Politicians sometimes tout “American exceptionalism”—the notion that we’re uniquely different from the rest of the world because our cultural values of freedom and equality are enshrined in our constitution. This makes us a beacon of inspiration for emerging nations (so the theory goes). It’s good fodder for stump speeches, even if our boasting does leave other countries feeling a bit slighted, especially those that share our values and would argue that there’s nothing too unique about us after all.
But lately, one way we differ from the rest of the world has been harder and harder to avoid.
We’re fat. Exceptionally fat.
A recent study of worldwide population characteristics found that although Americans comprise only 5% of the world’s population, we account for nearly one-third of its obesity.1 Compare that to Asia, which represents 61% of the global population but only accounts for 13% of global obesity.
That’s not just embarrassing, it’s unsustainable—for individuals and the environment. “If every country in the world had the same level of fatness that we see in the USA, in weight terms that would be like an extra billion people of world average body mass,” Ian Roberts, one of the study authors, told the BBC. Some beacon of inspiration we are!
OK, so we overindulge. That’s bad, but it’s only half the story. We also don’t burn off those extra calories nearly as much as we should. Another recent study found that roughly 41% of adults in America don’t take part in enough physical activity.2 Published in The Lancet last month, the study said that physical inactivity actually results in as many deaths as smoking.
“We should maintain cigarette smoking as public enemy number one, but we should move physical inactivity right up next to it,” John Thyfault, Ph.D., of the University of Missouri, told WebMD.
And what do obesity and inactivity often lead to? Diabetes, of course. The Lancet study found that 8.3% of type 2 diabetes cases in the U.S. are linked to inactivity—and again we eclipse the worldwide average, which is 7.2%.
As we discuss this month on page 74, a new report finds that 26 million Americans currently have diabetes and triple that number have “pre-diabetes.” At this pace, one third of our population will have diabetes by 2050. The report also finds that diabetic eye disease nearly doubled in the last decade.
It all adds up to a public health crisis—and that’s where you come in. As the doctors who perform the vast majority of routine eye exams, you’re in a unique position. More often than not, ophthalmologists see these patients after the horse has left the barn, when they’ve got full-blown proliferative diabetic retinopathy. But you’re able to intervene at a point in patients’ lives when lifestyle changes would still be able to interrupt the progression from diabetes to diabetic retinopathy to PDR.
It may seem impolite to bring up systemic health concerns like obesity in otherwise asymptomatic patients, but those are the people with whom you have the best chance of “bending the curve” on those grim charts predicting ever-increasing rates of DR.
I know that during a busy clinic day it’s hard to find the time to address diet and lifestyle concerns, especially with an unreceptive audience (and for a consult that lacks a CPT code, no less). But it’s a message your patients need to hear. Too often, we fail to connect the dots between our actions (and inactions) and their consequences for our long-term health. As I write this, the Olympics are showcasing the world’s finest physical specimens, performing at their peak. Meanwhile, we Americans watch on the couch with a bag of Cheez Doodles.
Whenever the opportunity presents itself at your practice, try to instill a sense that, at least in our health risks, we’re not as exceptional as we think.
1. Walpole SC, Prieto-Merino D, Edwards P, Cleland J, Stevens G, Roberts I. The weight of nations: an estimation of adult human biomass. BMC Public Health 2012, 12:439.
2. Lee I, Shiroma EJ, Lobelo F, Puska P, Blair, S, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet, 21 July 2012,380:219-29.