In 2001, the Surgeon General issued a call to action in response to what has come to be known as the "obesity epidemic." The call to action heightened public debate over obesity, which causes health problems that threaten to reverse many of gains made in recent decades against heart disease, several forms of cancer, and various chronic health problems. While much is being done to combat obesity as a whole, the most dramatic part of the epidemic has remained hidden. New findings from the October 13 issue of The Archives of Internal Medicine reveal a growing epidemic within an epidemic.
In order to assess whether the rising trend in obesity of the "normal" kind is paralleled by increases in clinically severe obesity and super obesity, Roland Sturm, Ph.D., of the RAND Corporation, Santa Monica, California, analyzed data spanning 1986 to 2000 from the Behavioral Risk Factor Surveillance System. "Normal" obesity is defined as a body mass index of 30 or higher (BMI is weight in kilograms divided by the square of height in meters). Clinically severe obesity indicates a BMI of 40 or higher, or roughly 100 lbs. overweight. Super obesity denotes a BMI of 50 or higher. Using participants' self-reported weight and height, BMI was calculated and participants were categorized as follows: BMI of 30 or greater, BMI of 35 or higher, BMI of 40 or higher, BMI of 45 or higher, and BMI of 50 or higher.
Dr. Sturm documented a significant disparity among these groups of obese Americans. The results show that from 1986 to 2000, the prevalence of a BMI of 40 or higher quadrupled from about 1 in 200 adult Americans to 1 in 50. The prevalence of a BMI of 50 or greater went from about 1 in 2,000 adult Americans to 1 in 400, a five-fold increase. In contrast, obesity based on a BMI of 30 or greater roughly doubled from 1 in 10 adult Americans to 1 in 5 during the same time period.
What do these latest findings mean for health professionals? As the whole population becomes increasingly overweight and obese, the extreme categories are affected disproportionately. No longer will treating a clinically severe obese patient be an anomaly, as the prevalence of clinically severe obesity grows even more rapidly than that of "normal" obesity. Hospitals and clinics that are not properly equipped for clinically severe obese patients will have to invest in new equipment that is able to accommodate this growing number of new patients; if they don't, they may be faced by discrimination lawsuits against providers.
