The poison apple shape of our times/Healthwise Inc.

Obese Americans now an overwhelming majority

If you’re a regular air traveler in Alaska or even just an occasional one, as most are, you might have noticed that the people occupying the seats next to you have been getting wider and wider over the years.

And, for better or worse, the latest data would indicate there’s a good chance you’ve grown a bit wider, too.

When researchers studying new methods for determining the extent of obesity in this country turned their attention to the waistlines of “14, 414 participants representing 237, 700,000 U.S. adults” last fall, they discovered that approximately three out of every four of us are now technically obese based on waist-to-height ratio or waist-to-hip ratio.

The percentage did drop to 58 percent when measured only by waist circumference, according to the doctors from the Beth Israel Deaconess Medical Center, and Yale and Harvard universities, who published their works on the Open Network of JAMA, formerly known as the Journal of the American Medical Association.

Across the board, however, the researchers reported that the newly suggested waist-to-height or waist-to-hip ratios, the suggested “anthropometric criteria” for measuring obesity, “resulted in a substantial increase in estimated obesity prevalence” over the long-used, body-mass-index (BMI) standard.

BMI has come under fire in recent years for both over-estimating and under-estimating obesity, arguably the nation’s biggest health problem.  In June 2023, the American Medical Association (AMA) advised doctors to quit relying solely on BMI as a health measure because of its inaccuracy.

An AMA statement on BMI pointed out “that a person with lots of muscle and minimal body fat can have the same BMI as a person with obesity who has much less muscle. BMI also varies, because average body fatness varies, among people of different ages and whether they are active or sedentary. That means it can be misleading in some cases. For instance, an athlete with much more muscle than fat can have a BMI in the overweight range.”

Criticism of the BMI standard has also increased in recent years amid medical discoveries that where people pack on body fat is as significant or more significant than the weight of that body fat.

Where’s the fat?

Metabolic syndrome, one of the country’s newer epidemics, typically occurs in people who “have apple-shaped bodies, meaning they have larger waists and carry a lot of weight around their abdomens,” is how the Mayo Clinic summarizes the latest research findings. “It’s thought that having a pear-shaped body – that is, carrying more of your weight around your hips and having a narrower waist – doesn’t increase your risk of diabetes, heart disease and other complications of metabolic syndrome.”

Early in the Covid-19 pandemic,  metabolic syndrome was linked to a huge increase in the risk of death after infection by the SARS-CoV-2 virus. The ailment is now so common it is often referred to simply by the acronym “MetS.”

Doctors from the Tulane University School of Medicine in 2021 reported finding that MetS patients suffering from Covid-19 patients, the disease caused by the newest coronavirus to threaten the health of the human species, had a more than four-and-a-half times greater risk of ending up in an intensive care unit than healthy patients, a nearly five times greater chance of needing to be put on a ventilator, and a nearly three-and-a-half times greater chance of dying in the hospital.

MetS has since been identified as a major, global health problem.

“In 2023, an estimated 1.54 billion adults had MetS globally: 846 million women and 692 million men,” researchers reported in Nature Communications last month. “Prevalence increased with age, urbanicity, and income level, ranging from 7.5 percent to 45.0 percent among women and 6.5 percent to 59.6 percent among men across regions.”

The U.S. is, unfortunately, among the world leaders in MetS. Researchers reporting in Oxford University’s Postgraduate Medical Journal in 2023 noted a rise in MetS among Americans from 37.6 percent of the population in 2011-12 to 41.8 percent by 2017-18. 

All indications are that the upward trend has only continued since then thanks to ever more sedentary lifestyles in this country. MetS has long been linked to this lifestyle.

As far back as 2012, a peer-reviewed, meta-analysis of health studies published in the journal PLoS One  warned that “greater time spent sedentary increased the odds of metabolic syndrome by 73 percent.”

The data that followed in 2017-18 would indicate that not all that many were listening as machines did ever more to eliminate any required daily movement for Americans, and an internet boom encouraged people to spend evermore time sitting and staring at screens.

In order to watch a movie these days, they don’t even need to walk to the car to drive to a Blockbuster video store, stroll into the store, cruise the aisles to find a DVD to rent, and finally walk back to the car to drive home.

Now you can push a few buttons and do all this from your easy chair, sofa or bed, thanks to Netflix, Amazon Prime and more. In fact, if you do your shopping online with Amazon and order your food from Uber Eats, you really don’t need to get up to walk much of anywhere except to the door or the bathroom.

Individually, these losses of movement are small things, but the cumulative effect is large.

Americans take fewer and fewer steps per day, and the decrease in daily steps adds up to increases in MetS, heart disease, obesity, Type 2 diabetes and more. It not by accident that the U.S. is falling behind other Western countries in life expectancy and while the U.S. Department of Defense is warning that “77 percent of young Americans would not qualify for military service without a waiver due to being overweight, using drugs or having mental and physical health problems,” many of which are linked in whole or in part to lack of exercise.

The decline in fitness of the American population might be the biggest threat to the decline of a country that has led the free world since the end of World War II, but it goes almost unmentioned in a nation with a mainstream media focused on political arguments, even when many are petty.

Move, move, move

“Physical activity is the closest thing we have to a wonder drug,” then CDC Director Dr. Tom Frieden warned Americans in 2014, as it was becoming unavoidably obvious that lack of such activity was driving the steady rise in chronic illnesses in this country.

Few listened, and many of them ended up dead in the pandemic that came not long after Frieden’s warning.

Since then, few have paid attention to the fitness lesson that the pandemic should have taught, but then again, an American medical community more interested in pushing drugs than good health did almost nothing to spread the word that the best protection from the SARS-CoV-2 was to be fit and healthy.

Instead, attention was focused on members of the American military special forces – among the fittest people in the country, many of them medically trained – refusing to get vaccinated against the SARS-CoV-2 virus because they didn’t believe the vaccination would offer them much, if any, benefit.

The New York Times jumped into the debate that followed by publishing a Dec. 2022 commentary headlined “An Unvaccinated Military Puts Our National Security at Risk,” though there was never any evidence to support such a claim.

Almost 94 percent of the people dying from Covid-19 at that time were reported to be over the age of 50, and the number rose to more than 97 percent when the deaths of those over age 40 were included.

The U.S. military was at the same time reporting that 72.6 percent of U.S. troopers were under the age of 30, and although officers were older, their average age was 34.4 years, the 2020 Demographics Profile of the Military Community indicated that only about 5 percent of U.S. active forces were at that time likely candidates for severe Covid-19 or death from the disease. It would have been easy to screen for and vaccinate the most at risk among this group, given what was already known about comorbidities and the risk of severe or deadly Covid-19.

As early as Sept. 2020, just months into the pandemic, researchers at Stanford University reported that even in “pandemic epicenters,” Covid-19 death rates were remarkably low among those under age 65 and even lower among those under 65 and lacking comorbidities.

“The COVID-19 mortality rate in people less than 65 years old during the period of fatalities from the epidemic was equivalent to the mortality rate from driving between four and 82 miles per day for 13 countries and four states,” those researchers wrote in a study published in the peer-reviewed jounral Environmental Research, “and was higher (equivalent to the mortality rate from driving 106–483 miles per day) for eight other states and the United Kingdom. People less than 65 years old without underlying predisposing conditions accounted for only 0.7 to 3.6 percent of all Covid-19 deaths in France, Italy, Netherlands, Sweden, Georgia, and New York City and 17.7 percent in Mexico.

Fewer than 20,500 people were reported to have died of Covid-19 in New York City, the American epicenter for the pandemic, in 2020. Three-point-six percent of that would put the death toll of those under age 65 at 738. That’s barely over half the yearly average number of  1,744 deaths caused by unintentional injury among those under age 65, according to the city report for the years from 2017 to 2019.

Still, there’s no avoiding the fact that Covid-19 was a big killer of the old and/or already unhealthy in New York City and across the country, and that’s where the new report on American waistlines gets scary, because it indicates that not just those with inflated BMIs are at risk of early death.

Among those with BMIs over 30, the current BMI definition for obesity, the study reported that “practically all…have excess adiposity,” but then warned that “four in five adults with overweight and 38.5 percent with normal BMI also had obesity, reclassifying an additional 34 percent of the study population.”

These are all people at risk for MetS.

The American obesity epidemic would at this point seem so far out of control that it is surprising that no one has suggested adding GLP-1 drugs, the obesity wonder cure of the moment, to public water supplies in U.S. cities.

Certainly, the American medical community, which hasn’t seen a medical problem to which some new drug or drugs wasn’t the solution, gives indications of leaning in this direction.

When Dr. Christopher McGowan, a specialist in obesity treatment, wrote a commentary for MedPage Today last year about this time last year, suggesting that his experience with prescribing the GLP-1s had led him to believe they are a panacea, not a solution, the blowback from his professional colleagues was loud and heavy.

“Ok, obesity is a chronic disease. So are cardiovascular disease, CKD, sleep apnea, substance abuse disorder, cognitive impairment, depression and diabetes,” wrote one doctor. “GLP-1s are the best drugs we have for all of these conditions with new launches coming this year. Let’s give our patients the best treatments available.”

“Patients simply need to be advised that these medications MUST be taken long-term, the same as with meds for other chronic conditions,” added another doctor.

Meanwhile, nurses and other health care professionals chimed in to tell McGowan that “I’ll bet you don’t struggle with weight problems,” and inform him that obesity “is a much bigger issue than knowing how to eat and exercise properly. The obesity epidemic is a direct reflection of the high-stress world we live in where everyone is working too many hours to survive and have no time for self-care.”

So much for the idea that “exercise is the closest thing we have to a wonder drug,” or that it can be incorporated into a daily routine by walking or cycling to work, both of which have been shown to lengthen lives while improving their quality.

 “If all individuals (in the U.S.) were as active as the top 25 percent of the population, Americans over the age of 40 could live an extra 5.3 years on average,’ researchers reported in the peer-reviewed British Journal of Sports Medicine reported in 2024. The greatest gain in lifetime per hour of walking was seen for individuals in the lowest activity quartile, where an additional hour’s walk could add 376.3 min ( approximately 6.3 hours) of life expectancy.”

The study followed on another published in the peer-reviewed journal BMJ Public Health in July reporting that an examination of the health records of 82,297 Scots aged 16 to 74 years tracked from 2001 and 2018 found that “active commuters (those who walked or cycled to work) were less likely to suffer from a range of negative physical and mental health outcomes than non-active commuters.”

Bike commuters, that study concluded, cut their risks of all-cause mortality by 53 percent, of hospitalization for any reason by 90 percent, of cardiovascular disease (CVD) by 76 percent,  of death from cancer by 49 percent, of hospitalization for cancer by 76 percent, and of being prescribed drugs due to mental health problems by 80 percent.

“Pedestrian commuting,” the study added, was associated with “a 91 percent lower risk of hospitalization, a 90 percent lower risk of CVD hospitalization or of having a CVD prescription, and a 93 percent lower chance of a mental health prescription.”

None of which suggests there aren’t legitimate uses for GLP-1s. There are people who face medical issues that make them gain weight no matter how hard they work to lower the number of calories they consume each day and increase the amount of time they spend exercising.

But for most Americans, the obesity problem is more about lifestyles in a society where the machines have taken over people’s brains and convinced them that the easy way is always the better way, even when it isn’t.

If you truly want to see why three out of four of us are now obese, you can start by looking at the car, truck or SUVs – or the two or three or more – in your driveway and in that of pretty much all your neighbors, some of whom might now walk so little that their legs are starting to atrophy.

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