I have often described my blogging on diet and health as “fighting the rise of obesity.” The December 2019 New England Journal of Medicine article shown above details what the rise of obesity is likely to be in the near future. The abstract of “Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity,” by Zachary J. Ward, Sara Bleich, Angie Cradock, Jessica Barrett, Catherine Giles, Chasmine Flax, Michael Long and Steven Gortmaker shown above says:

… by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states.

“Obesity” is defined as a body mass index of 30 or above. “Severe obesity” is defined as a body mass index of 35 or above. (To get a sense of the body mass index, you can compute your own BMI here.)

Color-coded maps obesity and severe obesity prevalence for each state in 1990, 2000, 2010, 2020 and projected for 2030 are frightening. You can see them yourself with one of your three free New England Journal of Medicine articles. The map for severe obesity in 2030 struck me as looking like the map for obesity in 1990. This is one area where things are getting worse.

Women have more extremes: a higher frequency of both severe obesity and normal weight than men. Non-Hispanic blacks have quite a bit more obesity than Non-Hispanic Whites; Hispanics have a modest amount more obesity than Non-Hispanic Whites. The “Non-Hispanic Other” category, which I assume is mostly Asian Americans, has by far the least obesity. Higher income is associated with less obesity. (The categories are < $20,000 per year, between $20,000 and $50,000, and $50,000 and above.)

There are many health problems strongly correlated with obesity. Is obesity causal for those health problems? I don’t know. Bad eating could easily cause both health problems and obesity, with obesity not caused by bad eating as not so dangerous. Lack of exercise could easily cause both health problems and obesity, though I think the evidence shows it has a more powerful effect on health, happiness and cognition than it does on obesity itself (as most people would intuitively view the magnitude of the effects indicated by the evidence). And I suspect obesity not caused by bad eating or lack of exercise is both reasonably rare and likely to be caused by something dangerous in its own way, even if not dangerous in exactly the same way as bad eating.

Note that I say “bad eating,” not eating too much. My view is that bad eating is much more a matter of eating the wrong things and eating all the time, with eating too much being more a consequence of eating the wrong things and eating all the time than something to focus on in itself.

What do I mean by eating the wrong things? In the first instance I mean eating sugar, potatoes and bread. Beyond that, I mean eating things high on the insulin index. See “Forget Calorie Counting; It's the Insulin Index, Stupid.”

What to I mean by eating all the time? I mean eating right when you get up and right before you go to sleep, and times in between.

The other approach when to eat is to limit one’s eating to at most a 12-hour window, an 8-hour window or a 6-hour window. It’s not that hard if you strategize a little! And eating foods low on the insulin index will make it easier than you think.

Someday, maybe we may have safe and powerfully effective anti-obesity drugs. In the meantime, it takes avoiding eating the wrong things and not eating all the time to keep the chances of obesity down. If you do that, you can get to—or stay at—a normal weight.

For annotated links to other posts on diet and health, see:

• Miles Kimball on Diet and Health: A Reader's Guide