The Obesity Epidemic

In 2001, then Surgeon General David Satcher stated that obesity had “reached epidemic proportions in America.¹ Since then, and particularly within the past two years, most states have reacted to the rise of obesity rates and obesity-related diseases through the implementation of more nutritional public school lunches and safer community areas for exercise. Even with such improvements, state efforts have not matched the growing need to curb the obesity epidemic as nearly two-thirds or 68 percent of American adults are either overweight or obese² and 31.7 percent of American children ages 2-19 are overweight or obese.³

In Massachusetts particularly, the rates are not as dire as the overall national statistic. Recently in 2010, Massachusetts was named the fourth least obese state in the country, according to the seventh annual “F as in Fat: How Obesity Threatens America's Future” 2010 report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The state’s adult obesity rate is 21.7 percent compared to 38 other states, which have adult obesity rates above 25 percent.

Since the causes (increased access to cheaper and highly caloric foods, lack of time or desire for exercise, etc.) and effects (obesity-related illnesses, death, economic and social costs) of obesity are generally known, racial and socioeconomic disparities relating to obesity will be addressed. In Massachusetts, the adult obesity rate in 2010 is 29 percent among Blacks and 27.1 percent among Latinos, compared with 21.4 percent among Whites.⁴ Additionally, socioeconomic factors such as household income often contribute to obesity. Nationwide, households making less than $50,000 have 35.3 percent obese adults and 64.7 percent non-obese adults whereas households making more than $50,000 have 24.5 percent obese adults and 75.5 percent non-obese adults.⁵

A 2008-2009 study, which highlighted weight and height measurements for 110,000 students across Massachusetts, reflected the racial and socioeconomic disparities highlighted above. In the study, Lawrence, one of the state’s poorest cities, had the highest rate of students with excessive weight, at about 47 percent. In stark contrast, Arlington, a mere 25 miles away and a wealthier suburban city with a focus on nutrition and exercise, had the lowest level, at about 10 percent. Such differences reflect the notion that “impoverished, and especially inner-city communities, are almost optimally designed to promote obesity, depriving children of access to high-nutrition, lower-calorie foods like fruits and vegetables and beans.”⁶

Because the economic costs of obesity are approximately $1.8 million per year, Massachusetts has attempted to address the dual issues of the obesity epidemic and the disparities between the differing communities by setting standards for school lunches, breakfasts, and snacks that are stricter than current United States Department of Agriculture (USDA) requirements. Another state measure to curb obesity is the Mass in Motion initiative, which most notably (1) encourages small and medium-sized employers to have worksite wellness resources and (2) requires agencies with state contracts to provide food services to meet nutrition guidelines (i.e., promote fruits, vegetables, and whole grains; and reduce sugar-sweetened beverages).⁷ Additionally and in response to the issue of safer community areas for exercise, Massachusetts has passed Complete Streets legislation, which helps ensure that all users – pedestrians, bicyclists, motorists and transit riders – have safe access to a community's streets.⁸

Although much has been done to reduce obesity rates, additional efforts are needed. For instance, unlike 33 other states, Massachusetts currently does not tax sodas or sugar-sweetened beverages at a higher rate than other beverages. Even though pressure has been placed on schools to reduce soda availability to students, such initiatives do not necessarily help outside of the school setting. As such, proponents of soda taxes argue that (1) the intake of sugar-sweetened beverages is associated with higher body weight, poor nutrition, displacement of healthier drinks, and obesity and diabetes,⁹ and (2) raising taxes would reduce consumption, as did taxes on tobacco products. Opponents on the other hand argue that based on the dearth of research available (1) there is no evidence definitively linking the consumption of sodas with obesity,¹⁰ (2) such soda taxes will not deter consumption, (3) a soda tax has a negligible effect on obesity, and (4) such a tax will result in greater consumption of higher calorie milk or other sweetened drinks.¹¹ Regardless of the arguments, researchers at Yale University report that a national soda tax of one cent per 12 ounces would generate $1.5 billion per year, which could go towards obesity prevention in the state.¹²

Battling the national obesity epidemic will not be easy. From a state analysis however, the problem appears more manageable, as Massachusetts currently ranks as the fourth least obese state. In an attempt to mitigate obesity, a more holistic and uniform approach is needed so that variations do not exist amongst or within differing demographics. State policymakers must remain vigilant as change will not come overnight. Nevertheless, with realistic approaches such as those implemented and proposed above, we are headed in a more healthy direction.

Namita Agarwal is AyerHoffman's Health Law & Policy Contributor. Ms. Agarwal is currently a J.D. candidate at Northeastern University School of Law where she concentrates her studies on domestic and international health care, welfare, and immigration law.