Little exercise, little fresh food. Now the US government is forced to act on obesity

krsna · June 5, 2005

Special unit sent into West Virginia as weight-related health problems soar

Julian Borger in Washington

Saturday June 4, 2005

Guardian

West Virginia is used to indignity. Its Appalachian hills are a byword for poverty and its people derided as hillbillies.

Now insult has been added to injury in what will be seen as an unwelcome first in the history of the United States.

A team of federal "disease detectives", normally sent to combat outbreaks of infectious bugs, has been dispatched to the state to chart its frightening obesity epidemic. Epidemiologists from the Centres for Disease Control (CDC) have never before been deployed in this fashion, and it reflects the growing anxiety about the threat obesity poses to the health of the nation as a whole.

Over two-thirds of American adults are overweight and 30% are obese, as are 15% of the country's children. The incidence of diabetes and high blood pressure is widespread and rising.

The figures for West Virginia are even worse. A quarter of the state's children are obese. There are no available clinical statistics for the state population as a whole. On the basis of what West Virginians told researchers about 27% are obese (with a body mass index of over 30), but the actual figure is thought to be nearer 35%. The prevalence of obesity has nearly doubled since 1990.

The result is that 10% of the population suffer from diabetes, 33% have high blood pressure and 28% report doing no physical activity over the course of a month.

"We are the highest in the country for several things. For hypertension we're number one, we're number four for diabetes and three for obesity," said John Law, a spokesman for the West Virginia department of health and human services. "We determined we have a lot of people dying and we have a lot of health costs as a result of obesity, so we wanted the CDC to come in and look at this as they might look at an infectious disease."

The health "Swat" team has just spent three weeks taking their clipboards and scales around West Virginian schools, offices and restaurants in an attempt to understand why so many of the state's people, particularly its children, are getting so fat so very fast.

The disease detectives looked to see if there were any pavements along the roads for pedestrians, whether employees were encouraged to take any exercise, and whether bottled water was on offer alongside the sweet fizzy drinks in automatic dispensers in schools. People were asked whether they "were offered at least one or two appealing fruits and vegetables every day," and "would you replace regular sour cream with low-fat sour cream?"

"This is a team of public health professionals from CDC that are dispatched for West Nile virus and for meningitis. But this is the first time we've dispatched a team of disease detectives around the problem of obesity and it was a recognition in one of our states that their obesity problem was very large," said Donna Stroup, a CDC doctor in charge of health promotion.

However, the CDC's director Julie Gerberding, insisted that the inquiry had not been imposed on West Virginia, the butt of so many jokes through the ages.

"CDC doesn't send people into the states. We get invited, and we are just delighted that the health officials in West Virginia appropriately recognised that they had a serious problem with obesity in their state, and they really wanted to do more than just describe it," Dr Gerberding said.

The CDC produced an obesity map of America, confirming that the problem was worst between the coasts. That would not come as a surprise to anyone who has travelled through the American "heartland" where most restaurants are fast-food outlets, and fresh fruit and vegetables can sometimes be hard to find.

The figures also make clear that there is still a strong link between obesity and poverty, despite a recent study suggesting wealthy Americans are catching up fast. The three most obese states - Alabama, Mississippi and West Virginia - are also the poorest.

West Virginia is third from bottom of the league when it comes to child poverty, with 27% of its children living below the bread line. It has the highest death rate in the nation, is second among 50 states for cancer deaths, and second for smoking. High unemployment and heavy reliance on coal mining are undoubtedly other factors behind the low life expectancy.

The deployment of the medical version of a Swat team has helped dramatise the scale of the crisis, but some health statisticians were sceptical over whether the results of the West Virginia survey would teach the world anything new about obesity and its dangers.

"You're not going to find anything we don't already know. We'll find out that there aren't any sidewalks and there is lousy food in schools," said Daniel McGee, a statistician at Florida State University. "I don't think much will come of it. There is no comparison group, from somewhere where there are sidewalks and good food, maybe because they couldn't find one."

CDC spokesman Llelwyn Grant denied that the survey was a waste of federal money and time. "This is not about discovering the obvious," he said. "It is not about finding out why people are fat, but it will be used to guide the state's future planning in helping the community towards good health and nutrition."

Faced with dramatically rising rates of "adult-onset" diabetes and other obesity-related diseases among young West Virginians, the state's Public Employees Insurance Agency has taken unorthodox measures, using video games in an attempt to get sedentary children moving.

Eighty-five West Virginian children have been recruited for a study in the impact of a Japanese game called Dance Dance Revolution, which involves dancing on a metal mat in time to on-screen directions.

Initial results suggest the game could be effective for some children, but health experts argue that only a fundamental change in diet and lifestyle is likely to make a serious impact on the fat epidemic in West Virginia.

A growing epidemic

· Obesity is rising throughout the world and affects at least 300 million people.

· In the US the percentage of young overweight people has more than tripled since 1980. Some 16% of children and teens are considered overweight with childhood obesity growing at the rate of 20% a year. Some 30% of adults, more than 60 million people, are obese - one in three women and more than one in four men

· In the UK, two-thirds of adults are overweight. Of these, 22% of men and 23% of women are obese (at least 13kg-19kg overweight), putting their health at risk. The level of obesity has tripled in the past 20 years

· Obesity is rising among British children. In the past 10 years it has doubled in six-year-olds (to 8.5%) and trebled among 15-year-olds (to 15%)

· Obesity is responsible for $100bn (£55bn) in medical costs and 300,000 deaths annually, according to the American Obesity Association

· Throughout the 1990s, the average weight of Americans increased by 4.5kg (10lb). The extra weight meant airlines burnt 350m more gallons of fuel in 2000, costing an extra £157m.

· In 2004 24 states took steps toward phasing out soda and junk food in schools, following 20 states that already had such bans

· Americans eat 200 calories more food energy per day than they did 10 years ago. On any given day, 30% of American children aged four to 19 eat fast food. Overall, 7% of the US population visits McDonald's each day, and 20%-25% eat in some kind of fast-food restaurant