The Sage Colleges

Combating the Obesity Epidemic in America

Brittany M. Clark
Weight Management NTR 562
Dr. Sonya Hauser
Weight Management Evidence-Based Summary

Combating the Obesity Epidemic in America

If you go with the flow in America today, you will end up overweight or obese as twothirds of Americans do, said John Shonkoff.1 There is a complex public health problem in
America right now and change needs to happen fast or two-thirds will become 95%. Throughout
the semester we reviewed problems and solutions in regards to the obesity epidemic. I will use
what Ive learned to summarize and discuss the causes of obesity, the obesity etiology equation
(nature vs. nurture), and recommend treatment strategies. It is my hope that through educating
and policy we can combat the obesity epidemic and improve the health of the nation.
Obesity is a complex disease with many contributing factors. For the purpose of this
paper I would like to discuss only a few prominent environmental causes, the first being our
lackadaisical attitudes as Americans. It is no secret that this country is blessed with many
resources, however it has led us to over-rely on technology. As the obesity rate rises, we can also
see a rise in the use of devices such as escalators, automatic doors, electric toothbrushes, and
even pre-sliced fruits and vegetables. While these may not be directly linked to obesity, it is in
the larger picture that we see technology is causing us to cut corners in our everyday lives.
Whether it is saving effort by driving rather than walking or using a leaf-blower rather than a
rake, work is no longer work, play is no longer physical, and labor saving devices are
everywhere.2 Its safe to say that physical activity is not on the minds of many people because,
30% of Americans participate in no physical activity.2 This is a high percentage of people who
are not meeting the recommended 2.5 hours per week of moderate exercise or 1.25 hours per
week of vigorous activity.3
Along with lack of movement, there is a large discrepancy and lack of understanding
among the general public about what is healthy and what is not when it comes to topics like high

fructose corn syrup, diets, fat, etc. By 1980 The U.S. Department of Agriculture issued its
first dietary guidelines, and one of the primary directives was to avoid cholesterol and fat of all
sorts.4 However when it came to the results almost 25 years later, researchers suggested that its
the overconsumption of carbohydrates, sugar and sweeteners that is chiefly responsible for the
epidemics of obesity and Type 2 diabetes.4 This has led the general public to be confused and
discouraged about what should and shouldnt be consumed.
As many would agree, another large part in the obesity epidemic is sugar-sweetened
beverages. According to Erica Houghton and Madisyn Becker there have been many studies
done to prove the effects that sugar sweetened beverages can have on animals and humans. In
one study mice were fed either solid or liquid forms of fructose and/or sucrose for a
predetermined period of time and it was concluded that liquid high sugar diets might be a critical
component of obesity and fatty liver disease. This provides support to the theory that liquid vs.
solid high sugar diets modify intestinal sugar transporters and weight regulating hormones.5 Not
only are sugar-sweetened beverages high in calories and sugar, but its cheap and easy to
consume, Government policies have made corn cheap; cheap corn became cheap HFCS;
Americans now ingest HFCS in unprecedented quantities from their super-sized sodas to their
sweet snacks.6
Another factor that plays a large part in the increase in weight among Americans is
messaging. We are constantly being bombarded with food advertising.7 Large companies use
advertisements as a way of convincing us their product is good and that we should buy it. This is
an example of the cognitive distortion tactic, filtering. The companies magnify one detail, while
ignoring others (e.g. in childrens cereal they focus on the fiber, while ignoring how much sugar
is in it). Food advertisements have played a large role in shaping eating habits in children, The
worst foods are the ones that get marketed most aggressively, especially in children. Kids

develop brand loyalty very early in life.1 Not only are advertisements leading us towards eating
these unhealthy foods but they are leaving us with a distorted view of what/how we should eat.
As one can see, all of the examples I have listed above are environmental factors in the
cause of obesity. These represent the nurture side of the obesity etiology equation (things we
have conscious control over). In my opinion, the environment one grows up in plays a huge role
in a persons weight.
On the other side of the obesity etiology equation is nature (genetics and physiological
factors). A lot of people believe that obesity is passed down from generation to generation
because it ranks among the most heritable of genetic traits >.70,8 however it could be said that
being raised in the same overweight environment as your family affects weight more. There are a
few genetic disorders that cause obesity. One in particular is a gene mutation that causes a lack of
leptin in the brain, which is passed down through family members. According to Jeffery
Freidman, about 1 in 1000 people carry the disorder, which affects the ability to know when to
stop eating.9 When it comes to genetics we are programmed to consume as many calories as we
can when we have the opportunity because that is how we evolved, and in general its the
populations who have retained that hunter-gatherer lifestyle for longest, and then were exposed
to modern food environments, who have become the fattest.8 As strong as these genetic factors
are, I believe our environment plays a larger role in the upward trend of weight gain.
At the end of the day, no matter what the statistics, causes, or opinions, there is a large
problem and we need to solve it. There are several treatment options that have been experienced
small-scale success such as behavior changes, drugs, & surgery. I believe behavior change is the
most important treatment option for obesity, however it is challenging and most people dont
stick around to see the results. We all know diet and exercise can have a huge effect on health
and weight status if they are being done correctly. The mean weight loss for diet alone is 5-10.7
kg and the mean loss for diet plus physical activity is an additional 1.5 kg.4 However, getting a

person to change their lifestyle is challenging. Most people dont gain weight because they
dont know the things they need to do, they gain weight because they dont do them.10 In order
to help effectively change lifestyles we create models such as the health belief model and the
stages of change model to set goals, monitor behaviors, change antecedents, and provide
consequences/reinforces.10 These are popular and helpful ways of counseling a patient in hopes
of getting them to reach their goal of a healthier lifestyle.
Along with changing behavior there are other ways to lose weight: drugs and surgery.
Drugs, such as Qsymia and Contrave, work by releasing norepinephrine, which increases leptin
levels and in turn decreases appetite. Orlistat, another drug, works by blocking fat absorption in
the GI tract. It has been proven that Orlistat can induce significant weight loss if used with diet
and exercise therapy and has been shown to produce greater weight loss coupled with diet than
diet produces alone.11 In terms of weight-loss surgery the most common are Roux-en-Y, which
drastically reduces the size of the stomach and changes endocrine markers (lepin & ghrelin) and
gastric banding which is less invasive and also reduces the size of the stomach. Gastric bypass is
the most effective surgery in terms of losing weight and keeping it off.12
There are so many factors that influence obesity in America that it is hard to choose one
thing that needs to change. In order to reverse the obesity epidemic something drastic needs to
happen, and as we learned this semester, policy is much more effective than education has
proven to be. My two-part prevention/treatment idea starts with the regulation of unhealthy food
advertisements. Today the typical 8-12 year old sees about 19 ads for unhealthy foods and about
two for healthy foods.13 It is proven that humans are easily influenced by environmental
exposures and we respond to carefully crafted advertisement in particular.7 If we implemented a
policy that said for every unhealthy food advertisement there needed to be an ad for healthier
foods, we may see an increase in consumption of fruits and vegetables. Although it would cause
a lot of controversy and uproar part two of my idea is to implement a policy regulating

government spending on subsidies, like corn, which is used for high fructose corn syrup and
invest that money in produce farmers. There have been plenty of successful policy changes such
as Bloombergs large soda ban in NYC and the taxing of cigarettes.14 I truly believe that if fresh
fruits and vegetables were as readily available and as cheap as processed food is, people would
be more likely to consume them. If we, as health professionals, work together with the
government to promote the consumption of fresh produce and create advertisements that make
healthy living look good, we can reduce the obesity rates in America and lower health care costs
nationwide.
Obesity is a growing problem in America, being caused by factors such as technology,
confusion, sugar-sweetened beverages, and advertising. However we have all of the resources we
need to stop this epidemic. We can combat the human nature of eating to survive by behavioral
approach tactics, physical activity, surgery if need be, and policy. However in the end, the most
important behavior to change in this epidemic is participation,1 and we need everyone to work
together.

References
1. HBO: The Weight of the Nation, Four Films. http://theweightofthenation.hbo.com/.
Accessed September 2014.
2. Hauser S. The Role of Physical Activity in Weight Management 1: Recommendations vs.
Practice. http://moodle.sage.edu/pluginfile.php/84104/mod_resource/content/1/PA
%201.mp4. Accessed October 23, 3014.
3. Hauser S. The Role of Physical Activity in Weight Management 4: Where to Start?
http://moodle.sage.edu/pluginfile.php/84966/mod_resource/content/1/PA%204.mp4.
Accessed October 23, 2014.
4. Walsh B. Ending the War on Fat. June 12, 2014.
http://moodle.sage.edu/pluginfile.php/74200/mod_resource/content/1/Ending%20the
%20War%20on%20Fat%20-Time%20Magazine%202014.pdf. Accessed October 2,
2014.
5. Becker M, Houghton E. Shifts in Sugar Sweetened Beverages Related to Obesity.
http://moodle.sage.edu/pluginfile.php/71117/mod_resource/content/1/SSB%20Part
%201%20MB%20EH.mp4. Accessed September 25, 2014.
6. Harvie A, Wise T. Sweetening the Pot: Implicit Subsidies to Corn Sweeteners and the
U.S, Obesity Epidemic. February 2009.
http://moodle.sage.edu/pluginfile.php/90573/mod_resource/content/1/PB0901SweeteningPotFeb09.pdf. Accessed November 20, 2014.
7. Hauser S. Cognitive Distortions in Dieting.
http://moodle.sage.edu/pluginfile.php/71162/mod_resource/content/1/cognitive
%20distortions.mp4. Accessed September 23, 2014.
8. Hauser S. Energy Balance & the Etiology of Overweight & Obesity.
http://moodle.sage.edu/pluginfile.php/67411/mod_resource/content/1/Week
%202%20Lecture%201.mp4. Accessed September 11, 2014.
9. PBS: NOVA. Obesity. http://www.pbs.org/wgbh/nova/body/obesity.html. Published
September 3, 2006. Accessed September 18, 2014.
10. Hauser S. Behavioral Approaches: Theory & Practice, Behavioral Interventions for
Overweight & Obesity.
http://moodle.sage.edu/pluginfile.php/76934/mod_resource/content/1/Behavioral
%201.mp4. Accessed October 16, 2014.

11. Hauser S. Drugs and Surgery in Weight Management: FDA-Approved Weight Loss
Drugs, Part II.
http://moodle.sage.edu/pluginfile.php/87120/mod_resource/content/1/drugs%202.mp4.
Accessed November 6, 2014.
12. Hauser S. Drugs and Surgery in Weight Management: Bariatric Surgery, Part III.
http://moodle.sage.edu/pluginfile.php/87861/mod_resource/content/1/surgery1.mp4.
Accessed November 6, 2014.
13. Hauser S. What Needs to Change to Reverse the Obesity Epidemic: Part III.
http://moodle.sage.edu/pluginfile.php/90582/mod_resource/content/1/policy%203.mp4.
Accessed November 20, 2014.
14. Hauser S. What Needs to Change to Reverse the Obesity Epidemic: Part IV.
http://moodle.sage.edu/pluginfile.php/90587/mod_resource/content/1/policy%204.mp4.
Accessed November 20, 2014.