286 Diet and Health
as far back as 1986, the economic costs of illness associated with overweight in the
US were estimated to be $39 billion; today the estimated cost of obesity and over-
weight is about $117 billion.^64 The rise in US obesity is dramatic: between 1991
and 2001, adult obesity increased by 74 per cent. The percentage of US children
and adolescents who are defined as overweight has more than doubled since the
early 1970s, and about 13 per cent of children and adolescents are now seriously
overweight.^65 These general US figures disguise marked differences between ethnic
groups and income levels: according to the Centers for Disease Control and Pre-
vention, 27 per cent of black and about 21 per cent of Hispanics of all ages are
considered obese – that is, a third overweight – compared with a still worrying but
lower 17 per cent among whites.^66 The poor are more obese than the more affluent
within the US. The price of food is a key driver of obesity: saturated fats from dairy
and meat and hydrogenated (trans) fats are relatively cheap.^67
The connection between overweight and health risk is alarmingly highlighted
by the following list of the physical ailments that an overweight population (with
a BMI higher than 25) is at risk of:^68
- high blood pressure, hypertension;
- high blood cholesterol, dyslipidemia;
- type-II (non-insulin-dependent) diabetes;
- insulin resistance, glucose intolerance;
- hyperinsulinaemia;
- coronary heart disease;
- angina pectoris;
- congestive heart failure;
- stroke;
- gallstones;
- cholescystitis and cholelithiasis;
- gout;
- osteoarthritis;
- obstructive sleep apnea and respiratory problems;
- some types of cancer (such as endometrial, breast, prostate and colon);
- complications of pregnancy;
- poor female reproductive health (such as menstrual irregularities, infertility
and irregular ovulation); - bladder control problems (such as stress incontinence);
- uric acid nephrolithiasis;
- psychological disorders (such as depression, eating disorders, distorted body
image and low self-esteem).
There is a vocal position – particularly articulated in the US – arguing that the
critique of obesity is an infringement of personal liberty and ‘size-ist’, making cul-
tural value statements. If someone wants to be fat and is content and loved by
others, goes this argument, what does it matter? The list of health problems given