Obesity may soon be leading cause of preventable death in US
============================================================

* Barbara Sibbald

Fast food and larger portions of it are taking a toll in the US, where the surgeon general says 60% of adults are overweight or obese, as are nearly 13% of children.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/166/5/642.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/166/5/642.2/F1)

Figure. **Canadians' penchant for donuts and other high-fat foods is creating concern about obesity here too** Photo by: Canapress

“Being overweight [or] obese may soon cause as much preventable disease and death as cigarette smoking,” says Surgeon General David Satcher. Some 300 000 deaths are already associated with obesity and excess weight in the US every year. Tobacco use is associated with about 400 000 deaths annually.

The prevalence of excess weight and obesity has nearly doubled among children and adolescents since 1980, and is increasing in both sexes and among all adults. The trends are already associated with major increases in the prevalence of conditions such as asthma and type 2 diabetes mellitus in children. Satcher said failure to address the issue “could wipe out some of the gains we've made in areas such as heart disease, several forms of cancer, and other chronic health problems.” The direct and indirect costs attributed to excess weight and being overweight or obese were estimated to be $117 billion in 2000.

The US isn't alone. In Canada, physical inactivity is estimated to have cost about $2.1 billion — 2.5; of total direct health care spending — in 1999 (*CMAJ* 2001;163[11]:1435-40). Research has also shown that Canadian children are getting heavier (*CMAJ* 2001;163 [11]: 1429-33). Between 1981 and 1996, the prevalence of excess weight increased from 15% to 28.8% in boys and from 15% to 23.6% among girls. During the same period, the prevalence of obesity more than doubled in both sexes, from 5% to 13.5% for boys and to 11.8% for girls.

The US report, *The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity*, suggests various approaches to combat the problem. These include mandatory physical education classes for students, supplying healthier foods at schools and safe and accessible recreational facilities for people of all ages. The report also says Americans should spend less time in front of the TV and that more emphasis should be placed on educating health professionals about the prevention and treatment of excess weight and obesity. Satcher also wants the food industry to promote healthier food choices, including smaller portions.

He says a change in perception of obesity is also needed so that “health becomes the chief concern, not personal appearance.”