Obesity Rates, Studies, and Childhood Obesity

Obesity in America is becoming more common, especially among the aging population.

In its latest Data Brief, the Centers for Disease Control and Prevention (CDC) estimated 36.5% of U.S. adults were obese during the latest monitoring period, 2011-2014.

While recent concern has focused on obesity among children, the CDC report found the people most likely to be obese are middle-aged adults aged 40–59 and older adults aged 60 or over.

Obesity is a more serious condition than merely being overweight. The difference is determined by the body mass index (BMI), which is a formula based on a person's height and weight.

Having a BMI between 25 and 30 is considered overweight. Having a BMI of 30 or more is considered obese.

In its report, the CDC found the prevalence of obesity was higher in women than in men. Among all youth, no difference was seen by sex.

Encouraging sign

And among youth, the obesity rate has leveled off at 17%. Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation, says that's the report's one sign of progress.

“The obesity rate is declining for the youngest children, and has held steady for all children over the last two measurement periods,” Lavizzo-Mourney said. This reinforces our confidence that America's children are moving toward a healthier weight, and that bodes well for the long term health of our nation.”

At the same time, Lavizzo-Mourney said the fact that the adult obesity rate is rising is a cause of concern. She notes that rates are highest among Hispanic and black teenagers and adults. And women, she says, have overtaken men in the obese category.

Areas of action

“We will continue to address these inequities, and the many barriers to growing up and living a healthy life, Lavizzo-Mourney said. “Nutritious, affordable foods are out of reach for too many families, young people still see far too many ads for sugar-laden snack foods and beverages, and too few of our communities provide adequate safe, accessible spaces for kids to be active.

The Robert Wood Johnson Foundation is spending an additional $500 million in 2015 on anti-obesity programs.

The CDC says the prevalence of obesity among adults is still higher than the Healthy People 2020 goal of 30.5%. Although the overall prevalence of childhood obesity is higher than the Healthy People 2020 goal of 14.5%, the CDC says there are signs of progress among the youngest children in the survey, those aged 2–5 years.

America still has a serious weight problem, but if there is a silver lining to the latest State of Obesity report, it's the obesity problem isn't getting much worse.

The annual report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) finds obesity rates increased in Kansas, Minnesota, New Mexico, Ohio and Utah but held mostly steady in the rest of the country.

Arkansas has the highest adult obesity rate at 35.9%, while Colorado has the lowest at 21.3%. In three states – Arkansas, West Virginia and Mississippi – 35% or more of adults are clinically obese., meaning they have a body mass index (BMI) of 30 or higher.

The top 10 states with the highest obesity rates are:

1. Arkansas
2. West Virginia
3. Mississippi
4. Louisiana
5. Alabama
6. Oklahoma
7. Indiana
8. Ohio
9. North Dakota
10. South Carolina

Fairly recent trend

The report drives home how recently this epidemic has occurred. In 1980, no state had an obesity rate above 15%. In 1991, there was no state with an obesity rate above 20%. Today, more than 30% of American adults, nearly 17% of two to 19 year olds and more than 8% of children ages 2 to 5 are obese.

Not just overweight. Obese.

The 78 million Americans who are obese are at increased risk for a range of health problems, including heart disease, diabetes and cancer.

"Efforts to prevent and reduce obesity over the past decade have made a difference. Stabilizing rates is an accomplishment. However, given the continued high rates, it isn't time to celebrate," said Jeffrey Levi, PhD, executive director of TFAH. "We've learned that if we invest in effective programs, we can see signs of progress. But, we still haven't invested enough to really tip the scales yet."

The report authors suggest the best way to reduce obesity rates is to help children maintain a healthy weight. That's best done, they say, promoting good nutrition and physical activity. In that light, a new report by the Centers for Disease Control and Prevention (CDC) is not encouraging.

Fast food consumption

Its study of caloric intake from fast food between 2011-2012 finds that just over one-third of U.S. children and adolescents consumed fast food on a given day, getting 12.4% of their daily calories from fast food restaurants.

“Consumption of fast food has been linked to weight gain in adult.” the authors write. “Fast food has also been associated with higher caloric intake and poorer diet quality in children and adolescents.”

The CDC report also traces the rise in calories from fast food as a fairly recent trend. It also noted that older children frequent fast food restaurants a lot more than younger children do.

In years gone by, summer was a season for youthful activity. Kids played outdoors all day – swimming, playing baseball and kicking the can after dinner.

In short, kids got plenty of exercise during the summer – maybe more than any other time of year.

That doesn't appear to be the case today. Health officials say summer is one of the most challenging times of the year when it comes to preventing childhood obesity.

What's changed? The school year is still the way it always was. A lot of students walk to school, go to gym class, play outside at recess, and participate in after-school sports.

Even though they remain seated at their desks for long stretches of the day, they eat only during designated times. These days, school cafeterias and vending machines have been mostly purged of junk food.

Kids are healthier during the school year

Ironically, it is during the school year, when kids are more confined, that they maintain a more healthy lifestyle.

“In school, you can’t keep snacking while you’re learning history,” said Lara Dugas, a physical activity epidemiologist at Loyola University.

It's children's summer lifestyle that has undergone a change, and not for the better. During the summer months many children have relatively little structure or supervision. This is especially true in low-income households that can’t afford summer camps, says Dugas.

As a result, many children get less exercise during the summer and pass the time eating as much junk food as they want.

Fitter in June than August

“Many children finish the school year in June fitter and leaner than when they go back to school in August,” Dugas said.

This changing summer lifestyle has occurred over the last 30 years, at precisely the time childhood obesity has more than doubled in children and quadrupled in adolescents, according to the U.S. Centers for Disease Control and Prevention. The CDC reported that in 2012, more than one-third of children and adolescents were overweight or obese.

Dugas says the cycle can be broken, but it will take getting kids up off the couch and outside, involved in summer camps, sports teams, and park activities.

“Such structured activities provide opportunities to benefit both their physical and cognitive development,” she said.

Summer activity tips

The American Heart Association has these tips for keeping kids physically active during the summer:

• Encourage outdoor play that involves any kind of movement. Informal games like tag, jumping rope, or hopscotch are beneficial.
• Introduce new games to a group of children. When kids learn the rules of a game at the same time as their peers, they're more confident and are more likely to participate.
• Limit screen time to two hours a day.
• Keep it fresh. Don’t get stuck in a workout rut. Try and incorporate a new exercise or game every few weeks to keep kids motivated.
• Try to make sure kids get in 60 minutes of physical activity every day, but it doesn't have to be 60 uninterrupted minutes. Break it up into several shorter periods of play. As long as daily physical activity adds up to at least 60 minutes, it's fine.  

Common sense would tell you that it would be hard to attain a normal weight once you are obese. Researchers at King's College in London have figured out just how hard.

For an obese man, the odds of getting back a normal body weight is 1 in 210. Obese women face slightly better odds – 1 in 124.

The study, written up in the American Journal of Public Health, suggests current weight management programs that focus on dieting and exercise are not effective in tackling obesity at the population level.

First, it might help to understand what is obese and what is normal body weight. The terms are defined by each individual's body mass index (BMI) score. BMI is a measure of body fat that is based on a person's height and weight.

BMI calculator

The National Institutes of Health (NIH) provides this BMI calculator to help you find where you fit. You enter your weight and height using either standard or metric measures and the calculator gives you a number, which is your BMI.

A BMI of 18.5 to 24.9 is considered normal body weight. If your BMI is 25 to 29.9, it classifies you as overweight. A BMI of 30 or higher puts you in the obese category.

The Kings College researchers wanted to find out how likely it was for someone who was obese to lose enough weight to return to normal weight. They tracked the weight of 278,982 participants – 129,194 men and 149,788 women – using electronic health records from 2004 to 2014.

The study measured the probability of obese patients attaining normal weight or a 5% reduction in body weight through diet and exercise, excluding patients who received bariatric surgery.

Temporary results

The chance obese patients could achieve a 5% weight loss within a year was 1 in 12 for men and 1 in 10 for women. But for those who were able to lose 5% of their body weight, 53% regained the weight within 2 years and 78% had regained the weight within 5 years.

Out of the nearly 300,000 subjects, only 1,283 men and 2,245 women with a BMI of 30-35 reached their normal body weight, equivalent to an annual probability of 1 in 210 for men and 1 in 124 for women.

The study concludes that current obesity treatments aren't working for the majority of obese patients.

“Once an adult becomes obese, it is very unlikely that they will return to a healthy body weight,” said Dr. Alison Fildes, the study's first author. “New approaches are urgently needed to deal with this issue.”

Fildes says obesity treatments should focus on preventing overweight and obese patients from gaining more weight, while also helping those that do lose weight to keep it off. More importantly, she says, there needs to be more emphasis on preventing weight gain in the first place.

Bariatric surgery

According to NIH, bariatric surgery currently is recommended for people categorized as severely obese – with a BMI greater than 40.The surgery restricts food intake, which promotes weight loss and reduces the risk of type 2 diabetes. It has been shown to be effective, though like any surgery, there are risks associated with it.

There are also benefits from going from Obese to simply overweight. The Mayo Clinic points out that even modest weight loss can improve or prevent the health problems associated with obesity.  

Recognizing that you are overweight is usually the first step to getting healthier. Unfortunately, this admission is not always the easiest to make. A new study shows that adolescents have a particularly hard time recognizing that they have a weight problem.

The study, which was conducted by researchers at Georgia Southern University, was based on findings from two separate surveys. One survey was given over roughly six years, from 1988 to 1994. The second survey was given over five years, from 2007 to 2012. All participants from both studies were between the ages of 12 and 16 and were classified as obese, overweight, or normal weight through their body mass index (BMI) scores.

The surveys attempted to gauge how each era’s young people viewed their own weight. After adjusting for certain variables, such as age, race, sex, and socio-economic standing, the researchers found that the more recent generation was 29% less likely to classify themselves as overweight or obese.

Peer pressure and social comparison

So what do these numbers mean? Well, the researchers believe that self-perception has changed over the last 20 years, and there are a couple of ways that this could have affected the survey results.  

“In the wake of the obesity pandemic, the media, weight loss industries, and medical communities have encouraged adolescents to maintain slender frames. Facing harsher messages, more and more overweight and obese adolescents may be increasingly reluctant to admit that they are overweight,” said Dr. Jian Zhang, who led the study.

This seems to make some sense. With the amount of pressure that adolescents face to “fit in”, along with the media and peers venerating people who are thin, many teens may not be willing to admit that they don’t belong.

To offer a completely contrary explanation, many overweight or obese teens may not feel that they should be classified as such because of who their friends and family are. This is explained by the “Social Comparison Theory”. In short, the theory suggests that people compare their weight with those around them, rather than with any actual number or scale. As such, a teen who has a lot of friends or family members who are overweight may feel that they are perfectly normal for being overweight too.

Adopting healthy behaviors

Regardless of the cause, the researchers believe that it is extremely important for adolescents to be clearly informed about their own weight status. By being aware of how healthy they are (in terms of weight), adolescents can begin to make choices that will help them adapt healthier behaviors. This, in turn, will help reduce obesity numbers in adolescents and contribute to healthier living.

"Becoming conscious of one's excess weight is the precursor to adopting behavioral changes necessary for appropriate weight control. The declining tendency of correctly perceiving overweight status presents a vast challenge to obesity prevention among adolescents, making the overweight and obese adolescents less motivated to actively engage in effective weight loss behaviors,” said Dr. Zhang

The full study has been published in the American Journal of Preventive Medicine. 

Amid concerns about childhood obesity, the food industry adopted voluntary standards for the food it advertises on television programs for children.

The industry agreed to nutritional standards the advertised food should meet, setting limits on trans fat, saturated fat, sugar and sodium.

So how does reality sync up with aspiration? Dale Kunkel, a communications professor at the University of Arizona in Tucson, organized a research project to monitor 103 kids' shows on 2 cable channels and 5 broadcast networks.

The team said it found the industry has kept its promise, but still has a lot of room for improvement.

Nutritionally deficient food

"The long-standing pattern favoring nutritionally deficient food products over more-healthy items clearly persisted despite the advent of industry self-regulation,” Kunkel said. “This outcome occurred largely because participants in self-regulation achieved no significant improvement in the nutritional quality of their advertised foods between 2007 and 2013."

The research team found that 80% of the food products advertised to children fall into what it calls the poorest nutritional category set by US Department of Health and Human Services (HHS) guidelines.

So how can the food industry be keeping its promise but still be falling short? Kunkel says it has to do with the industry standards.

In 2006 the industry formed the Children's Food and Beverage Advertising Initiative (CFBAI), the means for the nation's 17 largest food companies to set nutritional standards for child-targeted ads.

However, it was left up to each participating company to set its own standards. For example, Kellogg pledged that all child-targeted advertising will contain a maximum per serving of 200 calories, 2 grams (g) saturated fat/0 g trans fat, 230 milligrams (mg) sodium, and 12 g added sugar.

Industry meeting its guidelines

The study finds that CFBAI-participating companies have completely delivered on promises by advertising only products that meet nutritional guidelines agreed to by their parent corporations and have used licensed characters solely in advertising for products that comply with their parent corporations' guidelines for healthier products.

In that regard, Kunkel says the industry has done everything it promised. His complaint is with the standards themselves. He says a number of companies have classified a product as healthy if only a small portion of an unhealthy ingredient has been removed from its formulation.

When the researchers analyzed the products they found the food hit the companies' stated benchmarks but fell short of HHS nutritional standards. Companies that did not sign on to CFBAI standards, Kunkel says, tended to advertise the least-healthy food products.

"Deficiency in the nutritional standards employed by industry self-regulation has already been recognized as a critical shortcoming," Kunkel said.

The Association of National Advertisers takes strong exception to Kunkel's conclusions. A spokesman told Reuters that the nutritional standards the researchers are holding the food industry to “went way overboard,” claiming 87% of the most consumed food products in the U.S. wouldn't pass the test.

"In the face of pleas for advertising reform, the food industry has achieved what might be labeled as baby steps," Kunkel said.

But he says the takeaway from the study is the limits of self-regulation. Continuing to rely on self-regulation, he predicts, won't achieve the goal of reducing childhood obesity.

The rise in U.S. obesity rates is undeniable. According to the Centers for Disease Control and Prevention (CDC), more than one third of U.S. adults – 78.6 million people – are obese.

Obesity rates have more than doubled in both adults and children since the 1970s, according to the National Center for Health Statistics.

The question is why. Food industry critics blame food additives and fast food restaurants. The food industry points to an increased sedentary lifestyle.

But researchers at Georgia State University economists quote political operative James Carville – “It's the economy, stupid.”

Abundance of calories

Theories about the economic causes of obesity have gained traction in recent years, but Georgia State health economist Charles Courtemanche says it's more fact that theory. He and his team conducted a study, published by the National Bureau of Economic Research, concluding that the abundance of cheap calories available to consumers is largely to blame for our expanding waistlines.

"People are doing a lot of eating," said Courtemanche, an assistant professor in the Andrew Young School of Policy Studies. "But as economists, we know people's preferences don't change overnight, so the steady rise since 1980 must involve their incentives to eat."

To arrive at their conclusions, the Georgia State team studied obesity rates in 27 states, looking at a number of economic variables. Things like unemployment and income, food prices, the density of food retail, and physical activity as it is influenced by gasoline prices and fitness centers.

Answering the question

They titled their study "Can Changing Economic Factors Explain the Rise in Obesity?" and answer it in one word: yes.

The bottom line? They conclude that big-box retailers Costco, Sam's Club, BJ's Wholesale and Walmart, along with full-service and fast-food restaurants, are key contributors to the nation's obesity epidemic.

"Changes in variables related to calorie intake collectively explain 37% of the rise in body mass index (BMI) rates and 43% of the rise in obesity," Courtemanche said. "And our data show that the pervasive presence of supercenters, warehouse clubs and restaurants are responsible for most of these gains."

Simply put, the researchers say what has changed over the last 3 or 4 decades is the abundance of cheap calories. We have gone from a time when calories were expensive – food wasn't that plentiful and cost a lot to prepare – to a time when someone with $5 in their pocket can easily ingest 1,000 or more calories.

Less physical occupations

Here's another economic factor the researchers say contributes to obesity – the loss of blue collar jobs and the rise of office workers and the unemployed. When people did physical labor, not only were they burning calories all day, they didn't have time to stop and snack.

"The best explanation for the difference between these workers, outside of physical movement, is time flexibility," Courtemanche said. "White-collar workers have the flexibility to graze all day at their desks, and they can take lunch out. It all points to caloric intake."

On the other side of the coin, economic factors like high gasoline prices and the presence of fitness centers worked to reduce obesity rates. But the research suggests these effects are not the same for everyone.

"The greatest rise in weight is concentrated among people already at risk for obesity," Courtemanche said.

Food technology

Courtemanche and his team are not the first to suggest that economic factors are a significant driver of obesity. In 2003 a Harvard study (pdf) pointed to technological advances in food preparation as a significant contributor to obesity. It held out the potato as an example.

“Before World War II, Americans ate massive amounts of potatoes, largely baked, boiled or mashed,” the economists wrote. “They were generally consumed at home. French fries were rare, both at home and in restaurants, because the preparation of French fries requires significant peeling, cutting and cooking.”

Then along came technology. French fries are now typically peeled, cut and cooked in a few central locations using sophisticated new technologies. They are then frozen and shipped to restaurants and supermarkets. Today, the French fry is the dominant form of potato and America’s favorite vegetable.

A medium-sized baked potato has 129 calories before you add butter or sour cream. A medium order of McDonald's French fries contains around 380 calories.

A U.S. Department of Agriculture (USDA) sponsored analysis of fast food over a 17-year period has some good news and some not-so-good news for consumers trying to stick to a healthy diet.

While the overall trend in restaurants has been to increase portion size, as a way to compete for customers, fast food restaurants, for the most part, haven't taken part.

Researchers at the USDA Human Nutrition Research Center on Aging at Tufts University found little change in fast food portion sizes and product formulation between 1996 and 2013.

Calories, sodium & fat

They also found that average calories, sodium, and saturated fat didn't change much, meaning they remain at pretty high levels. But they did observe a consistent drop in the trans fat found in French fries. In some ways, fast food restaurants are doing a better job than the rest of the restaurant industry.

"There is a perception that restaurants have significantly expanded their portion sizes over the years, but the fast food we assessed does not appear to be part of that trend," said Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at the USDA HNRCA. "Our analysis indicates relative consistency in the quantities of calories, saturated fat, and sodium.”

That said, some fast food chains are serving up healthier fare than others. And while most chains now have salads and wraps on their menu for health-conscious customers, that's not what tends to get ordered most.

Combo meals

So the researchers looked at burgers and fries, particularly the items frequently sold together as a meal. Lichtenstein says these meals often push the limits of what we should be eating to maintain a healthy weight and sodium intake.

"For example, among the three chains, calories in a large cheeseburger meal, with fries and a regular cola beverage, ranged from 1144 to 1757 over the years and among restaurants, representing 57% to 88% out of the approximately 2000 calories most people should eat per day," Lichtenstein said. "That does not leave much wiggle room for the rest of the day."

Using the researchers' 2013 data, calorie content of the cheeseburger meal among the three chains represented 65% to 80% of a 2,000 calorie per day diet and sodium content represented 63% to 91% of the recommendation.

Pay particular attention to sodium content. The U.S. Dietary Guidelines for Americans recommend adults limit their salt intake to a maximum of 2,300 milligrams per day.

Depending on the chain, between 1996 and 2013, eating a single 4 ounce cheeseburger could have accounted for 1100 to 1450 mg of daily sodium representing 48% to 63% of target limits.

The researchers focused on four popular menu items – cheeseburgers, fries, grilled chicken sandwiches and regular cola.

Lower trans fat

Over the years there were only small fluctuations in calorie content and the amount of saturated fat and sodium found in these products. The notable exception was fries, which decreased first in saturated fat in 2001 and then trans fat, most likely due to changes in the fat used to cook them.

"The decline in trans fat we saw between 2005 and 2009 appears to be related to legislative efforts," Lichtenstein said. "The success of New York City's trans fat ban and others like it, suggest it is worth pursuing these types of approaches because they make the default option the healthier option. Of course, it is important to note that the healthier option in terms of fat does not translate into lower calories or less salt."

The researchers continue to see fast food restaurants as contributing to America's obesity epidemic and say the industry could help by downsizing portions and cutting back on fat and sodium. But they conclude on a note of optimism.

"From what we hear some fast-food chains are heading in that direction and also introducing new healthier options,” Lichtenstein said. “If taken advantage of, these changes should help consumers adhere to the current dietary recommendations."

In other words, consumers have to make the healthier choice. Eating at McDonald's does not have to result in consuming 1,500 calories in one sitting. McDonald's Southwest Salad with grilled chicken contains 290 calories – adding balsamic dressing only increases it to 325 calories.

People tend to load up on empty calories at this time of year but perhaps this year we won't hit the cakes, pies, cookies and chocolate covered donuts quite as hard. At least, the recent trend suggests we won't.

Researchers at the University of North Carolina monitored consumers' purchases of these products – known as ready-to-eat grain-based desserts (RTE GBDs). The study appears in the Journal of the Academy of Nutrition and Dietetics.

They found that between 2005 and 2012 consumer purchases of RTE GBDs, which are high in calories and low in nutrition, fell by 24%. That's the good news.

The bad news – at a time when the food industry has made some progress is producing healthier types of food, the improvements really haven't extended to RTE GBDs. These types of products contribute a significant amount of energy, sugar, and saturated fat to Americans’ diets, so making them healthier could be a way to reduce the number of empty calories in the American diet.

Same nutritional content

While Americans are buying fewer of these cookies and pastries, the products that are being sold and consumed still have much the same nutritional content they have always had.

“The results of this study indicated that larger wide-scale efforts are needed among public health officials and all manufacturers of RTE GBDs to shift consumer purchases towards products with lower energy, sugar, and saturated fat content,” said the study's lead author, Dr. Kevin C. Mathias.

When companies do make their dessert and pastry products healthier they don't usually make a big deal about it, not wanting to call attention to the nutritional makeup of the previous version. But Mathias says if consumers were informed about the changes, they might be willing to resume buying the products, leading to an increase in sales.

Mathias says these potential issues highlight the need for continual monitoring of both the amount and nutritional content to ensure that efforts to improve consumer choices are effective.

Challenge for manufacturers

Manufacturers face many challenges when they set out to reformulate existing RTE GBDs to provide healthier food choices. They have to replicate the taste, appearance, and texture of the old products while keeping costs under control. That may be why the researchers say efforts so far haven't been all that impressive.

“The results from this analysis show that the new RTE GBD products released in 2012 did not have lower energy, sugar, or saturated fat densities than the products already existing on the market,” Mathias said.

On the public health sector side there is also room for improvement. Development of new front-of-package labeling systems that shift consumer purchases towards products with lower energy, sugar, and saturated fat content is another opportunity to help consumers improve their dietary intake.

Since obese consumers likely get a lot of their empty calories from RTE GBDs, the Carolina researchers says improving the nutritional content of these products could pay off in healthier consumers.

”The results from the product and purchase level analyses highlight an opportunity for both food manufacturers and public health officials to work together to develop strategies to shift consumer purchases towards products with lower energy, sugar, and saturated fat densities in addition to decreasing overall purchases of RTE GBDs," Mathias said.

Research continues to shed new light on childhood obesity, its consequences, and how best to prevent it. The latest findings underscore the importance of parental influence.

For example, pediatrics researchers at the University at Buffalo (UB) have made this correlation: preschoolers whose parents have rules about what they can and cannot eat don't seem to have a problem with obesity.

“Parents can make a difference here by training young children to self-regulate and also by setting food rules in the home,” says Xiaozhong Wen, senior author on the research. “We found that the combination of parental rules and young children’s ability to self-regulate their behaviors works best in teaching young children to eat healthy.”

The ability to self-regulate appears to be the wild card here. The researchers noticed that some children whose parents did not enforce strict food rules still managed to have healthy weights. The researchers noticed that these kids also seemed to be better able to control their emotions, which they say may be a controlling factor in food consumption.

Hard to change after fifth grade

It's important for preschoolers to maintain a healthy weight because researchers in Boston have found that if they are overweight or obese by fifth grade they have a high risk of becoming or remaining obese in their teen years.

The collaborative study by several universities highlights several risk factors, including too much screen time, having a parent who is obese, living in a lower education household and having a negative body image.

"We know from prior studies that obesity in children is correlated with their likelihood of being obese when they are older," said study lead author Dr. Mark Schuster, chief of General Pediatrics at Boston Children's Hospital and a Harvard professor. "But the pattern of change over time, of entry to and exit from obesity, hasn't generally been studied."

Overcoming the odds

While it is important to intervene with young children before they become overweight, Schuster says it is also important not to give up on kids who have become obese by fifth grade or later. While the odds may be against them, several interventions can help these kids.

"We as clinicians need to do more to educate families and encourage them to have healthier foods at home and especially when they eat outside the home,” Schuster said. “We also need to encourage them to increase exercise and reduce screen time."

Schools can play a role as well, such as improving school meals, removing sugar sweetened beverages and strengthening or restoring physical education programs. While there is hope, the present numbers are not encouraging.

The researchers found 65% of obese fifth-graders remained obese in tenth grade; 23% were no longer obese but were still overweight. Only 12% became normal weight.

On the other side of the coin, 87% of the children who were normal weight in fifth grade were still normal weight in 10th grade.

Helping or hurting?

Previous studies have suggested teens who are obese are almost certain to be obese as adults, leading to serious health problems, including cardiovascular disease and diabetes. Besides the health consequences, many of these adults spend millions of dollars on weight loss programs, drugs and even surgery.

A study by researchers at 3 universities suggests some of these obesity remedies are actually contributing to the problem.

"Weight management remedies that promise to reduce the risks of being overweight may undermine consumer motivation to engage in health-supportive behaviors," write authors Lisa E. Bolton of Penn State, Amit Bhattacharjee of Dartmouth, and Americus Reed, II of Penn. "Put simply, why put effort into living a healthy lifestyle when a weight management remedy can take care of the problem?"

The study warned that the very people who need to reduce weight the most and are desperately reaching for weight loss pills are unfortunately the ones most likely to then dangerously increase their consumption of unhealthy foods.

Food has been around forever. Kids that won't eat have been around forever as well. It just comes with the territory of being a parent. One thing you don't want to do is take it personally. It has nothing to do with your cooking. It's just part of being a kid.

Obviously, this isn't true of all children. Some kids will eat everything in sight and you need a deadbolt on the fridge, but for the sake of this article we are going to focus on the ones that you have to play games with if you want them to eat. I've been there.

Doctors say that most often picky eaters are "grazers" – that is, kids who eat small amounts of food throughout the day. Making sure your child has set meal and snack times will help ensure she's eating when she's hungry and lessen the chance she'll snack too much.

Jennifer Tyler Lee devoted a whole book on the subject, titled "The 52 New Foods Challenge" -- a family cooking adventure for each week of the year, she has your back with 150 recipes. She says she wanted to get her kids to be a little more adventurous and get past the plain pasta and peas.

"What I discovered was that the journey wasn't about getting my kids to change," Lee said. "It was about creating a change in me."

Dinners transformed

The book takes you on a journey with her and her family and how she was able to transform family dinners. It will help you change your perspective and it's packed like a well-stocked refrigerator with tips for stressed-out parents of reluctant eaters.

“When it comes to food, one of the pillars of parenting is to protect the home environment. If you don't want your child to eat it then don't bring it home. Be picky what you bring into the house,” says Dr. David Ludwig, the director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital and the author of “Ending the Food Fight.”

The Mayo clinic weighs in with a few ideas and says that you should serve small portions -- don't overwhelm your child with a huge plate of lasagna and peas. Serve small amounts like 3 peas and a teeny slice of lasagna. Give them the chance to ask for more.

Be patient with foods that are new to them. They might smell them and play with the texture of them.

Encourage your child by talking about a food's color, shape, aroma and texture — not whether it tastes good. By all means serve it with something they really like.

Serve breakfast for dinner. Change it up a little and make it fun.

Participation can be a real food additive. If your kids help pick things out at the grocery they take ownership. Then letting them help prepare the meal is all the better. Think about it -- anytime you participate in something it adds value to it.

The New York Times "Mother Lode" section's Picky Eater project suggests that you not label your child a "picky eater." If your child doesn't eat carrots, don’t stop serving them, or when your child is a guest at someone else’s table, don’t say, "My child doesn't like carrots." If you define them, it makes it that much harder for them to change.

The annual report on American obesity from the Robert Wood Johnson Foundation can't be considered a surprise. It can be considered a bit depressing, however.

In a nutshell, America's obesity problem got worse last year. The adult obesity rate increased in 6 states – Alaska, Idaho, New Jersey, Tennessee and Wyoming. In Mississippi and West Virginia, more than 35% of the adult population is obese.

In 20 states, the adult obesity rate is at or above 30%. In no state is the rate below 21%. And in no state did the obesity rate decline.

Obesity rates tend to be highest in the south and among low-income groups with the least education. Perhaps most depressing of all, these numbers are just for adults – they don't measure children.

The report's authors predict that 10% of children will become obese between the ages of 2 and 5.

Critical juncture

"Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling," said Jeffrey Levi, executive director of Trust for America's Health. "We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities - so every American has the greatest opportunity to have a healthy weight and live a healthy life."

If obesity had no health consequences no one would worry about it. But the fact is, obesity has huge consequences, both in terms of health and health care costs.

Heart disease

Obesity is a leading cause of coronary heart disease. The National Institutes of Health (NIH) warns that coronary heart disease packs a waxy substance called plaque inside your arteries. The result is your heart doesn't get the supply of oxygen it should.

“Obesity also can lead to heart failure,” NIH warns. “This is a serious condition in which your heart can't pump enough blood to meet your body's needs.”

High blood pressure

The Centers for Disease Control and Prevention (CDC) warns that obesity leads to high blood pressure. A dangerously high blood pressure reading means your heart is using more force to push blood through your veins and arteries.

That extra force can eventually cause a rupture in a blood vessel, causing a stroke. It can also lead to a heart attack.

Diabetes

One of the most common negative side effects of obesity is type 2 diabetes. Not surprisingly, doctors have seen explosive growth in that disease over the last 2 decades.

When you have diabetes, your body's blood glucose, or blood sugar, level is too high. When that happens your body doesn't break down food the way it is supposed it.

Your body's cells don't use insulin properly. At first, the body reacts by making more insulin but eventually it can't keep up.

It's a leading cause of early death, heart disease, stroke, kidney disease, and blindness. And in nearly every case, people who have type 2 diabetes are overweight.

Economic cost

All of this carries a very high price tag. The Harvard School of Public Health (HSPV) estimates treating obesity and obesity-related disease costs billions of dollars each year.

“The enormity of this economic burden and the huge toll that excess weight takes on health and well-being are beginning to raise global political awareness that individuals, communities, states, nations, and international organizations must do more to stem the rising tide of obesity,” HSPV says.

But the awareness appears to be limited. Because in the U.S., more Americans are classified as obese every year.

There's a good chance that if you are extremely obese, you're going to die at a relatively young age.

An analysis of data pooled from 20 large studies of people from three countries, shows such people have increased risks of dying earlier than they might otherwise as a result of cancer and many other causes including heart disease, stroke, diabetes, and kidney and liver diseases.

The study, whose findings appeared recently in PLOS Medicine, was led by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health. It found that people with class III (or extreme) obesity had a dramatic reduction in life expectancy compared with people of normal weight.

Extreme obesity on the rise

"While once a relatively uncommon condition, the prevalence of class III, or extreme, obesity is on the rise. In the United States, for example, 6% of adults are now classified as extremely obese, which, for a person of average height, is more than 100 pounds over the recommended range for normal weight," said Cari Kitahara, Ph.D., Division of Cancer Epidemiology and Genetics, NCI, and lead author of the study. "Prior to our study, little had been known about the risk of premature death associated with extreme obesity."

In the study, researchers classified participants according to their body mass index (BMI), which is a measure of total body fat and is calculated by dividing a person's weight in kilograms by their height in meters squared. BMI classifications (kilogram/meter-squared) are:

• Normal weight: 18.5-24.9
• Overweight: 25.0- 29.9
• Class I obesity: 30.0-34.9
• Class II obesity: 35.0-39.9
• Class III obesity: 40.0 or higher

The 20 studies that were analyzed included adults from the United States, Sweden and Australia. These groups form a major part of the NCI Cohort Consortium, which is a large-scale partnership that identifies risk factors for cancer death.

After excluding individuals who had ever smoked or had a history of certain diseases, the researchers evaluated the risk of premature death overall and the risk of premature death from specific causes in more than 9,500 individuals who were class III obese and 304,000 others who were classified as normal weight.

Greater risk of early death

The researchers found that the risk of dying overall and from most major health causes rose continuously with increasing BMI within the class III obesity group. Statistical analyses of the pooled data indicated that the excess numbers of deaths in the class III obesity group were mostly due to heart disease, cancer and diabetes.

Years of life lost ranged from 6.5 years for participants with a BMI of 40-44.9 to 13.7 years for a BMI of 55-59.9. To provide context, the researchers found that the number of years of life lost for class III obesity was equal or higher than that of current (versus never) cigarette smokers among normal-weight participants in the same study.

Study limitations

The accuracy of the study findings is limited by the use of mostly self-reported height and weight measurements and by the use of BMI as the sole measure of obesity. Nevertheless, the researchers noted, the results highlight the need to develop more effective interventions to combat the growing public health problem of extreme obesity.

"Given our findings,” said Patricia Hartge, Sc.D., Division of Cancer Epidemiology and Genetics, and senior author of the study, “it appears that class III obesity is increasing and may soon emerge as a major cause of early death in this and other countries worldwide."  

We're well aware of the problem. More than one-third of adults in the U.S. are obese, according to the Centers for Disease Control and Prevention(CDC).

That leads to increased risk of heart disease, stroke, type 2 diabetes and even certain types of cancer.

All of this carries a huge cost. The CDC says the estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 dollars.

Put another way, if you are obese your medical costs are, on average, $1,492 higher than for people of normal weight.

Reducing obesity requires access to good information, say researchers at the University of Alabama Birmingham (UAB).

“Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views,” said David Allison, associate dean for science in the UAB School of Public Health and senior author of the paper. “We refer to the former as presumptions and the latter as myths.”

Allison and his team have identified what they contend are 9 myths about obesity.

Myth # 1

Losing weight quickly will predispose to greater weight regain relative to losing weight more slowly. Not so, according to Allison. There may be health reasons for slowly shedding pounds but worries about weight regain isn't one of them.

Myth # 2

Setting realistic weight loss goals in obesity treatment is important because otherwise patients will become frustrated and lose less weight. The UAB team says their research doesn't support that.

Myth # 3

Assessing “stage of change” or “readiness” to diet is important in helping patients who pursue weight loss treatment to lose weight.

Myth # 4

Physical education classes, as currently delivered, play an important role in reducing the prevalence of childhood obesity. Any organized physical activity should be viewed as a positive but good nutrition and an active lifestyle – with less screen time -- are much more important.

Myth # 5

Breastfeeding is protective against obesity in breastfed offspring. There may be many benefits of breastfeeding but Allison says links to reduced obesity are largely mythical.

Myth # 6

Daily self-weighing interferes with weight loss. Not really, says Allison.

Myth # 7

Genes have not contributed to the obesity epidemic. In fact, researchers have identified a gene they say promotes obesity.

Myth # 8

The freshman year of college is associated with or causes 15 pounds of weight gain. The “Freshman 15” was not coined by scientific researchers but by Seventeen Magazine.

Myth # 9

Food deserts (i.e., areas with little or no access to stores offering fresh and affordable healthy foods, including produce) lead to higher obesity prevalence.

Instead of clinging to and perpetuating myths about obesity, the UAB researchers say health policymakers need to abandon them and move on.

“We believe scientists need to seek answers to questions using the strongest experimental designs,” Allison said. “As a scientific community, we need to be honest with the public about what we know and don’t know as we evaluate proposed strategies for weight loss or obesity prevention.”  

Kids love sugary cereal, the sweeter the better. It's just a fact of life.

Children, or course, don't usually buy cereal, their parents do. So to sell sugary cereal, cereal companies have to find a way to persuade children to lobby their parents to purchase a particular brand.

In the past, food companies relied heavily on advertising on television programs aimed at children. While you still see these ads, they're not quite what they once were.

Researchers concerned about food marketing influences on children remain vigilant and vocal when they find evidence of what they see as undue pressure. So the latest findings from a pair of researchers at Cornell are fascinating.

Brian Wansink, Director of Cornell’s Food and Brand Lab, and post-doctoral lab researcher Aner Tal have completed a study of the characters on the front of cereal boxes and how the boxes are displayed in grocery stores.

Eye contact

First, the researchers found that consumers are 16% more likely to “trust” a brand of cereal when the characters on the boxes – whether a photograph of a real person or a cartoon rendering – look them straight in the eye.

Next, the researchers went to supermarkets to see how cereal boxes were displayed on shelves. They found the characters on boxes of cereals aimed at adults looked straight ahead.

Not surprisingly, those boxes were displayed on upper shelves, at a typical adult's eye level.

But when they looked at the figures adorning boxes of children's cereal, the characters were looking down at about a 10 degree angle. Wansink demonstrates in the video below.

Avoid the cereal aisle

“If you are a parent who does not want your kids to go ‘cuckoo for Cocoa Puffs,’ avoid taking them down the cereal aisle,” said Wansink.

If you think products are displayed in grocery stores in a haphazard fashion, you are mistaken. Stores invest a lot of money in LED lighting, for example, to make produce look more appealing. Little is left to chance.

Tal says supermarkets are using psychology to influence what consumers buy.

“By studying more than 80 breakfast spokes-characters, we found that kids’ cereals are positioned at the same height as kids -- about 23 inches off of the floor and adult cereals are positioned at about 48 inches off of the floor,” Tal said.

Tool for good?

While all this may strike you as a little creepy, Wansink says it does not have to have negative connotations. There are plenty of healthy cereals and other food products out there for kids.

He urges marketers of those products to employ the same tactic. It could be a powerful tool, he says, to persuade both children and adults to choose a healthier breakfast cereal.

Wansink may be onto something here. There do seem to be plenty of healthier breakfast cereals.

A recent study by the Yale Rudd Center for Food Policy & Obesity found that cereal companies have actually improved the nutritional quality of most cereals that are marketed to children.

However, that same study found that the companies have stepped up advertising to children for many of their least nutritious products.

“Children still get one spoonful of sugar in every three spoonfuls of cereal,” said lead researcher Jennifer L. Harris, director of marketing initiatives at the Rudd Center.

The 2012 study examined the nutritional quality of more than 100 brands and nearly 300 individual varieties of cereal marketed to children, families and adults.

Parents concerned that their children may be putting on too much weight have reason to be concerned. Not only are more children overweight but obesity is a growing phenomenon with longterm health implications.

The rate of childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years, according to the Centers for Disease Control and Prevention (CDC). In 1980 only seven percent of U.S. children between the ages of six and 11 were obese. By 2012 the percentage had surged to 18%.

The record for adolescents is even more distressing. The obesity rate rose from five percent in 1980 to 21% in 2012.

In most cases being overweight or obese is caused by consuming more calories than are expended. To reduce or prevent these conditions, doctors say efforts should focus on reducing consumption and increasing activity.

Healthy diet

Experts point out that it starts with a healthy diet. According to the National Institutes of Health (NIH), a nutritious meal for a child includes plenty of fruits and vegetables. NIH suggests fruits and vegetables should cover half the plate at a typical meal.

Children should also get plenty of healthy forms of protein, such as lean meat, nuts and eggs. When preparing food, broil, steam or grill instead of frying. Avoid fast food as a regular source of meals. When you do eat out, take advantage of fast food restaurants' recent addition of healthier fare to their menus.

It's also important to keep an eye on beverage consumption. Encourage your children to drink plenty of water and go easy on sugary beverages. Fruit juice may be healthy but should be consumed in moderation, since juices tend to be loaded with calories.

Get moving

A second step is to keep kids active, and here, sports participation appears to significantly diminish obesity risk. The Academy of Dietetics and Nutrition says children who participate in sports have a lower body mass index (BMI) than those who are not active in sports.

To maintain healthy weight, encourage your child to find a sport or activity he or she enjoys — basketball, softball, soccer, martial arts, swimming or running. The Academy says it doesn’t matter as long as it gets them moving.

Lose the bedroom TV

A third step may be just as important as a healthy diet and regular exercise – limiting time spent in front of a computer or TV screen. A recent study by researchers at the Dartmouth-Hitchcock Norris Cotton Cancer Center found that having a bedroom television was a significant predictor of adolescent weight gain.

“This study suggests that removing bedroom TVs is an important step in our nation’s fight against child obesity,” said study first author Diane Gilbert-Diamond. “We found that adolescents with a TV in their bedroom gained about one extra pound a year, compared to those without one, even after accounting for hours of TV watched each day and socioeconomic factors.”

Kids having a TV in their bedroom is a lot more common than you might think. According to the researchers, over half of adolescents in the U.S. have one.

Gilbert-Diamond says this obesity risk factor accounts for over 15 million pounds of excess weight gain per year among U.S. adolescents. She points out that unlike other parenting strategies that require persistent effort and vigilance, parents can make a difference by simply keeping televisions out of their children’s bedrooms.

“Get rid of the TV while children are still in elementary school,” says James Sargent, a pediatrician and collaborator on the study. “You will all go through a couple of weeks of complaining and misery, and then everyone will forget that it was there in the first place.”

In a country where the obesity rate has generally increased each year since 2008, two states have taken the lead as the most and least obese.

For 2013, Mississippi had the nation's highest obesity rate at 35.4%, while Montana was the lowest at 19.6%, according to Gallup.com.

From 2010 through 2012, West Virginia maintained the highest obesity rate nationwide while Colorado had the lowest. Five states -- Mississippi, West Virginia, Louisiana, Arkansas and Kentucky -- have been listed among the 10 states with the highest obesity rates in the nation since 2008.

Colorado, Massachusetts, Connecticut, and California have routinely been states with lower levels of obesity -- all four have made the list of the 10 states with the lowest obesity rates in the nation each year since 2008.

Rising obesity rate

The national obesity rate, as computed by respondents' self-reported height and weight in the Gallup-Healthways Well-Being Index, increased in 2013 to 27.1% from 26.2% in 2012, and is up 1.6% from 25.5% in 2008, Gallup's initial year of tracking. People with a BMI of 30 or higher are classified as obese.

More than two in 10 adults were obese in nearly every state last year, with the exception of Montana. Three in 10 adults were obese in 11 states -- Mississippi, West Virginia, Delaware, Louisiana, Arkansas, South Carolina, Tennessee, Ohio, Kentucky, Oklahoma, and Alaska -- compared with only five states in 2012.

Obesity rates continue to be highest in Southern and Midwestern states and lowest in Western and Northeastern states -- a trend that has been ongoing since Gallup and Healthways began tracking the obesity rate in 2008.

The sick states

People living in the 10 states with the highest levels of obesity are more likely to report having had a diagnosis of chronic disease at some point in their lives, including high blood pressure, high cholesterol, depression, diabetes, cancer, and heart attacks, than are those living in the 10 states with the lowest obesity rates.

Data from Gallup-Healthways show an average 35.8% of those living in the 10 states with the highest obesity rates report a high blood pressure diagnosis, while 26.4% of people in the 10 least obese states say the same -- a difference of 9.4 points.

The healthy ones

Individuals living in the 10 states with the lowest rates of obesity also report higher instances of healthy eating and exercise than do those who live in the 10 states with the highest obesity levels.

For example, an average 66.7% of those living in the 10 least obese states say they ate healthy all day yesterday compared with 60.8% of those living in the 10 most obese states.

The cost of obesity

As the rate of obesity among adults continues to increase across all 50 states, health issues and costs associated with the chronic diseases that can accompany obesity will continue to rise. Gallup-Healthways Well-Being Index data show people are not eating as healthily or exercising as often as in past years, which might play a role in the increase of national and state obesity rates.

"While there are a variety of factors that are often correlated with rising obesity rates, such as an unhealthy food environment, poor eating habits, increasing portion sizes, and inactivity, experts agree that the health consequences of obesity are real," Dr. James E. Pope, senior vice president and chief science officer at Healthways said. "Research has shown that the average healthcare costs for an obese individual are over $1,300 more annually than someone who is not obese. Although slowing and even reversing this trend may seem daunting, even modest weight loss of 5% to 10% of initial body weight can lower the health risks associated with obesity."  

We're still a nation of tubbies.

A national survey study in the February 26 issue of JAMA found that about one-third of adults and 17% of children and teens were obese in 2011-2012.

Obesity and childhood obesity, in particular, are the focus of many preventive health efforts in the United States. These include new regulations implemented by the U.S. Department of Agriculture (USDA) for food packages; funding by the Centers for Disease Control and Prevention (CDC) of state- and community-level interventions; and numerous reports and recommendations issued by the Institute of Medicine, the U.S. Surgeon General, and the White House.

Two articles published by the authors in JAMA in 2012 demonstrated that the prevalence of obesity leveled off between 2003-2004 and 2009-2010, but "given the focus of public health efforts on obesity, surveillance of trends in obesity remains important."

Taking the measure

Cynthia L. Ogden, Ph.D., led a team from the CDC examining trends for childhood and adult obesity among 9,120 persons with measured weights and heights (or recumbent length) in the 2011-2012 nationally representative National Health and Nutrition Examination Survey.

The prevalence of high weight for recumbent length -- a standard measure of weight among infants and toddlers from birth to age 2 years -- was 8.1 percent in 2011-2012, with a difference between boys (5%) and girls (11.4%). For youth (2- to 19-years of age), 31.8% were either overweight or obese, and 16.9% were obese.

Among adults, more than two-thirds (68.5%) were either overweight or obese, 34.9% were obese (body mass index [BMI] 30 or greater), and 6.4% were extremely obese (BMI 40 or greater).

Little change seen

Overall, there was no change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers or in obesity in 2- to 19-year-olds or adults. The prevalence of obesity among children 2 to 5 years of age decreased from 14% in 2003-2004 to just over 8% in 2011-2012, and increased in women age 60 years and older, from 31.5% to more than 38%.

The authors conclude that "obesity prevalence remains high and thus it is important to continue surveillance."

People who are prone to impulsive behavior are known to be more likely to abuse alcohol and other drugs. And now a new study says they may also be more susceptible to food addiction.

In a paper published recently in the journal Appetite, University of Georgia researchers found that people with impulsive personalities were more likely to report higher levels of food addiction — a compulsive pattern of eating that is similar to drug addiction — and this in turn was associated with obesity.

"The notion of food addiction is a very new one, and one that has generated a lot of interest," said James MacKillop, the study's principal investigator and associate professor of psychology in UGA's Franklin College of Arts and Sciences. "My lab generally studies alcohol, nicotine and other forms of drug addiction, but we think it's possible to think about impulsivity, food addiction and obesity using some of the same techniques."

It's not an idle question. With more than one-third of U.S. adults not being categorized as obese by the Centers for Disease Control and Prevention, a huge portion of the population has a heightened risk of heart disease, stroke, type 2 diabetes and certain types of cancer. The estimated annual medical cost of obesity was $147 billion in 2008 U.S. dollars, and obese people pay an average of $1,429 more in medical expenses than those of normal weight.

Treatments and interventions

MacKillop said he and his team hope their research will ultimately help physicians and other experts plan treatments and interventions for obese people who have developed an addiction to food, paving the way for a healthier lifestyle.

The contemporary food industry has created a wide array of eating options, and foods that are high in fat, sodium, sugar and other flavorful additives and appear to produce cravings much like illicit drugs, MacKillop said. Now they will work to see how those intense cravings might play a role in the development of obesity.

"Modern neuroscience has helped us understand how substances like drugs and alcohol co-opt areas of the brain that evolved to release dopamine and create a sense of happiness or satisfaction," he said. "And now we realize that certain types of food also hijack these brain circuits and lay the foundation for compulsive eating habits that are similar to drug addiction."

There is no debate that the U.S. – and the world – is struggling with rising obesity that poses a threat to long-term health. The debate is over who is to blame – or if anyone is.

Because the rising rate of obesity coincided with rapid growth of fast food restaurants, they get a lot of the blame. Because the rise in obesity also coincided with the increasing use of high-fructose corn syrup as a sweetner in food, the food industry gets a lot of the blame as well.

In the debate over what to do about obesity, fingers have been pointed at grocery stores and even government policy makers. However, researchers say that if you ask consumers, they are likely to say individuals are to blame for their own obesity.

Not that effective

University of Illinois researcher Brenna Ellison and her colleague, Jayson Lusk at Oklahoma State University, say their research leads them to conclude that creating and enforcing public policies to help reduce obesity and/or encourage healthier food choices may not be as effective as policy makers think.

For example, to give consumers better information about the food they are consuming policymakers have required some restaurants to post calorie information on menus. In some jurisdictions they are taxing sugar sweetened beverages.

Ellison and Lusk asked why aren't these policies working? Why aren't consumers responding to increased soda prices or calorie information on menus?

"Obesity is in the news every day so it would be hard to say that people are unaware of the policy initiatives in place to reduce U.S. obesity rates," Ellison said. "Based on our study results, the more likely conclusion is that consumers' beliefs about who is to blame for obesity don't necessarily align with the beliefs of policy makers and public health advocates. In the United States, we're known for being an individualistic-based society, so it's not exceptionally surprising that we would put this responsibility for obesity on ourselves."

Survey results

The survey was conducted by Clear Voice Research, which asked 774 consumers to assign blame for the rise in obesity, with seven choices: individuals, parents, farmers, food manufacturers, grocery stores, restaurants and government policies.

The results were unambiguous. They showed that 94% of people surveyed believed individuals are primarily or somewhat to blame for the rise in obesity, with parents coming in second at 91% primarily or somewhat to blame.

On the other hand, survey respondents felt farmers and grocery stores were relatively blameless for the rise in obesity. And there was at least one surprise.

"We learned that farmers and people who received food stamps were more likely to blame government and farm policy," Ellison said. "That seems off. You wouldn't expect that opinion from people who are benefiting from those policies; however, these individuals could be in the best position to observe the potential harm that some government policies create."

Why is it important?

Why assign blame? Because until you can find out what's causing the problem, it's hard to address it effectively. For example, if individuals are indeed to blame for their expanding waistlines, giving them information about calories may not change their behavior if they simply don't care. They have to want to process the information and order a salad instead of a triple bacon cheeseburger.

There are many reasons to avoid obesity, most having to do with health. Obesity increases the risk of heart disease, diabetes and cancer. Carrying extra weight places stress on knee and hip joints.

Whether individuals are to blame for their own obesity or whether other factors are at work is a matter for debate. After all, the rise in obesity has been relatively sudden, coinciding with more sedentary lifestyles and changes in diet. But what consumers in the survey seem to be suggesting is the solution lies, at the heart of the matter, with individuals. Solutions, the researchers suggest, need to focus on individuals.

"Unquestionably, U.S. obesity and overweight rates are much higher than they were 20 or 30 years ago so it is not surprising that policy makers and public health officials are looking for potential solutions,” Ellison said. "That being said, if individuals view obesity as a personal problem, how confident can we be that these solutions will work? We need to be realistic about the solutions we're proposing and implementing, and if people are not buying into them, they may need to be re-evaluated."  

There is a school of thought that holds the mystery of rising obesity rates is no mystery at all. The reason Americans are packing on pounds is obvious. We eat too much food, not just between meals but during meals.

Pay attention the next time you watch TV and see an advertisement for a restaurant chain. Is the portion the commercial shows you small or large? Silly question. What restaurant chain is going to purchase air time to suggest it's going to serve a small portion?

Restaurants compete for customers by promising bigger servings than their competitors. The extra food doesn't cost all that much but it justifies higher menu prices. So consumers are conditioned to seek out restaurants that “give them their money's worth.”

A day's worth of calories

Except the amount of food on your plate or serving tray might contain enough calories to last you all day – or a couple of days. It's no secret portion sizes have increased dramatically in the last 40 years. Think about that the next time you order a steak in a restaurant.

Restaurants typically offer steaks that are eight to 12 ounces. A “petite” steak might be six ounces. But the government's recommended portion size is closer to three ounces.

Let's assume you visit your favorite Italian restaurant and order the spaghetti and meatballs. While you are waiting for your food to arrive you eat two slices of garlic bread. Let's forget calories for a moment and just focus on servings – what the U.S. Department of Agriculture (USDA) sets out as a serving, or portion size.

Estimate the size of the serving of spaghetti and meatballs. After surveying your plate you may decide that there are two cups of spaghetti, a cup of tomato sauce and about six ounces of meatballs.

Totaling it up

It might seem like a reasonable meal and you probably don't feel like you are overindulging. But according to USDA, you consumed four servings of spaghetti, two servings of tomato sauce, two servings of garlic bread and two to three servings of meatballs. 

USDA doesn't just make up these serving sizes. They use surveys, analyze nutrition content and reach back to previous food guides. And they don't use this formula the same way for each food group. Nutritional content was the determining factor for the serving size of milk but ease of use was considered most important for serving sizes of fruits and vegetables. 

With restaurants piling on the food, weight-conscious consumers need to learn how to size up food portions so that they don't overeat. That isn't always easy.

One reason pre-packaged diet systems work, at least initially, is because they provide all the food the users consume. The portion control is done for you. That doesn't work in restaurants, although some chains have recently taken steps to provide more nutrition information on their menus.

Consumers increasingly aware

A 2011 study by the NPD group found consumers are becoming more aware of portion size and its importance in maintaining a healthy weight. Out of the 30 healthy eating attributes, eating smaller portions ranked 11th in importance among adult consumers across all generations as a healthy eating characteristic.

Interestingly, younger consumers see it as more important than their elders. It ranks highest among Generation X – second-highest among Generation Y. Because of that, you might see restaurants begin to reduce their portion sizes – or at least, provide more options.

"Based on the interest in smaller portions among the younger age groups and the size of these age groups,portion control is an area of opportunity for food manufacturers," said Dori Hickey, director, product management at NPD and author of the report. "As they move through their life, these generations may continue the healthy eating behaviors they adopted in their younger years, making portion-control a long-term opportunity."

In the meantime you can eat in restaurants and not fall into the super-size trap. Consider sharing a dish instead of ordering two entrées. Don't fill up on the hot bread sticks they bring to the table before they serve the meal, no matter how delicious they are.

Finally, stop eating once you are full, no matter how much food is still left. No one is making you clean your plate.

There's a newly defined class of weight risk -- severely obese. And according to a scientific statement from American Heart Association, published online in the journal Circulation, about 5% of U.S. children and teens are in that category.

"Severe obesity in young people has grave health consequences," said Aaron Kelly, Ph.D., lead author of the statement and a researcher at the University of Minnesota Medical School in Minneapolis. "It's a much more serious childhood disease than obesity."

While childhood obesity rates are starting to level off, severe obesity has increased, Kelly said.

What is 'severely obese?'

The statement defines children over age 2 as severely obese if they either have a body mass index (BMI) that's at least 20 percent higher than the 95th percentile for their gender and age, or a BMI score of 35 or higher. A child in the 95th percentile weighs more than 95 percent of other children of the same gender and age.

BMI is a measurement based on weight and height. Age- and gender-specific growth charts are used to calculate BMI for children. Children at the 95th BMI percentile or higher are obese, and those between the 85th and 95th percentiles are overweight.

A 7-year-old girl of average height weighing 75 pounds, or a 13-year-old boy of average height weighing 160 pounds, would be defined as severely obese.

The consequences

Severely obese children have higher rates of type 2 diabetes and cardiovascular issues at younger ages, including high blood pressure, high blood cholesterol and early signs of atherosclerosis -- the disease process that clogs arteries.

Treatment options for children with this level of obesity are limited, as most standard approaches to weight loss are insufficient for them.

What to do

Most experts recommend a step-wise approach for treating severely obese children, with treatment getting gradually more intensive from lifestyle changes, to medication and potentially surgery.

"But the step from lifestyle change and medication to surgery is unacceptably large because weight loss surgery isn't appropriate for or available to all severely obese children," Kelly said.

The statement calls for "innovative approaches to fill the gap between lifestyle/medication and surgery."

The statement suggests ways to close the gap, including:

• conduct more research on bariatric surgery's effects and safety;
• evaluate effectiveness of lifestyle modification interventions, including adherence to dietary and physical activity plans;
• fund research to find other useful interventions, including better drugs and medical devices; and
• recognize severe obesity as a chronic disease requiring ongoing care and management.

Except for Arkansas, no state saw an increase in obesity rates in the past year, according to the latest report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

But it's small consolation. Thirteen states now have adult obesity rates above 30%, 41 states have rates of at least 25%, and every state is above 20%.

Three decades ago, in 1980, no state had an obesity rate above 15%. Two decades ago, in 1991, no state was above 20%. In fact, the trend appears to be climbing higher, faster. In 2007, just six years ago, only Mississippi was above 30%.

The question is why. What is causing America – and indeed much of the world – to pack on the pounds? Is it something in the food? Too much food and not enough exercise? Or some combination of factors?

Modern life

A 2003 study (pdf file) by Harvard economists David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro placed much of the blame on changes in the way we prepare and consume food. The new ways make it faster, easier and cheaper to prepare food and the results are not always healthier. They say the potato provides a good illustration. 

“Before World War II, Americans ate massive amounts of potatoes, largely baked, boiled or mashed,” the economists write. “They were generally consumed at home. French fries were rare, both at home and in restaurants, because the preparation of French fries requires significant peeling, cutting and cooking.”

Then along came technology. French fries are now typically peeled, cut and cooked in a few central locations using sophisticated new technologies. They are then frozen and shipped to restaurants and supermarkets. Today, the French fry is the dominant form of potato and America’s favorite vegetable.

Baked potato vs. French fries

Now, let's compare the calories in a baked potato and French fries. A medium-sized baked potato has 129 calories before you add butter or sour cream. A medium order of McDonald's French fries contains around 380 calories. According to Cutler, Glasser and Shapiro total potato consumption increased by about 30% between 1977 and 1995, accounted for almost exclusively by increased consumption of potato chips and French fries.

The bottom line, according to the economists, is the technological advances of modern life have made calories cheaper to buy and easier to prepare. Our self-control, they say, hasn't kept up with these advances.

The National Institutes of Health (NIH) has cited the environment as a contributing factor that increases the obesity trend. Fewer jobs involve manual labor and more require sitting at desks. There are a lot more automobiles than there used to be and we spent a lot of time sitting in them. Then, there's Madison Avenue.

“Food is everywhere, and so are messages telling us to eat and drink,” the National Heart, Lung and Blood Institute, a division of NIH, says on its website. We can get something to eat in places where it was never available before—like the gas station. “Going out to eat or getting carryout is easy.”

Obese Baby Boomers

And what about demographics? It's no secret that you tend to become heavier as you get older. Members of the huge Baby Boom generation, active, lean and trim in their 20s and 30s, are a lot less active in their 50s and 60s and account for a significant number of obese Americans. But it may be more than just numbers.

A 2011 AP-Life Goes Strong poll found that higher percentage of Baby Boomers are obese than any other group in the U.S. While the poll showed that 36% of Baby Boomers were obese, only 25% of the generations directly above and below them were.

For Boomers, the news is getting worse. While the AP-Life Goes Strong poll found 36% of Boomers were obese in 2011, this latest survey finds the percentage has climbed to 40% in just two years.

"While stable rates of adult obesity may signal prevention efforts are starting to yield some results, the rates remain extremely high," said Jeffrey Levi, Ph.D., executive director of TFAH. "Even if the nation holds steady at the current rates, Baby Boomers—who are aging into obesity-related illnesses—and the rapidly rising numbers of extremely obese Americans are already translating into a cost crisis for the healthcare system and Medicare."

The report makes a number of policy recommendations to reduce obesity. They include many that are already being implemented in some areas – serving only healthy food in schools, posting calorie information on restaurant menus and encouraging people to walk and bike, rather than ride in cars.

It doesn't pay to get sick. Aside from the serious health issues an illness raises, there is a strong economic concern too.

People faced with a chronic health condition often find they have to spend thousands of dollars over time on treatment. A recent Harvard study found that illness or medical bills contributed to 62.1% of all bankruptcies in 2007.

Now, researchers writing in the American Journal of Preventive Medicine have put a price tag on the cost of developing type 2 diabetes, a preventable condition most often brought on by obesity or a poor diet.

Younger is worse

The younger you are when diagnosed with the disease, the more it will cost to treat it over your lifetime. For example, for men diagnosed with type 2 diabetes between the ages of 25 and 44, the lifetime direct medical cost of treatment is $124,700. Diagnosed between the ages of 55 and 64, the condition costs $84,000 to treat.

The treatment costs are higher for women, the researchers found. Women diagnosed between the ages of 25 and 44 can expect to pay $130,800 for treatment over the remainder of their lives.

“Over the lifetime, type 2 diabetes imposes a substantial economic burden on healthcare systems,” the researchers conclude. “Effective interventions that prevent or delay type 2 diabetes and diabetic complications might result in substantial long-term savings in healthcare costs.”

According to the American Diabetes Association, type 2 is the most common form of diabetes. Though it can be hereditary, type 2 diabetes is, in many cases, a preventable disease.

Insulin resistance

When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin, a condition known as insulin resistance. As a result, blood sugar does not get into these cells to be stored for needed energy.

In most cases type 2 diabetes develops slowly. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin correctly. Maintaining a healthy weight and diet and getting regular exercise is one way to prevent this condition.

Other conditions can also be expensive to treat. In addition to increasing your risk of heart attack and stroke, high blood pressure carries an economic cost as well. It may require one or more prescription medications and, should you have a heart attack or stroke, can result in hospitalization and a lengthy recovery.

High cholesterol

Having too much cholesterol in your blood is another potentially costly condition. Cholesterol is a waxy substance that's found in the fats, or lipids, in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease.

Some people who develop high cholesterol have a genetic predisposition to the condition. However, many have too much cholesterol because of an unhealthy diet and lifestyle.

Statins, a class of drugs to treat high cholesterol, are among the most commonly prescribed drugs in the U.S. and tend to be very expensive. Suffering a stroke because of high cholesterol is even more expensive, not to mention a threat to your life.

Drinking too much alcohol can lead to inflammation of the liver and, eventually, cirrhosis. In extreme cases it can require a liver transplant.

Obesity may be key

Obesity is another mostly-avoidable condition that can lead to a lifetime of high medical bills and may be a key to preventable diseases. In addition to being a contributing factor to type 2 diabetes, high blood pressure and high cholesterol, obesity can place undue stress on all the body's internal organs.

In 2012 researchers at Lehigh University reported obesity alone adds $190 billion in U.S. medical expenses each year. The figure includes prescription medications, hospitalizations and higher health insurance premiums.

For individuals, physicians say maintaining a healthy weight, getting regular exercise and eating a healthy diet is not only a good way to protect your health but, over the long run, to reduce the amount of money you have to spend on health care.

Finally, some progress.

After decades of rising rates, A new report from the Centers for Disease Control and Prevention shows obesity among low-income preschoolers declined slightly in 19 states and U.S. territories from 2008 through 2011, after rising for decades.

The Vital Signs report found that Florida, Georgia, Missouri, New Jersey, South Dakota and the U.S. Virgin Islands saw at least a one percentage point decrease in their rates of obesity. Twenty states and Puerto Rico held steady at their current rates, while rates were up slightly in three states.

Previous research shows that about one in eight preschoolers in the U.S is obese. Kids are five times more likely to be overweight or obese as an adult if they are overweight or obese between the ages of three and five years.

“Although obesity remains epidemic, the tide has begun to turn for some kids in some states,” said CDC Director, Tom Frieden, M.D., M.P.H. “While the changes are small, for the first time in a generation they are going in the right direction. Obesity in early childhood increases the risk of serious health problems for life.”

Wide-ranging survey

For the Vital Signs report, CDC researchers analyzed measured weight and height for nearly 12 million children aged two to four years who participate in federally funded maternal- and child-nutrition programs. Forty states, the District of Columbia and two U.S. territories (U.S. Virgin Islands and Puerto Rico) were included report. The data come from the Pediatric Nutrition Surveillance System.

“Many of the states in which we’re seeing declines have taken action to incorporate healthy eating and active living into children’s lives,” said Janet L. Collins, Ph.D., director of CDC’s Division of Nutrition, Physical Activity, and Obesity. “We must continue to strengthen and expand proven strategies that help our children live healthier lives by avoiding obesity in the first place.”

CDC is encouraging state and local officials to step up efforts to drive down rates of childhood obesity. Business leaders, childcare providers, healthcare providers, communities and families are some of the groups that influence nutrition and physical activity in the places where young children live, learn, and play.

What to do

State and local officials can assist these groups by:

• Making it easier for families to buy healthy, affordable foods and beverages in their neighborhoods.
• Helping provide access to safe, free drinking water in places such as community parks, recreation areas, child care centers and schools.
• Helping local schools open gyms, playgrounds, and sports fields during non-school hours so children can play safely after school, on weekends and over the summer.
• Helping child care providers adopt best practices for improving nutrition and physical activity and for limiting computer and television time.
• Creating partnerships with civic leaders, child care providers and others to make community changes that promote healthy eating and active living.

With one-third of Americans being obese, members of the American Medical Association (AMA) have voted to recognize obesity as a medical condition that requires treatment.

The vote by the AMA's House of Delegates followed a debate about whether the new classification would create more help for patients or simply add to the stigma many obese people already feel. 

If nothing else, the vote puts pressure on insurance companies to reimburse doctors for the time they spend urging their patients to pay a little more attention to the scale. It also makes it part of a physician's professional obligation to raise the subject, even if it makes the doctor and patient uncomfortable.

The Medicare program, which covers about 13 million obese Americans, already covers the cost of behavioral therapy as well as bariatric surgery, but coverage is spotty among private insurers.

Based on BMI

The decision was controversial and went against the conclusion of the AMA's Council on Science and Public Health, which concluded that the new classification is problematic because the measure used to define obesity -- the body mass index (BMI) -- is flawed. 

"Given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a 'condition' or 'disorder,' will result in improved health outcomes," the council wrote in its conclusion.

Obesity is defined by the National Institutes of Health as having a BMI of 30 and above. BMI describes the body weight relative to height. Although very muscular people may have a BMI of 30 or more without being obese, for the rest of us it probably means we're lugging around too much fat.

In its report opposing the reclassification, the Council on Science and Public Health said it feared that defining obesity as a disease would result in "greater investments by government and the private sector to develop and reimburse obesity treatments."

The Food and Drug Administration (FDA) has approved just two new prescription weight-loss drugs since 1999 and is likely to face pressure to approve more drugs, leading to higher spending and exposing patients to unforeseen risks and side effects that often accompany newer drugs. 

If you want your child to crave less junk food, it might be best to watch your favorite shows in a different way.

According to researchers at the University of Michigan, watching programs that don't have food commercials will lower your child's desire to want unhealthy foods.

So it's best to view programs by streaming them or by using cable TV's On-Demand feature -- or any other way that doesn't include food commercials.

Media exposure

Researchers Kristen Harrison and Mericarmen Peralta spoke to 100 parents and asked them about their household routines, including how much their children were exposed to media.

Many of the parents who watched programing that included junk food commercials had children who couldn't distinguish a healthy food item from an unhealthy one.

In addition, Harrison and Peralta found children whose families had higher incomes were more likely to consume junk food as they got older because their families could afford it. And those families with limited incomes were less able to purchase all the junk food they saw on TV.

The role of advertising

Although there have been numerous studies on the relationship between junk food advertising and childhood obesity, Harrison and Peralta said there aren't any studies on the difference between watching regular TV and watching digitally-recorded TV with no food commercials.

The researchers wanted to take a look at the relationship between TV commercials and preschool-aged children as well. 

"Even though parents and other caregivers are the primary gatekeepers regarding your children's food intake, children are still learning about food as it relates to health from family, media, and other sources, and may use this knowledge later on to inform their decisions when parents or other adults aren't there to supervise them," explained Harrison.

In addition, the researchers said parents should be instilling healthy food habits in their children during preschool years, as waiting until children get older could be too late.

"The preschool years are especially important," said Harrison. "Because the adiposity rebound in kids who grow up to be normal weight tends to be around age 5 or 6, whereas for kids to grow up to be obese, it happens closer to 3. "We need to know as much as we can about the factors that encourage obesogenic eating during the preschool years, even if that eating doesn't manifest as obesity until the child is older."

Effect on Hispanics

A separate study called "Food Marketing to Children on U.S. Spanish-Language Television" reveals that Spanish-language television has a disproportionate number of junk food commercials compared with English-language TV.

Statistics show that more than 84% of all foods and beverages promoted on Spanish-language television are unhealthy, compared with 74% of the commercials on English programing.

Cause for concern

Dale Kunkel, lead study author and professor of communication at the University of Arizona, says the recent findings really have him concerned.

"All children and especially Latinos are bombarded with television ads that sell junk food and sugary drinks," he said. "These findings are particularly concerning given the high rates of obesity among Latino youths."

Other findings of the study show that 78% of food commercials that target children use well-known cartoon characters to promote products, while 49% of the commercials on English-language television do the same thing.

Kunkel says the promise by companies to change how they advertise isn't working, especially in the Latino community.

"Our findings suggest that the food and beverage industry pledge to self-regulate is not effective, especially on Spanish-language television," he said. "Most of the ads aimed at kids feature Whoa products, so clearly there's a big gap between the industry's definition of healthy and what nutrition experts say."

Today's concern about rising childhood obesity is not the only time health officials and policymakers have fretted about the fitness of American youth. In the years following World War II, American young people were viewed as soft and out of shape.

The official response was the President's Council on Youth and Fitness, established during the Eisenhower Administration. However, it wasn't until the Kennedy Administration that physical fitness was hammered into the American consciousness as a national goal.

In late 1962, President Kennedy discovered an executive order from Theodore Roosevelt, early in the 20th century, challenging U.S. Marine officers to finish a 50-mile hike in 20 hours. Kennedy sent the document to Commandant of the Marine Corps Gen. David Shoup, suggesting that Shoup bring it up as his own discovery and challenge modern day Marines to duplicate this feat.

But he didn't stop there. The council developed and promoted a curriculum for schools to improve fitness. The council's fitness curriculum was devised with the cooperation of 19 U.S. educational and medical organizations and offered to schools. Very quickly, schools around the nation began providing regularly-scheduled physical education classes for students of all ages.

Baby boomers benefited

Some children in the baby boom generation who were not particularly gifted athletically began to get regular exercise for the first time in their lives as part of their school activities.

According to the John F. Kennedy library, the program produced a measurable improvement in fitness nationwide as well as a shift in public attitudes and wider participation. The work of the council also helped shape the American identity in the 1960s with fitness, vigor, and preparedness, coincidentally, goals of the Kennedy Administration's New Frontier.

Over the following decades, however, physical education fell out of favor with school administrators.

In 2011, the Centers for Disease Control and Prevention (CDC) reported only 29% of high school students surveyed had participated in at least 60 minutes per day of physical activity on all 7 days before the survey. It found that only 31% attended a physical education class daily.

Abolishing recess

Despite the research showing the benefits of a physical education curriculum, the University of Michigan reports only 8.0% of elementary schools, 6.4% of middle schools, and 5.8% of high schools provide daily physical education to all of its students. In addition, 20% of all elementary schools in the U.S. have abolished recess in favor of increased classroom time under pressure to improve student achievement.

With schools under increasing pressure to raise academic test scores, school administrators and government policymakers have been quick to cut back physical education. First Lady Michelle Obama has led a private initiative to encourage young people to exercise, called "Let's Move," but it is not part of a regular school curriculum.

Only six states -- Illinois, Hawaii, Massachusetts, Mississippi, New York and Vermont -- require physical education in every grade, K-12. While 74.5% of states mandate physical education in elementary through high school, the National Association for Sport and Physical Education (NASPE), in a report in December 2012, found most still fail to require a specific amount of instructional time and nearly half allow exemptions, waivers and/or substitutions.

Inadequate physical education policies

"While other studies demonstrate the importance of quality physical education in helping students learn the necessary skills, knowledge and experiences they need to be physically active for a lifetime, the Shape of the Nation Report has been disclosing the inadequacies of physical education policies in this country since 1987," said NASPE President Mary Jo Sariscsany, associate professor, California State University, Northridge.

"It is time to eliminate the loopholes. We urge parents to join our efforts to be more proactive and effective advocates for physical education to ensure that their children's schools and school districts are complying with required state physical education policies," she said.

New research is adding to the pressure to bring physical education back to schools. A recent study by Cornell University researchers found that increasing the amount of time that elementary schoolchildren spent in gym class reduces the probability of obesity.

The research serves as ammunition for the CDC, Institute of Medicine, and the American Academy of Pediatrics, all of which have called for restoring gym class to America's schools. The findings suggest an extra 60 minutes per week of PE time reduces the probability that a fifth-grader is obese by 4.8 percentage points.

Forcing your kids to clean their plates at each meal increases their chances of becoming obese, say researchers at the University of Minnesota.

Katie Loth and her team used two separate studies to learn more about the relationship between food and children. One study involved 2,800 kids from Minnesota public schools; the other was called Project F-Eat, which focused on the eating habits of teenagers.

After examining both studies, researchers said they found a strong link between parents and their relationship with food, and how their children saw food.

Pressuring to eat

“We found that between 50% and 60% of parents from our sample reported requiring that their child eat all of the food on their plate at a meal,” said Loth in an interview with CNN. “Further, we found that between 30-40% of parents from within our sample reported encouraging their child to continue eating even after their child stated that they were full.

“While these pressures-to-eat behaviors were more frequent among parents of non-overweight adolescents, they were still endorsed quite frequently by parents of overweight and obese adolescents, indicating that many parents endorse these behaviors regardless of their child’s current weight status.”

In addition, Loth said that forcing a child to clean his plate could start an unhealthy relationship between that child and food, and instead of eating something because he's hungry or because it’s mealtime, a child could start eating for other reasons, which could lead to obesity.

“Parental pressure to eat can be detrimental to children because it takes away from a child’s ability to respond naturally to their own hunger,” Loth said. “Instead, (it) encourages them to respond to cues in their environment which can lead to unhealthy weight gain over time.”

And placing food restrictions on your children isn’t the best approach either, researchers say, as it can make them want that particular food even more when they become adults.

Moderation the key

Teaching moderation instead of banning certain foods is a much better approach, said Loth, since at some point kids will have to learn how to live among items like salty snacks and desserts -- so it’s better to teach them coping skills from early on.

Elaine Schulte, MD, of Cleveland Clinic Children’s Hospital, who didn’t participate in the study, believes parents have to do a complete about-face when it comes to their involvement with their kids eating habits, especially with older kids.

“Parents are doing way too much in controlling the way kids eat,” said Schulte in an interview with MedPage Today. They “need to back down in terms of the way they are helping children figure out how to eat.

“When you’re a teenager, you don’t want to be controlled; parents need to help regulate what their children put in their mouth, and it’s not by telling them what to eat," she said.

Other studies have confirmed that telling kids what to eat has very little influence on what they’ll eat when they grow older. One group of researchers found that 72% of adults who were forced to eat a particular food as a child, stayed away from it when they got older.

Experts say a better way for parents to teach their kids healthier eating is by being patient with them; many times a child will start liking healthier foods after they’ve tried it several times.

Additionally, parents should eat the same foods as their child, as this should work much better than sticking a plate of broccoli in front of them while you’re away from the table.

And it’s extremely important for parents to practice what they preach, say experts. If you’re eating pizza while making your child eat his vegetables, you’re sending the wrong message.

Loth says it’s the parent’s responsibility to establish healthy eating habits and that these lessons should come through example, not force.

The annual state-by-state obesity ranking by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) suggests the nation's weight problem isn't getting any better.

The study of data compiled by the Centers for Disease Control and Prevention (CDC) found that 12 states had obesity rates of 30 percent or more -- the same number as last year. Mississippi once again recorded the highest obesity rate -- 34.9 percent. It was 34.4 percent last year.

Twenty-six of the 30 states with the highest obesity rates are in the Midwest and South.

Rise in chronic disease

“Obesity has contributed to a stunning rise in chronic disease rates and health care costs. It is one of the biggest health crises the country has ever faced,” said Jeffrey Levi, PhD, TFAH executive director.

Despite the lack of improvement, Levi says there is a growing body of evidence and approaches to help reduce obesity, improve nutrition and increase physical activity based on making healthier choices easier for Americans.

"The bad news is we’re not investing anywhere near what we need to in order to bend the obesity curve and see the returns in terms of health and savings,” he said.

Economic as well as health toll

Obesity is expected to take an increasing health toll as the population ages. Being obese, as opposed to merely overweight, raises the risk of type 2 diabetes, heart disease and stroke, hypertension, arthritis and obesity-related cancers.

There is also a rising economic toll. In 2006, obesity-related medical costs totaled $147 billion a year, or nearly 10 percent of total medical spending, according to a 2011 study in Health Affairs. The bulk of the spending is generated from treating obesity-related diseases.

“Our nation has made important inroads to creating healthier communities,” said Risa Lavizzo-Mourey, MD, MBA, RWJF president and CEO. “Some cities and states that have taken comprehensive action to address the epidemic are beginning to see declines in their obesity rates. But we need to expand and intensify our efforts. Investing in prevention today will mean a healthier tomorrow for our children.”

While the obesity problem is centered in the south and midwest, the states that have the fewest obese citizens tend to be grouped in the west and the northeast. Only 20.7 percent of Coloradans are classified as obese -- the lowest level of any state.

See how your state is doing

According to the newly released CDC data, part of the 2011 Behavioral Risk Factor Surveillance Survey, the obesity rates by state from highest to lowest were:

1. Mississippi (34.9%); 2. Louisiana (33.4%); 3. West Virginia (32.4%); 4. Alabama (32.0%); 5. Michigan (31.3%); 6. Oklahoma (31.1%); 7. Arkansas (30.9%); 8. (tie) Indiana (30.8%); and South Carolina (30.8%); 10. (tie) Kentucky (30.4%); and Texas (30.4%); 12. Missouri (30.3%); 13. (tie) Kansas (29.6%); and Ohio (29.6%); 15. (tie) Tennessee (29.2%); and Virginia (29.2%); 17. North Carolina (29.1%); 18. Iowa (29.0%); 19. Delaware (28.8%); 20. Pennsylvania (28.6%); 21. Nebraska (28.4%); 22. Maryland (28.3%); 23. South Dakota (28.1%); 24. Georgia (28.0%); 25. (tie) Maine (27.8%); and North Dakota (27.8%); 27. Wisconsin (27.7%); 28. Alaska (27.4%): 29. Illinois (27.1%); 30. Idaho (27.0%); 31. Oregon (26.7%); 32. Florida (26.6%); 33. Washington (26.5%); 34. New Mexico (26.3%); 35. New Hampshire (26.2%); 36. Minnesota (25.7%); 37. (tie) Rhode Island (25.4%); and Vermont (25.4%); 39. Wyoming (25.0%); 40. Arizona (24.7%); 41. Montana (24.6%); 42. (tie) Connecticut (24.5%); Nevada (24.5%); and New York (24.5%); 45. Utah (24.4%); 46. California (23.8%); 47. (tie) District of Columbia (23.7%); and New Jersey (23.7%); 49. Massachusetts (22.7%); 50. Hawaii (21.8%); 51. Colorado (20.7%).

Forty-two percent of the U.S. population could be obese by 2030, putting a huge strain on health care costs, according to a new public health study.

That's an additional 32 million obese people within two decades. While reducing obesity is the goal, the researchers from Duke University, RTI International and the Centers for Disease Control say just keeping obesity at its present high rate would have a big payoff.

"Keeping obesity rates level could yield a savings of nearly $550 billion in medical expenditures over the next two decades," said lead author Eric Finkelstein, Ph.D., associate research professor in the Duke Global Health Institute.

The study, based on data from the Behavioral Risk Factor Surveillance System and state-level data from the Bureau of Labor Statistics and other organizations, was published in the American Journal of Preventive Medicine.

Severe obesity also rising

It also forecasts an increase in the number of individuals with severe obesity, with rates rising to 11 percent by 2030. Severe obesity is defined as a body mass index over 40 or roughly 100 pounds overweight.

Severely obese individuals are at highest risk for the health conditions caused by excess weight, resulting in substantially greater medical expenditures and rates of absenteeism.

"Should these forecasts prove accurate, the adverse health and cost consequences of obesity are likely to continue to escalate without a significant intervention," said senior author Justin Trogdon, Ph.D., of RTI.

Solution requires commitment

The solution isn't complicated, says William H. Dietz, M.D., Ph.D., director of CDC's Division of Nutrition, Physical Activity and Obesity, but it requires a focused effort.

"People need to make healthy choices, but the healthy choices must first be available and accessible in order to make them," Dietz said.

About 36 percent of the population was classified as obese in 2010. People who are obese tend to have more health problems, including diabetes, high blood pressure and cardiovascular disease.

In Mississippi, 34.4 percent of the adults in the state are obese. Not just overweight, obese.

Not to pick on the Magnolia State, which has led the nation in the Trust for America's Health and Robert Woods Johnson annual obesity survey for the seventh year in a row, it should be noted Alabama was close behind, with an adult obesity rate of 32.3 percent. West Virginia was third at 32.2 percent.

According to the report, obesity rates increased in 16 states in the past year and did not decline in any state.Twelve states now have obesity rates above 30 percent. Four years ago, only one state was above 30 percent.

Geographic pattern

When you place the obesity rate on a map of the country, a geographic pattern emerges. The problem appears to be the most dramatic in the south, with nine of the 10 states with the highest adult obesity rates.

States in the Northeast and West tend to have lower rates. Colorado has the lowest obesity rate and, remarkably, is the only state with a rate under 20 percent.

This year's survey takes a look back, measuring today's epidemic against conditions 20 years ago. The contract is startling.

A lighter country 20 years ago

Twenty years ago, no state had an obesity rate above 15 percent. Today, more than two out of three states, 38 total, have obesity rates over 25 percent, and just one has a rate lower than 20 percent.

Since 1995, when data was available for every state, obesity rates have doubled in seven states and increased by at least 90 percent in 10 others. Obesity rates have grown fastest in Oklahoma, Alabama, and Tennessee, and slowest in Washington, D.C., Colorado, and Connecticut.

“Today, the state with the lowest obesity rate would have had the highest rate in 1995,” said Jeff Levi, Ph.D., executive director of TFAH. “There was a clear tipping point in our national weight gain over the last twenty years, and we can’t afford to ignore the impact obesity has on our health and corresponding health care spending.”

What happened?

How did this happen? Chances are, a lot of factors have contributed to America's weight problem. Processed food provides plentiful and cheap calories. During the Great Depression, people shed pounds because calories were expensive and scarce. Today, the opposite is true.

More adults spend their work days in front of computer screens, getting little exercise – moving from the office chair in the day to the living room couch in the evening. And while the survey measures only adult obesity, it's easy to conclude that each year children enter adulthood already packing too many pounds.

Health officials are alarmed at the trend because obesity has long been associated with other severe health problems, including diabetes and high blood pressure. New data in the report show how rates of both also have risen dramatically over the last two decades.

Since 1995, diabetes rates have doubled in eight states. Then, only four states had diabetes rates above 6 percent. Now, 43 states have diabetes rates over 7 percent, and 32 have rates above 8 percent. Twenty years ago, 37 states had hypertension rates over 20 percent. Now, every state is over 20 percent, with nine over 30 percent. 

Obesity is plaguing America’s children with a multitude of health problems -- now there’s a new risk to be added to the list: shorter life expectancy. For the first time in history, the next generation will not live longer, or even as long, as their parents.

“Diseases such as Type II diabetes, high blood pressure, heart conditions and joint deterioration - what were once considered ‘adult’ diseases - are regularly being diagnosed in children, due to the prevalence of obesity,” said Jessica Bartfield, MD, internal medicine and medical weight-loss specialist at Gottlieb Memorial Hospital, part of the Loyola University Health System.

Bartfield is also part of Gottlieb’s medically supervised weight-loss program involving physicians, nutritionists, exercise physiologists and behavioralists.

“What is particularly tragic is that studies have suggested that obesity in children today may contribute to a 2-5 year decline in their life expectancy, shorter than that of their parents, due to obesity related diseases that are largely preventable,” said Bartfield.

The causes for childhood obesity, she said, are “multifactorial, including environment and culture.”  Genetics and parental weight status also plays a role.

“If one parent is obese, a child has a 50 percent likelihood of being obese, and if both parents are obese, that skyrockets to 80 percent likelihood,” said Bartfield.

Research by the Center for Disease Control found that 80 percent of obese children between the ages of 10 to 15 continue to be obese at age 25. Furthermore, the earlier obesity develops in children, the more severe it tends to be as an adult.

In addition to health implications, there are psychological and social damages as well.

“In addition to decreasing years of life, obesity decreases the quality of life through social ostracism, bullying, social isolation, and poor self-esteem which can lead to poor performance in school, in jobs and in life,” said Bartfield.

What to do

Here are the top five ways we can reverse the obesity trend among children:

1.  Parents take charge. “Focus on getting the family healthy, not putting someone on a diet,” said Bartfield. “Monitor and take accountability for what the family is eating. Plan meals, set limits and take the team approach.”

2.  Involve the Kids. “As a family, create a weekly meal plan, look up calorie counts, make a grocery list, read product labels, choose fresh rather than packaged and get everyone’s participation,” said Bartfield. “Everyone has to get on board to be successful.”

3.  Add fresh fruits and vegetables. Bartfield recommends replacing applesauce for oil in baked goods, adding carrots, broccoli and kale to soups and omelets, and cutting up fresh fruit as a side dish -- even if it means including moderate amounts of low-calorie whipped topping or low-calorie salad dressing to make the fruit or vegetable more appealing.

4.  Cut liquid calories. “Soda, flavored and full fat milk, fruit punches and fruit-flavored beverages are loaded in sugar and empty calories,” Bartfield said. “Substitute 2 percent for whole milk, or skim for 2 percent, and try adding water, seltzer or club soda to juices to cut calories.”

5.  Prioritize breakfast and keep meals consistent. According to Bartfield, eating within the first hour of waking up powers the brain and jump-starts the metabolism for the rest of the day and choosing protein and fiber in breakfast foods boosts endurance. Establish set meal times, and calories per meal, and stick to them, with defined healthy options for snacking.

Another key to helping children lose weight is to have healthy expectations.

“In overweight children with medical complications or obese children, strive for a one-pound individual weight loss per month,” said Bartfield, who uses guidelines by the American Academy of Pediatrics.

Bartfield also encourages parents to focus on weight maintenance for overweight kids without medical complications since, as they grow in height, their Body Mass Index (BMI) will decrease on its own.

Bartfield practices medicine in Chicago, a city whose youth population has increased in obesity.

“Most recently, data from 2007 National Survey of Children’s Health found Illinois to have the 4th highest rate of child obesity in the nation -- 1 out of every 5 children is obese. In particular, our children entering schools in Chicago (age 3-7) have about double the rate of obesity as the national average of similar aged kids,” said Bartfield.

Where children live may have a lot to do with their risk of becoming obese, according to a new study by the Seattle Children's Research Institute.

Researchers studied kids living in King County, Washington and found obesity most common in those living in neighborhoods with the least-educated females, most single-parent households, lowest median household income, highest proportion of non-white residents, and fewest homes owned.

Together, these five socioeconomic factors accounted for 24 percent of the variability in childhood obesity rates across neighborhoods.

"Children are raised not only at home but also in their community," said lead author H. Mollie Greves Grow, MD MPH, an assistant professor of pediatrics at the UW, Seattle Children's, and Harborview Medical Center.

Everybody's problem

Disadvantaged neighborhoods may present many obstacles for children's weight, such as less access to healthy foods and more unhealthy fast-food outlets, the authors said. They also often lack safe places for children to play outdoors.

"Childhood obesity is not just a family problem, but a larger community and societal problem," Grow said. "A disadvantaged environment can set families up for ill health, and it's unfair to blame them for not taking enough 'personal responsibility' to manage their weight. We don't yet know all of the factors that may create disadvantage, but we know it is present and associated with higher obesity."

The research team collected anonymous, "de-identified" electronic medical record information on 8,616 children age 6-18 receiving care at Group Health Cooperative-and then correlated these data to the social and economic characteristics of Seattle-area census tracts.

Cumulative effect

"We were a little surprised that each of the census tract factors we included appeared to contribute, in a slightly different way, to the likelihood of childhood obesity," Grow said.

The likelihood of childhood obesity rose by 17 percent to 24 percent for each of three measures of neighborhood social disadvantage: each 10 percent decrease in female education and two-parent households, and each $10,000 decline in household income. Effects related to race and homeownership were smaller but still statistically significant. Overall, King County's demographics resemble those of other urban U.S. areas.

"But King County has one of the strongest public health efforts, a relatively walkable environment, and efforts to expand affordable access to healthy, fresh foods," said Grow.

So she and her colleagues expect the links between childhood obesity and neighborhood disadvantage may be even more pronounced elsewhere.

A Kaiser Permanente study of 710,949 children and teens appears in the Journal of Pediatrics. It found that extreme obesity is affecting more children at younger ages, with 12 percent of black teenage girls, 11.2 percent of Hispanic teenage boys, 7.3 percent of boys and 5.5 percent of girls now classified as extremely obese.

It's the first study to provide a snapshot of the prevalence of extreme obesity in a contemporary cohort of children ages 2 - 19 years from a large racially and ethnically diverse population using the recent 2009 U.S. Centers for Disease Control and Prevention extreme obesity definition.

"Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children's futures," said study lead author Corinna Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California's Department of Research and Evaluation in Pasadena, Calif. "Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their twenties that we typically see in 40 - 60 year olds."

Children who are extremely obese are at higher risk for heart disease, type 2 diabetes, fatty liver disease and joint problems. That makes the findings even more alarming, Koebnick says.

The study found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, translating into more than 45,000 extremely obese children in this cohort. The percentage of extreme obesity peaked at 10 years in boys and at 12 years in girls. The heaviest children were black teenage girls and Hispanic boys. The percentage of extreme obesity was lowest in Asian-Pacific Islanders and non-Hispanic white children.

According to the recent CDC recommendations, extreme obesity is defined as more than 1.2 times the 95th percentile, or a body mass index (BMI) of more than 35 kilograms/meter squared. Obesity is defined as more than the 95th percentile or a BMI of more than 30 kg/m2. Overweight is defined as more than the 85th percentile or a BMI of more than 25 kg/m2.

Health risk

The BMI is a reliable indicator of body fatness and calculated based on height and weight. For children, BMI percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child's BMI number among children of the same sex and age.

"Our focus and concern is all about health and not about appearance," said study co-author Amy Porter, MD, a Kaiser Permanente Baldwin Park pediatrician who leads the Pediatric Weight Management Initiative for Kaiser Permanente's Southern California Region. "Children who are morbidly obese can do anything they want - they can be judges, lawyers, doctors - but the one thing they cannot be is healthy."

Porter said the most important advice to parents of extremely obese children is that this has to be addressed as a family issue. She says it's rare to find one extremely obese child in a house where everyone else is extremely healthy.

"It's important that everyone in the family is invested in achieving a healthier lifestyle," Porter said.

Three decades ago the government banned cigarette ads from the airwaves in a bid to reduce smoking-related illness. Now, some health experts say its time to take similar action against ads for fast food restaurants.

Researchers at the National Bureau of Economic Research say such a ban could reduce the number of obese children in the U.S. by as much as 18 percent. Economist Shin-Yi Chou of Lehigh University in Pennsylvania says the study is the first empirical research to make the connection.

The research team used data from the 1979 Child-Young Adult National Longitudinal Survey of Youth, commissioned by the U.S. Labor Department. They measured the rate of child obesity against the number of hours of fast food restaurant ads viewed in a given week.

"Our results indicate that a ban on these advertisements would reduce the number of overweight children ages 3-11 in a fixed population by 18 percent and would reduce the number of overweight adolescents ages 12-18 by 14 percent," the authors write.

Approximately 30.3 percent of U.S. children, age 6 to 11, are overweight and 15.3 percent are obese. Among adolescents, ages 12 to 19, 30.4 percent are overweight and 15.5 percent are obese, according to the U.S. Centers for Disease Control and Prevention. These numbers are even more dramatic when compared to Mexican American children of whom 39.3 percent are overweight and 23.7 percent are obese, the agency notes.

In speculating on the possible reasons for the explosion in childhood obesity, the CDC says "there has been a surge in the amount of time children are spending watching TV and playing video games instead of playing outside."

The Institute of Medicine reported in 2006 that there was compelling evidence linking food advertising on television and increased childhood obesity.

TV can be a negative influence on children's health, whether the message is in English or Spanish, according to research led by pediatricians from the Johns Hopkins Children's Center.

Latino children, who make up one-fifth of the U.S. child population, also have the highest obesity and overweight rates of all ethnic groups. A report on the study, funded by the Robert Wood Johnson Foundation, was released earlier this year.

"While we cannot blame overweight and obesity solely on TV commercials, there is solid evidence that children exposed to such messages tend to have unhealthy diets and to be overweight," said study lead investigator Darcy Thompson, M.D., M.P.H., a pediatrician at John Hopkins Children's Center.

Past research among English-speaking children has shown that TV ads influence food preferences, particularly among the more impressionable young viewers.

An estimated 25.6 percent of U.S. adults reported being obese in 2007 compared to 23.9 percent in 2005, an increase of 1.7 percent. The report also finds that none of the 50 states or the District of Columbia has achieved the Healthy People 2010 goal to reduce obesity prevalence to 15 percent or less.

Once again, Mississippi led the nation in obese adults, with 32 percent classifying themselves as obese. Colorado had the lowest obesity prevalence at 18.7 percent.

Obesity is defined as a body mass index (BMI) of 30 or above. BMI is calculated using height and weight. For example, a 5-foot, 9-inch adult who weighs 203 pounds would have a BMI of 30, thus putting this person into the obese category.

The data were derived from CDC's Behavioral Risk Factor Surveillance System, a state-based telephone survey that collects information from adults aged 18 years and older. For this survey more than 350,000 adults are interviewed each year, making BRFSS the largest telephone health survey in the world. BMI was calculated based on this self-reported information.

"The epidemic of adult obesity continues to rise in the United States indicating that we need to step up our efforts at the national, state and local levels," said Dr. William Dietz, director of CDC's Division of Nutrition, Physical Activity, and Obesity. "We need to encourage people to eat more fruits and vegetables, engage in more physical activity and reduce the consumption of high calorie foods and sugar sweetened beverages in order to maintain a healthy weight."

The study found that obesity is more prominent in the South, where 27 percent of respondents were classified as obese. The percentage of obese adults was 25.3 in the Midwest, 23.3 percent in the Northeast, and 22.1 percent in the West.

By age, the prevalence of obesity ranged from 19.1 percent for men and women aged 19-29 years to 31.7 and 30.2 percent, respectively, for men and women aged 50-59 years.

"Obesity is a major risk factor for a number of chronic diseases such as type 2 diabetes, heart disease and stroke. These diseases can be very costly for states and the country as a whole," said Deb Galuska, associate director for science for CDCs Division of Nutrition, Physical Activity and Obesity.

Obesity has gotten much worse within the last decade. The CDC has produced an animated map that starkly shows how quickly the problem has spread.

For each additional $100,000 in the median price of homes, UW researchers found, obesity rates in a given ZIP code dropped by 2 percent.

The study, based on analyses of responses to a telephone survey conducted in King County, Washington by the local health department and the federal Centers for Disease Control, found six-fold disparities in obesity rates across the Seattle metropolitan area. Obesity rates reached 30 percent in the most deprived areas but were only around 5 percent in the most affluent ZIP codes.

"Obesity is an economic issue, said Dr. Adam Drewnowski, director of the UW Center for Obesity Research and leader of the study. Knowing more about the geography of obesity will allow us to identify the most vulnerable neighborhoods.

Working with the local health agency, Public Health-Seattle & King County, the researchers aggregated multiple-year data from Washington state's Behavioral Risk Factor Surveillance System (BRFSS) to analyze data for more than 8,000 respondents.

The Centers for Disease Control and Prevention use the same data to map rising obesity rates in the United States at the state level. However, unlike most states, Washington codes the BRFSS data by the respondents ZIP code, which permits more detailed analyses of local obesity rates at a finer geographic scale. Other information about the ZIP code areas was provided by data from the U.S. Census.

Residential property values were used as a proxy measure of ZIP code socioeconomic status. Incomes are not the same as assets and wealth, said Drewnowski. The chief financial asset for most Americans is their home.

Area prosperity can also be a good predictor of access to healthy foods, or opportunities for exercise.

The UW study was the first to examine obesity rates by area-based indexes of poverty and wealth across a metropolitan area. Previous studies have found higher obesity rates among racial and ethnic minorities and groups of lower education and incomes.

Analyses of the same BRFSS data for King County showed that obesity rates were higher for African-Americans (26 percent) than for whites (16 percent), and were higher for people with annual incomes below $15,000 (20 percent) than for those with incomes above $50,000 (15 percent), all consistent with national trends.

These disparities were much lower than those dependent on ZIP codes and geographic location. The study concluded that social and economic disparities were more important in predicting obesity than previously thought.

Well-known maps of rising obesity rates in the United States, also based on BRFSS data, showed only small differences among the poorest and the richest states.

Those maps were used to support that argument that the obesity epidemic did not discriminate," said Drewnowski. "Our research shows that geography, social class, and economic standing all play huge roles in the obesity problem. Some of the most disadvantaged areas -- those hardest hit by low income, low education, and low property values -- are also the ones most affected by the obesity epidemic."

More than a quarter of Americans (27 percent) named obesity as the top health issue for kids, followed by lack of health care/insurance (16 percent) and nutrition/unhealthy diet (9 percent).

Americans are divided on whether addressing obesity is an individual or societal issue.

According to the poll, 52 percent think obesity is a public health issue that society should help solve; 46 percent say it is a private issue that people should deal with on their own.

When asked who should be responsible in addressing obesity, Americans say it should be an individual and community effort. They say responsibility to help address obesity lies to some or a great extent with parents (98 percent agree), individuals (96 percent), schools (87 percent), health care providers (84 percent), the food industry (81 percent) and government (67 percent).

More than half (57 percent) of Americans say most adults in the United States are overweight or obese, and more than a third (35 percent) say most children are. Perceptions are close to reality: 66 percent of American adults (ages 20 to 74) are overweight or obese, although only about 17 percent of children (ages 2 to 19) are, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention.

"Clearly, Americans recognize the obesity epidemic facing this country and our children," said Dr. Leonard Wartofsky, president of the Endocrine Society.

"However, the poll shows that the public thinks we should address obesity as a public health issue to bolster the actions of individuals and families. Health care professionals and researchers need to help convey the importance of a stronger public health response to this epidemic."

When asked about the most important health issue for all ages, 24 percent cited health insurance/health care costs, followed by cancer (15 percent), access to health care (11 percent) and obesity/nutrition (9 percent).

Other key findings in the poll include:

• Most Americans (92 percent) say their school required participation in physical education (PE) when they were children;

• 68 percent think PE is now required daily in elementary school, when actually less than one-fourth of the nation's elementary schools provide daily physical education (U.S. Dept. of Education, National Center for Education Statistics);

• 81 percent say it is important for the U.S. government to invest in obesity research, and 84 percent say it is important to invest in public health and prevention programs to help reduce obesity among Americans; and

• 67 percent would be willing to pay $1 per week more in taxes if they were certain the money would fund research to improve health.

"Research is the answer to many of the health issues we face, including obesity," said Mary Woolley, Research America president. "Americans understand that and clearly want adequate funding for research that can improve their health and the health of their families."