The Tipping Point in America's Obesity Epidemic

Earlier this month, we released the seventh annual edition of our F as in Fat: How Obesity Threatens America’s Future 2011 in partnership with the Robert Wood Johnson Foundation.

This year, we look back at the increase of obesity in the United States over the past two decades.

  • Twenty years ago, no state had an obesity rate above 15 percent. Fifteen years ago, Mississippi had the highest obesity rate, at 19.4 percent, which is lower than the lowest ranking state today (Colorado at 19.8 percent).
  • Over the past 15 years, seven states have doubled their rate of obesity. Another 10 states nearly doubled their obesity rate, with increases of at least 90 percent. And 22 more states saw obesity rates increase by at least 80 percent.
  • Ten years ago, no state had an obesity rate above 24 percent, and now 43 states have higher obesity rates than the state that was the highest in 2000.

We found a clear tipping point in our national weight gain over the last 20 years – and it’s had serious ramifications for our health and health care spending.

Obesity puts people at increased risk for more than 30 major diseases. Over the past 15-20 years, rates for many of these diseases have grown dramatically. For instance, type 2 diabetes and hypertension rates have grown dramatically. Over the past 15 years, type 2 diabetes rates have doubled in eight states. In 1995, 28 states had type 2 diabetes rates below 5 percent, by 2010, nine states had type 2 diabetes rates above 10 percent and only two states had rates below 6 percent. In 1995, just four states had hypertension rates above 25 percent. Fifteen years later, 45 states had rates above 25 percent, and rates exceeded 30 in nine states.

Obesity is hurting more than just our health, it’s hitting us in the pocketbook. Obesity-related health care costs total around $147 billion annually, roughly 10 percent of health care spending. And it’s hurting our productivity. Obesity-related job absenteeism costs about $4.3 annually, lower productivity accounts for approximately $506 per obese worker per year, and as a person’s BMI increases, so do his or her sick days, medical claims, and health care costs.

Obviously, over the past two decades, trends in eating and physical activity have changed in America. We’re eating less nutritious foods and more of them. Americans eat, on average, 300 more calories a day than in 1985 and 600 more than in 1970. We’re eating bigger portions, more dietary fat and sugar.  We eat out and prepared food much more. And, we’re not as active. We spend more time in cars and commuting, and in front TVs, computers, and other media.

Many neighborhoods don’t have sidewalks or safe places to be active like parks and recreation centers. Some don’t have grocery or corner stores that sell healthy affordable foods. These factors make it harder for people to make healthy choices. As a result, obesity and overweight rates have climbed.

Ten years ago, then Surgeon General David Satcher started ringing the alarm bells. He issued a groundbreaking national call to action about the growing obesity crisis. He noticed what most of the country had yet to recognize. In a retrospective commentary in our F as in Fat report, he advised that “the obesity crisis would not be solved by treating it as a personal failing on the part of those who weigh too much…. We must realize that our predicament cannot be solved through individual action alone. Both the public and private sector must pitch in to ensure that we live in a society where gaining weight becomes more difficult and maintaining a healthy weight becomes easier.”

Simply put, if we’re going to reverse the obesity trends, willpower alone won’t do it. We’re going to have to make healthier choices easier for Americans – giving all of us more opportunities and options.

Our report tracks not only obesity trends, but also policy efforts focused on helping make it easier to improve nutrition and increase physical activity in our daily lives. We’ve found a lot of momentum around the country:

  • Twenty states and Washington, D.C. now have school meal standards that are stricter the U.S. Department of Agriculture requirements. Seven years ago, only four states had stricter requirements.
  • Twenty-nine states and Washington, D.C. limit when and where competitive foods (foods sold in vending machines and outside of the formal meal programs) may be sold beyond federal requirements.
  • Every state has some physical education requirements for students. However, these requirements are often limited or not enforced, and many programs are inadequate.
  • Twenty-one states now have legislation that requires Body Mass Index (BMI) screening or weight-related assessments other than BMI for children and adolescents. Seven years ago, only four states required BMI screening or other weight-related assessments.
  • Twenty-six states and Washington, D.C. have now established farm-to-school programs. Five years ago, only New York had a law establishing a farm-to-school program.
  • Sixteen states now have Complete Streets laws. “Complete streets” are roads designed to allow all users – bicyclists, pedestrians, drivers, and public transit users – to access them safely. Seven years ago only five states had these laws.
  • The Patient Protection and Affordable Care Act authorizes new resources and strategic planning initiatives aimed at reducing obesity and increasing opportunities for physical activity and improved nutrition, including the Prevention Fund, the National Prevention Strategy, Community Transformation Grants, greater coverage for preventive services, a Childhood Obesity Demonstration Project, and strategic new approaches through the Center for Medicare and Medicaid Innovation.
  • The Healthy, Hunger-Free Kids Act, the Agriculture Appropriations Act, and the Healthy Food Financing Initiative all also include a number of important nutrition and obesity-related provisions.

However, we also have found the difficult economic climate has created new obstacles, particularly major cuts to federal, state, and local governments. Last year, 33 states reduced funding for public health, approximately 15 percent of local public health jobs have been cut and major cuts are proposed to the U.S. Centers for Disease Control and Prevention’s core budget. These cuts put obesity prevention programs and implementation of policies in jeopardy.

If we’re going to start tipping the scales in favor of better health, as governments at all levels are facing hard budget decisions, it is critical to think about the other side of the ledger. Cuts to obesity programs today mean higher health costs and a less healthy workforce down the road.

Investing in preventing and reducing obesity is one of the most common-sense ways we can start to bend the cost-curve on health spending, improve the productivity of the American workforce and speed the economic recovery.

We cannot afford to ignore the impact that obesity has had on our health and corresponding health care spending. We cannot afford to continue to kick the health and financial costs down the road. The stakes are too high.


“Opinions”  blog postings are intended to allow non-Altarum Institute authors to pose their own opinions and policy positions in the realm of health care and health policy. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions.



Good information. But when you say clear “tipping point” I expect you to describe how and why increasing obesity correlates to a small number of relevant policy decisions at the national or state level. Are there a set of policy decisions that obesity is the unintended consequence?

Thousands of studies have shown and proven without any doubt that losing body fat will improve and lengthen your life. Knowing the dangers of being overweight is a tremendous motivator to not only lose fat, but to keep it off.

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