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THE NATION

Obesity Gaining on Tobacco as Top Killer

Bad diets and inactivity are rampant and could cancel out many health advances, studies say.

March 10, 2004|Rosie Mestel | Times Staff Writer

Poor diet and physical inactivity are closing in on tobacco use as the leading preventable causes of death in the U.S., primarily because of a dramatic rise in obesity, according to a new scientific report.

The analysis, published today in the Journal of the American Medical Assn., reported that deaths caused by poor eating habits and sedentary lifestyles rose by 33% between 1990 and 2000 to an estimated 400,000.

Deaths related to smoking or exposure to tobacco came to 435,000. Their share of total U.S. deaths have dropped from 19% to 18.1% since 1990.

The number of deaths related to other preventable health threats, such as illicit drug use and environmental toxins, changed only slightly, the authors reported.

"Our poor eating habits and lack of activity are literally killing us, and they're killing us at record levels," said Health and Human Services Secretary Tommy G. Thompson at a news conference in Washington.

Another study released Tuesday from the Santa Monica-based Rand Corp. predicted that within the next 20 years obesity-linked disease in the U.S. will cancel out health strides caused by improvements in medical technology and disease-fighting measures, such as vaccinations.

The Rand study estimated that by 2020, about one in five healthcare dollars spent on people ages 50 to 60 will be due to obesity-related disabilities, if the current trend of overeating and inactivity continues.

"Obesity is very recent phenomenon," said Roland Sturm, a senior economist at Rand and first author of the report. "We're finding that obesity is strong enough that it can reverse, or at least upset, the past trend toward better health.... That's a pretty shocking finding."

Obesity experts said they were not surprised by the sobering statistics.

"We saw this coming," said Dr. Henry Anhalt, director of the division of pediatric endocrinology at New York's Infants and Children's Hospital of Brooklyn.

"We've seen the incidence of children and adults becoming overweight double in front of our eyes," he said.

Anhalt said he had seen increasing numbers of young children at his clinic with obesity-related conditions, such as high blood pressure, Type 2 diabetes, cirrhosis of the liver and diabetes-associated nerve damage.

The numbers are underestimated if anything, said Dr. J. Michael McGinnis, senior vice president at the Robert Wood Johnson Foundation in Princeton, N.J., and author of a similar 1990 report on causes of U.S. mortality.

"Unless we turn this around somehow, we may be seeing the first generation of children who are sicker and die younger than their parents," McGinnis said.

According to the National Institutes of Health, nearly two-thirds of American adults are overweight (with a body mass index of 25 to 30). Of those, nearly one-third are obese (with a BMI above 30).

Body mass index is an individual's weight in pounds multiplied by 703, divided by the square of a person's height in inches.

Obesity rates have steadily increased in both men and women in all age groups, ethnic groups and educational levels.

A variety of societal changes probably contributes to the rise. Obesity experts still debate the relative importance of factors such as inactivity, burgeoning portion sizes and the contribution of sugar or fat content.

But the baseline cause is simple: We're eating more calories than we burn up.

In February, the Centers for Disease Control and Prevention reported that American women are consuming 335 additional calories a day, and men an extra 168 calories, compared with their intake in 1971.

The JAMA study was conducted by a team led by Ali Mokdad, chief of the behavioral surveillance branch at the Centers for Disease Control and Prevention in Atlanta.

To conduct its analysis, the team used U.S. mortality data for the year 2000. Then it estimated the effect of lifestyle factors based on scientific studies that have examined the role of behaviors in causing diseases such as diabetes or strokes. Finally, the scientists compared their findings with the similar study conducted with 1990 U.S. mortality data.

The team found that about half of the deaths in the United States were due to a small set of behaviors and exposures that largely could be prevented, such as drinking alcohol, unsafe sex and death from firearms.

Most of these had not changed significantly, although there was a slight decrease in deaths linked to sexual behavior, alcohol consumption, infectious diseases and firearms.

The consequences of unhealthy eating and inactivity were by far the biggest change over the decade.

To combat the growing epidemic, the Department of Health and Human Services announced Tuesday a new public awareness and education campaign featuring advertisements that encourage Americans to make small lifestyle changes. Recommendations include going for walks instead of clutching the TV remote and taking the stairs instead of the elevator.

The campaign is "an important message the government is sending -- that we must stop stigmatizing children and adults with obesity. It's a medical problem," Anhalt said.

However, some experts said they doubted whether a public service campaign alone would make much of a dent in an environment that is awash with food, much of it with scant nutritional merit, and which requires less and less physical exertion with each passing year.

"I think the current administration's effort is too weak to have much effect," said Kelly Brownell, director of the Yale Center for Eating and Weight Disorders in New Haven, Conn.

"It is good as far as it goes, but it is ignoring glaring problems in the environment -- such as the need to rid schools of soft drinks and snack foods, control food advertising aimed at children and restructure agricultural policy to promote the production of safe and healthy food," Brownell said.

Times staff writer Jon Marino contributed to this report.

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