Obesity in America: Causes, Consequences, and Cures

Obesity remains a pressing health concern across the United States (U.S). For instance, it is ranked by 70% of the county officials as a leading challenge in their counties (Segal, Rayburn & Beck , 2017). Likewise, the factors associated with obesity are also rated as the priority health issues in communities. These factors include physical activity, nutrition, hypertension, diabetes, and heart disease. There is a consensus amongst scholars that obesity is amongst America's major health problems (Segal et al., 2017; Hruby & Hu , 2015; Callahan , 2013; Menifield , Doty & Fletcher, 2008; Salinsky & Scott , 2003). Salinsky & Scott (2003) argue that while obesity is a hot topic in the U.S currently, this is not a new phenomenon. The authors cite that obesity has been an issue of concern in the U.S since the early 1950s. Despite this fact, it is only recently that obesity has emerged as a widespread epidemic in America. Consequently, the economic, as well as health costs of obesity in the U.S, cannot be overstated. Obesity is a more significant threat to America's economy and health now compared to a century ago. Segal et al. (2017) postulate that if the trend is not reversed, today’s children are likely to be the first generation to live not only shorter but also less healthy lives compared to their parents. While the rates of obesity vary from one state to another, nationally, they remain high. Segal et al. (2017) also cite that across the country, one in every six children aged 2 to 19 and one in every eleven children aged 2 to 5 are obese. Likewise, one in every three American adults is obese. Secondly, they argue that the highest rate of adult obesity stands at 37.7% in West Virginia, and the lowest is 22.3% in Colorado. Lastly, they highlight that the highest and lowest childhood rates stand at 21.7% and 9.9% in Mississippi and Oregon respectively (Segal et al., 2017). These figures have resulted in renewed efforts by the policy makers to address the epidemic. There is a need to mainstream healthcare organization and administration in support of these efforts so as sustainably address the obesity epidemic in the U.S. 

Literature Review 

Unpacking Obesity: Obesity versus Overweight 

There is a close relationship between obesity and overweight. Obesity can be conceptualized as the presence of excess body fat in the human body ( Hruby & Hu , 2015; Callahan , 2013). T his occurs when the amount of calories consumed exceeds the amount that is burned. Obesity is commonly screened using the body mass index (BMI). This tool measures an individual's weight in relation to his or her height. The tool is limited in that it does not directly measure a person's muscle or fat directly. Instead, measurements are taken by dividing an individual's weight (in pounds) by his or her height (in inches squared) and then multiplying this by 703. While men and women can boast similar BMI’s, they are likely to have different body fat percentages. Conventionally, women have more body fat compared to men. An individual with low body fat and large muscle mass, such as a bodybuilder, may share the same BMI with a person whose body fat is more. A closely related terminology is overweight. Overweight refers to BMI of between 25 and 29.9 while obesity refers to BMI that is greater than or equal to 30 ( ≥ 30) (Segal et al., 2017; Hruby & Hu , 2015) . Obesity can further be broken down into Classes I, II and III. These classes have BMIs of 30-34.9, 35-39.9 and greater than or equal to 40 ( ≥ 40) respectively. Thus, a BMI of 30 or more suggests the presence of extreme body fat with Class III obesity denoting ‘extreme obesity’ ( Hruby & Hu , 2015). 

Obesity is not only multifactorial and complex but is also preventable. Hruby & Hu (2015) reckon that coupled with overweight, obesity is a concern for more than one-third of the global population today. If the current trend continues, Hruby & Hu (2015) argue that about 20% of the global adult population will be obese while 38% of the same population will be overweight. However, the case is more worrying in the U.S whereby 85% of the adult population is projected to be either obese or overweight by 2030 ( Hruby & Hu , 2015). Overall, obesity's growth trends in the majority of developed countries are seen to have leveled off. However, morbid obesity in the same countries continues to increase in both adults and children. Interestingly, the prevalence of obesity in developing countries is on the rise and slowing catching up with the levels seen in America. Typically, obesity merely is defined as the presence of excess body weight for height. However, this definition fails to give the real impression of the etiologically complex phenotype that is mainly associated with excess body fatness or adipose, and which can be manifested metabolically and not just the form of body size ( Hruby & Hu , 2015). Menifield et al. (2008) reckon that both overweight and obesity denote ranges of weight that are more than what is considered healthy for a particular height. For instance, overweight may be conceptualized as the increase in body weight in relation to height when a comparison is made to some standard desirable or acceptable weight. Overweight may or may not be as a result of increased body fat or lean muscle. For instance, one may be very muscular and lean and with little body fat. However, at the same time, he or she may weigh more than another person of similar height. In this case, while the individual may be deemed overweight owing to his or her large muscle mass, he or she is not ‘over fat,' irrespective of the BMI. In the same breath, obesity can be conceptualized as the presence of an excessively high amount of adipose tissue or body fat in relation to lean body mass. The amount of adiposity is of concern with regard to the distribution of fat throughout the body as well as the amount of adipose tissue deposits. Further, Menifield et al. (2008) argue that overweight and obesity refer to ranges of weight that are likely to increase the likelihood of various diseases and related health problems. In particular, obesity results in a high risk of chronic disease morbidity ( Hruby & Hu , 2015; Menifield et al., 2008). Examples of these diseases include depression, cardiovascular disease, disability, particular cancers, type 2 diabetes. In extreme cases, obesity increases the risk of mortality. Childhood obesity leads to the same conditions. In this case, their onset may either take place prematurely or increase the likelihood of occurrence in adulthood. Thus, the adverse implications of obesity to the American economy cannot be overstated. 

Prevalence and Trends of Obesity in the U.S 

The recent years have been characterized by increased cases of obesity and overweight in the U.S. Hruby & Hu (2015) postulate that the prevalence of obesity and overweight in the country has risen over the last fifty years partly due to the limited restriction on food availability and access. Subsequently, the obese and overweight are currently twice as many as those with a healthy weight. For instance, between 1960 and 1994 the levels of overweight American adults were about 31%. However, within the same period, the age-adjusted obesity rose to 23% from 13%. This meant that the prevalence of the two conditions rose to about 55% of the national population. An upward trend in incidence was also observed between 2003 and 2004 whereby the percentage of obese adults rose to 32% from 23%. In the subsequent decade, a percentage of 35% was achieved. The prevalence of obesity has also varied across sub-populations. For instance, the percentage prevalence for non-Hispanic Blacks and Hispanics were 48% and 43% respectively between 2011 and 2012. These figures suggest that there a disproportionate burden of the condition across the different ethnic, racial and socioeconomic groups in the U.S. Another notable factor is gender, with women been disproportionately affected compared to men. In this case, irrespective of race or age, more American women are likely to have obesity compared to the men ( Segal et al., 2017). 

The prevalence of obesity amongst American children is slightly better compared to that of their adult counterparts ( Cheung , Cunningham, Narayan & Kramer ., 2016) . About 30% of the American children aged between 2 and 19 are obese ( Hruby & Hu , 2015) . However, despite this, projections indicate that there is a long-term trend in the increasing prevalence of obesity amongst children that is similar to that of adults (Segal et al., 2017; Cheung et al., 2016; Hruby & Hu , 2015). For instance, the prevalence of class two obesity in this demographic has risen to 5.9% from 3.8% since the year 2000. On the other hand, the prevalence of class three obesity has increased to 2.1% from 0.9%. Similar to the adults, Black and Hispanic children are more likely to be overweight or obese compared to those of other ethnic backgrounds. 

Causes of Obesity 

Obesity is caused by an energy imbalance between the calories that are consumed and those that are used. This results in the presence of surplus energy or positive energy balance which ultimately leads to excess body weight. Partially, the energy imbalance may be occasioned by economic and social factors that are beyond an individual's control. Currently, these changes include the availability of nutrient-rich, abundant and cheap food; urbanization; economic growth; industrialization; and mechanized transportation (Segal et al., 2017; Hruby & Hu , 2015). These factors affect not only the U.S but also other high-income and developed nations. Moreover, such hereditary factors as family history, genetics, and race-ethnic grouping have been linked with obesity. Thus, the regulation of body weight should be conceptualized as a complex interplay of genetic, environmental as well as socioeconomic factors. However, the personal behaviors in response to these factors play a crucial role in the prevention of obesity. 

Genetics 

The elevated susceptibility to obesity has been linked to more than sixty genetic markers that are relatively common. However, the thirty-two most popular genetic variants account for less than 1.5% of the total inter-individual difference in BMI ( Hruby & Hu , 2015) . Therefore, while genetics play a role in the manifestation of obesity, this small difference in BMI combined with the unprecedented increase in recent years suggest that the risk factors of obesity go beyond an individual's genetic make-up ( Hruby & Hu , 2015) . This realization has led to an emphasis on the interaction between genetics and the environment ( Moleres , Martinez & Marti , 2013). The basis of interest in this interaction is the argument that a person's underlying genetic risk predisposes him or her to certain adverse effects of environmental or behavioral exposures. Notable exposures in this regard include exercise and diet. 

Besides lifestyle and parental diet, other factors that have been linked to an offspring’s subsequent risk of obesity include smoking, parental obesity, exposure to famine, exposure to endocrine-disrupting chemicals and other related chemicals, gestational diabetes, and lastly, the gaining of weight during gestation ( Hruby & Hu , 2015). These factors point towards the influence of fetal programming, which through epigenetic mechanisms, are likely to influence an individual's health throughout his or her life. This phenomenon is likely to be manifested across the food availability or socioeconomic spectrum. Therefore, it is critical for mothers to manage their lifestyle and diet carefully during both prenatal and perinatal periods. This is because these factors impact the obesity epidemic considerably and for many generations. 

Individual Factors 

Diet 

The role of physical activity and diet in mitigating the risk of obesity cannot be overstated. This argument can be supported by the fact that a significant proportion of deaths in the U.S are caused by excess weight which arises as a result of poor diet coupled with lack of physical activity ( Hruby & Hu , 2015; Callahan , 2013) . Subsequently, efforts to understand this issue have been focused on the caloric intake as well as caloric expenditure. The latter is needed to maintain healthy weight and growth. Based on the interplay between caloric intake and expenditure, most clinical weight-loss and weight management strategies today have placed their emphasis on caloric restriction ( Callahan , 2013 ). Besides the role of caloric intake in regulating body weight, a significant amount of effort has been directed towards understanding the role of dietary patterns and quality of diet. 

There is a consensus amongst scholars that irrespective of the dietary pattern, caloric restriction is bound to result in better weight outcomes ( Hruby & Hu , 2015). Based on this narrative, adhering to a particular diet, irrespective of type significantly influences weight control or weight loss. Consequently, to maintain a healthy weight in the long run, an individual ought to only take diets that are considered healthy. This is because these diets are likely to aid in managing one's weight in the long run. They are also more useful in mitigating weight gain. In the U.S, weight gain is associated with the uncontrolled intake of processed and unprocessed red meat; potatoes and potato chips; and beverages that have been sugar sweetened. It is also inversely associated with the consumption of such foods as fruits, yogurt, vegetables, nuts and whole grains ( Hruby & Hu , 2015; Callahan , 2013). Specifically, the sugar-sweetened beverages have received special focus since their increased consumption has been linked to the rising prevalence of obesity. This has led to the development of targeted public health policies and interventions such as limitation of the advertising of these products, limitation of the quantity that can be sold at any given time, restricting sale in institutions of learning, and taxation among others. 

Physical Activity 

Such behaviors as stress, physical activity, sedentary lifestyles, and sleep are significantly linked to weight maintenance and change, especially in adulthood. When coupled with diet, these factors produce cumulative and synergistic effects on a person's ability to obtain as well as maintain a healthy body weight throughout their life (Segal et al., 2017; Ding & Gebel , 2012; Culter, Glaeser & Shapiro , 2003). Hruby & Hu (2015) cite that combined with dietary restriction, doing between 150 and 250-minute moderate-to-intense physical activity per week, an individual is likely to prevent gaining weight and facilitate weight loss. Interestingly, leisure-time activities that entail sitting while not providing adequate rest are likely to increase the likelihood of a person to become obese. These activities include getting too little or too much sleep, viewing of television, and leisure-time sitting ( Culter et al., 2003 ). 

Socioeconomic Factors 

Education and Income Levels 

Currently, there is an inverse correlation between wealth and the prevalence of obesity ( Hruby & Hu , 2015). Consequently, the highest levels of prevalence of obesity are found amongst the individuals that are either at or below the poverty level. Contrary to the conventional narrative that thinness is likely to be associated with homelessness and food insecurity. Thus, in the U.S, an inverse relationship exists between the socio-economic status (SES) and obesity. The SES, in this case, is conceptualized as the occupation-based social class or the level of household income. Thus, irrespective of gender, individuals are likely to portray a higher prevalence of obesity or overweight the lower their SES is. Apart from the SES, another essential factor to consider is education. In the U.S, education is inversely related to obesity and overweight. This is particularly the case in women. Therefore, the less educated an American is, the higher the prevalence of obesity. 

Environmental Factors 

The Built Environment 

It has been established that the neighborhood in which an individual resides plays a crucial role in fueling obesity. For instance, such attributes as the presence of parks, fast food restaurants, transportation, and supermarkets are associated with factors like the healthiness of a neighborhood and the walkability of its residents ( Ding & Gebel , 2012; Durand , Andalib, Dunton, Wolch & Pentz , 2011) . Thus, the presence of infrastructure that is supportive of physical and recreational activities is likely to increase energy expenditure, in the process reducing obesity levels. Nevertheless, the presence of healthy foods in neighborhoods plays a more critical role. This can be exemplified by availability and accessibility to supermarkets as opposed to fast food restaurants and convenience stores. Thus, to reverse the trends in obesity prevalence, the American authorities have to invest in ensuring that public spaces are laden with health-promoting attributes. 

Environmental-Based Infectious Agents and Social Networks 

Recent research efforts have established that infection may result in obesity and that obesity may be an infectious disease by itself ( Hruby & Hu , 2015). The infectious agents, in this case, include viruses and microbiota in the human gut. Interestingly, obese individuals are also likely to be infectious. The viruses have been associated with causing obesity due to their role in promoting adiposity. A notable example, in this case, is the Ad-36. On the other hand, gut bacteria have been proven to play a role in obesity, digestion of lipids and carbohydrates as well as energy metabolism. The proportions of these bacteria have been established to differ in obese and healthy individuals, and are likely to reduce as an individual loses his or her weight. The narrative of humans as infectious agents can be conceptualized in the form of social networks. Thus, having a network of obese or health unconscious individuals is likely to increase an individual’s chances of becoming obese. 

The Cost of Obesity to the U.S Government 

Obesity is undoubtedly associated with the increased risk of almost all chronic conditions. This is because an individual is likely to experience higher disease incidences owing to excess body weight. Thus, both overweight and mortality result in increased risk of mortality as well as accidental deaths ( Hruby & Hu , 2015) . Obese and overweight individuals are likely to contract diabetes, heart and other vascular diseases, cancer and mental health. They are also more prone to various infectious diseases and trauma ( Hruby & Hu , 2015; Hammond & Levine , 2010) . These conditions have far-reaching implications on the American economy. These costs may be directly in the form of treating obesity and obesity-related ailments ( Hammond & Levine , 2010) . Indirectly, obesity is a threat to America's productivity. This is associated with such issues as absenteeism, disabilities, premature mortality as well as increased cost of health insurance. Obesity has also been associated with reduced academic achievement owing to such factors as lowered self-esteem. Hruby & Hu (2015) estimate that about $190 billion is spent annually on health care due to obesity and other related diseases. This accounts for about 21% of the national healthcare expenditure, with women spending double what their male counterparts spend. 

Addressing Obesity from the Health Care Organization and Administration Perspective 

The organization and administration of health care systems, existing hospital networks, and other related settings play a vital role in influencing the quality of care, health outcomes and patient satisfaction ( Schaecher , 2016; Dietz et al., 2015; Lavis et al., 2005). Likewise, care coordination and integration coupled with new approaches to the delivery of care are requisite to attaining these goals. Given the gravity of the obesity epidemic in the U.S, there is a need to leverage healthcare organization and administration. It is also important to recognize that health care delivery is currently characterized by unprecedented dynamism. Consequently, the relationship between administrators and those charged with delivering care is not only challenged and tense but is also significantly fractured. Firstly, this is owed to the rapidly changing healthcare industry. However, secondly and most importantly, there is a lack of understanding and trust between healthcare administrators and physicians. 

To sufficiently address the obesity epidemic in America, there is a need to strengthen the relationship between physicians and administrators across the country’s healthcare systems ( Dietz et al., 2015). In this pursuit, it is important to formalize healthcare structures and processes so as to unlock the knowledge and creativity of physicians. This is in a bid to maximize the physicians' input in the process. In this case, besides delivering care, the physicians would be charged with redesigning healthcare. This approach would result in genuine insights that are vital in addressing the obesity challenge. There is also a need for physicians to be trained in healthcare administration, policy, finance as well as organizational behavior ( Lavis et al., 2005). This would help reduce mistrust and create harmony in the healthcare systems. To achieve this, incorporation of entities that offer such training in different healthcare settings is vital. Further, it is critical for healthcare administrators to be exposed to clinical medicine in a bid to bridge the gap between them and the physicians so as to foster collaboration between the two in the fight against obesity ( Bose, 2003 ). Lastly, there is a need to stop the general reference of nurses, physicians, and pharmacist as providers. This would ensure that these individuals are not conceptualized as being interchangeable and that the role of each is taken seriously. Overall, the obesity epidemic cannot be addressed by physicians alone. Rather, the help of knowledgeable and dedicated administrators is needed. The reverse is also true for the administrators. 

Conclusion 

O besity is amongst America’s most pressing health problems and is a more significant threat to America's economy and health now compared to a century ago. Across the country, both children and adults are affected by obesity and the prevalence rates are on the rise. Given this scenario, the adverse implications of obesity to the American economy cannot be overstated. There is a disproportionate burden of the condition across the different ethnic, racial and socioeconomic groups in the U.S, with women been disproportionately affected compared to men. Obesity is caused by an energy imbalance between the calories that are consumed and those that are used. This results in surplus energy or positive energy balance which ultimately leads to excess body weight. Notable causes of this phenomenon include g enetics, d iet, lack of physical activity, low income and education levels, infectious agents, adverse social interactions, and favorable built environments. Obesity adversely affects the American population both directly and indirectly. Given the severity of the epidemic, there is a need to leverage healthcare organization and administration. This can be done by strengthening the relationship between physicians and administrators across the country's healthcare systems. It can also be achieved by training physicians on health care administration, policy, finance as well as organizational behavior. Lastly, it is critical for healthcare administrators to be exposed to clinical medicine in a bid to bridge the gap between them and the physicians. Given these dynamics, future research should be directed towards understanding how o rganization and a dministration of health care can be linked to the prevalence of obesity in different American states. 

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