Although the obesity epidemic in the United States has been instrumental in bringing worldwide attention to the problem, obesity also has become a problem worldwide. In the United States alone, one-third of adults are now obese, and the prevalence of obesity among children has risen from 5 to 17 percent in the past 30 years. Equally disturbing, these percentages generally are higher for ethnic minorities, for those who are low-income or less educated, and for rural populations. With obesity at these levels and with current trajectories suggesting the possibility of further increases, future health, social, and economic costs are likely to be devastating. Obesity is associated with major causes of death and disability, and its effect on predisposing individuals to the development of type 2 diabetes is so strong that the onset of this disease now is occurring in childhood.

In economic terms, the estimated annual cost of obesity-related illness based on data from the Medical Expenditure Panel Survey for 2000-2005 is $190.2 billion (in 2005 dollars), or nearly 21 percent of annual medical spending in the United States. Childhood obesity alone is responsible for $14.1 billion in direct medical costs. Many of these health-related obesity costs are absorbed by Medicare and Medicaid, important programs already under attack because of their national price tag. Moreover, obesity-related medical costs in general are expected to rise significantly, especially because today’s obese children are likely to become tomorrow’s obese adults. In fact, U.S. military leaders report that obesity has reduced their pool of potential recruits to the armed forces. As the U.S. economy struggles to stabilize and grow, obesity projections reveal that beyond the impact of growing medical costs attributable to obesity, the nation will incur higher costs for disability and unemployment benefits, and businesses will face the additional costs associated with obesity-related job absenteeism and lost productivity.

The causes of increased obesity in the United States—the influences that have led people to consume more calories (or energy) through food and beverages than they expend through physical activity—are multifactorial, ranging from cultural norms, to the availability of sidewalks and affordable foods, to what is seen on television. Many causes of obesity are the result of multiple changes in U.S. society that have affected various aspects of contemporary life, including physical activity and food consumption patterns. Exposure to these influences, both positive and negative, varies by subpopulation and can result in inequities in the prevalence of obesity. If a community has no safe places to walk or play, lacks food outlets offering affordable healthy foods, and is bombarded by advertisements for unhealthy foods and beverages, its residents will have less opportunity to engage

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