America’s Growing Waistline


America’s collective waistline has been growing for several decades. And that’s causing problems for most of us in terms of poor health and the higher cost of coping with obesity-related diseases and conditions.

Recall the conversations from your latest high school or college reunion.

“Joe sure has put on weight since we played basketball together!”

“I wouldn’t have recognized Rebecca outside of this party. She was always so slender.”

Among our relatives, we nag one another and ourselves about how many pounds we’ve put on. And we moan about how hard it is to lose the weight, how much we need to get more exercise, and so on.

Was it always this way? Yes . . . and no.

How We Got Here

The early Greek physician, Galen (129-210 C.E.), tried to help his overweight patients by urging them to eat more slimming foods such as greens and garlic. He held that appetite was controlled by the liver and that a balance in “humours” needed to be restored.

During the Middle Ages and Renaissance, ballads, plays, and literary works often poked fun at those who were considered fat. But such concern with weight has had its ups and downs throughout history and in various cultures.

When food was scarce, consuming large quantities of food whenever possible led to the storing of body fat as a hedge against leaner days. People even regarded being overweight as a sign of prosperity when food was scarce for most of the population.

Of course, one could go too far in that direction and become guilty of gluttony—one of the seven deadly sins according to Christianity. And when food became more plentiful, gluttony was an obvious sign of selfishness. Being overweight carried a stigma of moral condemnation.

As food production became more reliable in Europe and North America in the 19th and 20th centuries, to a large extent because of mechanized farming, average intake of calories gradually increased for most people.

Historians have now determined that the Body Mass Index (BMI) for students at West Point during the 19th century averaged only 20.5. For persons born between World War I and World War II, however, a surge occurred that pushed the average BMI to about 22.4. BMI averages have ballooned in the decades since then, except for a minor dip in the trend during the Great Depression (another time of food scarcity).

Many factors have worked together to accelerate the trend toward our current situation where about 70% of Americans are considered clinically overweight or obese. In addition to more reliable availability of food, these factors include labor-saving devices and technology at work and in the home, a more sedentary lifestyle for millions, and a fast-food and processed food industry that has pumped unneeded sugar, carbohydrates, and saturated fats into the American diet at the expense of fresh fruits and vegetables.

Our Obesity Epidemic

Conduct an Internet search for “obesity” and you will find that we are now confronting an “obesity epidemic” (see the CDC video, The Obesity Epidemic).

This means that according to official public policy for government agencies and professional associations such as the AMA, obesity is considered a medical condition.

The CDC calculates overweight and obesity BMI levels according to the following criteria:

  • If your BMI is less than 18.5, it falls within the underweight range.
  • If your BMI is 18.5 to <25, it falls within the normal range.
  • If your BMI is 25.0 to <30, it falls within the overweight range.
  • If your BMI is 30.0 or higher, it falls within the obese range.

Being overweight or obese now has recognized consequences, a variety of causes, and methods of treatment. We will consider these topics in later posts, but for now we’ll briefly mention the general significance of this condition for our society.

In an important 2015 article, “How Obesity Became a Disease,” for The Atlantic, Harriet Brown reports that the AMA’s decision in 2013—to “recognize obesity as a disease state” that includes several characteristics requiring many different approaches to treatment—was not without controversy.

In fact, the AMA’s Committee on Science and Public Health advised against such a step. In their view, obesity does not resemble other diseases since it has no symptoms and is not always harmful (as in times of famine).

“[T]he committee worried that medicalizing obesity could potentially hurt patients, creating even more stigma around weight and pushing people into unnecessary—and ultimately useless—‘treatments.’”

By voice vote, the AMA membership decided otherwise. Such a decision promotes greater standardization in treatment options and more advanced research into how society can cope with the problems resulting from an overweight and obese population.

The situation is indeed dire. Overweight and obese persons are at much higher risk for cardiovascular disease, type 2 diabetes, sleep apnea and deprivation, and other health problems. Childhood obesity is also increasing and clearly contributes to higher rates of adult obesity.

While treatments also contribute to much higher expenditures for health care, many of the costs to society are indirect or hidden. Transporting overweight persons by car takes more gasoline, while buses and trains need to be refitted to accommodate heavier riders. Even loss of productivity at work represents a significant economic cost.

Higher medical and other costs explain why the increasing number of overweight and obese persons has become such an urgent public and health care issue. In future posts, we’ll address how health care professionals can help individuals and society to cope.

In the meantime, feel free to add your own comments and observations. To add or view comments, click on the title of this article above.