Obesity piling up death rates  Oregonian – March 10, 2004                                                                                                                

Poor diet and exercise habits killed 400,000 U.S. residents in 2000 and now rival smoking, the CDC says...

Americans are increasingly eating themselves into the grave, and obesity is poised to overtake smoking as the main preventable cause of death in the United States, an influential new federal study says.

By causing or aggravating conditions such as heart disease and diabetes, poor diet and exercise habits killed 400,000 U.S. residents in 2000, the U.S. Centers for Disease Control and Prevention estimates. That toll probably will exceed 500,000 in the next few years, barring major changes in Americans' eating patterns, a dramatic increase from the 300,000 estimated deaths in 1990.

In contrast, tobacco-related deaths held steady during the 1990s: 435,000 in 2000 versus 400,000 in 1990, the study estimated. The increase came from including deaths linked to secondhand smoke, which was not done in the 1990 tally.

Oregon is squarely in the expanding middle of the obesity epidemic. In 2000, Oregon became the first Western state in the continental United States in which a fifth of adults were found to be obese, said Dr. Mel Kohn, the state epidemiologist. California and Idaho hit that mark in 2001.

Combined, tobacco, diet and poor fitness contributed to the demise of nearly 35 percent of the 2.4 million U.S. residents who died in 2000, according to estimates published in today's Journal of the American Medical Association. The two doctors who made the 1990 estimates said in an accompanying article they suspect diseases linked to poor diet and exercise already kill more U.S. residents than tobacco.

The statistics bolster serious and growing concerns about the health toll obesity imposes on industrialized nations. Noting the death estimates, Health and Human Services Secretary Tommy Thompson on Tuesday announced a new ad campaign designed to encourage Americans to slim down and exercise.

"We need to tackle America's weight issues as aggressively as we are addressing smoking and tobacco," Thompson said in a written statement.

He said the campaign will stress taking "small steps," such as taking brief walks during coffee breaks or eating home-cooked food instead of fast food. Federal leaders also mentioned a continuing effort by the National Institutes of Health to improve scientific research into the causes of and treatments for obesity and related diseases.

'Actual causes of death'

The CDC study estimates what public health officials call "actual causes of death" -- factors affecting disease that are not related to genetics and can be modified. The study considers factors ranging from rates of seat belt use to firearms deaths and exercise levels.

"This is really the way that we, in public health, look at deaths," Kohn said. State health officials use the estimates "all the time" in designing and tracking the success of health and safety programs.

The dramatic increase in obesity is the most striking finding of the new "actual cause" estimates, and it shows where the nation needs to focus its attention, health experts said. Federal estimates say that 64 percent of U.S. adults are overweight, including nearly 21 percent who are obese -- meaning they carry more excess weight and are significantly more likely to develop diseases.

Separate CDC studies say that 57 percent of Oregon adults were overweight or obese as of 2002. The number of obese Oregon adults rose by 86 percent from 1990 to 2002.

"Our disease rates go along with that," said Njeri Karanja, an obesity researcher with Kaiser Permanente Center for Health Research in Portland. "Our stroke rates are probably the highest in the West."

In Washington, 59 percent of adults were overweight or obese in 2002, and the state's obesity rate shot up by 127 percent from 1990 to 2002.

How to figure body mass

For adults, the CDC defines overweight and obesity on a scale called the body mass index, or BMI. The CDC considers a BMI of 18.5 to 24.9 normal, while 25 to 29.9 is overweight, and 30 or higher is obese.

But BMI alone doesn't determine fitness, health experts say: Muscle increases BMI, so fit body builders could have numbers over 25. Other factors also affect a person's fitness, including blood pressure, cholesterol levels, waist size and family health history.

To figure BMI, multiply the weight in pounds by 703. Divide that result by height in inches, then divide that result by height in inches again. The CDC Web site at www.cdc.gov/nccdphp/dnpa/bmi has an automatic BMI calculator.

Doctors said that the obesity epidemic has many causes but boils down to a simple equation: People have been eating more over time, and they are less active.

"People's jobs are more sedentary. Kids are not walking to school; they're being driven," said Dr. Keith Bachman, a Kaiser Permanente internist who works with weight-loss programs. "So I'm seeing obese people every single day."

Problem actually underestimated

The death statistics actually underestimate the problem from obesity, Bachman said. Many more people are suffering with obesity-related illnesses. That's true even among young people, who increasingly suffer diabetes, stroke and heart disease linked to obesity, Karanja said.

Excess weight is also troubling because it's hard to treat. Everyone knows the solution: eating better and exercising more. But those behaviors are hard to adopt and stick to over the long haul, doctors said. Because of that, Karanja said, it is important to focus on preventing excess weight, starting as early as possible -- even with a mother-to-be's nutrition.

The good news, Bachman said, is that "small amounts of weight loss, for a lot of people, have significant health benefits." Losing about 5 percent of one's body weight can lower blood pressure, and getting 200 or more minutes of activity a week can lower the risk of diabetes and other diseases.

Some rays of hope in report

The report did contain some good news. Although CDC scientists said they were disappointed with the slow change in tobacco-linked deaths, Kohn noted that the deaths were trending down, considering the growing U.S. population. Evidence shows that some programs against tobacco, such as Oregon's tobacco quit line, do help prevent disease, he said.

Other successes were more obvious from the study: Deaths from diseases including AIDS, pneumonia and the flu fell in the 1990s, as did deaths linked to drinking and illegal drug use. The number of deaths in alcohol-related car crashes fell from 22,084 in 1990 to 16,653 in 2000. Firearms deaths, mostly from suicides, fell from about 36,000 to less than 29,000 in that period.

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