Section 1: Overweight and Obesity as Public Health Problems in America

This Surgeon General’s Call To Action To Prevent and Decrease Overweight and Obesity seeks to engage leaders from diverse groups in addressing a public health issue that is among the most burdensome faced by the Nation: the health consequences of overweight and obesity. This burden manifests itself in premature death and disability, in health care costs, in lost productivity, and in social stigmatization. The burden is not trivial. Studies show that the risk of death rises with increasing weight. Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years.¹

Overweight and obesity are caused by many factors. For each individual, body weight is determined by a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences. Behavioral and environmental factors are large contributors to overweight and obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

For the vast majority of individuals, overweight and obesity result from excess calorie consumption and/or inadequate physical activity. Unhealthy dietary habits and sedentary behavior together account for approximately 300,000 deaths every year.^2,3 Thus, a healthy diet and regular physical activity, consistent with the Dietary Guidelines for Americans, should be promoted as the cornerstone of any prevention or treatment effort.^4,5According to the U.S. Department of Agriculture’s 1994–1996 Continuing Survey of Food Intakes by Individuals, very few Americans meet the majority of the Food Guide Pyramid recommendations. Only 3 percent of all individuals meet four of the five recommendations for the intake of grains, fruits, vegetables, dairy products, and meats.⁶ Much work needs to be done to ensure the nutrient adequacy of our diets while at the same time avoiding excess calories. Dietary adequacy and moderation in energy consumption are both important for maintaining or achieving a healthy weight and for overall health.

Many adult Americans have not been meeting Federal physical activity recommendations to accumulate at least 30 minutes of moderate physical activity most days of the week.^4,7 In 1997, less than one-third of adults engaged in the recommended amount of physical activity, and 40 percent of adults engaged in no leisure-time physical activity.⁷ Although nearly 65 percent of adolescents reported participating in vigorous activity for 20 minutes or more on 3 or more out of 7 days, national data are not available to assess whether children and adolescents meet the Federal recommendations to accumulate at least 60 minutes of moderate physical activity most days of the week.^4,8 Many experts also believe that physical inactivity is an important part of the energy imbalance responsible for the increasing prevalence of overweight and obesity. Our society has become very sedentary; for example, in 1999, 43 percent of students in grades 9 through 12 viewed television more than 2 hours per day.⁸

Both dietary intake and physical activity are difficult to measure on either an individual or a population level. More research is clearly necessary to fully understand the specific etiology of this crisis. However, these statistics and the increasing prevalence of overweight and obesity highlight the need to engage all Americans as we move forward to ensure the quality and accessibility of prevention and treatment programs.

Public Health and the Surgeon General Through cooperative action, public health programs have successfully prevented the spread of infectious disease, protected against environmental hazards, reduced accidents and injuries, responded to disasters, worked toward ensuring the quality and accessibility of health services, and promoted healthy behaviors.9 Over the past 100 years, thanks largely to public health efforts, the life expectancy of Americans has increased by approximately 50 percent.10 Public health success has traditionally come from the reduction in the incidence of infectious diseases through improved sanitation and nutrition, cleaner air and water, and national vaccination programs. As the threats to America’s health have shifted, so too have public health efforts. In recent years, public health efforts have successfully navigated new frontiers such as violence prevention, tobacco cessation, and mental health. Public health officials remain poised to address new health challenges through the collaborative processes of scientific research, policy development, and community mobilization.