“It is easier to change a man's religion than to change his diet.”
― Margaret Mead
Global obesity rates are rising and based on last years data, obese people encompass 13% of the global population, while overweight individuals total 39% (WHO, 2023). Comorbidities associated with obesogenic lifestyles contribute to 8% of total deaths annually. Despite the extensive evidence pointing to it being preventable for most people, we still haven’t found many solid solutions to ameliorate this epidemic's health and economic impact. Obesity has been on a steady incline since the 1980s, with rates taking a sharp spike in recent years.
What Is Obesity?
Obesity is a disease characterized by excessive adipose (fat) tissue or having a BMI (body mass index) equal to or greater than 30, increasing the risk of several diseases. While BMIs are not always accurate due to muscle weighing more than fat, they are a general guideline for determining whether someone is obese based on weight.
Obesity has been linked to many diseases, such as type 2 diabetes mellitus, chronic kidney disease, heart disease, all-cause mortality and cancer, gall bladder disease, and COPD as well as mental health issues like depression, anxiety, and eating disorders (CDC, 2022). According to World Obesity Atlas (2022), one billion people are expected to be obese by 2030. That is broken down to 1 in 5 women and 1 in 7 men globally living with and suffering from this disease (World Obesity Atlas, 2022).
New Zealand and the US as Areas of Interest
To narrow down the focus and, in so doing, possible causes, outcomes, and mitigations, this article will compare and contrast two countries on several factors, such as obesity prevalence and incidence rates, including future trajectories and consequences as well as possible solutions. The two countries under analysis are the US and New Zealand, which, according to data from the OECD’s (Organisation for Economic Co-Operation and Development) 2017 report, are among the top five countries with the highest obesity rates among 36 selected countries around the world (OECD, 2017).
New Zealand is the fourth-highest country on the OECD’s list for obesity rates, with one in three adults and one in ten children challenged by this disease (Ministry of Health, 2023). (OECD, 2017).
America made number one on the OECD list of obesity rates across 36 countries, with two in three adults being overweight or obese and one in five children being obese (OECD, 2017) (NIH, 2021).
What Is Prevalence?
The term prevalence is used in epidemiology and refers to the number of disease cases in a given population at a specific time or over a specified period.
Prevalence can help measure the burden of the disease of obesity, such as the stress it puts on health services in a nation.
Prevalence Rates for New Zealand and USA
NZ- Obesity prevalence- 34.3% (Ministry of Health, 2023).
USA- Obesity prevalence- 41.9% (CDC, 2023).
What Is Incidence?
Incidence determines new disease cases over time and within a particular population. Understanding incidence rates can help us to determine future outcomes and affect primary and primordial approaches to curbing the rise in obesity rates.
Incidence Rates for New Zealand and the USA
New Zealand- Obesity incidence- 2 million of the 5.39 million citizens are expected to be obese by 2038 (Otago University, 2018). 37,105 per 100,000 people.
USA- Obesity incidence- almost 50% of 349.28 million US citizens by 2030 (Harvard T.H. Chan School of Public Health, 2019). The incidence is 49,857 per 100,000 people.
Why Are Obesity Rates on the Rise?
There are several factors for rationalizing the acceleration of obesity rates worldwide. According to the CDC (Centers for Disease Control and Prevention) (CDC, 2022), food, activity, and sleep were the top three determinants of obesity, followed by social determinants of health, genetics, illnesses, and certain medications.
Causes Of Obesity
Food: diets high in processed, refined, and sugar and salt-laden prepackaged products tend to have the highest calorie content and the lowest nutritional value. The body requires nutrients to carry out vital functions and seeks out these nutrients through food. Calories don’t equate to nutrient content and the body will continue to seek out those nutrients if the foods that are being consumed have low or no nutritional value. This means that someone who consumes a diet high in fast food and prepackaged foods is likely lacking vital nutrients and will continue to remain hungry even when they have surpassed their daily caloric requirements. This results in malnutrition.
Foods that are processed tend to also be high in the GI index, and due to the influence, this has on blood sugar levels, it influences hormones like insulin, leptin, and ghrelin (the hunger hormone), and the body remains in a state of hunger.
Most foods like fast food lack nutritional value and keep the body seeking the vital nutrients it needs to carry out its many functions. And fast food consumption is on the rise, with 331 Billion dollars being spent on fast food and fast casual dining in the US in 2022 (Statista, 2023).
I recently polled people on my business account on Instagram for how many times a month they eat at fast food or fast-casual restaurants. Of the participants, 77% consumed fast food at least multiple times a month, and I should note all participants in the study were male.
What Drives Fast Food Consumption?
It is convenient and inexpensive.
It is rich in calories
Continuity of flavor
and perhaps due to a lack of education on nutrition, the consequences of increased fast-food consumption, and its link to diseases and malnutrition fast food continues to be consumed frequently. While other people are challenged to change behaviors or choose not to, some ironically use obesity as a form of self protection, or lack access to healthier foods. Some individuals struggle with mental health issues like binge eating, depression and addiction and this could be driving the increase in fast food consumption in both countries.
Activity: Low activity levels are associated with an increased risk of obesity and disease, especially when paired with a standard American diet high in saturated fat, processed foods, and meats.
Sleep: Not getting sufficient sleep is linked to increased obesity risk.
Social Determinants of Health: income, education, zip code, food security, housing, employment, and social inclusion influence the likeliness of developing obesity. Some people live in food deserts where they need access to fresh produce or whole foods. Some people need more transportation or funds to buy healthy food. Others are affected by poor housing or toxic living conditions that negate health and contribute to obesity. Education also influences obesity factors, with the trend being that those with the least education have the highest propensity for the development of obesity.
Genetics: No single genetic variant can pinpoint or be blamed for obesity onset.
Instead of blaming genes, we can look at genetic influences in two ways-
1. Behavior patterns, aka eating habits, run in families. This can explain, to some degree, why we see obesity in familial settings.
2. Epigenetics- Several genes within the body control energy balance. These genes also work with hormones to regulate appetite, blood sugar levels, fat-burning or fat-storing mechanisms, and neurotransmitter signaling. These genes can be influenced by epigenetic factors on an interpersonal level, such as whether an infant was breastfed and for how long and how lack of breastfeeding is linked to a higher likelihood of developing obesity later in life.
Illnesses: certain illnesses can cause obesity, such as Cushing’s Disease
Medications: certain medications can cause weight gain and obesity, such as antidepressants, steroids, birth control pills, beta-blockers, and insulin.
The Burden of Disease- Based on peer-reviewed data from 2017, high BMI (body mass index) caused 2.4 million deaths worldwide (PLOS Medicine, 2020).
The Global Cost of Obesity- By 2035, overweight and obesogenic lifestyles will result in $4.32tn a year in global health costs unless new intervention strategies are implemented (Mahase, 2023).
How Can We Prevent Obesity Rates from Rising?
America still has the world beat in obesity rates among countries highest in resources. Current data suggests that nearly all fifty US states have a prevalence rate of 60%, with the lowest rate being the current trend at 40% (Harvard T.H. Chan School of Public Health, 2019). There are currently 332 million people living in America, and of them, around 41% are obese [332x41%=136.12].
This calculates to around 136 million Americans suffering from obesity today.
Yet, both countries sing the credo that obesity is a threat to public health, and both implemented policies, taxes, and free educational classes in past years to curb its increase.
Public health professionals are making a concerted effort to curb the rising obesity rates in their nation and have been on this trajectory for some time now without seeing much improvement. Education, policies, and taxes are in place but do not affect positive behavior changes associated with food choice and quantity of food intake that result in obesogenic lifestyles.
When I compare drivers for obesity, the Global Obesity Observatory (2023) lists one different driver of obesity in the US: a lack of breastfeeding in infancy leading to obesity later in life. New Zealand and America are similar in all other drivers listed, such as lack of exercise, grain consumption, fruit consumption, mental health issues, and processed meats (Global Obesity Observatory, 2023).
I believe the increase in hustle culture norms increases people’s stress, anxiety, sleep, food choices, dependency on conveniences, activity levels, and overall self-efficacy, leading to a rapid rise in obesity rates.
Call me a cynic, but I am not seeing many upstream efforts in reducing this disease nationally and globally. There’s a great deal of awareness of the issue as it has been a rapidly rising trend since the eighties. Most people know Mcdonald’s is bad for them. And yet. We are still eating foods that we know are aging us on a biological level and are increasing our odds of becoming part of the statistic by continuing to remain uneducated and unable to change behaviors to improve the health of ourselves, our community, country, and planet.
Do You Know Your BMI?
Follow this link to calculate your BMI to gauge if you are within a healthy weight range-
Adult BMI Calculator | Healthy Weight, Nutrition, and Physical Activity | CDC
Harvard T.H. Chan School of Public Health. (2019). Close to half of U.S. population projected to have obesity by 2030. https://www.hsph.harvard.edu/news/press-releases/half-of-us-to-have-obesity-by-2030/
CDC. (2022). Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html
Avila, C., Holloway, A. C., Hahn, M. K., Morrison, K. M., Restivo, M., Anglin, R., & Taylor, V. H. (2015). An Overview of Links Between Obesity and Mental Health. Current obesity reports 4(3), 303–310. https://doi.org/10.1007/s13679-015-0164-9
Newman, Katelyn. (2019). Obesity in America: A Public Health Crisis. https://www.usnews.com/news/healthiest-communities/articles/2019-09-19/obesity-in-america-a-guide-to-the-public-health-crisis
OECD. (2017). Obesity Update. https://www.oecd.org/health/obesity-update.htm/