I’ve spent three posts detailing the internal and external causes of obesity: appetite, metabolism, and our environment. The next question is: why do we care? Why should we concern ourselves about treating obesity?
Not just vanity
Beauty and weight have a complicated social position. Over the centuries, the ideal shape, size, and fatness of “beauty” have varied. In the early middle ages, there’s evidence that a very thin woman with small breasts was idealized. The high renaissance is famous for its depictions of heavier subjects. In America in 2025, the standard is typically impossible. You can’t be too or too heavy. Women have to keep track of an ever-changing litany of beauty standards–the size of our breasts, our butts, the length of our hair, the shape of our eyebrows. Nobody is ever enough.
I’m not going to talk about self image and weight, however. It’s a very important topic, but I can’t do it justice. However, it is important to recognize how weight and the concept of beauty are intertwined, because it directly affects how people perceive the disease of obesity. For many people, including policymakers and insurance companies, weight is purely a matter of cosmetics and vanity. It is not their job to assist people in pursuing cosmetic results.
The health impacts of obesity
However, obesity the disease has significant longterm health effects. The abnormal, “sick fat” of obesity creates a cascade of additional health issues. Obesity can directly lead to the development of, among other things:
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Arthritis
- Sleep apnea
- Fatty liver disease
Obesity also significantly increases the risk of several cancers including colorectal, breast, prostate, and uterine cancer. The inflammation of obesity weakens the body’s immune system and increases inflammation, one of the reasons why people with obesity are more likely to die from COVID. Beyond this, obesity creates significant emotional and mental distress. Individuals with obesity experience significant discrimination in social, professional, and healthcare settings.
Severe obesity can shorten a person’s lifespan by up to 14 years–similar to the decrease seen with smoking. Currently, obesity and its complications are costing the US about $173 billion a year in healthcare costs. There are also costs associated with lost wages and productivity due to the complications of a chronic disease, although it is harder to get data for that. It takes some time for most complications of obesity to develop, so the costs we are seeing right now are likely related to the obesity rate of 10-15 years ago–which was 10% less than it was before. As obesity rates increase, we will see more and more of these significant complications and the strain on our society will continue to increase.
Treating obesity strengths our country
I’ve believed for a long time that the best investment a country can make for its future is to invest in its people. This includes investing in the health of its citizens. There is a lot of talk in the public sphere about making America a better version of itself. If we want to realize our full potential as a country, we have to take care of the health of our citizens. We have made a lot of progress in this over the past hundred years–I’ll discuss more about public health wins in the near future. However, right now, our public health is at a major inflection point and we have to act to decrease the burden of chronic diseases. Unless we are treating obesity, we are not treating the root cause of these diseases, and we will always be playing catch up and intervening five steps down the path instead of the beginning.
The Centers for Medicare and Medicaid Services are accepting public comments on the proposed rule. They need to hear from Americans about how important this rule will be for our health! You can find more information about the proposed rule and tips for submitting a comment at the Obesity Action Coalition’s website, found here.