Historically, excess body fat has been a symbol of great wealth and opulence. Prior to the man-made developments that exist today, obtaining proper sustenance to survive was a huge threat to civilizations across the globe. One would have to be of high status, financially or socially, to be able to have the resources in order to acquire enough food to eat gluttonously (Eknoyan, 2006). As technology has advanced and the threat of food scarcity has been sorted out for the most part in western societies, Americans now find themselves with countless options of what to eat. However, the advancement of technology has also brought about a new set of food options that are, more often than not, processed and unhealthy. The combination of excess consumption of calories and a lack of physical activity has led to the prevalence of the disease, obesity, in certain demographics more than others. As a result, obesity has become an epidemic in America that has grown exponentially over the last couple of decades. There are arguably no regions in the country that have experienced the same numbers in rising obesity rates as the south. In this research paper, southern obesity will be analyzed from various points of view. The aim is to provide a full picture of the current condition of the disease (including its clinical presentation, causes, and usual treatment methods), the reasons for its elevated presence as well as its position in the public health and political fields. Its projected trajectory for upcoming years will also be looked at in order to fulfill my objective and complete a full analysis of this topic.
Clinical Presentation
Obesity is defined as an excessive amount of body fat that exceeds what is generally considered normal for a specific height. (Trust for America’s Health, 2017) Another way to look at it is as an energy imbalance where the energy consumed is greater than the recommended energy that should be expelled through physical or metabolic activity (Akil & Ahmad, 2011). The disease is typically diagnosed through the measuring of body fat in a routine physical examination with a family physician. The most commonly used measurement tool is the body mass index ratio. The body mass index system takes into account a person’s height in inches as well as their weight in pounds to come up with a percentage of their total body fat. Doctors are encouraged to take into account a patient’s body composition as an excess muscle being reflected in their weight value could be mistaken for fat by the ratio. Obesity values are broken down into three categories: Class 1 of 30-34.9 kg/m2, Class 2 of 35-39.9 kg/m2 and Class 3, also known as extreme obesity, of greater or equal to 40kg/m2. Waist circumference measurement is an additional step in obesity diagnosis as it evaluates the risk of comorbidities that could be developed in the given individual. While there are no official symptoms associated with obesity, other serious health concerns could be developed as a result of surplus body fat. Some of these diseases include coronary heart disease, hypertension, type 2 diabetes, sleep apnea, osteoarthritis, various cancers, asthma and many other conditions. (National Institutes of Health, 2000)
Causes
The general physical causes of obesity are quite straightforward. They are the excess consumption of unhealthy foods filled with sugars, sodium or fats and a lack of the recommended physical activity (Trust for America’s Health, 2017) Taking those two physical factors into account, it is no surprise that southern states have been affected by obesity at such high rates. From the deep-fried foods and sugar-filled pies, there is no doubt that southern culture revolves heavily around its delicious yet detrimental cuisine. In terms of physical activity, the CDC has reported that the top 6 states who have self-reported the least amount of activity during their free time were all southern states (AL, KY, LA, MS, OK, and TN). The inactivity rates were at 29% or greater in over 70% of the counties in those respective states (Fiore, 2011). Additional physical causes that vary from individual to individual include genetic factors or other disorders and prescribed medications. Now, it would completely unrealistic to blame the obesity issue in the south solely on the physical causes. For there to be such a frequent occurrence of a disease among a specific region, it is obvious that there are unique environmental factors that are contributing to the issue.
As spoken about in class, socioeconomic factors, such as poverty, urbanization and region types, are often responsible for a host of health issues. One of the most important elements contributing to southern obesity is the persisting poverty rates. In both rural and metropolitan areas, the south has the highest poverty rates in the country. Between both areas, there is nearly a 6% difference between in poverty rates with the metro areas at 15.9% and rural areas at 21.7% (Farrigan, 2017) Additionally, as of 2013, the south has the highest rate of households relying on government assistant programming, like food stamps, to be able to afford food (Chokshi, 2015). Nutritional deficiencies are the top potential consequence that tends to occur as a result of a lack of financial resources. Meaning, those recommended healthy food choices are often not an option for those of lower income due to their elevated prices and lack of availability in their specific communities, racially and economically (Akil & Ahmad, 2011).
In terms of urbanization and regional effects, it has been found that rural residents generally have higher rates of obesity than those in urban and urban surrounding areas. The South have several states that have are more than 50% rural (Bishop,2012). In fact, “the highest adult obesity rates in the United States [are] found in rural counties of Missississipi and Alabama” (Trust for America’s Health, 2017, p.24). Urban residents often face high levels of obesity that can be contributed to the lack of physical activity space in cities, rural residents do not seem to utilize their extra activity space. Rural areas are ranked worst in health behaviors that are linked to adult obesity. The reliance on vehicular transportation rather than public transit or walking in rural areas is an issue contribution to low fitness levels. Also, because of the distance between establishments, rural residents often find themselves farther from supermarkets with healthy food options as well as recreational physical activity centers (Trust for America’s Health, 2017).
Race’s role in southern obesity cannot go unmentioned either. The South also happens to account for 55% of the national African American population (United States Census, 2011). Among racial groups, national data shows that Blacks are ranked the highest with an obesity occurrence rate at 48.4%, Latinos follow at 42.6%, Whites are next at 36.4% and Asians are last at 12.6% (Trust for America’s Health, 2017). These rates are linked directly to the geographical food availability. Primarily Hispanic and African American communities have been found to have 50% to 70% fewer supermarkets in their neighborhoods. A lack of access to supermarkets results in a lack of access to fresh and healthier food options (Akil & Ahmad, 2011). Instead, there is a much higher presence of fast food businesses in those marginalized communities (Trust for America’s Health, 2017). In addition to a lack of healthy food access, the previously mentioned racial groups also have less access to physical activity facilities and outlets, leading to a diminished level of energy exertion which directly relates to weight gain (Akil & Ahmad, 2011).
Public Health Intervention
Seeing how big of an issue obesity has become across the country, it is no surprise that it has become a hot topic in public health. Those working on obesity from the public health sector are currently attempting to come up with, and release strategies to communities to help prevent obesity and improve the health of those who already have the disease. Public health essentially observes obesity in southern states as a crisis that needs to be controlled as soon as possible (Trust for America’s Health, 2017). An example of a type of public health organization focused on address the elevated obesity rates in southern states is the Southern Obesity Summit (SOS). At this summit, representatives from every southern state come together to come up with an agenda of issues that need to be addressed then create strategies for these strategies to be fully implemented. One of their intervention strategies includes a program called Worksite Wellness. This program encourages companies to add written worksite wellness policies. These policies would allow for a guideline to be created for the further development of workplace health-conscious initiatives (“Southern Obesity Prevention Strategies, 2018).
Intervention and strategy creation from other southern public health groups is necessary to push southern residents as well as government officials to make valuable changes to stop the rising trend of obesity in the region by increasing and encouraging the availably of healthy foods and adequate physical activity.
Treatment
Obesity is curable in most cases. In the most basic terms, all that is needed is the loss of body fat until healthy, optimal weight is attained. With the loss of the unhealthy body fat, certain comorbidities that had been developed when obese could be cured. Other associated conditions may not be fully curable but would certainly be more manageable and less serious with the loss of weight. For individuals with genetic or medical conditions related to weight gain, a cure is usually reached by taking medications. The idea of losing weight to solve obesity seems simple in theory. In execution, it is very difficult for obese individuals to completely change their lifestyle habits all at once to cure themselves. Consulting accredited health care professionals is necessary so that they have guidance and are being held accountable for reaching their weight loss goals. The treatments that are typically available depending on obesity level classification include types of therapy (Weight loss, behavioral or dietary) and weight loss surgery (National Institutes of Health, 2000). Most qualified physicians use the mentioned treatments, making it the standard methods of care. Unfortunately, as with all professionally related procedures in America, money is often an issue in the acquisition of the required care.
Obesity-related medical care costs are among of one the highest disease-specific costs in the country. In the year 2008, the CDC estimated that the U.S. healthcare system spent a total of around $147 billion towards direct and indirect obesity costs (“Adult Obesity Causes and Consequences”,2017). While Medicaid is on an option to help cover these expenses, there are strict criteria that a patient must meet for that to happen. (Staff, 2017) Also, due to several southern states refusing to expand Medicaid coverage, many people find themselves ineligibility for the program due to gross income yet would not meet high tax credit criteria. In this coverage gap, it is shown that the South has the highest rate of uninsured adults as well has highest uninsured rates and limited Medicaid eligibility than any other region in the country. (Garfield & Damico, 2017) This makes it harder for southern residents to seek obesity treatment as they do not have the necessary funds or medical coverage.
Political Presence
As public health is showing growing vigor in addressing southern obesity it is no surprise that its political presence has grown as well. In early 2017, one of the Trump administration’s first actions was to reverse the school lunch program, Healthy Hunger Free Kids Act, that had been led by former first lady Michelle Obama to specifically combat childhood obesity. The Agriculture Secretary, Sonny Perdue, claims while the act’s nutritional standards were put in place with good intent and childhood obesity is a problem, students are not consuming the healthy foods the schools are providing. He specifically referenced the South as children are not consuming the whole wheat grits because of the appearance compared to the regular grits. Additionally, the use of healthy foods has led to higher food costs and a decline in student involvement in the program. As a result, the national Department of Agriculture would not implement the sodium-reduction targets and would allow flavored milk back into school cafeterias. Unsurprisingly, the change was met with much criticism from a host of individuals, specifically Democratic representatives. The opposition’s argument was that the healthier option is not always the popular option, but regardless health should be prioritized over preferences. Perdue concluded with say that the Obama standards will not be completely dismantled, simply adjusted to allow schools more leniency. (Evich, Cheney & Bade, 2017)
Conclusion
As of right now and in its current state, obesity is a huge health problem in the southern United States that will increase in occurrence in the future based on its developmental factors. Most of the key causes of the disease have been identified, however, on-going research is still being done by public health establishments, like the Southern Obesity Summit, to find solutions to these causes. With the future trajectory showing that obesity rates will continue to rise, so will the associated morbidity and mortality rates that are associated with the disease (Trust for America’s Health, 2017). It is clear more policies promoting better health-related habits need to be created and incorporated in the south for anything change and for better regional health to be attained.