Obesity (1) is considered a chronic, metabolic disease caused by multiple and complex inherited and acquired factors, including excessive calorie intake, decreased physical activity, and genetic influences. Obesity affects at least 39 million Americans, including more than one-quarter of all adults and about one out of five children. The number of obese Americans has consistently increased in the United States since 1960. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity is a strategy to combat obesity and seeks to engage public health leaders in addressing this growing epidemic.

Certain population groups are more at-risk for obesity including children, African-Americans, Latinos and low-income individuals. The impact of obesity on mortality and morbidity are substantial. Research reveals that the morbidity from obesity can be as great as from poverty, smoking or problem drinking. Obesity increases one’s risk of developing life-threatening health conditions such as high blood pressure, diabetes, heart disease, stroke, gall bladder disease and cancer of the breast, prostate and colon. The adverse health effects of obesity have created enormous added direct and indirect health care costs. In 2000, the total cost of obesity was estimated to be over $1 billion (U.S. Department of Health and Human Services).

In Southeastern Pennsylvania, more than one out of five (22.6%) adults 18 years of age and older are considered obese; this percentage represents 640,100 adults. The percentage of obese adults in Southeastern Pennsylvania is higher than the Healthy People 2010 objective of no more than 15% of adults considered obese. In addition, almost four out of ten (38.2%) children in the region are considered at-risk for obesity (2), representing 296,500 children in the region. Although obesity is prevalent in all population groups, some population groups are more likely to be obese than are others. In recognition of this year's theme for Public Health Week (April 7-13, 2003), "Overweight and Obesity", the following data from PHMC's 2002 Southeastern Pennsylvania Household Health Survey examines obesity among adults and children in the region.

• Adults ages 40-59 are more likely to be obese (26%) compared to adults 60 years of age and older (24.7%) and adults ages 18-39 (18%). Young children (ages 10 or younger) are twice as likely to be at-risk for obesity (50.2%) compared to older children ages 11-17 years of age (26%).
• Black adults in Southeastern Pennsylvania are more likely to be obese (36.3%) compared to white adults (19.5%). This pattern is similar for children in the region (48.5% and 33.4%, respectively).
• One quarter of Latino adults are obese (25.6%) compared to 22.5% of non-Latino adults. Similarly, more than four out of ten Latino children are at-risk for obesity compared to non-Latino children (45.9% and 37.8%, respectively).
• Women in Southeastern Pennsylvania are slightly more likely to be obese (23%) compared to men (22.1%). Among children, boys are more likely to be obese (42.3%) compared to girls (33.9%).
• Poor adults are more likely to be obese (33.3%) compared to non-poor adults (21.3%).

Obesity is a known risk factor for numerous chronic and life-threatening health conditions such as high blood pressure, heart disease, diabetes, and certain types of cancer. Findings from the survey show that obese adults are more likely to have chronic health conditions compared to adults of normal weight. In Southeastern Pennsylvania more than one-third (38.1%) of obese adults have a chronic health condition; this percentage represents 242,900 adults. Among children, 16.8% of obese children have a chronic health condition, representing 49,900 children.

• More than two out of five adults who are obese have high blood pressure (46.5%); this represents 297,500 Southeastern Pennsylvania adults. One-third of obese adults have high cholesterol (33.4% or 212,700 persons).
• Obese adults are twice as likely to have a heart condition (12.5%) compared to adults who are of normal weight (6.9%).
• Obese adults are five times as likely to be diabetic (16.3%) compared to adults who are of normal weight (3.2%).
• Adults who are obese are twice as likely to have asthma (13.3%) compared to adults who are of normal weight (7.2%). Twelve percent of obese children have asthma (12.5%) compared to one in ten non-obese children (10.8%).

Research has shown that healthful dietary habits, such as decreasing fat intake and increasing consumption of fruits and vegetables, combined with decreased sedentary behavior and increased physical activity help to achieve and maintain a normal body weight. Weight loss has been shown to decrease the many health risks associated with obesity.

• Despite that physical activity is believed to be a key factor in weight loss and its maintenance, only one-quarter (23.7%) of obese adults exercise the minimum recommendation of three or more days a week. Among children at-risk for obesity, nearly 5% do not exercise at all in a given week and one out of five (20.3%) exercise only one to three times per week.
• More than half of obese adults have talked to their doctor about the benefits of exercise (51.8%) and nutrition (55.7%). Among children at-risk for obesity, less than one in five (18.4%) have been advised by a doctor or health care professional to lose weight.

These findings indicate that a large proportion of adults and children in Southeastern Pennsylvania are obese. Obesity is a major public health concern due to the health risks associated with it, such as higher rates of chronic conditions and life-threatening diseases. Through increased physical activity and a more healthful diet, those who are obese can achieve and maintain a more normal weight and, in turn, decrease the health risks associated with obesity. The findings underscore the need to educate the public about obesity and its role in causing illness and unnecessary deaths. It is critical that health providers encourage efforts to prevent obesity, especially among children. Also, insurers and third-party payers could ultimately reduce costs by providing adequate coverage for obesity treatment and prevention. For more information on obesity in Southeastern Pennsylvania, please contact Francine Axler, Senior Research Associate, at francine@phmc.org.

Notes:

(1) Individuals are considered obese if they have a Body Mass Index (BMI) of 30 or greater. BMI is calculated using the following formula: (weight/2.205)/(total height in inches)^2.

(2) Obesity for children is calculated by examing height and weight and using the following equation: (weight/2.205)/(total height in inches)^2*0.00064516. BMI percentile is calculated based on the child’s BMI level and age, as defined by the Center’s for Disease Control and Prevention (CDC). A percentage of 85 or higher is considered at-risk for obesity.