Obesity Trends
On a recent Monday in November, hundreds of University at Buffalo students packed the Crossroads Culinary Center (C3), where they were treated to an all-you-can-eat buffet of Japanese, Italian, Chinese, Mexican and American foods. While healthy eating options exist, the majority of the fare is rich in saturated fat, sugar and sodium. Every day, countless students eat at one of three such dining halls on campus. Consequently, 3 of 10 college students are either overweight or obese, as defined by body mass index (Obesity 2007). This problem extends far beyond the confines of the classroom; it is reflective of the general United States population. As highlighted in recent studies, obesity is usually a result of poor diet and lifestyle choices, not genetics and medical conditions.
Sadly, this problem is just as rampant on the streets of Western New York as it is on the dirt roads of Alabama and the classrooms of Southern California. Obesity is one of the largest risk factors for premature death in this country. In 2017, the Center for Disease Control estimated that the prevalence of obesity was 39.8% in the United States in 2015-16, up from 34.3% a decade earlier (Hales, 2017). Despite the large volume of available resources to cut down on this trend, poor diet and lifestyle choices are making it more and more difficult to get back in the right direction.
For one, college students spend much of their days sitting at a desk. The classroom is structured so that sitting is the norm. When students travel from place to place, they primarily use cars and buses, not bikes and feet. If students wish to interact with their peers, they can do so remotely, over their phones or computers. This practice is only emboldened once they enter the workforce, where they will sit at their cubicles and spend most of their time indoors. When many Americans return home after a long day of schooling or work, they will be greeted by their TVs and computers, not their ellipticals and treadmills. All of these factors contribute to the sedentary lifestyle, which affects as many as 50 million Americans a year, according to the American Psychological Association (Blair 1998). This problem is bigger than just obesity; it is a risk factor for heart disease, diabetes, high blood pressure, and stroke. Research shows that people who sit for six hours a day for 10-20 years lose seven quality-adjusted life years (annums without medical issues or death).
On the flip side, colleges do encourage physical activity by offering easy access to programming and gyms. In addition, towns across the country have more healthy options than ever before. However, people usually lack the motivation to take advantage of these resources, and don’t improve as a result.
Obesity doesn't just happen overnight. Rather, it is the culmination of a poor eating lifestyle. Not only does the amount of calories that people eat or drink have a direct impact on their weight, but the type of calories that they ingest also has a strong effect. The specific nutrients and foods that people consume have a clear connection to the diseases and illnesses that people develop. This is especially true on college campuses, where students are lacking in variety but are replete with fats and oils.
On campus, students have unlimited access to processed foods high in fat. It isn’t uncommon to see trays upon trays filled to the brim with french fries or mozzarella sticks. One of the biggest barriers to a healthy lifestyle is that many students either don’t know how to cook for themselves or prefer the convenience of having other people cook for them. Therefore, much of the food that they devour can be higher in fat and sugar than if they cooked the same food themselves. There are other problems as well. More than 80 percent of college students drink alcohol (College 2015), which contains a lot of calories and lends itself to obesity. More than 45 percent of college students are stressed, which leads to comfort eating and packing on the weight (Annual 2017). More than 60 percent of college students suffer from a poor sleep quality, which can have a negative impact on grades, and more importantly, their health (Schlarb, 2017).
This is reflected in the concept of the compression of morbidity — that a healthy lifestyle will “compress” illness into a shorter period of time before death. The theory goes that in an ideal world, life would have a rectangular curve — good health for most of adulthood, with a precipitous decline towards the end of life. If people were closer to the ideal, they would be able to live life to its fullest.
Sedentary lifestyle and poor nutrition are key risk factors in developing obesity. The prevalence rate is highest among Hispanic and Non-Hispanic blacks, middle-aged adults and college students, as these groups tend to be less educated and have limited access to healthy food.
Diseases
In 2012, Nike released the “Find Your Greatness” campaign, aimed at inspiring people from all over the world to get up and start moving. “It’s not the biggest stadium in the world / Not the biggest players either / But the pursuit of greatness is kinda big enough, isn’t it?” the company asks. In the present moment, with millions of overweight and obese people in the United States, this commercial serves as a sort of rallying call. The secret to reversing bad health is recognizing the solution — that through exercise and good eating habits, people have the power to prevent Type II diabetes and cardiovascular disease. If that isn’t greatness, what is?
The Centers for Disease Control and Prevention recommends getting at least 150 minutes a week of moderate-intensity aerobic exercise (Azar, 2018). Walking briskly, water aerobics, cycling slower than 10 mph and tennis (doubles) are all considered safe ways to achieve this goal. Tasks like general gardening and ballroom dancing also count towards this target. Despite this, more than 70 million Americans engage in no regular physical activity (Armstrong, 2015). It is suggested that exercising even a little bit could go a long way in reducing the prevalence of Type II Diabetes and cardiovascular disease, two of the biggest ailments in the country.
For starters, exercise is a great way to lower blood pressure, which also has the effect of preventing or reducing the need for blood pressure medications. In a study, researchers found that exercise changes the heart volume — that is, the heart chambers (ventricles) are bigger and more elastic (they can hold more blood). Physical activity is also a great way to reduce triglyceride levels and increase the concentration of “good” cholesterol, or high-density lipoproteins (HDLs). Exercise is correlated with a reduction in the prevalence of type 2 diabetes. Overall, exercise is just a really great way of maintaining a healthy lifestyle.
Meanwhile, healthy eating habits have also been linked to a lower prevalence of these diseases. One exercise that has been linked to positive health outcomes is keeping more fruits, low-fat dairy products, vegetables, and whole-grain foods at home and work. Instead of just ignoring unhealthy food, people can add health to their diet. In addition, making your own food is a popular suggestion by nutritionists and dietitians. That way, people can have complete control over the food that they eat — the fat and sodium content, portion size and eating schedule.
Diets rich in fruits, vegetables, and low-fat dairy products are conducive to reducing your risk of Type II diabetes and cardiovascular disease because they are instrumental in maintaining blood pressure and cholesterol levels. The opposite of this is a diet rich in sodium and saturated fat. In general, a healthy diet checks off all four of these boxes — variety (different foods from within each group), balance (intake of high-energy, high-fat with low-energy, low-fat), moderation (limit amounts of sugar, salt and fat) and adequacy (foods that provide essential nutrients, fiber and energy). Additionally, the Japanese practice of eating until you are 80 percent full — called Hara Hachi Bu — has been very effective in keeping obesity rates down. Despite this, Americans have found it difficult to adhere to these guidelines. In the words of Nouf Al-Qasimi, a writer for The National, “Americans are snackers who eat on the run and don’t take a lot of time to do so; they eat everywhere and constantly, with neither ceremony nor apology…”
Living a healthy lifestyle is an attainable goal for nearly all Americans. You don’t have to be a prodigy or a superstar to do it. You just need to understand that this is something you can do and put words into action. In the words of the Nike campaign, “Sometimes greatness is something you plan / But most of the time is just something you try.”
Italy and the United States
The United States and Italy are both members of the North American Free Trade Organization, and they both prominently feature the colors red and white on their respective flags. But that is where the similarities end. When it comes to public health, the countries could not be further apart. From top to bottom, Italy exceeds the United States in affordability, quality and health outcomes — disturbing numbers, especially considering that America spends nearly three times as much per capita on healthcare.
In the years following World War II, Italy established a social security program that included social health insurance as one of its central features. In the 1970s, more than seven percent of the population remained uninsured, prompting leaders to rewrite the system. In 1977, the government instituted the SSN (Servizio Sanitario Nazionale), the Italian version of a National Health Service, which includes universal coverage and tax funding.
The SSN is a mixed public-private system, which is administered on a regional level and overseen by the federal government. Surgeries and hospital visits are completely free of charge for everyone. Prescription drugs can be obtained via a family doctor, and are mostly subsidized by the government (there is, however, a small copay). People can choose the “free market” option, which would be paid for out-of-pocket; otherwise, they will be under government care.
There are a number of advantages to the Italian system. For starters, everybody has access to affordable care in the Bel Paese, which encourages citizens to screen for risk factors and disease. In March, the West Health Institute conducted a survey that found that 44 percent of Americans have “skipped a recommended medical test or treatment” in the last 12 months due to cost (Americans 2018). When people screen for illnesses and regularly see the doctor, their health outcomes improve. In recent decades, breast cancer rates have decreased as more women have screened for the disease.
In Italy, the government provides subsidized preventative medicine for its citizens. “Italian Regions established prevention activities using an innovative combination of population and high-risk individual approaches,” the authors of a comprehensive study conducted in 2015 found (Rosso, 2015). “… Issued approximately every 3-5 years, the NPP (National Prevention Program) … [is] committed to the development of health promotion and disease prevention activities.” By comparison, the United States only spends 3 percent of its health care dollars on prevention.
But the contrasts extend far beyond the national systems. In Italy, citizens have better eating habits and are far more active than their counterparts in the United States. These decisions are imbedded in the fabric of Italian society. Uncle Sam, by contrast, is a messy constellation of traditions, customs and mores. Diversity in people is a strength; diversity in health outcomes isn’t.
In the words of the writer Nouf Al-Qasimi, “Americans are snackers who eat on the run and don’t take a lot of time to do so; they eat everywhere and constantly, with neither ceremony nor apology, and often with a degree of thoughtlessness and self-absorption so earnest that it’s impossible to call it vulgar.” Americans eat whatever is in front of them, while Italians have a pretty set food schedule. For example, in Florence, citizens eat a light breakfast, followed by a heavy lunch and an insubstantial dinner.
For lunch, Italians will usually have a light starter (i.e. salami) followed by a first course (rice, pasta or soup), a second course (meat or fish), a side dish (vegetables or salad) and dessert (seasonal fruit, ice cream or cake). This may seem like a considerable amount of food, but Italians are actually really good at pacing themselves and eating only as much as they can eat. Italians are more likely than Americans to cook food at home and eat only until they are full.
Of course, there are exceptions in both societies, but Italians tend to be healthier as a whole. This is a little surprising, because Italian fare tends to be high in carbohydrates and fat. But as these people prove, it isn’t so much what you eat as it is how you eat it. In Italy, citizens have a set food schedule, ingest less calories at night, and eat only small portions. In America, people eat everywhere and everything.
In 2003, the Italian government instituted a program called PIEDIBUS, which allows students to walk to school under the guidance of paid staff and volunteers. Just a few years later, they established two hours of mandatory physical activity in schools, also to encourage students to get up and go. “Movement is health! … at all ages” (Il movimento e salute! … a tutte le età) is a program that raises awareness about physical activity and personal fitness, and promotes participation in sports and recreation. The Sport di Classe program was initiated in 2017 by the Ministry of Education, University and Research and the Italian National Olympic Committee — intergovernmental cooperation that is rarely seen in the United States. With all these programs, it is little surprise that Italy is less sedentary and more active than their North American peers.
Overall, Italy’s obesity rate is at 19.9 percent, compared with the United States’ at 36.2 percent (Obesity 2018). Similarly, the life expectancy in Italy is 82.7 years, as opposed to 79.3 years in the United States (World 2016). The Bel Pease enjoys lower rates of behavior driven illnesses, like cardiovascular disease and type II diabetes. With that in mind, it should surprise nobody that Italy has all the ingredients to success — set eating schedules, lots of physical activity programs and affordable health coverage.
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