Eating Ourselves Sick: The Health Consequences of the Expanding American Waistline

It’s 6 o’clock in the evening in middle America. A man, let’s call him average John, has just returned home from work. He sighs as he sinks into a recliner, remote control in hand. At 5’9” and 198 pounds (this is average according to the National Center for Health Statistics), John is overweight, bordering on obese. Lunch today was fast food; his dinner, an oven pizza, bubbles in the oven. The time he allots to staring at screens is also typical: he spent 5 hours today looking at his smartphone, and he’ll watch about 33 hours of TV this week. Months have passed since John exercised, and he hasn’t stuck to a steady regime in years.

The average American has never been heavier or less physically active than they are right now, and it’s seriously affecting our health. Late last year, a study in The Journal of the American Medical Association revealed some disturbing information about American life expectancy: in an analysis spanning from 1959 to 2016, life expectancy increased until 2014 but then started to drop. The main cause for the decline was an increase in deaths among 25–64 year olds due to overdoses, suicides, and diseases such as heart and lung disease, hypertension, stroke, and diabetes.

Identifying the specific biological and environmental factors that lead any one person to addiction, depression, or disease — or any combination of the three — is nearly impossible. But recognizing key behavioral trends that lead many middle-aged Americans into the latter group, those affected by disease, is less complicated.

The risk of getting every disease mentioned is higher in an obese person. And the bigger the waistline, the bigger risk, according to the National Institutes of Health’s Obesity Expert Panel. Compared to a man of healthy weight, the risk of coronary heart disease for John (an overweight male) is 30–50% higher; for an obese man the risk may be up to 150% higher. The numbers are similar for women, and the rate of all of these diseases goes up as weight increases.

Having spent my entire career in healthcare roles — first as a hospital phlebotomist, then a clinical laboratory technician, and finally a writer and communicator about healthcare issues — I have seen firsthand the manifold health consequences of obesity. Overweight and obese people are more likely to suffer from illness and more difficult to get well once they do. According to a 2017 study published in the Journal of General Internal Medicine, medical costs related to obesity in American adults topped $340 billion in 2013, which accounted for a stunning 28% of total U.S. healthcare costs.

Unfortunately, many Americans don’t have access to healthy food options based on a wide variety of socioeconomic and geographic factors. A study published in 2017 looked at nearly 800 U.S. supermarkets and found that healthy food options like fruits, vegetables, and dairy cost about twice as much as unhealthy ones such as soda, sweets, and salty snacks. Millions of people, both in urban and rural areas, either can’t afford healthy options at the grocery store or are forced to shop at convenience stores devoid of nutritious foods.

But John has the means to eat and drink whatever he chooses. He also isn’t genetically predisposed to obesity, as is certainly the case for some. No, the formula for John’s physique is more simple: he gets most of his calories from junky, processed foods, and he rarely exercises.

Walk through any grocery store today and pay attention to the products with prime shelf space, that which is at eye level toward the middle of each aisle, on the endcaps, and in high-traffic areas. The companies that make these products all paid big money for this privilege. Not only do food companies pay just to get into a store, they must pay additional “display fees” for prime space.

The second thing that the vast majority of these products have in common, and this is true of snacks, sugar cereals, beverages, most sandwich breads, and even yogurts emblazoned with catchy slogans like Live healthy!, is that they have all been carefully engineered to hit the consumer’s “bliss point.” The bliss point, a term coined in the 1970s when highly processed foods were really taking hold in America, is the ideal combination of sugar, salt and fat to thrill human taste buds and leave them wanting more. Ultra-processed is the current industry term for these products.

On a recent trip to my neighborhood supermarket, I noted some of the products that jumped out at me due to the quality and quantity of their shelf space. As I entered the store, I was besieged by candy. To my left was an entire wall of Sour Patch Kids, Reese’s Cups, a half dozen varieties of M&Ms, Skittles, and more. In front of me, parked directly in the middle of the aisle, was a four-tiered display of Ghirardelli chocolate.

After passing through this gauntlet, I turned right and noted that the first endcap was filled with a treat called Little Bites, a confetti cupcake masquerading as a muffin. Of the 35 ingredients listed on the label, only five (sugar, flour, water, egg, and salt) were something I’ve ever put into a muffin, and a full 20 of them were words I didn’t even recognize.

I took a left after the next endcap (Doritos) and was met with a 25-foot-long wall of Gatorade. Gatorade is sugar water; each 12-ounce serving of original Gatorade contains over five teaspoons of sugar, and the entire 32-ounce bottle contains nearly 14 teaspoons. Gatorade has zero nutritional value, and yet somehow it sells. And with this much prime shelf space, you can bet it’s selling.

According to a report by the Center for Science in the Public Interest, a consumer advocacy group, an astonishing 25% of Safeway’s $9.7 billion in profits for 2014 came from placement and display fees. (Safeway is just one of dozens of corporations that all operate the same way.) This single data point demonstrates how the main food source for American pantries — the supermarket — has been hacked by capitalism. Although it’s true that supermarkets must procure a wide enough variety of products to get customers in the store, the real game is maximizing profits for the shareholders, which means selling prime shelf space to the highest bidder. In this system, only the biggest and best selling companies can afford to keep their products from languishing on the lower shelves or being dropped by the store altogether.

We’re bombarded with bad food choices everywhere, not just in supermarkets. Convenience stores often offer exclusively junk, and fast food chains have also dialed in the sugar, salt and fat ratios of their irresistible offerings.

So what is a hungry American to do in such fraught terrain? We must think before we purchase — with our brain, not our mouth — and challenge ourselves to eat better. Today, around 60% of the calories consumed in this country come from ultra-processed foods. When we reach for Doritos, Froot Loops, or Wendy’s, we’re not only training ourselves to seek out these blissful flavor explosions, we’re generating revenue for companies that will use those funds to continue pushing out less profitable, less processed products that are usually more nutritious. Better options exist — at least in the supermarket — but we must overhaul our shopping habits to remind ourselves what real, actual food tastes like.

At this point, over 70% of American adults are overweight. The staggering prevalence of obesity and its health consequences are on display for all to see. Ultra-processed foods are a big part of what’s making us fat, but it’s not the only bad habit we need to kick.

As John cleans up his diet and retrains his mouth to enjoy real food, he also needs to get up out of his recliner. Based on a 2018 national health survey, less than one in four adults is getting enough exercise. If John traded just three of his 33 hours of TV per week for exercise, he would almost surely lose weight. A mountain of scientific evidence has shown that regular physical activity also makes us feel energized, reduces anxiety levels, and improves sleep. It doesn’t have to be a marathon, but we have to get moving.

America has grown flabby due, in part, to ultra-processed convenience foods and inactivity. Little by little, these bad habits are eroding the quality and length of our life. There are millions just like John — well-meaning, hard-working people that long for the day when they can sleep until 10 a.m., or make a tee time for noon on a Tuesday — those looking forward to retirement.

But middle-aged Americans have never had a better chance of dying before they even reach retirement age. The scientific data are screaming at us to make some changes. It’s time we listened, and started thinking about our choices. Let’s take back our health.

Science writer who believes in the power of storytelling to improve individual, global, and environmental health.

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