Obesity: The Gateway Condition

By: Joe Miller
September 2011

The number of people in the United States that are overweight and obese increases every year.  One study conducted by a national wellness provider suggests that even with awareness of their health status, the average person will gain just under two pounds every year. Consider before-and-after pictures of people that have been in the workplace for the past 20 years.

While the numbers get more and more discouraging every year, it appears the general opinion of the obesity epidemic in this country is similar to the opinion of freeway speeding: almost everyone does it and no one seems to care until it directly impacts their life.

This is particularly hard to fathom since the consequence of speeding is a ticket, versus life-long ailments that can permanently degrade the quality of your life.

Can you really put things such as a stroke, heart disease or diabetes in the same compartment as a speeding ticket? Many people are ignoring the obesity issue, which affects more than two-thirds of the American population and is estimated to account for more than $147 billion in medical expenses each year.

The rise of obesity cannot be overstated, which is defined as body mass index (BMI) over 30. According to the Centers for Disease Control and Prevention:

  • In 1990, there was not a single state in the U.S. that had an obesity rate of more than 15 percent of their population.
  • In 2000, that number rose, but there was not a single state above a 25 percent rate of obesity.
  • In 2010, 12 states had obesity rates of more than 30 percent of their populations.
  • The national rate of obesity now stands at 33 percent. About one-third of U.S. adults are obese.

The reason that this issue is so neglected can be boiled down to a simple analysis of cause and effect.  Without immediate consequences for their actions, humans are not wired to trace the root cause of their situation over time and use that as motivation to change behavior.

Take a simpler case. Everyone knows that smoking is bad for you and can cause medical issues like cancer and COPD, or chronic obstructive pulmonary disease. Does this make people stop smoking? Not nearly at the rate that it should. If every time someone took a puff of a cigarette they had a 25 percent change of falling over and dying, do you think the immediate and visual consequence of this would make more people quit?

The obesity epidemic in the United States is misunderstood, and this is another reason for the inattention. Most people think obesity is something that affects only our vanity. No one ever says, “Oh boy, do I hope I don’t have to have a leg amputated because I developed type 2 diabetes due to my morbid obesity.”

What people don’t realize is that obesity should be looked at as a “gateway condition.” Just as people refer to gateway drugs leading to the use of more dangerous drugs, obesity is a precursor to several conditions which people do not realize are considerably more dangerous…Very few people in the United States have ever heard the term metabolic syndrome (MetS), let alone, do they know what it means, nor do they understand the diagnosis. This condition isn’t like cancer, where doctors identify a tumor that you have for diagnosis or like HIV, where there is a clear test to see if the virus is living in your system. MetS is a grey diagnosis. The diagnosis for MetS is when you have three out of five measurements out of range (glucose, HDL cholesterol, triglycerides, waist circumference, and blood pressure) at a given time.  It should be noted that in any given day, these numbers can change up or down and is therefore a hard condition to put your finger on…

Obesity is the gateway Metabolic Syndrome, and the rate of MetS nationally is only slightly lower than that of obesity, estimated around 25 percent.

What can be done about this terrible epidemic? There are two simple things that will draw out the issue and make it more palpable for the public to gravitate toward. In fact, these are not complex issues that deal with standard of care or major overhauls of the health system. These can be looked at as the “street smart” ways to make a difference on obesity and MetS rates.

The first technique to impact these two issues is to start thinking outside of the box and look at a new way to consider obesity. In a sense, it needs to be marketed to the masses in a way that is more intimidating and real. What if obesity were considered as stage 1 heart disease and MetS considered stage 2 heart disease? This approach would allow people to better identify the fact that they are on a path with serious consequences. Another way to look at it is the gruesome pictures that other countries require as a warning on cigarette packs.  If the consequence is more clearly identified along with the cause or issue, the subject may be more likely to change behavior. The medical field seems to have adopted this approach with single factors such as pre-diabetes and pre-hypertension. Let’s adopt the same approach with obesity.

Secondly, another message that is so simple to get across to the American public which can help drive home the issue of obesity is “Get off your butt!”  Most people intrinsically know this message, but a vast majority of people may not realize their true level of activity, may be in denial, or may be too overwhelmed to know how to work activity into their daily routine.

A recent sampling of an office environment that was studied showed that on average, employees had taken about 3,500 steps from the time they left their house to the end of business. Now, factor in the drive home, a few hours of television and a good night sleep.  Many people are not reaching 5,000 steps per day, let alone 10,000 or better yet, the 30 minutes of exercise that is recommended most days.

In a survey of more than 25,000 participants in a wellness program in 2010, 80 percent of respondents said they wanted to increase their level of activity and 73 percent said they wanted to lose weight.  Furthermore, when comparing the obese population from the year before, 9 percent of respondents had lost enough weight that they were no longer obese.  The problem was that 96 percent of this positive impact was completely offset by others becoming obese.  The issue for the U.S. healthcare system and the employers that pay for this, is like bailing water from a boat that is sitting under a waterfall.

Another recent study showed that participants with MetS that walked 10,000 steps per day were able to lose one entire risk (remember the definition is having three or more risks of the five) in a single four-month period. Companies can tackle obesity head on with simple gains in activity.  By offering contests or programs designed around walking, employers can engage their employees in an activity that is fun, make the employees feel like they are cared for and more part of a team, form work camaraderie and, as a result, lower their health care costs and increase productivity.