The purpose of this essay is to investigate the problem of obesity in two different nations – American and Japanese. Obesity is a chronic disease characterized by deposition of excess fat in the body. The paper provides historical discourse analysis of the issue of obesity, describes it and determines its main consequences. The main emphasis is laid on comparison of the extent of the problem in the USA and Japan. Suggestions provided in the conclusion part of this paper may be useful in drawing up prevention measures of the obesity problem at the state level.
Far back in the past, ability to store fat was an evolutionary advantage, allowing a person to survive periods of forced starvation. The ingenious invention of the nature, fat, which had protective function in the past, now is the cause of sufferings of millions of people. Obesity is an extremely urgent health problem in many parts of the world. According to WHO, there are more than 1.7 billion people with the excess weight or obesity (Rippe and Angelopoulos, 2012: 5). Population-based epidemiological studies data indicates steadily increasing prevalence of this disease in the past three decades, as well as the probability of preservation of this trend in the near future. Obesity leads to a number of adverse health effects, as well as social, psychological and economic problems, which affect every single person and the society on the whole. Therefore, the problem of obesity in our time is becoming increasingly important and begins to pose a social threat to the life of people. The issue is relevant to all regardless social and professional affiliation, area of residence, age and gender. The paper will discuss different aspects and severity of the problem of obesity in the USA and Japan.
The History of Obesity Health Problem
Vast majority of products that have a high glycemic index were included in a daily diet only in the last few decades. Three of them, which are currently being consumed, were not known at the beginning of the 18th century: sugar, refined premium flour and potato.
Until the 16th century, sugar was extremely rare product, because it was very expensive. Sugar consumption in the 18th century was less than two pounds per person annually (today – 100-110 pounds per person annually). Sugar became a mass consumption product only in 1812, when a new method of producing sugar from beets was discovered and this fact has led to a radical change in the world diet (Gilman, 2008: 23).
Until 1870, when a cylindrical grinder was invented, only very wealthy people could afford well sifted flour, and the rest were content with bread from wheat flour containing a large amount of fiber. The following historical fact suggests the following benefits of such flour: Danish cooks started to bake bread from wheat flour in 1917, which led to a decrease in obesity and mortality by 17% (Gilman, 2008: 29)
Potatoes became actively consumed in the 18th century, though they were firstly introduced in North America in the16th century as pet food. This currently popular product surpasses even sugar by the glycemic index. Caloric food has become more accessible in the 19-20 centuries, due to active development of the livestock and the associated consumption of large quantities of high-caloric meat and butter (Gilman, 2008: 50).
Achievements of civilization have made high-calorie foods available for general public while reduced the need for physical activity. This contributed to the fact that the number of patients, who are obese, started growing catastrophically in the 20th century. In 1948, obesity was included in the International Classification of Diseases as decease. Today, the cases when the mass of the human body reaches 700, 900 and even 1500 pounds were reported.
Problem Description and Its Consequences
One of the main reasons leading to development of obesity is energy imbalance, which lies in discrepancy between the number of calories coming from the food and energy expenditure of the body. Obesity is accompanied by metabolic disorders and a whole range of different diseases. The following diseases are likely to develop on the ground of obesity: atherosclerosis, hypertension, coronary heart disease, cholelithiasis, reproductive dysfunction, gout, osteoarthritis, some cancers (women - cancer of the endometrium, cervix, ovary, breast; men - prostate cancer and; colorectal cancer in both genders), varicose veins and hemorrhoids (Bagchi and Preuss, 2012: 41, 44, 45).
Socio-economic significance of the problem of obesity is determined by the threat of disability of patients of young working age and reduction of overall survival in relation to frequent development of severe comorbidities.
Excessive body weight or obesity entails economic consequences. In the past decade, numerous studies have attempted to assess economic consequences of obesity. Most of these studies focused on medical costs associated with obesity (direct costs), while some studies have examined the costs associated with the lost productivity (indirect costs) (Acs and Stanton, 2010: 87). There is much less scientific data on the individual costs of obese people and their families, such as the costs of providing home care, special clothing or weight loss products.
According to a research conducted by the WHO, the direct costs of medical care for obesity amount to 2-4% of the total national health expenditure (Acs and Stanton, 2010: 103). Sturm (2002), Finkelsteinetal (2005) and Thorpe et al. (2004), have found that the health care costs of obese people are about 35% higher mainly because of the high cost of treatment and associated costs (Acs and Stanton, 2010: 105).
An alternative approach for assessing medical expenses for treatment of obesity involves the use of personal data. Quesenberry et al. (1998), based on the data of typical health care organizations, has estimated the cost of treating obesity at $92 per person for the USA. Individual data was also used to assess the health care costs in Japan. Japanese research results are very interesting because the prevalence of obesity in Japan is relatively low, but treatment costs associated with obesity are close to the average costs in other countries (Acs and Stanton, 2010: 115).
Indirect costs associated with obesity are related to loss of productivity as a result of absence from work due to illness. Estimates of such losses indicate that these costs could be twice as high as the direct costs of medical care. A number of one being absent from work and approximate value of these working days were estimated in both types of studies. The most important result is that obese people have a higher risk to be absent from work than people with normal body weight.
Obesity in the USA
Body mass index (BMI) at 30 points or higher is considered to be the indicator of obesity. Today, according to statistics, BMI in the United States is 28% for men and 34% for women, that means that one person out of three suffers from obesity (Crawford, 2010: 19).
The first studies that demonstrated such deplorable results were conducted in the 1960s. One of the employees of the Center for Disease Control and Prevention in the United States, Catherine Flegal, had noticed that 24.3% of adults are overweight. By the early 1980s, this figure exceeded 30%. However, these changes remained unnoticed. Sales of XXXL clothing size were growing up and the obesity epidemic started to capture the United States. It is recorded that between 1970 and 2000, the U.S. residents began to consume up to 162% more cheese, 109% more lemonade, 102% more poultry, 18% more alcohol, etc.
The first who started to pay attention to the issue of obesity were the armed forces. In 2006, 40% of young men and 25% of young women did not meet the military standards due to being overweight and could not be in the service. The changes affected all spheres of public life: from the size of hospital wheelchairs and the width of doors in supermarkets to funeral parlors. New models of coffins, capable of bearing the weight up to 1000 lb were constructed. It is also worth mentioning that airlines bore losses in terms of $ 250 million spent on fuel equivalence annually.
Currently, the average American weighs 30 pounds more than it was in the late 80s. The largest number of people suffering from obesity lives in the state of Mississippi (30% of the adult population), quite a bit behind is West Virginia (29.8%) and Alabama (29.4%). In addition, the state of Mississippi is a home to the largest number of obese children and teenagers - 44.4%. The state of Colorado takes the first place in reverse ranking, where the ratio of obese patients is only 17.6%. It should be noted that these states are also at the top of the list by the percentage of the poor population and the number of “McDonalds” fast food restaurants. Therefore, the conclusion naturally arises: obesity is a disease of the poor not the rich. The reasons of obesity health problems in the U.S. are as follows:
1. Incorrect work and life balance. The United States ranks the 28th among the developed countries in terms of the balance of work and life. (Cummins, 2012: 89). Increasingly stringent working conditions in addition to everyday stress and overwork leave no chance to the U.S. citizens in terms of leading healthy life.
2. Lack of sleep. Working conditions 40-50 years ago were far from perfect, but still they were much better than at those of the present time. In the 21st century, the U.S. citizens work more but get paid less and their sleep became shorter as compared to the middle of 20th century. American researchers have found a correlation between increased appetite and lack of sleep, since lack of sleep provokes a craving for snacks (Easton, 2004). (Easton, 2004).
3. Ongoing stress. Uncertainty of keeping a job and high level of unemployment make the life for the USA citizens more and more tough. The studies show a strong connection between stress and obesity. Stress contributes to weight gain, even if the person refrains from overeating. Additionally, stress has not only short-term effects, but also can cause long-term metabolic alterations, facilitating weight gain and impeding weight loss (Melhorn et al, 2010).
4. Inability to purchase healthy food. Very often, frozen corn products and semi-finished products are more affordable in terms of price than fresh and healthy food. Economic crisis entailed many negative moments such as mass dismissals, corporative downsizings, etc., which, in turn, resulted in decline of population’s purchasing power. It is very difficult to eat healthy food with a small budget, especially when there is no difficulty to get unhealthy convenience foods.
Urgent need to solve the problem of obesity forced both representatives of healthcare sector and members of the Congress to come out with projects aimed at changing the attitude of Americans to diet and lifestyle. Some corporations completely prohibit fast food in their buildings. Other companies decided to pay workers, which lose extra pounds, a premium of $500 per year. Board of Health Insurance in the Alabama decided to fine officials on the $25 a month if they will not start to lose weight. Other states create special military training camps for those willing to lose weight.
Obesity in Japan
Body mass index in Japan is 3% for men and 3% for women respectively. According to statistics, Japanese live longer than any other nation and are the healthiest nation on the planet. Typical elderly Japanese man preserves good health and lives up to 75 years (Senauer and Gemma, 2012). Experts explain it by various factors, including strong spiritual and social traditions as well as lifestyle. Many experts agree that the main difference of Japanese lifestyle is the diet. Apparently, Japanese diet is the healthiest in the world. The basis of the diet is mainly composed of fruits, whole grains, legumes and soy products.
Japanese cuisine contains 26% of fat, while the U.S. cuisine – 34% (Senauer and Gemma, 2012). Hence, Japanese dishes have less sugar and calories. Additionally, Japanese get large doses of “good fat”, such as omega-3. Consumption of processed and refined foods per capita is less in Japan as compared to the USA. Generally, the total number of calories in Japanese food is much lower than in any developed country.
Therefore, Japan encounters little risk of becoming a country with obese population. However, Japan is the first country in the world, which introduced rigid legislative norms to solve the problem of obesity. The law, intended to struggle with obesity, entered into force in 2009. This law requires all companies and local authorities to measure waist size of the entire population aged 40 to 74 years each year - that is 56 million of Japanese (Jayarajan, 2011).
The law determines the maximum allowed waist size - 33 inches for women and 34 inches for men respectively. These figures are taken from the recommendations of the International Diabetes Federation, which considers measurement of the waist to be the simplest diagnostic method that allows evaluating the risk of disease. Those with a waist wider than the prescribed norms are required to be re-measured after three month of the first measurement. If improvement has not occurred during this time, citizens that did not meet the state standard recommendation will be recommendation to keep to a diet. If improvement has not occurred during the next six month, such citizens will get the referral to special courses of proper nutrition (Jayarajan, 2011).
Japanese government had also introduced penalties for companies that do not achieve the state strategic objectives - to reduce the number of overweight citizens by 10% over three years and by 25% over seven years (Jayarajan, 2011).
Comparison of obesity health problem in the USA and Japan shows substantial difference between the two countries. Obesity in the United States has become a national problem, while Japanese have no difficulties with the overweight.
More and more larger portions of fast food products, their cheapness and availability for all classes of the population contribute to American mass obesity. The average American person is not informed on the amount of food he/she needs to eat to stay healthy or how many calories he or she has consumed.
Instead, such person relies on external clues like the size of the portions, in order to know when he or she should stop eating.
Implementation of measures in the field of public health is often hampered by a mismatch between the scale and importance of the public health problems and lack of evidence of potential interventions in the problem. This is the current state of affairs with the problem of obesity prevention. The growing interest in the problem of obesity in the media over the last five years has led to government interference in this problem in Japan.
Choosing the means of prevention of obesity requires evaluation of evidence and taking into account the contextual factors leading to obesity. At the same time, the process of engaging stakeholders, who give priority to solving problems rather than studying them, should be implemented worldwide. Such approach makes it possible to create a portfolio of priority actions for prevention of obesity, which are evidence-based and closely linked to the contextual situation involving the parties concerned. At the strategic level, governments should assess the value of these measures in terms of efficiency. At the local level, they can be chosen as an investment in health.
Measures for prevention of overweight and obesity can lead to short-term savings in health care and potentially greater savings resulting from a general increase in economic productivity. Prevention of obesity can delay the onset of illness or change its nature, but does not eliminate the risk of the disease entirely. Programs for prevention of obesity would certainly lead to both short-term and long-term gains in terms of economic productivity.
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