Is Your State Overweight?

As a country, we're getting fatter. Fast.

Each year, the U.S. Centers for Disease Control and Prevention updates its series of maps that show how the rate of obesity is expanding. States where, as recently as 1990, 10 percent or fewer adult residents were obese now report levels double that. In the latest edition of the maps, three states estimate that a third of all adults are obese.

Add those merely overweight (defined as having a body mass indexof between 25 and 29.9) to those officially obese (BMI of 30 or higher), and the number of adults who weigh more than they should reaches six in 10. It’s a once shocking statistic that now seems numbingly familiar to anyone who has visited a food court lately. What's harder to understand is why as a country we can't hold the line on obesity.

Please note: BMI is only a guide and is not perfect. It does not consider individual factors such as bone mass, high or low muscle mass, or physical fitness to provide a more accurate assessment of your overall health.

"The easy answer is there are two things that drive obesity: Diet and physical activity," says Kelly Brownell, professor of psychology at Yale University and director of the Rudd Center for Food Policy and Obesity. "And if those two things are getting worse, then the situation is getting worse."

Beyond that, the factors that contribute to obesity are numerous and complex. As the CDC explains, body weight is the result of genes, metabolism and behavior. But, the agency acknowledges, it also has to do with environment, culture and socioeconomic status.

"Everybody knows they should be more active and eat more fruits and vegetables, and still the rates [of obesity] go up," Brownell says. "This is not a problem that will yield to education alone. This requires fundamental change in the drivers of the problem."

The high cost of low-calorie food

What are those drivers? To start with, Brownell says, "The fundamental economics of food is the reverse of what it needs to be. Healthy food costs more than unhealthy food."

Adam Drewnowski, director of the nutritional sciences program and professor of epidemiology and medicine at the University of Washington, studies the relationship between poverty and obesity. His research suggests that "energy-dense foods," those that are high in calories but not necessarily high in nutrients, tend to be less expensive than more nutritious choices.

"Refined grains, added fats, added sugar," he says. "The problem is that diets full of these are inexpensive, while diets with whole grains, fresh vegetables and fresh fruits are not as affordable. They're even slipping out of grasp for middle-class people."

If you lay a map showing rates of obesity over a map illustrating rates of poverty, Drewnowski says, it's likely you'll find a high degree of correlation. For example, rates of obesity estimated by the CDC in 2005 are highest in the Southern states. The U.S. Census estimates that for the same year, the South had the highest level of poverty of all U.S. regions. Drewnowski contends that's not a coincidence, and says that closer study of obesity and poverty rates by ZIP code show a correlation in areas across the U.S.

"We're showing that the rates of obesity by state are very well predicted by the poverty level in that state," he says. "So as far as we're concerned, poverty is probably a better predictor of obesity and diabetes than race or education."

No longer a purely personal issue

The burgeoning percentage of heavy Americans has broader economic consequences as well. Researchers at the CDC and RTI International, a nonprofit think tank, estimated that 2003 health care costs attributable to obesity reached $75 billion, with taxpayers picking up about half of the bill through programs such as Medicare and Medicaid.

As a result, federal, state and local governments have taken notice. Nearly every state has a program targeting kids in schools, their parents in the workplace and their grandparents in senior centers—all with the aim to encourage people to move more and eat better. The plans are varied: Stock school vending machines with healthier foods, repair sidewalks to make them safer for pedestrians, locate farmers markets in areas where affordable fruits and vegetables are hard to come by, or pit neighbors against one another in friendly fitness competitions.

And it's not just health departments that are getting involved. Legislatures are taking action.

"There is a trend toward legislation, definitely," says Laura Segal, co-author of "F as in Fat, 2006," from the Trust for America's Health, a nonprofit, nonpartisan group that studies disease prevention. The 2006 edition of the trust's annual obesity report notes that 16 states have passed taxes on junk food or sodas and 11 require school lunches to meet higher nutritional standards than U.S. Department of Agriculture requirements.

The report also notes that 24 states have passed laws limiting lawsuits related to obesity, perhaps an indication that people see what you weigh in large part as your personal responsibility.

"Our position is, yes, individual responsibility is at the core of this issue," says Segal. "But there are roles for government and business to look at practices that contribute to obesity."

As Segal points out, what we eat and how much we exercise can be affected by factors that individuals alone don't control, from zoning laws governing the width of sidewalks to regulations regarding the content of school lunches.

A change for the thinner?

Yale's Brownell likens the steps necessary to halt the spread of obesity to those taken 40 years ago to reduce cigarette smoking. "Take taxes on cigarettes," he says. "That's the single most effective thing we've done to curb use of tobacco."

But will those kinds of policy changes—such as increasing taxes on junk food or banning the sale of sodas to students at school—work for obesity? Brownell concedes that it's too early to know, but he advocates trying. And he's encouraged by signs that Americans are beginning to realize something's wrong.

"Actually," he says. "I'm quite optimistic. The driving factors are terrible, but what you need to reverse that is to have people perceive it's a problem. You need to have people open to making a change, and I think they are now open to making a change."