Causes, consequences, and a critical review of solutions to address it
Obesity has increased dramatically over the past several decades, becoming one of the most significant preventable causes of morbidity and mortality in the U.S. In Indiana, one in three adults is obese. Obesity rates are even higher in Marion County, where 38.6% of adults are obese. Indiana has the 12th highest rate of obesity among adults and the 11th highest rate of obesity among children and teenagers in the U.S. More than 13% of Indiana’s young children from low-income families are obese before they reach kindergarten. In 2018, the Richard M. Fairbanks Foundation commissioned this report to better understand the prevalence, causes, and consequences of obesity and effective solutions to address it.
Obesity results from an excess of calories consumed compared with those expended, which leads to excess fat. It is a complex condition caused by a multitude of factors. Some genes may make certain individuals more susceptible to obesity; however, the rapid rise in obesity over a relatively short period of time indicates that genetics alone are not the cause of the obesity epidemic. Rather, changes to the environment combined with genetic susceptibility and social determinants have affected health behaviors, leading to a rise in obesity among various populations.
Urban sprawl and land use policies have affected how communities are designed and how easy or difficult it is for people to use active transportation to get to work, school, or other destinations. There is abundant access to cheap, energy-dense, highly palatable foods. People are inundated with marketing for these unhealthy foods and beverages. Families are eating at home less and eating out at restaurants more, where food often comes in larger portion sizes, has more calories, and is less healthful. Most people do not get enough physical activity and consume too much media through television, computers, cell phones, and video games. At worksites, technology advancements have changed the ways people work, and many people are sedentary for hours throughout the day. In schools, not all children have access to daily recess and physical education (PE) class, and unhealthy foods and beverages, such as soda, cookies, and other snack foods, are allowed to compete with more healthful options served through school meal programs.
Obesity is associated with serious health consequences, including increased risk of type 2 diabetes, cardiovascular disease, some cancers, arthritis, sleep apnea, liver diseases, kidney diseases, and gallbladder diseases. Obesity also affects socioemotional factors, increasing the risks of depression, low self-esteem, and bullying. Obese individuals may face stigmatization and discrimination in the workplace and in their communities. Obesity is also associated with significant costs to government, healthcare, and individuals. Obesity costs Indiana more than $8 billion per year and Marion County $1.3 billion per year in increased healthcare costs, lost productivity, and premature death.
In 2018, we conducted a review and critical analysis of the literature on obesity solutions in five key areas: healthcare, worksites, schools, communities, and policy. We concurrently conducted key informant interviews with local and state leaders from Indiana, as well as national obesity experts, to inform the literature review and recommendations. We identified and reviewed the findings from more than 1,300 studies primarily focused on interventions to prevent or treat obesity. Our review focused in particular on studies conducted within the last five to 10 years and features some of the most common types of interventions, especially those that are the focus of one or more systematic reviews, metaanalyses, or expert recommendation guidelines reports. This review is comprehensive; however, it does not exhaustively cover all interventions that could be conducted to prevent or treat obesity.
Download the full report to view findings on the prevalence and trends in obesity in Indiana, recommended strategies for addressing obesity, and other key findings from the report, including the economic burden of obesity to government, healthcare, and individuals.