There’s no sense being sensitive about this heavy issue. The word “fat” has taken on evil proportions in the last few years to the point where political correctness borders on absurdity. Yes, it’s unhealthy to aspire to unrealistic images of leanness promoted by media. But the opposite can be equally unhealthy and even more life-threatening.
It’s time to take it out in the open, start talking about obesity in plain language, and set aside hurt feelings. Especially Black feelings. The issue becomes doubly sensitive when focus zooms in on the African American community vis-à-vis obesity. Reporting about this phenomenon is always met with accusations of racism, racial profiling, stereotyping, and all that narrow-minded politically correct mumbo-jumbo. But statistics don’t lie. Black Americans are, by far, the fattest ethnic group. It’s time to suck it all in and face the truth if something is to be done about the problem.
Here we focus on four areas most commonly discussed. Let’s call them the 4Cs of Black American Obesity.
Causes
First, let’s get this out of the way. When are you fat and when are you not? There are globally accepted standards for this, referenced to the body mass index (BMI). BMI is calculated by dividing mass (weight) by the square of height. Anything in excess of 25.0 is considered overweight. Hit 30.0 and you’re in obesity territory. Someone six feet tall, for example, and weighing 220 pounds would have a BMI of 29.8, which is overweight but not quite obese, yet.
Is genetics to blame for obesity? The jury is still out on this. The scientific evidence for a genetic basis is, at best, indirect. No genes have as yet been named as directly responsible for the condition. The thrifty gene hypothesis was one of the earliest theories proposed. For tens of thousands of years, food was scarce and our bodies adapted accordingly by teaching itself to be thrifty (store food) when it became available. The sudden abundance of food supplies in the 20th century led to food consumption patterns that the human body still handles in the survival mode, an adaptive mechanism that enabled it to survive famines.
This thrifty gene hypothesis is just one among many ways that genes can favor fat accumulation. Genes can be responsible for the drive to overeat (poor regulation of appetite and satiety); the tendency to be sedentary (physically inactive); a diminished ability to use dietary fats as fuel; and an enlarged, easily stimulated capacity to store body fat. Not all people living in industrialized countries with abundant food and reduced physical activity are or will become obese; nor will all obese people have the same body fat distribution or suffer the same health issues.
Here’s the rub for African Americans. This diversity occurs among groups of the same racial or ethnic background and even within families living in the same environment.
If not genetics, what then? Diet is the most obvious culprit. Unfortunately for African Americans, their problems with diet are compounded by a host of other factors. The most pressing of these is the unavailability of healthy food choices in the areas where they live. Many Black communities live in “food deserts,” a term used to describe areas where there is limited access to affordable nutritious food. These food deserts tend to be in low-income neighborhoods where the nearest supermarket can be many miles away. Instead, they rely on fast food outlets, takeaways, and corner delis serving unhealthy and chemical-induced meals high in fat and calories.
These communities usually have lower end markets, which are privately owned, have limited business hours, as well as very limited food selections. The variety of fresh vegetables and fruits is limited. When the fresh produce are available, they tend to be more expensive and are often of poorer quality. Most food items sold in these markets are canned, boxed, frozen and/or highly processed. Compared to fresh produce, processed foods are nutrient-poor, have excessive salt, sugar, and harmful fats – all key ingredients for obesity.
Strange but true. In developing nations, obesity is a sign of prosperity. In a very prosperous America, poverty can make you fat.
A sedentary lifestyle multiplies the diet problem. This is true for everyone regardless of ethnicity, but being African American adds a whole new dimension to an already long list of excuses for avoiding sweat. Hairstyles, for example. A study published by the Archives of Dermatology found that hair care practices actually prevented African Americans from engaging in physical activity. But hair care presents much less of an obstacle to exercise than do living conditions.
Low income, unstable living conditions and other environmental limitations can contribute to infrequent exercise among obese adults and children. African American families in low-income urban areas may face insufficient support for physical education in schools and inaccessibility to gym memberships. Also, children who are unattended at home after school are often required to stay inside for safety and security reasons. They are more likely to watch television or play games on the computer instead of being active.
Culture
Is culture a major factor in the obesity of African Americans? Quite hard to believe considering that modern purveyors of culture (mass media) hardly ever glorify excess weight. In magazines and billboards and even online, the prevailing images are impossibly lean and toned individuals captured during happy moments in their successful and satisfying lives.
If anything, Black Americans are supposed to suffer the same angst with their body image, loosely defined as a person’s sense of his or her own physical appearance, usually in relation to others or in relation to some cultural “ideal.” But several studies show that Black women are more accepting of their own weight and are less likely to have distorted body images leaning towards the tall, thin model types prevalent on mainstream media. Black men have also been reported to prefer fleshier body types.
While this general acceptance of weight and absence of pressure to be thin both liberate and empower, the very same tolerance also puts Black women at a greater risk for obesity. In fact, many have identified this tolerance as symptomatic of the low socio-economic expectations required of them. Many African American women are not in career or community positions that demand them to be conscious of their appearance.
Let’s add to this picture the role that food plays in African American culture, where food is the focus of social and cultural events. These traditions have an impact on the choices African Americans make. Soul food, cooked with lots of fat, sugar and unhealthy amounts of salt only contributes to the problem. Fried chicken, fried fish, lots of gravy, macaroni and cheese, and candied yams are viewed as comfort food that sticks to the ribs and are good for the soul. Ironically, they’re often perceived as healthy and superior to fast food. In reality, they often contain as much fat and calories.
Consequences and Cost
What’s the current picture of obesity for adults and children in the United States?
- 33.0% of U.S. adults aged 20 and over are overweight, 35.7% are obese, and 6.3% are extremely obese.
- In 2009–2010 and 1988–1994, no significant differences were seen between racial and ethnic groups in the prevalence of obesity among men. However, non-Hispanic black men posted the greatest increase of 17.7%, from 21.1% in 1988-94 to 38.8% in 2009-2011.
- Among women in 2009–2010, non-Hispanic black women (58.5%) were significantly more likely to be obese than non-Hispanic white women (32.2%) and Mexican-American women (44.9%). The same disparities existed in 1988–1994, however the jump in prevalence was from 38.4% to 58.5% among non-Hispanic black women.
- An estimated 16.9% of children and adolescents aged 2–19 years are obese. This rate is more than triple that in 1980.
- No significant differences in prevalence of obesity by race and ethnicity were observed among adolescent boys. Among girls in the 2009–2010 survey period, however, non-Hispanic black adolescents (24.8%) were significantly more likely to be obese compared with non-Hispanic white adolescents (14.7%)
The human cost is heavy on many levels:
- There are 112,000 deaths related to obesity each year in the United States.
- Overweight and obesity-related conditions are the second leading cause of preventable deaths
- Obese children are twice more likely to die before the age of 55 than their thinner counterparts
- More chronic conditions are related to obesity than smoking, drinking or poverty:
- Sleep apnea
- Stroke
- Liver and gallbladder disease
- Hypertension
- Osteoarthritis
- Coronary heart disease
- Respiratory problems
- Type 2 diabetes
- Endometrial and colon cancers
The country is now only starting to realize the economic costs of obesity. Reuters reports that “U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960.”
Citing a report by Cawley and Chad Meyerhoefer of Lehigh University in the January 2012 edition of the Journal of Health Economics, the Reuter report revealed that the direct medical costs of obesity was estimated to be at $190 billion. These costs include health care services, medical tests and drug therapy. Obese men spend an additional $1,152 a year. Obese women spend an extra $3,613. The figure was even higher for the uninsured: annual medical spending for an obese person was $3,271 compared with $512 for the non-obese.
Lost productivity from obesity-related absenteeism costs employers as much as $6.4 billion a year. Even when present at work, the productivity of obese persons is greatly diminished and they may lose as much as one month’s worth of work from not being able to perform at optimal levels. The cost of this decreased productivity is estimated to be $30 billion a year.
Future Shock?
A report released by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) states it in no uncertain terms. F as in Fat: How Obesity Threatens America’s Future reveals that the number of obese adults, along with related disease rates and health care costs, is on course to increase dramatically in every state in the country over the next 20 years. The number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020—and double again by 2030. Medical costs associated with treating obesity-related diseases could balloon to $66 billion per year.
The report does present an alternate reality, where states are successful in reducing the BMI of their at-risk citizens by 5%. In this other future, nearly every state could save between 6.5 percent and 7.9 percent in health care costs. This could equate to savings ranging from $81.7 billion in California to $1.1 billion in Wyoming. Even Florida’s projected savings of only 2.1% could translate to $34 billion.
To Win, We Have to Lose
So goes the tagline for HBO’s four-part documentary “Weight of the Nation.” It’s a comprehensive look at the burden obesity has become, and how Americans are affected in the struggle to bear its tremendous weight. It’s the inspiration behind this article and highly recommended for everyone who has faithfully read this piece up to this point. It’s a clear indicator of your interest on the subject. The documentary may help spur you into action for yourself, your family, and your community. If you don’t have the time, then the Center for Disease Control and Prevention offers a quick guide on how to combat obesity.
And combat obesity we must. The epidemic has outgrown discrimination, or vanity, or acceptance and tolerance. Strangely, the human race has come full circle. While sub-Saharan Africa is still fighting the war on hunger caused by food scarcity, African Americans must now start fighting the war on obesity brought about by abundance.