adipose tissue which serves as a store against the demands of lactation.  Many women gain more and retain a part of this weight. They become progressively obese with each succeeding child.  After age 60, the incidence of obesity among women begins to increase.

In the quoted article by Dr. Susan Davis, it was asserted that "the rich are thin, and everyone else is getting heftier."  The next chart shows the incidences by household income and education.  Generally, the incidence of obesity decreases with household income.  As for education, the relationship is not monotonically decreasing.  Within those who did not proceed past high school, the incidence is higher among those who did not graduate from high school.  Among those who went to college, the incidence is higher among those who did not graduate from college.  It is as if, other things being equal, failure to graduate has negative implications.

Obesity constitutes a serious health hazard as the extra fat puts a strain on the heart, kidneys and liver as well as the large weight-bearing joints such as the hips, knees and ankles, which ultimately shortens the life span.  Overweight persons are susceptible to physical diseases like coronary thrombosis, heart failure, high blood pressure, diabetes, arthritis, gout and liver and gall-bladder disorders.  

There are also psychological factors involved in obesity.  On one hand, the chief cause of obesity is overeating, especially excessive intaking of high-calorie foods.  Persons who are generally bored, unhappy, lonely or unloved, those who are discontented with their families or social or financial standing usually tend to overeat as eating is a pleasure and solace to them.  On the other hand, there are also psychological effects.  In today's society it is considered unattractive to be obese.  Fat people are thought to be lazy, gluttons, and even sometimes dirty.  Obese individuals often face prejudice and discrimination at work, school, and in public.  Obese individuals often feel shameful, rejected, and most of all depressed.

In the next chart, we show the incidence of obesity by a number of other disease states.  For example, with people who have reported that they suffered from nutritional deficiencies within the past 12 months (either self-diagnosed or professionally diagnosed), 27.3% reported being obese, compared to the 7.9% in the general population.

The facts are known in that obesity has a significant impact or correlational relationship with general health.  The libertarian approach would hold this to be a matter of individual responsibility.  But when sufficient many individuals encounter this problem, there are now enormous social costs, and it may take active government intervention to solve a social problem.  For each individual, body weight is the result of a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences.  Obesity result from an imbalance involving excessive calorie consumption and/or inadequate physical activity.  Behavioral and environmental factors are large contributors to obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

 (posted by Roland Soong, 9/06/2002)

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