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Obesity is now just as much of a drag on health as smoking

The views expressed are those of the author and are not necessarily those of Scientific American.


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obesity smoking preventable illness deathIn case anyone needs a reminder to stick to that New Year’s resolution to slim down or kick the cigarette habit, researchers have confirmed that obesity and smoking are still the country’s leading contributors to preventable deaths and illnesses. In fact, the new findings, from a 16-year survey of more than 3.5 million adults, reveal that being overweight has taken the lead as contributing the most to preventable poor health in the U.S.

The results, tabulated from the U.S. Centers for Disease Control’s (CDC) Behavioral Risk Factor Surveillance System and published online Tuesday ahead of print in the February issue of American Journal of Preventive Medicine, document what public health officials have long predicted, that with the country’s expanding waistlines, widespread health consequences have become increasingly common.

"The total health burden of obesity surpassed the total health impact of smoking," concluded the authors, who are based at the Department of Biostatistics at the Mailman School of Public Health and School of Nursing at Columbia University in New York City and the Department of Community Health and Social Medicine at the Sophie Davis School of Biomedical Education at The City College of New York. They ascribe this shift in large part to the drop in the number of U.S. adults who smoke (from 22.7 percent in 1993 to 18.5 percent in 2008) and the increase in the proportion of people who are obese (from 14.5 percent to 26.7 percent).

When the survey started, in 1993, smoking was by far the leading cause of preventable death and disease. But by the study’s conclusion, in 2008, obesity had tipped the scales—increasing in prevalence by 85 percent—to become the primary cause of preventable illnesses and poor health-related quality of life. Smoking, however, still causes more cumulative years to be lost due to premature death. A CDC-sponsored study, published last April in PLoS Medicine, found that as of 2005 smoking was the most frequent killer (causing about one in five deaths), with high blood pressure following up close behind (causing one in six deaths). Obesity came in third at that point, being responsible for almost a quarter of a million deaths—or one in 10.

And although total life expectancy in the U.S. rose by about 3.5 percent between 1993 and 2008, the authors caution that morbidity and mortality from obesity eventually "may result in a decline in future life expectancy." By analyzing the data in terms of health-related quality of life, the researchers found that this metric is already on the decline (it dropped about 2.2 percent during the study period). Obesity alone contributed to a 127 percent drop in a measurement of quality-adjusted life years over the course of the study, the authors report. 

The large dataset was based on telephone surveys of 3,590,540 individuals who reported their recent physical and mental health levels, so no direct medical examination or follow-up took place. (The survey information was matched with the National Death Index to collect mortality figures.) The authors note that, if anything, "these calculations would likely undervalue the total health impact of smoking and obesity." And reporting bias might also have played a role in understating the numbers: "Data shows that participants tend to under-report both smoking and weight and, therefore, the burden of disease due to both smoking and obesity might actually be higher."

Image courtesy of iStockphoto/RBFried





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  1. 1. the Gaul 12:59 am 01/5/2010

    Does any addictive substance in today’s food similar to nicotine cause obesity? How large is the role of self-control? Why should the nation’s health expenditure pay any costs associated afflictions that result from personal choices like either smoking or obesity?

    Link to this
  2. 2. the Gaul 1:01 am 01/5/2010

    That’s: . . . costs associated with afflictions . . .

    Link to this
  3. 3. Al Toti 1:56 am 01/5/2010

    What has changed? Should this not be steady state equilibrium model or is it changing. The boundary conditions are similar that suggests a driving force?

    Link to this
  4. 4. prometheorist 3:15 am 01/5/2010

    Actually, whey protein has been known to be an appetite stimulant for decades. That is why you will find whey in pretty much every snack food and junk food out there…also in fast food, etc.

    Link to this
  5. 5. billsmith 3:56 am 01/5/2010

    prometheorist- You may be confusing whey protein with something else. It’s known to be an appetite *suppressant*, particularly the lactalbumin component of whey.

    http://www.ncbi.nlm.nih.gov/pubmed/?term=whey%20protein%20appetite

    As for why protein and yeast extracts are added to junk food, they increase the savoriness (umami) of the food. That is, because people buy tasty food.

    Link to this
  6. 6. tmusselman26 12:58 pm 01/5/2010

    I am an RD in weight management for 6 years, I currently run a bariatric program. This is a funny thing. Obesity, for many, is like a huge snowball that cannot stop rolling. There are many factors, and yes, the food industry does prepare food in a way to trigger certain brain chemistries and increase the desire for food and the feeling of being unrestrictive when eating. Nutrition action just published a great article on this.

    The other thing that should be considered is the metabolic and epigenetic changes that occur with obesity. As a person gains weight, there are endocrine changes including increased insulin, inflammation, insulin resistance etc that make weight loss difficult and slow the metabolism.

    Also obese individuals move less, they lose muscle mass, especially after years of yoyo dieting. Combined with joint pain and general feeling of lousyness, movement is discouraged even more. As muscle mass is lost, metabolism is slowed even more…..hence the snowball effect.

    I would encourage you all to open your minds about obesity, the cause, consequence and the ‘disease’ portion of being obese.

    I agree that something has to be done to help these individuals, starting with education and a change in public policy.

    Link to this
  7. 7. tmusselman26 12:59 pm 01/5/2010

    I am an RD in weight management for 6 years, I currently run a bariatric program. This is a funny thing. Obesity, for many, is like a huge snowball that cannot stop rolling. There are many factors, and yes, the food industry does prepare food in a way to trigger certain brain chemistries and increase the desire for food and the feeling of being unrestrictive when eating. Nutrition action just published a great article on this.

    The other thing that should be considered is the metabolic and epigenetic changes that occur with obesity. As a person gains weight, there are endocrine changes including increased insulin, inflammation, insulin resistance etc that make weight loss difficult and slow the metabolism.

    Also obese individuals move less, they lose muscle mass, especially after years of yoyo dieting. Combined with joint pain and general feeling of lousyness, movement is discouraged even more. As muscle mass is lost, metabolism is slowed even more…..hence the snowball effect.

    I would encourage you all to open your minds about obesity, the cause, consequence and the ‘disease’ portion of being obese.

    I agree that something has to be done to help these individuals, starting with education and a change in public policy.

    Link to this
  8. 8. JGM 2:30 pm 01/5/2010

    They are responsible for their own actions. We should not have to pay for their laziness & selfishness. Public policy should focus on those individuals who have serious illness through no fault of their own; muscular dystrophy, cystic fibrosis, etc. Money should not be drained from these worthwhile causes to address lack of willpower.

    Link to this
  9. 9. tmusselman26 10:49 pm 01/5/2010

    To JGM: That is a great comment. Given that cancer is only 2-3% genetically based and environment (i.e. water, physical activity, food etc) plays a large portion in disease. So we should not pay for these programs as well. Why should we pay for cancer treatment for someone who smokes, didn’t exercise and ate junk? We are too, technically paying for their laziness and lack of willpower….right?

    What about substance abuse? Should we pay for their lack of willpower?

    True, there are inborn genetic errors and predispositions, it is all unfortunate and deserve funding and research. Obesity as well as many other disease are due to predisposition and environmental interactions. We need to stop turning eye to what is done to the environment we live in and what is permitted in the food industry.

    Trans fats are a great example of a killer food additive that was approved as "safe" by our government. Now they can’t get it out of our food fast enough. Learn a little bit about what is done before you make comments like that

    Link to this
  10. 10. msm 9:06 am 01/6/2010

    Does that mean I can take up smoking again? I was thin when I smoked.

    Link to this
  11. 11. msm 9:07 am 01/6/2010

    Does that mean I can take up smoking again? I was thin when I smoked.

    Link to this
  12. 12. Senior Physical Therapist 11:43 am 01/6/2010

    You said:
    " As a person gains weight, there are endocrine changes including increased insulin, inflammation, insulin resistance etc that make weight loss difficult and slow the metabolism."
    You did get close. The process starts in Utero and yes the diet we consume does produce all the above. That is were the almost total misunderstanding occurs i.e. what to eat? The informaiton cascades connected with this area are legion, which also includes exercies with or without diet restrictions.
    You are seo right, this is a very complicted problem and so far we get an F minus for our understanding and constructive efforts to deal with the problem.

    Link to this
  13. 13. mrshog 7:59 pm 01/8/2010

    Good one, msm, me too. When the government, insurance companies and health industries went after smokers, I predicted that obesity would not be far behind. Who shall we weed out next?

    Link to this
  14. 14. vasail2 11:07 pm 09/27/2010

    The simplistic view of disallowing offenders from accessing health care is just that, simplistic. Where do you start; where do you stop? Everyone has their pet area that should be allowed on the list even though it is a culprit.
    Unfortunately education, slow that it may be, is one of the answers.
    Taxing the dickens out of offending companies is another.

    Will C Jensen http://willsweightlosssecrets.blogspot.com/

    Link to this
  15. 15. Senior Physical Therapist 5:49 am 09/28/2010

    Education might have a chance to work if anyone really knew what was required. In fact NO ONE knows, so what would people be educated too?
    The "Experts" ( Are there any really?) are simply whistling in the grave yard. The rest are ignorant, plain stupid or greedy.
    Sorry, but wake up. This is killing us all. Realize that the co morbid conditions that accompany obesity can and are killing us all. This is likely occurring also without obesity being a co morbid condition (associated). So you smug sanctimonious skinny guys are dying as well. And you thought you knew?

    Link to this
  16. 16. John Burn Fat 5:00 am 09/29/2010

    Obesity worse than smoking? Unbelievable…

    I heard that people who quit smoking, switch to obesity, because they removed a "bad habit" and didn’t find a new habit that could replace the bad habit. They simply "miss something".

    One example is my own grandfather. When he tries to stop smoking, he starts to eat a lot. Terrible. How good I’m not smoking.

    Greetings, John
    http://johnsteczko.com/

    Link to this
  17. 17. RenePadilla 7:18 pm 09/30/2010

    being obese is not healthy. One should know the limit of eating or balance diet and of course, exercise.

    If you want to lose weight. I can recommend, 30 days now. I am currently using that product and it is very effective.

    <a href="www.start30daysnow.com">www.start30daysnow.com</a>

    Link to this
  18. 18. MattWheyProtein 5:04 pm 10/6/2010

    Wow those are some staggering results I must say. I just want to let you know I bookmarked this page.

    I know that obesity in the United States is completely out of control. Look at the commercials for food these days. It’s all about portion control, exercise, and supplements if you want to control your body weight.

    One of the best ways to supplement great health is through whey protein because it helps reduce junk food cravings while boosting your body with vitamins, enzymes, and amino acids.

    I recently wrote an article over here on <a href="http://www.wheyproteinpowders.org/organic-whey-protein-powder/">whey protein weight loss</a> you should check out to see all the benefits. I personally lost 30 pounds using this.

    Link to this
  19. 19. ways to lose weight 10:57 am 11/22/2010

    Obesity is as bad as smoking .. what if you are obese & smoke too. Would you be more likely to die twice as fast or more prone to illness.

    Anyway check out my blog about <a href="http://fasterwaystoloseweight.com">ways to lose weight</a> without smoking !

    Link to this
  20. 20. cha123 4:59 am 03/11/2011

    Obesity is the most common problem that we cannot get rid of. Unless we have courage and discipline to engage in some exercise that can burn our calories. But sometimes there are remedies on to loss weight that is very affordable and safe. I try it and it is really effective.

    http://www.africanmango-dietpill.com/

    Link to this
  21. 21. healthguru 1:47 pm 05/5/2011

    Obesity today ranks as a significant health challenge and studies show obesity to be a major cause of preventable mortality. The etiology of obesity is multifactorial. Over eating is the primary cause, but – psychological problems, hormonal imbalance, eating disorders, lack of proper directions in diet could all play a part. Likewise, the treatment options for <b><a href="http://www.forerunnershealthcare.com/obesity-surgery-India-low-cost-benefits.html">obesity surgery</b></a> are varied – including diet and exercise, body contouring surgery, bariatric surgery, psychological counseling, endocrine management, etc.

    Link to this
  22. 22. healthguru 2:15 pm 05/5/2011

    Yes, I appreciated the above comments, but there is so many surgens which getting more fast and easy surgery in there medical profession. Obesy disease recovery is not only other country, It is in India also <a href="http://www.forerunnershealthcare.com/obesity-surgery-India-low-cost-benefits.html">Obesity Surgery India</a> has there own medical research Institute which recover patients in there so many disease.

    Link to this
  23. 23. hugoweightloss 8:36 pm 05/18/2011

    In short, smoking and obesity, are the habits that are killing us. We must try to educate the very young on these modern evils.

    Link to this
  24. 24. hugoweightloss 8:38 pm 05/18/2011

    In short, smoking and obesity, are the habits that are killing us. We must try to educate the very young on these modern evils.

    Link to this
  25. 25. reneewood 6:39 am 06/5/2011

    they are just as bad, if not worst.

    Link to this
  26. 26. jessiechaplin 6:53 am 06/10/2011

    I really thought that it will never happen to me. Obesity is the least thing I never imagine would haunt me just recently. Even though I don’t smoke nor drink, but stress makes me really crave to eat more. How do i cope with this? http://ezinearticles.com/?What-Are-the-Features-to-Look-for-in-a-Hand-Held-Back-Massager?&id=6329161

    Link to this
  27. 27. Jhonson74 4:29 am 05/6/2012

    If you want to reduce your weight. Just you have to use some product and you have to know about the limit of balance diet.I hope with in a few month you will get good result.Please don’t smoke.It’s bad for health.
    http://protein-shakes-forweightloss.com

    Link to this

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