Indiana University Research & Creative Activity


Volume 30 Number 1
Fall 2007

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Lloyd Kolbe
Lloyd Kolbe
Photo courtesy Indiana University

fat belly

Pulling Our Weight

by Lauren J. Bryant

Live sicker, die younger. That's the future for America's children, says national public health expert Lloyd Kolbe, unless we stop skyrocketing rates of obesity in the United States soon. How? The solution is equally pithy: Move more, eat less.

"It's not rocket science," says Kolbe, a professor of applied health science at Indiana University Bloomington.

Simplicity vanishes, however, when it comes to the reasons for the overweight and obesity epidemic in the United States, starting with the definition of the terms.

Coming to Terms

What, exactly, do overweight and obese mean? The answer to that question has "layers and layers of complexity," Kolbe says, and has produced "enormous confusion for the public," especially when it comes to kids. Back in the mid-1990s, he explains, a committee of medical organizations came up with new nomenclature for classifying children's weight. They advocated that the term "at risk for overweight" be used instead of "overweight," and "overweight" be used instead of "obese." Eventually, those terms took hold and for the past decade or so, most if not all practitioners have used the "at risk" terminology when evaluating children.

Then in June 2007, a new report released by the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity suggested that the terms obesity and overweight should be applied to children just as they are to adults. (The Expert Committee was funded jointly by the U.S. Centers for Disease Control and the U.S. Health Resources and Services Administration and convened by the American Medical Association.) At the end of summer 2007, the final decision about which terms should be used was still under review.

Kolbe thinks the switch in terms is appropriate, but mainly, he thinks the whole fuss is a "tempest in a teapot" that is further confusing the public. What's most important is not the words we use for people's size, but the size of the problem itself.

Body-Mass Index is the widely accepted measure of overweight and obesity in children and adults. (BMI is weight in kilograms divided by height in meters squared, or weight in pounds divided by height in inches multiplied by 703.) For children, a BMI at or above the 85th percentile on standardized BMI charts is considered at risk for overweight; a child at or above the 95th percentile is considered overweight. Similarly, adults with a BMI at or above the 85th percentile on standardized BMI charts are considered overweight, while those at or above the 95th percentile are considered obese.

According to the National Center for Health Statistics (a part of the U.S. Centers for Disease Control), 17 percent of all U.S. children and adolescents (ages 2 to 19) are overweight or obese. That's more than 12 million children and teens. The statistics for adults are far worse. The NCHS estimates that 66 percent of adults 20 and older--fully two-thirds of the U.S. adult population--are overweight or obese.

"By any measure, no matter what you call it, the problem of obesity has tripled over the last 20 years. It's almost quintupled in the 6 to 11 age group," Kolbe says. "So we have an enormous problem."

Does This Culture Make Me Look Fat?

A friendly, soft-spoken man given to dressing in crisply pressed suits, Kolbe considers himself an optimist. So when he calls overweight and obesity a "pandemic" that is "one of the most serious problems our nation has ever faced," he really means it.

And Kolbe should know. A founding director of the Division of Adolescent and School Health at the Centers for Disease Control and author or co-author of numerous national and international reports on obesity, Kolbe has spent nearly three decades working on the issues of obesity and children's health in various government and academic settings. Over those 30 years, he says, huge cultural changes have upended the balance between calories in and calories out, resulting in rampant weight gain. He ticks off a list:

"On the input side, we have more foods. Cheaper food. More widely available food (you can get Slim Jims at any gas station these days). Better-tasting food. More intensely marketed food. More calorie-dense food. More family meals in restaurants. More super-sized food.

"And on the output side," he continues, "we have fewer occupations that require physical labor. Fewer opportunities to walk or ride bikes for transportation. Markedly fewer opportunities for physical activity in our schools. Fewer adults participating in physical activity as a form of recreation or social activity."

Couple these changes with an increase in sedentary behaviors (TV-watching and computer use), and you have a severe impact on human health. The sharp rise in the incidence of Type 2 diabetes is frequently noted as a negative consequence of widespread overweight, but Kolbe identifies multiple diseases directly associated with excess fat tissue including heart disease, stroke, diabetes, asthma, arthritis, sleep apnea, and several cancers.

The repercussions of excess weight for personal and public health are grim indeed, but there is an equally urgent problem: the effects on our economy. At present, according to Kolbe, the United States spends around $2 trillion per year on health care, which is about 16 percent of our national Gross Domestic Product. "When you consider that other nations are spending 6 or 9 percent, we're not going to be able to compete," he says.

"Many people think that if they're not overweight, they're not 'paying the freight,'" he continues. "But they are. They're paying for it in increases in the costs of goods and services, increases in taxes to pay for Medicaid and Medicare, increased health insurance rates, and more. It's an enormous burden that has all the potential to break the economy of the United States. It's that serious."

'It Requires Action'

Kolbe spends a lot of time considering the economic impact of obesity because, "the metrics that legislators understand are economics, as in dollars," he says. And Kolbe believes that given enough time and fiscal support, legislative policies can have powerful positive effects on public health. "Many people characterize obesity as an individual's problem, and certainly, individuals are responsible," Kolbe says, "but policies can also protect people [e.g., prohibit certain food ads to young children] and provide for their well-being."

The state of Indiana, for example, is implementing an obesity prevention plan that Kolbe helped create in 2005. It's a complex systems plan, linking numerous groups including schools; faith-based organizations; and the state's Departments of Health, Education, and Agriculture in comprehensive obesity prevention efforts. The Hoosier state is fortunate to have an administration that is paying attention to public health, Kolbe says, but the stakes are high. He notes that the percentage of overweight/obese Indiana adults increased from 46 percent in 1990 to 62 percent in 2004, and the percentage of Indiana high school students who are obese increased by 30 percent between 2003 and 2005.

It's far too soon to tell if Indiana's obesity prevention policies and programs are having an impact, and in any case, Kolbe takes the long view. "We don't expect to know if we have been effective for at least a decade," he says. "It took us three decades to get to this place, and it will take years to increase the population's caloric output and decrease caloric consumption. We don't have a silver bullet."

Which is precisely the problem. Change is hard, and humans crave the quick fix. The influence of overweight peers, a culture that simultaneously obsesses over fast food and weight loss, and alluring advertising encouraging overconsumption make change even harder. "Many people feel, what's the use, we can't do anything about it," says Kolbe. "That attitude is pervasive."

But he insists there is hope. He points to the example of China, a country in which he has worked for nearly 25 years. "China has a triple problem--obesity, underweight, and overweight but undernourished, meaning in the rural areas, people, especially children, are overweight but do not get enough protein-calories or micronutrients." Kolbe currently is working with China to implement requirements for daily physical education--a straightforward act that Kolbe calls "extraordinary" in its power to effect change.

"The data are wondrously clear, as clear as they can be, that school physical education programs work," he says, because they "require action." A former (now part-time) surfer nearing 60, Kolbe says that "action--rather doing something that omits physical action such as trying to change dietary habits--can moderate appetite and influence the entire biological/biophysical system to make it easier to lose weight."

For the Children

But is there anything that will really make the majority of Americans move more and eat less?

Kolbe says there is--our kids. If we want our country's children to have a longer, healthier future free of the physical, psychological, and economic burdens of obesity/overweight, it's up to the adults who surround them. He offers a personal example: "When I was 10, my dad smoked two packs of Lucky Strike cigarettes a day. But he stopped smoking because he did not want me to start. I have no doubt that if he had continued, I would likely have become a smoker.

"In this nation, tobacco use has come down dramatically among adults," he continues. "I have hope that we could do the same thing with obesity. To me, the hope is in saying to adults, 'If you're not going to reduce your own weight, then focus on kids.' We can assure the conditions in which people can be healthy. It's our children whose lives are being affected."

If we do not . . . well, the possibilities make even the optimistic Kolbe falter. "The obesity epidemic was predicted to begin leveling off in 2000, but it has only climbed since then," he says. "There are about 6.6 billion people around this globe, and one third of them--a third of the world's population--is overweight or obese. We have no idea what the real implications of that are, but we know they are serious, and probably more serious than we anticipate."

Lauren J. Bryant is editor of Research & Creative Activity magazine.

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