I wrote about these insights, first for a local magazine, then in my column in USA Today, where I write about the politics of health. I then moved on to other topics. As is the case with most subject matter, fatness had remained, at least for me, somewhat abstract, distant — intellectual rather than emotional. It was certainly nothing one could view as a matter of national urgency.
Then, two things happened which would change that. For one, I met a man named James O. Hill. Hill is a physiologist at the University of Colorado’s Health Sciences Center. Curly-haired, a bit provocative, Hill is a vigorous, intellectually engaged fellow with an agile debating style and a wide-ranging presence in his field. Hill’s field is the study of obesity, everything from its epidemiology to its causes to its treatment. It was Hill who, only a few years ago, coined what may be the single most quoted line in regard to today’s soaring obesity rates. "If obesity is left unchecked," he told the Associated Press, "almost all Americans will be overweight by 2050." Becoming obese, he went on, "is a normal response to the American environment." With a presence on all of the leading public health committees charged with doing something about the nation’s expanding waistline, Hill is the dean of obesity studies. It was my fortune to meet him at just the right time.
Hill spelled out the problem more clearly than anyone else. "See, for decades, most of us believed that the rate of overweight in this country was relatively static — somewhere around 25 percent of the population would be always overweight," he recalled one day. "But then, beginning in the late eighties, we started seeing that rate spike upward, 30, 35, 40 percent. And that started freaking a lot of us out. Where were the gains coming from? We know that obesity has a strong genetic component, but twenty years — anyone knows that is a laughingly small amount of time for genetics to change so much. So for the guys like myself, the question has become, basically, what has changed in the environment to allow the inclination toward overweight and obesity to express itself? What changed around us to allow us to get so big?"
Big, of course, is putting it mildly. Today Americans are the fattest people on the face of the earth (save for the inhabitants of a few South Seas islands). About 61 percent of Americans are overweight — overweight enough to begin experiencing health problems as a direct result of that weight. About 20 percent of us are obese — so fat that our lives will likely be cut short by excess fat. More than 5 million Americans now meet the definition of morbid obesity; they are so obese that they qualify for a radical surgical technique known as gastroplasty, wherein the stomach is surgically altered so as to keep food from being digested. (The American Bariatric Society, whose members perform gastroplasty, reports that its waiting lists are months long and that its surgeons "can’t keep up.") Children are most at risk from obesity. About 25 percent of all Americans under age nineteen are overweight or obese, a figure that, Hill points out, has doubled in thirty years. That one figure recently moved U.S. Surgeon General Dr. David Satcher to declare obesity to be a national epidemic. "Today," he told a group of federal bureaucrats and health policy officers, "we see a nation of young people seriously at risk of starting out obese and dooming themselves to the difficult task of overcoming a tough illness."
Obesity itself is slowly moving into the middle and upper classes, but the condition disproportionately plagues the poor and the working poor. Mexican American women aged 20 to 74, for example, have an obesity rate about 13 percent higher for those living below the poverty line versus those above the poverty line. Diabetes occurs at a rate of 16 to 26 percent in both Hispanic and black Americans aged 45 to 74, compared to 12 percent in non-Hispanic whites of the same age.
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