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Application of Epidemiology to Obesity

In the last decade, obesity in America has significantly increased to the extent that today, more than half of American people are obese. Obesity rates in developed countries range from alarmingly high, especially in the US, where almost one person in a group of three is obese, to 3 to 4 per cent in Korea and Japan (Bagchi, 2010). Obesity is a medical condition, where a person has accumulated high amounts of body fats. One becomes obese, when his body mass index is above 30, or when his body weight is 20 per cent higher than it should be (Bagchi, 2010). If a person has a body mass index of between 25.1 and 29.9, then that person is overweight. One becomes obese, when he/she consumes more calories than he/she burns. This is due to eating a lot and not exercising enough.

In Japan, only 3.6 percent of the population is obese, whereas more than 32 percent of the American people are obese. 66.5 per cent of the American population today is overweight, as compared to 24.7 percent of Japanese. Some of the reasons for this difference between America and Japan are as following: first, the food prices in Japan are substantially higher than in the US. The average person in Japan consumes about 200 calories per day less than an average American does. The traditional Japanese dietary habits are healthier (Bagchi, 2010). These traditional diets are heavy on vegetables, fish and rice, making them balanced. The Japanese are more physically active than the Americans, not because they do more planned physical exercises but because they walk more as a part of their daily lives. The Japanese urban design is mass transit centered; this is because the cost of driving is higher, with a convenient public transport system that requires more walking than the use of cars.

About the social economic status, more women in the US work in jobs requiring them to sit rather than to be involved in physical activity. This means that they are likely to be obese, as compared to the Japanese women involved in daily physical activities (Moreno, 2011). Children from families with low social economic status are likely to be obese. This is because these families exhibit lower intake of fruits, vegetables, vitamins, and minerals, while consuming more soft drinks, fried food, oils, and sugars (Moreno, 2011).

As one gets older, the body’s ability to metabolize food slows down. Therefore, it is unnecessary to consume many calories, as the body does not require much to maintain its weight. This explains why people, aged above forty, gain much weight, as compared to younger ones, when they consume the same amount of calories.

Women tend to be more obese than men, because men have a higher metabolic rate than women. Men burn more energy at rest than women. In addition, when women reach menopause their metabolic rate decreases. Thus, most women gain weight after menopause (Moreno, 2011).

Genetic factors also determine the body structure of a person. In case, where a biological parent to a person is overweight or obese at adulthood, there is a 75 percent chance that that person will be overweight or obese at adulthood. Psychological factors influence eating habits and obesity as well. Most people eat in reaction to undesirable feelings, such as boredom. More than 30 percent of people with weight problems have psychological and emotional issues (Wadden, 2010).

Obesity is one of the major public health concerns in the US. The effects of obesity on the society contribute to the increasing health care costs (Wadden, 2010). Over the past 3 decades, the obesity prevalence has more than doubled. Recent estimates have put direct medical estimates of obesity at about 147 billion dollars, which is almost 10 percent of total medical costs in the United States. Various diseases, such as type 2 diabetes, associated with obesity fall disproportionately to those with the low levels of income. Half of the obesity-related medical costs was paid by Medicaid and Medicare; this puts a strain on the public budget (Wadden, 2010). Beyond the direct healthcare cost of preventive, diagnostic, and treatment services, there are even greater indirect costs, such as the revenue lost from reduced output, missing work and value of future income lost through premature death.

Several approaches can help to curb this threat to the public health. The basic step towards reducing obesity and excess weight gain is to cut calorie intake and to increase physical activity. The American people should consider shifting to more plant based diets, which emphasizes on vegetables, beans, peas, fruits, whole grain, nuts, and seed (Wadden, 2010). They should increase intake of seafood and fat-free and milk foodstuffs.  Lean meat and poultry product should be eaten only in moderate quantities. In addition, the amount of soft drinks consumed should be reduced, while affordability and availability of fruits and vegetable should be increased (Wadden, 2010).

Epidemiologists study patterns of diseases and the health risk in populations, cultures, and societies. The primary goal of an epidemiologist is to reduce the public health risk, which can be done by predicting a disease occurrence and by developing the prevention strategies. Policies, laws, and regulations need to drive the environmental and social changes geared towards reducing obesity. Dealing with the issue of obesity will require changes in legislation, such as public liability, urban planning, transport, food safety, agriculture, and trade (Wadden, 2010). This may require rules to eliminate the factors that contribute to obese favoring environment. It is beneficial for the political willingness to use policy instruments to drive changes. The political environment in the US is probably not willing. In the ideal word, where governments care about the wellbeing of the publics, the government would monitor obesity trends and act early to implement necessary actions to reverse the epidemic, which has not been the case (Kumanyika, 2009).

The law has a pivotal role to play in promoting and protecting public health. In the federal and state legislative and regulatory responses, there should be efforts to improve nutrition, physical activity, and health education in schools. Community based interventions to support activities such as farmers, markets and pedestrian and bicycle paths will also be helpful. The following intervention could help if implemented (Wadden, 2010).

Another solution would include regulating marketing in order to protect consumers. It is evident how the food market is offering nutrient-poor and calorie loaded food. There should be legislation compelling an industry to provide information to consumers and the government about the nutritional status of their products (Moreno, 2011). The government can ban or otherwise regulate the large portion of food and beverage advertising, directed towards audiences primarily composed of children. These advertisements tend to be deceiving and misleading to children. In regard to food, factual disclosures through detailed labeling will enable consumers to make decisions to benefit their health and safety (Moreno, 2011).

Regulating conduct by compelling all retail establishments to have a place for fresh products at the front of the store, while processed products will be put at the back, and to have junk-free checkout aisles. The government should limit the amount of sugar permitted in processed foods and beverages (Moreno, 2011). The government should also regulate the location of certain retail establishments within the community. Economic incentives should be structured to encourage the American people to use public transport more and drive less, as well as typically encourage more walking.

A number of factors are accountable for the high obesity rates today. The people are consuming more than enough calories. Most people tend to overeat; for instance, in the US, the consumption of calories by women per day has risen from 1,877 in 2004 to 2,653 in 2012. Most importantly, the increased food consumption consists of carbohydrates and other sugars. Increased consumption of sweetened drinks has also contributed an outstanding deal to the intake of sugar among American people over the last 2-3 decades (Moreno, 2011). Over the same period, the consumption of fast-foods has also tripled. Some agricultural policies are to blame for this increased calories consumption. For example, the subsidized wheat, corn, and rice have made them and their products to be much cheaper than vegetables and fruits, as well as their products (Moreno, 2011).

Lack of enough sleep is another reason for increasing obesity. In both adults and children, lack of enough sleeping time doubles the risk of becoming obese. Reduced sleeping time results in the hormonal changes that increase appetite. Lack of sleep increases production of Ghrelin (a hormone that stimulates appetite), as well as reduces production of Leptin (a hormone responsible for suppressing appetite).

Most Americans lead a sedentary lifestyle in this modern era of computers, televisions, video games, wash machines, and remote controls among other convenience devices.  Today, most people lead a sedentary lifestyle compared to those, who lived in the previous decades. The less one moves around, the fewer calories he/she burns. Physical activity also influences the way hormones work (Kumanyika, 2009). Hormones affect the way the body deals with food. For example, physical activity has a beneficial effect on keeping insulin levels stable. Unstable insulin levels lead to weight gain. Children with a TV in their sleeping quarters are more likely to be overweight or obese than those without a television.

Some foods are endocrine disruptors and interfere with lipid metabolism. Fructose in beverages and soft drinks may alter lipid energy metabolism and result in fatty liver and metabolic syndrome. Consumption of these beverages causes lipid accumulation, fatty liver, and eventually hypertension, resistance to insulin resulting to diabetes and/or obesity (Bagchi, 2010). Poor balanced diets and lack of physical exercises are main contributing factors in the increase of obesity and metabolic diseases in modern societies. Obesity is self-perpetuating in the sense that the longer a person stays obese, the harder it becomes for them to lose weight. Some medications, such as antidepressants, also cause weight gain. Clinically significant weight gain related to commonly prescribed medicine is happening, depending on individuals (Wadden, 2010).

Descriptive epidemiology deals with describing a disease distribution relating to time, place, and people. The more fully a descriptive epidemiologist can describe people, place, and time, and most importantly the correlation between the three, the likely it is that the patterns will emerge, which can be considered as risk factors for certain health risk, which for this case is obesity. Epidemiologists use data as an information source to communicate information to people to influence public policy (Kumanyika, 2009).

Epidemiology increases the general understanding of a disease, the ways it is spread, as well as its causes. It helps to identify people at higher risk and those to benefit from various interventions. Epidemiology is particularly useful in developing prevention strategies (Bagchi, 2010). Managerial epidemiology involves the use of epidemiological tools in managing health care. It involves the use of epidemiology to design and manage healthcare for populations, effective management of resources to run and promote health among populations, finally the use of epidemiological concepts and tools to improve decisions in the management of health services. With the changes in the healthcare delivery systems, epidemiology is an indispensable prerequisite for health care practitioners. Managerial epidemiology focuses on delivering healthcare services to the entire population, rather than to single individuals (Wadden, 2010). With the current obesity situation in the US, health care must focus on population based management. This makes managerial epidemiology an essential tool in the development and implementation of specialized programs to address the situation.

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