Introduction

As recently reported by the CDC, the number of states with obesity rates of 35% or higher has almost doubled in the past two years. In 2018, 9 states reported having obesity rates above 35%. In 2020, that number rose to 16 states reporting obesity rates above 35% with Delaware, Iowa, Ohio, and Texas being the latest states added to the list. States with rates above 35% prior to 2020 were: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia. As a nation, the overall prevalence of obesity has risen to 42.4%.  This is not a new development as obesity rates have been rapidly increasing since the 1980s. Poor diet, a leading cause of obesity and other chronic disease, is only exacerbated by the federal policies in place regarding our agricultural and food systems.

The Problem

Obesity is a problem in and of itself but can also lead to a host of other chronic diseases such as heart disease, type 2 diabetes, cancer, and stroke all of which can lead also to premature death. It is estimated that 6 in 10 adults in the US currently have a chronic disease and chronic diseases are the leading cause of death in the United States. The CDC has estimated that 80% of these deaths are preventable through lifestyle changes. One of these lifestyle factors, nutrition, is a large driver. Poor diet has surpassed tobacco as the number one risk factor for premature death and the combination of poor diet and physical activity alone contribute to 300,000 deaths annually. This became increasingly evident during the pandemic, where those with diet related conditions were much more likely to experience severe outcomes from COVID. Having obesity may triple your risk of hospitalization due to COVID-19.

The Cost

Chronic diseases are costly not to health but to our overall economy as well. Chronic disease costs reach $3.7 trillion each year which is close to 20% of the nation’s GDP. It’s also important to note that 97% of healthcare costs are spent on treatment while only 2-3% of costs are spent on prevention. This begs the question; how can we start to reverse the chronic disease already present and incentivize prevention of further chronic disease? With diet being the strongest predictor in premature death, it seems logical to start there.

What Can We Do?

Our current food system is not conducive to promoting health behaviors. We are constantly being bombarded with ultra-processed options. Ultra-processed foods are cheap, convenient, and plentiful. So plentiful that two-thirds of our children’s diets are comprised of ultra-processed food. These foods are devoid of nutrients and high in calories, added sugars, and saturated fats. But it’s not just what Americans are eating that is contributing to this health crisis, it’s what they are not eating as well.

Despite the USDA suggesting that half of our plates should be fruits and vegetables, 9 out of 10 adults do not meet the recommended daily average for fruit and vegetable intake.

The US government heavily subsidizes certain crops such as wheat, corn, rice, and soybeans. These crops make up the vast majority of US farmland while fruits and vegetables make up 2-3% of farmland and receive just a small fraction of federal subsidies. Commodity crops go on to get used to make processed foods among other things.

A study was conducted to examine if there was a relationship between consumption of subsidized foods and cardiometabolic risk factors. Cardiometabolic risk factors are factors that put individuals at higher risk for things like heart attack, stroke, and developing diabetes. Researchers found that over half of calories consumed were from subsidized food sources and those who consumed more of these foods saw increases in Body Mass Index (BMI) which indicates obesity, abdominal adiposity or excess fat around the midsection, cholesterol levels, and blood sugar levels, all risk factors for chronic disease.

There is a disconnect between how our food system is set up and what we should be eating to promote health and prevent disease.

So, what’s the solution?

Reducing subsidies is one way we can begin to change our food system but it’s not the only contributing factor. Price is just one barrier that may influence fruit and vegetable consumption. Region, availability of produce, proximity to stores selling produce, shelf life of produce, taste, knowledge of how to prepare healthy foods, and cultural influences all contribute to the diet choices individuals make. These are the factors we should also look to target as we look to implement new policies to solve this public health crisis.