Dr. Charles H. Hennekens, M.D., Dr.P.H., the first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University has published a report in the current issue of the American Journal of Medicine that obesity is becoming as big a hazard worldwide, comparable to cigarette smoking. The epidemic of obesity in the United States as well as globally, contributes to avoidable and premature deaths from cardiovascular disease, cancer and other causes. He notes that obesity is the leading avoidable cause of the current epidemic of type 2 diabetes in the U.S., which is also increasing worldwide. He also notes that during the last several decades, there has been a systematic underestimation of the hazards of obesity. Hennekens has published these findings with co-author Felicita Andreotti, M.D., Ph.D., professor of medicine at Catholic University in Rome, Italy.
"I am deeply concerned that the United States is the fattest society in the world and likely to be the fattest in the history of the world," said Hennekens. "Unfortunately, most people prefer prescription of pills to proscription of harmful lifestyles. I am, however, optimistic that weight loss of 5 percent or more combined with a brisk walk for 20 or more minutes daily will significantly reduce cardiovascular and total deaths."
In the commentary, Hennekens emphasizes the importance of therapeutic lifestyle changes beginning in childhood. As this current generation of American children and adolescents reach middle age, morbidity and mortality from cardiovascular disease will increase. This generation of adolescents are more obese and less physically active than their parents and already have higher rates of type 2 diabetes. It is likely that the current generation of children and adolescents in the U.S. will be the first since 1960 to have higher mortality rates than their parents due mainly to cardiovascular disease, including coronary heart disease and stroke. In addition, obesity is a major risk factor for several cancers, especially colorectal, but also breast and prostate.
Hennekens notes that clinicians should not let the perfect be the enemy of the possible. For American adults, this implies the need for evidence-based doses of drugs of lifesaving benefit for those at high risk. He also comments that in the U.S. today, 40 percent of adults age 40 and over have metabolic syndrome, a constellation of obesity, lipid abnormalities, hypertension and insulin resistance, a precursor of diabetes. These individuals have a 10-year risk of a first coronary event of 16 to 18 percent and require aggressive management to lower their high risks of premature death and disability.
According to the U.S. National Institutes of Health, approximately two-thirds of adults age 20 or older are overweight or obese with body mass indexes (BMI) greater than 25, and nearly one-third have BMI's greater than 30. Less than one-third of them are at a healthy weight with a BMI of 18.5 to 24.9. In 1995, the economic cost of overweight and obesity in the U.S. alone was estimated to be $117 billion.
Hennekens cautions that "unless Americans lose weight and increase their levels of physical activity, cardiovascular disease will remain the leading killer in the U.S." He adds, "the export of our diet and lifestyle, which increases rates of obesity, together with tobacco, to developing countries will result in cardiovascular disease emerging as the leading killer in the world."
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