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American Obesity: A Growing Epidemic


Julia Botvinov
Rhetoric and Civic Life 138
Professor Babcock
14 April 2019
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Abstract
Obesity in the United States has been a continuous problem for decades. The percentage of
obesity is at an all-time high, ultimately cutting the lifespan of over a third of Americans. This
status has caused a large portion of citizens to suffer a severe amount of dangerous health
complications, some even leading to mortality. Before being able to provide effective solutions
for the epidemic, one must acknowledge and assess the economic, technological, demographic,
and geographic causes of the nation’s current state. Once doing so, the examination of
attempted and current policies like NFL’s PLAY60 Campaign, New York Mayor Bloomberg’s
soda ban proposal, and President Obama’s calorie labeling are pertinent for developing future
programs. Upon analysis of numerous factors regarding prior attempts to eliminate the obesity
issue, two potential solutions have been formulated. The first is the sugar sweetened beverage
tax and the second is improving the currently enacted policy called the Healthy Food Financing
Initiative. Both policies are derived from research and follow two separate approaches: positive
punishment and positive reinforcement. The goal for both of these potential policies is to cause a
sharp decrease in the number of obese people in America before the majority of the nation’s
population falls victim to the egregious repercussions of this disorder.
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American Obesity: A Growing Epidemic


Obesity in the United States has affected the population in a radical way. It has become a
defining factor of the country so much so that it has embarrassingly evolved into a commonly
understood stereotype by others around the globe. The epidemic made the nation a worldwide
example of what ​not​ to do, created economic disadvantages, and more importantly, health
complications.

Obesity is defined as having a weight that is higher than what would be considered healthy for
one’s height. Someone who has a body mass index (weight in kilograms divided by square height
in meters), or BMI, of 30 or higher is considered obese, and someone with a BMI of over 40 is
considered morbidly obese.1 While there are multiple sub-classifications for obesity and
different factors that
contribute to an obese
person’s health, the important
point to emphasize is that the
amount of Americans that are
becoming obese is growing. In
2018 the adult obesity rate in
the United States reached
31.1% increasing by five
percentage points in the
matter of a year.2 To put that
into perspective, based on the
347,813,910 adults that lived
in the country last year,3 about
108,170,126 of them were
obese. This rather unnerving
statistic raises many questions,
but the biggest one must be
how can it all be fixed before it
is too late? 4

1
​Defining Adult Overweight and Obesity | Overweight & Obesity | CDC. (2017, April 11). Retrieved from
https://www.cdc.gov/obesity/adult/defining.html
2
​Our Nation's Health: Obesity Rate at All-Time High; Childhood Poverty Continues to Decline. (2018, December
12). Retrieved from https://www.apnews.com/d5e6aa2046b546b581af50a4bf60fd21
3
​How Many Adults Live in the USA? (n.d.). Retrieved from
https://www.reference.com/government-politics/many-adults-live-usa-b830ecdfb6047660
4
​McCarthy, N., & Richter, F. (2017, October 17). Infographic: America Is Fatter Than Ever. Retrieved April 5,
2019, from https://www.statista.com/chart/11497/america-is-fatter-than-ever/
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The Consequences
As more research is developed, the rising number of health complications that are attributed to
obesity is frightening. When looking at the top twelve leading causes of death in the United
States, almost half of them align with obesity being a listed risk factor.5 The notable causes are
heart disease, cancers, stroke, diabetes, and kidney disease. Considering ranks one and two,
heart disease and cancer, respectively, are shown to be heavily influenced by excess weight,
directing attention to the root of the problem will be incredibly helpful in battling the American
people’s most aggressive killers.

While the relationship between obesity and heart disease is one that is commonly known, the
more recently discovered correlation between obesity and certain cancers has grown
significantly as well. In 2012, four percent of cancers worldwide were caused by excess body
weight and obesity has been linked to higher risk of developing breast, colon, esophageal,
gallbladder, kidney, liver, ovary, pancreatic, and many other cancers as well.6 The studies
explain that obesity affects hormone levels in the body, which, in turn promotes the growth of
cancers. By maintaining a healthy weight, the body’s environment is less apt to provide
cancerous cells with the tools they need to multiply and spread. Given that there is so much
evidence pointing to obesity as being the cause for these terrible conditions, one must be curious
as to how the number of obese people in the country was permitted to reach such a high. Using
this knowledge and the analysis of multiple prior attempts to eliminate the obesity epidemic,
two potential policies have been curated: the sugar sweetened beverage tax and the
improvement of the currently enacted policy titled the Healthy Food Financing Initiative which
will be discussed further along in this brief.

The Causes
Factors such as the increase of technology and sedentary activity, development of fast food
chains, logistics of restaurants, and food deserts all seem to have a part in the increasing number
of obese Americans.

5
​Holland, K. (2018, November 1). 12 Leading Causes of Death in the United States. Retrieved from
https://www.healthline.com/health/leading-causes-of-death
6
​Preidt, R. (2018, December 13). Obesity at fault for 4 percent of cancers worldwide, study says. Retrieved from
https://www.upi.com/Health_News/2018/12/12/Obesity-at-fault-for-4-percent-of-cancers-worldwide-study-says/111
1544648963/
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The production of computers and television in tandem with the decrease in agricultural-based
jobs that require physical activity have caused an overall decline in active behavior. As staying in
shape is a two part effort -- involving diet and exercise, the latter is quite important. According
to the Centers for Disease Control and Prevention, in 1997, 40% of American adults stated they
do not engage in physical activity such as sports or exercise during their spare time.7 With the
growth of ‘e-activity’ increasing, it is no surprise the rate of obesity is increasing as well.

On the front of fast food chains and restaurants, in the past decade or so, more and more fast
food restaurants have been established and while the food maybe fast, it is far from healthy.
While there are numerous arguments against these chain restaurants having the biggest direct
cause for obesity, certain statistics show 44% of Americans claim to eat at these food places at
least once a week.8 Similarly, while regular restaurants, supermarkets, and convenience stores
may have healthier options for
their customers, their food
portions have gotten completely
out of hand. Natural News recalls
changes such that “A muffin which
used to be the size of a baseball, is
now the size of a softball. A Big
Gulp soda from the popular store
7-11 used to be 32 ounces, now they
offer a hefty 44 ounce Super Big
Gulp and even a Double Gulp that
has a staggering 64 ounces of
sugary liquid.”9 This ridiculous
upsizing of products not only
targets obese Americans but more
specifically Americans who are
living in food deserts.10

Food deserts are geographic areas where the ability to obtain affordable and nutritional food is
difficult, specifically for those who do not own automobiles. These areas are dominated by the
less healthy, but more affordable fast food restaurants which become the main source for food
for inhabitants of these areas. These food deserts are quite synonymous with low-income areas.
Research in 2009 showed that 11.5 million people living in low-income areas are located further

7
​Prevalence of Sedentary Leisure-time Behavior Among Adults in the United States. (2010, February 03). Retrieved
from https://www.cdc.gov/nchs/data/hestat/sedentary/sedentary.htm
8
​When did obesity become an issue? (2012, October 19). Retrieved from
https://www.naturalnews.com/037596_obesity_statistics_junk_food.html
9
Ibid.
10
​Barclay, E., Belluz, J., & Zarracina, J. (2018, August 09). It's easy to become obese in America. These 7 charts
explain why. Retrieved from https://www.vox.com/2016/8/31/12368246/obesity-america-2018-charts
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than a mile from a supermarket.11 The combination of being unable to purchase healthy food and
relying on obtainable and unhealthy food has lead to the nearly inevitable path of obesity. In
addition to the lower class facing the brunt of financial and health problems, there are
economically related issues as well. According to Kelly Brownell, psychologist and director of
Yale’s Center for Food Policy and Obesity, in 2012 health care costs were 150 billion dollars per
year, and half of those expenses came from public funding for Medicare and Medicaid.12 If the
suffering of low-income Americans does not serve as necessary means for change, then the
constant tax raises and government spending may provide a bit more motivation.

There are an unbelievable amount of components researchers and health gurus have narrowed
down to pinpoint the greatest cause of obesity in the States. All these factors warrant a
multifaceted approach from the government to regulate the population into a better standing
with their health. But, the policies in place currently have only created a stir-up in the epidemic,
rather than an intervention which is becoming a lot more necessary as the years go by and the
country’s average BMI goes up.

Current Policy
When looking at policies that are presently set in place to combat the obesity epidemic, we see
them targeting either food consumption or amount of exercise. Examining policies that have
been implemented in the past, regardless of if they were state-wide or federally enacted helps to
provide insight as to where the greater success may potentially lie.

A good example of a rather effective effort to curb childhood obesity falls under the NFL
PLAY60 Campaign. This program was started in late 2007 by the National Football League with
a goal to promote a healthier next generation. In 2017 a published study led by assistant
professor in Rehabilitation and Movement Sciences at the University of Vermont, Yang Bai,
evaluated the effectiveness of this program. After analysing statistics from 500 schools, the
study showed that the percentage of youth that reached the national health standard for aerobic
fitness between the years 2012 to 2015 went up in the 95 schools that took full participation.13
Overall, the campaign was effective only if there was complete commitment amongst the staff,
students, and even members of the community. This helps to define to what extent regulation is
needed to be had with future policies made to target obesity. Without constant implementation

11
​Breneman, V., & Farrigan, T. (2009). ​Access to Affordable and Nutritious Food: Measuring and Understanding
Food Deserts and Their Consequences​ (Rep.). United States Department of Agriculture.
12
​Brownell, K. (2012, May 14). Pounding Away At America's Obesity Epidemic. Retrieved from
https://www.npr.org/2012/05/14/152667325/pounding-away-at-americas-obesity-epidemic
13
​Staff, S. X. (2017, January 17). First study to measure effectiveness of NFL PLAY 60 program shows positive
results on youth fitness. Retrieved from
https://medicalxpress.com/news/2017-01-effectiveness-nfl-positive-results-youth.html
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of this program, the results would have been futile. This hints at necessary intervention from
numerous perspectives in order for any sort of policy to be successful.

Another example to learn from is of a state-wide


policy that was almost implemented, but never
passed through. In 2012, the mayor of New York,
Michael Bloomberg, proposed to limit the sale of
certain sweetened drinks greater than 16 ounces.
Critics stated the proposed ban was unconstitutional.
Others questioned whether it would make a
difference in obesity rates at all. The largest issue
with the soda ban was there were numerous
loopholes, preventing any direct change. Under the
proposed policy, New Yorkers could still buy the 50
ounce Orange Explosion Slurpee from 7-Eleven and
Dunkin Donuts’ large Vanilla Bean Coolatta,14 both
extremely sugary and arguably worse than sodas. 15
However, Bloomberg claimed he knew about the
loopholes and exclaimed the point is to force citizens
to educate themselves on what they are putting into
their bodies. Unfortunately, in 2014 the New York
Court of Appeals halted the proposal from passing because it overstepped its regulatory bounds.
However, the proposal itself brought attention to the possible effectiveness of a soda ban and the
obesity epidemic as a whole. A lot more studies were made based on the mere idea of this policy
being enacted. For example, studies showed if New Yorkers cut their portion of one sugary drink
from 20 to 16 ounces every two weeks it was save overall 2.3 millions pounds in a year.16 Studies
like these that stemmed from the proposal have been valuable to the process of creating more
policies in the future.

The last policy and one of the biggest that was implemented nationwide to combat the obesity
epidemic is calorie labeling. Under the Obama administration, a section under the Affordable
Health Care Act required retail food establishments with at least 20 or more additional chains to
display the number of calories contained in each standard food item on their menus. Similar
requirements pertain to vending machines as well, requiring close-by signs for the calorie counts
of all the products being sold. After facing pushback from numerous establishments such as
movie theatres and grocery stores, the date was postponed -- for compliance purposes -- to

14
​Neistat, C. (2012, September 10). 'Soda Ban Explained'. Retrieved from
https://www.nytimes.com/2012/09/10/opinion/soda-ban-explained.html
15
​Pen Publishing Interactive, Inc. (n.d.). What's In Your Drink? Retrieved from
http://www.deltadentalks.com/communitybenefit/sugarydrink/
16
​Neistat, C. (2012, September 10). 'Soda Ban Explained'. Retrieved from
https://www.nytimes.com/2012/09/10/opinion/soda-ban-explained.html
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December of 2016.17 Looking back on the efficiency of this policy change, the results are quite
mixed. One study conducted in 2008 looked at the contrast between New York City, a location
that had already implemented a menu calorie listing policy and Newark, New Jersey, a location
with no policy regarding caloric listing. Findings pointed to the fact that while a substantial
amount of New York subjects claimed to have acknowledged and taken the menu labels into
consideration, their mean caloric intake did not change.18 Another study was conducted after the
state of Washington took similar measure at enforcing a menu labeling policy in 2009. The
research was focused on how the restaurants were affected by the new law as opposed to the
consumers. After a month and a half of the rule being in effect in King County, Washington,
sit-down chain restaurants lowered their entrees on average to be 73 calories lighter than before.
19
This policy forced the restaurants to limit the amount of unhealthy food they sold which then
prevented people from making unhealthy purchases in the first place.

While there has not been enough research to see if this indirect strategy influences obesity at all,
many of these studies help to reinforce what the proposal of the soda ban suggested: providing
the public with health conscious options does not guarantee that those options will be chosen.
This important lesson is crucial in determining how to move forward in battling the beast of
obesity in America.

Future Policy
The next few steps the government decides to take will have a vital impact on the future of the
nation. As a result of how severe the epidemic has gotten, focus needs to be placed on the
implementation of numerous productive policies. While the goal is to lower the rate of obesity
amongst the American population as a whole, preventative care and damage control for the
youth of the nation is a priority. If policies directed at youth can severely impact the numbers for
adolescent obesity, there is no doubt the overall population rate would be impacted as well.
According to the National Division of Nutrition, the risk of becoming obese in adulthood is at
least two times higher for obese children than nonobese children.20 The decision to protect the
future generation’s health would not only be effective, but also easier than correcting adult
behavior and is an overall ideal plan of action.

17
​Kliff, S. (2015, July 09). FDA delays calorie label requirement until late 2016. Retrieved from
https://www.vox.com/2014/11/25/7279689/obamacare-menu-calorie-labels
18
​Elbel, B., et al. (n.d.). Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People
In New York City. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.6.w1110
19
​Norton, A. (2012, July 19). Restaurant meals a bit healthier after menu law. Retrieved from
https://www.reuters.com/article/us-seattle-restaurant/restaurant-meals-a-bit-healthier-after-menu-law-idUSBRE86I1
4M20120719
20
Serdula, M., Ivery, D., Coates, R., Freedman, D., Williamson, D., & Byers, T. (1993). Do Obese Children Become
Obese Adults? A Review of the Literature. ​Preventive Medicine,​ ​22(​ 2), 167-177. doi:10.1006/pmed.1993.1014
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One economically driven policy that has been proposed is the sweetened drink tax, which stems
from a positive punishment strategy. A positive punishment strategy is a concept studied by
behavioral psychologists that calls for adding an aversive consequence to an action. As a result,
the tendency for execution of said action is then minimized. In this policy the aversive
consequence would be taxation on sugar sweetened beverages, abbreviated as SSBs. The goal of
this tax would be to deter adults from purchasing these unnecessary beverages for their
children. A study done in 2012 testing this policy found promising results. The investigators
used Markov microsimulation models to estimate the impact of a one cent per ounce excise tax
on SSBs after 20 years of implementation. The results expressed that the tax would result in a
decrease of 2.4% in adolescent (ranging from ages 13 to 18) obesity and a decrease of 1.6% in
child (ranging from ages six to 12) obesity.21 Tax on SSBs could also create revenue for other
prevention policies and programs. Accordingly, in this specific simulation 13.25 billion dollars
worth of tax dollars could be generated in just the year of 2010.22 The enactment of this tax
policy would be a self-sufficient one, considering there is no need to externally regulate and fund
it. The statistics show using the tax regulation leads to a decrease in obesity amongst children in
a hands free manner and should be a serious consideration for future policies.23

Another policy that should be


expanded and improved on a much
wider scale is the Healthy Food
Financing Initiative (HFFI). This
program was established as part of
the Farm Bill in 2014. Its main
target is the food desert areas that
have caused so many issues for the
lower-class. It is a public-private
partnership managed by the
Reinvestment Fund under the
USDA. Rather than taking a
positive punishment strategy, it
instead takes a positive
reinforcement approach. A positive
reinforcement strategy uses the
method of adding a reinforcing
stimulus that promotes action and
behavior. The program provides
financial and technical assistance for eligible projects that are working to improve the ability for

21
​Kristensen, A. H., Flottemesch, T. J., Maciosek, M. V., Jenson, J., Barclay, G., Ashe, M., . . . Brownson, R. C.
(2014). Reducing Childhood Obesity through U.S. Federal Policy. ​American Journal of Preventive Medicine,​ ​47​(5),
604-612. doi:10.1016/j.amepre.2014.07.011
22
​Ibid.
23
​(n.d.). Retrieved April 7, 2019, from
http://www.healthyfoodaccess.org/resources/library/healthy-food-financing-initiative-hffi
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those living in underserved communities to obtain healthy food. Here the reinforcing stimuli are
the grocery stores that are provided for food desert locations, while the supported behavior is
the purchasing of healthy foods. While the HFFI has already been running for a few years, the
potential it has to grow and assist thousands of more communities is substantial. However, the
contingency that remains pertinent to the success of this policy is limiting the sale of unhealthy
foods and also selling healthy foods at a lower price. While proximity to a food store may be
beneficial to those in impoverished areas, studies show that when modeling a comparison
between distance to the store and food prices, the prices alone remain statistically significant,
with increased prices predicting a lower chance of obesity.24 The current state of the HFFI is a
positive one as it provides jobs, generates tax revenue, expands market opportunities, and
provides low-income citizens with the ability to purchase nutritious food. In addition to lowering
price sales, the markets themselves can provide educational tools for consumers to make healthy
choices. Ideas such as displays of infographics, advertisements for fruits and vegetables,
promotion of healthy dishes, nutritionist helpers and knowledgeable customer service
employees can warp the way grocery shopping works for future generations. Children who were
once at risk for obesity will be inspired to make nutritional choices and shop healthy because the
societal norms will reinforce those sort of actions. The idea of HFFI is a good one, but if change
is to be had on the obesity epidemic, there needs to be a severe alteration in how food shopping
takes place in this country.

The demand for new and improved policies is evident when looking at the unnerving rate at
which obesity in America is rising. Putting the epidemic on hold is not ideal if the country’s
population wants to live a long and healthy life. The consequences have proven themselves and
they will only continue to get worse. Numerous causes for the country’s state of obesity have
been identified and researched, it is now the duty of policy makers and officials to make the
changes necessary to fix it.

24
​Ghosh-Dastidar, B., Cohen, D., Hunter, G., Zenk, S. N., Huang, C., Beckman, R., & Dubowitz, T. (2014).
Distance to Store, Food Prices, and Obesity in Urban Food Deserts. ​American Journal of Preventive Medicine,
47​(5), 587-595. doi:10.1016/j.amepre.2014.07.005

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