Obesity Now Outweighs Overweight

America’s obesity epidemic has reached a new milestone.

It’s hardly news that the prevalence of overweight and obesity has been growing steadily over the past few decades. However, recent survey data from the CDC’s National Center for Health Statistics (NCHS) shows that while rates of overweight have remained fairly steady at about 33%, obesity rates have increased from 23% to 34% since the early 1990s.

This increase is startling on two levels. First of all, it means that a total of 67% – a whopping two-thirds – of Americans are unhealthily overweight. It’s clear that past and current efforts have not adequately addressed the problem, and that something innovative and dramatically successful is needed.

Secondly, and more interestingly, it means that more Americans are now obese than overweight. This could have resulted from an overall national trend toward weight gain; it could be that those groups who were previously overweight are now obese, and that those who were in the normal range are now overweight. Or – and I suspect this is the case, given how steady the rates of overweight have remained and how quickly obesity has increased – our past and current efforts have focused too exclusively on the low-hanging fruit. We’ve controlled overweight with some success, but at the expense of the obese.

I feel that this speaks to a larger problem in public health. When choosing target audiences for health education and promotion campaigns, it’s easier to choose those groups who are closest to change – people who already have the intention to change, for example, or communities that already have the necessary infrastructure. Success is more likely and more easily attained. That helps when applying for grants, or when selling a program idea to potential stakeholders. And as public health practitioners and planners, knowing that we will have a positive effect keeps our morale up.

But what happens to those more challenging audiences when they get left behind? According to the NCHS data, 2.9% of survey respondents were extremely obese between 1988 and 1994. In the latest survey, that percentage more than doubled to 6%. Looking at just the differences between the two surveys, the prevalence of extreme obesity increased by 107%, that of obesity increased by 48%, and that of overweight was virtually unchanged. Without specifically targeting those who are already obese or who have less environmental support for reaching and maintaining a healthy weight, the evidence shows that they will suffer.

Fortunately, there’s something we can do. Without abandoning the low-hanging fruit, public health as a community needs to make a shift in the way we define success for those harder-to-reach populations. We need to realize that behavior and health outcome change is relative, and get ourselves to believe that a weight reduction from extremely obese to obese can be just as important as a reduction from overweight to the normal range.

After all, it’s the difference between those before and after photos that gets the reaction.