Application of Epidemiology to Obesity Essay

Obesity has been defined as a condition in which excess body fat has accumulated to an extent that health may be adversely affected. The classification of overweight and obesity allows the identification of individuals and groups at increased risk of morbidity and premature mortality. 1.Analyze the obesity problem in the U.S. as compared to another developed country in which the obesity problem is not as significant. Include factors such as age, gender, race, socioeconomic status, and marital status in your analysis. Hypothesize the reason why the rate of obesity is higher in the U.S. than the other country. Obesity has been such a struggle for Americans since the early 1980s. According to Fleming, major effort to reduce the proportion of members who are overweight or obesity involves a strategic plan (Fleming, 2008). Obesity varies by age, gender, and by race-ethnic groups. A higher body weight is associated with an increased incidence of a number of conditions, including diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease, and with an increased risk of disability. Obesity is associated with a modestly increased risk of all-cause mortality. However, the net effect of overweight and obesity on morbidity and mortality is difficult to quantify. It is likely that a gene-environment interaction, in which genetically susceptible individuals respond to an environment with increased availability of palatable energy-dense foods and reduced opportunities for energy expenditure, contributes to the current high prevalence of obesity (The Epidemiology of Obesity, 2007). The United States is not alone in experiencing increases in the prevalence of obesity. Similar increases have been reported from a number of other countries and regions of the world. For example, in England, the prevalence of obesity (BMI is greater than or equal to 30) among women 25–34 years of age increased from 12% to 24% in only 9 years between 1993 and 2002. In Portugal, increases in overweight among school-age children also have been found. Less-developed countries also have seen increases in obesity (The Epidemiology of Obesity, 2007). Among preschool-age children in urban areas of China, the prevalence of obesity increased from 1.5% in 1989 to 12.6% in 1997(The Epidemiology of Obesity, 2007). Differences in the prevalence of obesity between countries in Europe or between race-ethnic groups in the United States tend to be more pronounced for women than for men. For example, in Europe, the WHO Multinational Monitoring of trends and determinants in cardiovascular disease study, which gathered data from 39 sites in 18 countries, found the prevalence of obesity was similar for men across all sites (The Epidemiology of Obesity, 2007). For women, however, there were marked differences in prevalence between sites, with higher values for women from Eastern Europe. Similarly, in the United States, there are marked differences in the prevalence of obesity by race-ethnic group for women but not for men. According to the U.S. obesity trend, the southern states have the highest prevalence of obesity out of all the fifty states. The CDC stated that more than one-third of U.S. adults (35.7%) are obese. Approximately 17% (or 12.5 million) of children and adolescents aged 2-19 years are obese (Overweight and Obesity, 2011). 2.Compare obesity rates and obesity-related health care costs in your state to all of the U.S. Recommend how your state can treat obesity as a threat to public health. As stated above, Georgia is one of the southern states that have a high prevalence mortality rate. The greatest problem with the statistical linkages between body mass and mortality is that other confounding factors are not considered, leaving little basis for drawing causal inferences. Most epidemiological studies estimating the relationship between body weight and mortality do not control for fitness, exercise, diet quality, weight cycling, diet drug use, economic status, or family history. Furthermore, in studies that control for some of these factors, the data are usually self-reported and thus of extremely questionable reliability. Georgia ranks seventeenth most obese state in the nation. Obesity is one of the biggest public health challenges. Millions of Americans still face barriers like the high cost of healthy foods and lack of access to safe places to be physically active. There has been a significant increase in health care cost in accordance to obesity. The annual cost of obesity in Georgia is estimated at $2.1 billion ($250 per Georgian each year), which includes direct health care costs and lost productivity from disease, disability, and death (indirect costs) (Georgia Data Summary, 2008). Treatment of this epidemic would be rather difficult. At a federal level, the new health reform law, the Patient Protection and Affordable Care Act of 2010, has the potential to address the obesity epidemic through a number of prevention and wellness provisions, expand coverage to millions of uninsured Americans, and create a reliable funding stream through the creation of the Prevention and Public Health Fund. People who are overweight or obese have a higher risk for death than people of optimal (normal) weight. An estimate of excess mortality is called the population attributable risk (PAR). PAR is an estimate of the proportion of deaths caused by a particular risk factor, in this case, overweight and obesity. The PAR represents the proportion of deaths in a population that would be eliminated if the risk factor were removed from the population. The PAR for overweight and obesity is the fraction of all deaths that would not occur if everyone were of optimal (normal) weight. The PAR from overweight and obesity is estimated using the prevalence of overweight and obesity in Georgia and the relative risk for dying among overweight and obese persons compared with normal weight persons. The risk varies by age and sex. In Georgia, approximately 10% of the total number of deaths each year is attributable to overweight or obesity, indicating that about 6,700 Georgians dies annually because they are overweight or obese. About 1,500 (22%) of the excess deaths occur among people who are overweight, and 5,200 (78%) occur among those who are obese (Georgia Data Summary, 2008). 3.Suggest how politics of this issue will hinder your ability as an epidemiologist to help your community and / or state deal with the issue of obesity. The medical costs of obesity in the U.S. have been estimated at $75 – $100 billion a year. The estimate for Georgia is about $2.1 billion per year, or $250 per Georgian per year. Excess body fat is associated with both direct costs such as diagnostic and treatment services related to overweight and obesity, and indirect costs such as lost wages and reduced productivity due to illness, disability, and premature death (Georgia Data Summary, 2008). As an epidemiologist, the extra funds would not be available to help those individuals that are obese and want to lose the weight. The U.S. is already spending a large amount of money through medical cost for those obese individuals. A government grant to help individuals may even get refused because again, the funding is coming from the government. Politics would not want to provide funding for a start of a program because it is cost efficient and could be expensive. We are now at a point where governments are belatedly aware of the threat that rising obesity poses to population health as well as to society’s economic well-being and the natural environment. The awareness of the size and complexity of the problem is also evolving into an awareness of the need for multiple actions to achieve a high enough ‘dose of solutions’. There is widespread agreement that a multi-sectorial response will be needed from governments, the private sector, civil society and the public. 4.Propose four (4) new policies or laws that the government can implement to address the obesity problem in the U.S. Include the implications of those policies or laws on people, health insurance, health care providers, businesses, and the food industry. In an ideal world, governments would have been monitoring population obesity trends and have acted early to implement the actions needed to halt and reverse the obesity epidemic. However, this is not the common reality and, indeed, only a handful of countries have monitoring systems in place to detect changes in the prevalence of obesity and its risk factors. As stated above in question number two a new health reform law has to address the obesity epidemic through different wellness, and providing coverage to the millions of Americans. Government could also issue a community transformation grant to individuals that have transformed their obese bodies into healthy balanced bodies. Policies to reduce greenhouse emissions, such as corporate and individual carbon trading, would be powerful stealth interventions for obesity prevention. Congestion taxes, car-free cities, public transport growth and other urban planning options will have increased physical activity as a beneficial side effect and thus contribute to obesity prevention. Reducing the carbon cost of food could also have an effect on energy intake since many of the energy dense foods which promote obesity tend to be more processed, packaged foods in other words, higher in carbon costs. 5.Assess and address the causes which have made obesity rates increase for the past decade. Over the past three decades, obesity has increase significantly. While the exact reasons for increased global obesity were still undetermined, experts said changing habits were likely contributors. Diets are different than they were 30 years ago, and modern technology has decreased physical activity. Developing countries now have a lot of the conveniences that are commonplace in wealthier nations. There are also an increase of automobile, which we are widely dependent on and less walking or bicycling. In conclusion, the drivers of this pandemic that is now affecting rich and poor countries alike must be global in nature and relatively recent in onset. While biological hard-wiring explains the potential for the development of obesity, it cannot explain the secular trends in obesity prevalence. Humans have, for good survival reasons, evolved a biology that is designed to maximize energy intake and minimize physical activity. We seek and enjoy good tasting food (especially sweet, fatty and salty foods) and we seek to reduce the effort needed to do work (by designing machines and technology to do it for us). While these are powerful factors, our biology has not changed over the last 30 years. What has changed dramatically is the environment around us – especially the easy availability of foods and energy-saving machines that feed those biological desires. It is the increasingly obesogenic environments which are promoting especially excessive energy intake but also reduced physical exertion that are driving secular trends.