Although there is an enormous body of epidemiological studies that link obesity with poor health, a 2009 review by Wildman* concluded that a third of obese people have normal levels of metabolic markers that would suggest no increased risk of heart disease. This field of study is in its infancy, and we don’t know why, but genetics may play an important role. It is also likely that physical activity, healthy eating, good self-esteem and stress management in concert with managing metabolic risk factors and holding weight stable improves fitness for obese individuals.
Once established, obesity is intractable. Americans spend billions of dollars each year losing weight, only to regain it. Therefore, we must recognize that preventing weight gain is essential, especially for children, adolescents and young adults. For many who carry the burden of the obesity epidemic, healthy foods are too costly and neighborhood environments are not safe and welcoming places to walk or play.
Our entire nation needs to become “metabolically fit”. This requires major changes in food systems, schools and health care; and at the level of the social and the “built environment”. If we want to improve the health of all Americans—young and old, obese and lean– we must find ways to address the underlying causes of the obesity epidemic at the policy level.
*Wildman RP. Healthy obesity. In Current Opinion in Clinical Nutrition and metabolic care. 2009 12:438-443.