Obesity as disease

You may have noticed the following graph all over the Internet recently. Yes, obesity is on the rise.  Is there anyone left who doesn’t know?

I’m getting a little concerned about how we are talking about obesity, though. It’s an “epidemic”. A medical problem. A disease. This implies that somehow we will find the “cure”. Some medicine. Some medical intervention.

Obesity is a complex problem. And I think by medicalizing it, we may be missing larger issues. All problems should not be treated the same.  We keep talking about obesity like it is a health care issue;  it is, but it’s also a public health and societal issue.

I’ve been trying to get a number of papers out the door, so I’ve been immersed in statistics the last week or two.  Let’s put those skills to use.  Here, I took the obesity data from 2009 and plotted it against poverty. Here’s what you get:

Each dot represents a state in the US.  The size of the dot is its relative population.  The x-axis is the percent of the state in poverty, and the y-axis is the percent of the state that is obese. As you can see, there is a direct correlation between poverty and obesity state by state. In fact, for each percent increase in a state’s population in poverty, the population’s average BMI increases by 0.6.  This may come as a surprise to readers who assume that obesity is from having too much food. It’s not. It’s from having too much of the wrong food.

Obesity doesn’t have a simple fix.  It’s tied up in socio-demographic factors. We can’t fix something like poverty in a doctor’s office alone. We need to change society.

I know, I know. This will tick off about half of you. You think that obesity should be left to families and not the government. You think it shouldn’t be a public health issue; you think it’s an issue of personal responsibility. That’s a perfectly valid political philosophy, and it’s certainly not uncommon. One problem – that philosophy may also be associated with obesity.

Here’s another chart.  As a proxy for a more conservative mentality, I used the percent of the state voting for the Republican ticket in the 2008 presidential election:

For each percent increase in support of the McCain/Palin ticket in 2008, the BMI of a state is almost 0.2 higher.

I’m not saying these analyses are perfect.  They are completely exploratory and are no more a single explanation for obesity than any other factor.  The point is, obesity is complex.  It’s tied up in public health and societal norms and culture and families and even politics.

I have a rule of thumb I tell parents when I’m playing my pediatrician role: you shouldn’t expect a disease to go away in less time than it took for it to develop.  Maybe it’s time for all of us to stop watching this problem develop and start doing something about it.

* DISCLAIMER: These are simple analyses here.  They are uncontrolled and would never pass peer-review as explanations for obesity.  But part of me feels that hypothesis-generating data like these are what the blog is for.  I want to stimulate discussion.  My hope is that analyses like these force you to question your assumptions, not provide you with definitive answers.

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