The Obesity Crisis #1: How Did We Get Here?

Obesity kills. The Covid pandemic has thrown this into sharp focus: obese individuals (defined as BMI >30) suffer more serious covid outcomes, with increased risks for hospital admission, ICU admittance, and death.

The Obesity Crisis is growing. Between 1975 and 2016, the worldwide prevalence has nearly tripled. If current trends continue, by 2025, 1 in 5 people worldwide will be obese.

Obesity rates are rising by epic proportions, with numbers tripling between 1975 and 2016. Credit: obesitypreventionforamerica.org

When we think about obesity, we often think of it as a problem affecting middle aged people in high income countries. This isn’t the case anymore. Whilst under 1% of children and adolescents were obese in 1976, today that number stands at over 124 million (and rising!). It’s no longer an exclusively high-income country problem, either. In Africa, the number of overweight children under 5 has increased by nearly 25% since 2000.

Why It Matters: The Consequences of Obesity

The consequences of obesity follow someone throughout their entire lifespan. From increased risk of bullying, self-esteem issues and schooling absences as a child, to increased risk of serious preventable diseases as adults. Credit: Psychology Today

Obesity affects all stages of the lifespan. As children, obesity is associated with increased bullying, lower self-esteem, and more school absences. These children are then more likely to become obese adults, continuing to suffer the consequences.

In adulthood, obesity is the leading cause of poor health and premature death, associated with the most serious preventable diseases: heart disease, diabetes and cancers.

Obesity exacerbates inequalities. In England, adults and children living in the more deprived areas are 2x more likely to be obese. Obesity leads to poorer health, which leads to poorer employment prospects — driving a self-perpetuating cycle of obesity and deprivation.

For children in more versus less deprived areas, there is little difference in achieving the recommended amount of exercise, or in total calorie intake. So why this socioeconomic difference in obesity levels? Well, more affluent children tend to do more vigorous-intensity organised sport, and eat more fruit and vegetables than their less affluent counterparts. The socioeconomic difference in obesity therefore seems to lie in quality, rather than quantity.

So we have an obesity crisis. How did we get here?

The Technological Boom

In the last couple of decades, we’ve experienced rapid technological advances. This has obviously had many benefits —just think about how much worse lockdowns would be if we didn’t have video-call or Netflix! However, this has come at a cost to our waistlines.

Increased sedentary lifestyles in both work and leisure time are to blame for the obesity crisis. Credit: depositphotos.com

Sedentary lifestyles are a byproduct of the Information Age, where work and entertainment are often achieved by sitting in front of a screen. On average, 55% of our days are spent sat down. It wasn’t always this way. For one, we used to be more active in our work-life. In the 1960s, almost 50% of jobs in the US private sector required moderate physical work. By 2010, this had dropped to under 20%. Our down-time activity levels are no better, either. Only 5% of American adults meet the guidelines for leisure-time exercise — a mere 30 minute walk a day.

What’s the result of this? Studies have shown that too much sitting is harmful: in a study comparing the most enthusiastic TV watchers(>3.6 hours a day) with the least ( <2.5 hours a day), the most arduent TV watchers had larger waistlines, despite the 2 groups consuming the same amount of calories. In addition, the more sedentary group had higher blood pressures, blood sugar levels, and lower levels of good HDL cholesterol: all risk factors for cardiovascular disease.

The Insidious Role of Sugar

Sugar is thought to be a major contributer in fuelling the obesity crisis. The rise in total sugar consumption in the US population has paralleled the rise in obesity. Credit: Britannica

Everybody loves sugar. After all, where would we be without our chocolatey Easter treats?

Unfortunately, mounting evidence suggests that our increased sugar consumption is a prime candidate for fuelling the obesity rise. In particular, high fructose corn syrup (HCFS), a ubiquitous substance found in everything from fizzy drinks and cakes to the ‘healthier’ salad sauces and granola.

What’s the evidence for the key role of sugar in obesity?

In the US, total sugar consumption drastically increased between 1970s and 1990s — likely due to the large influx of HFCS in the mid-1970s. This was followed by an exponential growth in obesity prevalence from the late 1970s to 2000s. During the 1990s, there was a drop in total sugar consumption, followed by a slowing of the annual increase in obesity in the 2000s (but still an increase nonetheless). So, total sugar consumption is closely tied to the population obesity rates.

What can we do about it?

So now we know that our increased sedentary lifestyles and augmented sugar consumption have contributed to this staggering rise in obesity seen in the last half-century. The next question is: what solutions are being put forward to address this? We’ll be exploring this, and more, in our next article.

About That Medic Network

If you like this article, be sure to follow us for more content on our Website, Facebook, Twitter, Instagram, LinkedIn.

Feeling friendly or excited for our next article? Email us at info@thatmedicnetwork.com or subscribe to our newsletter.

About the author

Jessy Zhang is a fourth year medical student at University of Cambridge, with interests in healthcare inequality, policy, and mental health. In her free time, she enjoys baking, reading and travelling!

References

1. Senthilingam M. Covid-19 has made the obesity epidemic worse, but failed to ignite enough action. BMJ. 2021;372:n411.
2. Tedstone A. Sugar reduction and obesity: 10 things you need to know [Internet]. Gov.uk. [cited 2021 Apr 4]. Available from: https://publichealthmatters.blog.gov.uk/2016/11/01/sugar-reduction-and-obesity-10-things-you-need-to-know/
3. Lampard AM. Obesity. In: Encyclopedia of Feeding and Eating Disorders. Singapore: Springer Singapore; 2015. p. 1–5.
4. Health inequalities and obesity [Internet]. Rcplondon.ac.uk. 2020 [cited 2021 Apr 4]. Available from: https://www.rcplondon.ac.uk/news/health-inequalities-and-obesity
5. Adams J. Addressing socioeconomic inequalities in obesity: Democratising access to resources for achieving and maintaining a healthy weight. PLoS Med. 2020;17(7):e1003243.
6. Obesity and overweight [Internet]. Who.int. [cited 2021 Apr 4]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
7. Harvard Health Publishing. Obesity in America: What’s driving the epidemic? [Internet]. Harvard.edu. [cited 2021 Apr 4]. Available from: https://www.health.harvard.edu/staying-healthy/obesity-in-america-whats-driving-the-epidemic
8. Faruque S, Tong J, Lacmanovic V, Agbonghae C, Minaya DM, Czaja K. The dose makes the poison: Sugar and obesity in the United States — a review. Pol J Food Nutr Sci. 2019;69(3):219–33.