Overweight and Obese Americans - a Comparison with Germany

Granted, the above shown video depicts the stereotype of the obese American in an extremely bold way and also suggests the correlation of poverty and overweight. However, this portrayal is no surprise. This article aims to investigate the reasons, the consequences, and the prevention of overweight in America. In addition to this, the article tries to crystalize the actual truth of this stereotype. Although it seems to be a stereotype that is mainly applied to Americans, it can also be observed in several other nations – among these, Germany. Therefore, the second half of this article aims to draw a comparison between America and Germany, and their own causes for their problem with obesity and overweight.

To understand the true size of what we might as well call an obesity epidemic, overweight itself needs to be defined first: generally speaking, doctors or nutritionists categorize people as underweight, healthy weight, overweight, and obese, with the help of the body mass index (BMI). The BMI “is a person’s weight in kilograms divided by the square of height in meters” (CDC, 2020), enabling, thus, a categorization system which sheds light on the possible suffered overweight. Following this system, the obesity world-wide has nearly tripled since 1975: both children and adults are dramatically affected, so that in 2016 “more than 1.9 billion adults […] were overweight [and] over 340 million children and adolescents” (WHO, 2013), according to the World Health Organization. The CDC states as well, that the prevalence of obesity was 42.4% in 2017 and 2018, which depicts an increase of 11.9% in 18 years (CDC, 2020). Although obesity is, indeed, preventable, the numbers seem to speak a different language – one has to ask: is fat the new normal? The aforementioned key facts show, how overweight and obesity depict a world-wide problem. However, especially America seems to be stigmatized the most. The following map shows the prevalence of self-reported obesity among U.S. adults by state and territory from 2019.

What causes such an extreme spread of overweight and obesity, especially in the U.S.? The pivotal reason is “an energy imbalance between calories consumed and calories expended” (WHO, 2013). Especially America is known for its large, unhealthy, and cheap meals. In his book, Critser names the increase of US corn and soybean production, the invention of a new cheap food sweetener, the creation of value meals and supersizing, the increase of eating out and poor food offers at schools as the main reasons “that led to the increased availability and consumption of high-calorie, large-sized food” (Benton, 2015) in America. As Eliza Barclay has put it: “In America, the unhealthiest foods are the tastiest foods, the cheapest foods, the largest-portion foods” (Barclay, 2018).

Hence, we can observe that the fact that many people overeat is the main cause for the extreme increase of overweight: however, experts agree that people do not choose consciously to overeat, but that the food environment rather predicts and influences our eating habits.

To begin with, I would like to introduce the concept of Food Deserts, which is a concept rather unknown to most Europeans. Food deserts are areas “where access to affordable, healthy food options [i.e. fruits, vegetables, etc.] is limited or non-existent because grocery stores are too far away” (DoSomething, 2018). America’s number of food deserts is huge, i.e. around 23.5 million people do actually live in food deserts. This lack of access to healthy food is directly correlated with health risks, such as obesity which can also lead to several other conditions and diseases such as an increasing risk of diabetes, heart diseases, dyslipidaemia, arthritis, sleep apnoea, gallstone formation, and cancer, and is, on top of this, worryingly dangerous for the mental state of affected people, since studies have shown that a lower self-esteem, fewer relationships, depressions, and emotional difficulties such as discrimination and stigmatization plus a constrained lifestyle, can all be considered the results and consequences of (extreme) overweight.

Food deserts tend to be in low-income areas, i.e. 50%. Speaking of low-income, studies have found that fresh organic produce is rather available in middle- and upper-class communities than for low-income people (Segal 2010, p. 197). A 2,000-calorie diet would cost $3.52 a day consisting of junk food, while a healthy meal would cost $36.32 a day (Segal 2010, p. 199). The following image emphasizes this.

The economic and social factors make it thus already hard to have a healthy nutrition. On top of that, American’s vegetables consist mainly of potatoes and tomatoes (mostly accompanied by a lot of sugar, far and salt), adding, thus, to the problem.

Moreover, Americans prefer it the large way: meal portion sizes have gone drastically up. According to the CDC, sizes grew in average four times larger than in the 1950s (CDC, 2020). Figure 3 2 Edited by Author; Data from: vox.com

Poor neighborhoods tend to have small grocery stores only (so-called bodegas) that advertise unhealthy items like cigarettes, alcohol, soda, and non-nutritious food (Segal 2010, p. 197). This bombarding of ads for unhealthy food especially affects kids and promote unhealthy eating from an early age onwards and, thus, strengthens overweight. According to Rudd’s analysis (cf. vox.com), “food companies spent $1.28 billion to advertise snack foods on television, in magazines, in coupons, and, increasingly, on the internet and mobile devices. […] advertising of sweet snacks increased 15 percent, even from 2010 to 2014” (Barclay, 2018).

This lack of access to healthy food is also directly correlated with the rise of eating out. A rise so drastic, that “in 2015, for the first time, Americans spent more money eating away from home than they did on groceries” (Barclay, 2018). The lack of healthy, wholesome meals in poor areas is strengthened through the lack of knowledge and awareness of the importance of a healthy lifestyle. Studies have found that the “highest levels of obesity […] were observed in census tracts with no supermarkets” (Segal 2010, p. 198). According to Segal, the government plays a critical role in depriving underprivileged communities from healthy food by increasing food deserts and waste taxpayers’ money to dissuade potential farmers from participating in a sustainable food system (Segal 2010, p. 199). Since the current food industry not only perpetuates food deserts and, thus, willingly increase the risk of obesity, but on top of this also destroys the environment, solutions must be found. Segal suggests utilizing rooftops in food deserts like New York City for growing fruits, vegetables, and herbs and having a working agriculture network that works with communication and co-operation (Segal 2010, p. 200). On top of that, people need to get educated, especially the very young ones, just like the non-profit organization Food Trust already aims to fulfil. Community gardens, farmers’ markets, and Community Supported Agricultures (CSUs) are, on top of that, good ways to tackle the issue. Other organizations invented supporting helps like the Food Stamps or the Health Bucks that try to promote a healthy way of eating by enforcing it on them with the help of vouchers.

I have begun this article by stressing the imbalance between calories consumed and expended. The paragraph above mainly described how calories are increasingly consumed especially through food deserts: when talking about calories expended, one cannot avoid noticing a decrease in physical activity. In modern society, being active is a conscious choice rather than an obligatory part of everyday life (Benton, 2015). Critser rightfully points out the predominance of TVs, computers and computer games as the main form of leisure activity and also stresses “sedentary jobs, long commutes, sprawling suburbs with no sidewalks, and unsafe neighbourhoods” (Benton, 2015), plus the decrease of offered sports teams and PE in schools. These all are logical causes that make sense, however, most of these causes are not necessarily American and could be applied to countless other nations. What is typical American, though, is the comparably massive dependency on cars in comparison to all European countries. As with the aforementioned aspects, this issue is as well an environmental aspect and no inward cause. Let me explain briefly, why in 70% of the time, Americans prefer the car even for trips under one-mile, while Europeans would choose either a bike, walking, or make use of the public transportation system (Bloomberg, 2015).

In his article, Ralph Buehler names nine main reasons for American’s somewhat cardependency. America happened to have a greater and earlier mass motorization, creating everything for a car-friendly surrounding (Bloomberg, 2015). As a result of this, American’s cities adapted quickly to cars with the help of road standards. Vehicle taxes and gasoline tend to be cheaper in the U.S. (Bloomberg, 2015). The interstate systems, where highways rather penetrate than link cities and the government subsidies also led to a higher car dependency. On top of that, Americans tend to rely on technological changes rather than on altering behavior, plus, public transport is much rarer than in Europe. One of the main reasons is probably the difficulty of walking and cycling due to a lack of sidewalks, bicycle paths, traffic calmed neighborhoods, car free zones or crosswalks. Plus, zoning laws in America require a minimum of parking spots while European countries tend to limit parking spots. Each of these aspects show, how easily and almost necessarily everything can be reached by car in America, creating a lack of walking or in general a lack of physical activities.

Having mentioned European countries, now leads me to the intended comparison with Germany, another nation facing problems with overweight and obesity, in order to see in how far America really is “the fattest nation” and in how far Germany is similarly problematic.

The above shown chart shows the obesity rates in U.S. States (red) and European countries (blue) and, thus, makes it very obvious, how very far leading the American states are in comparison to the European countries. However, it is worth a note how, for example, Colorado is sharing its position with Germany, which will be the focus of the following paragraph.

Overweight Germans

In order to analyze overweight and obesity numbers in Germany it is important to note that all numbers are taken from surveys conducted by institutes, for instance the Robert-Koch Institut (RKI) or surveys commissioned by associations/organizations, e.g. The Organization for Economic Co-operation and Development (OECD). Moreover, there is no official data conducted by the federal government, according to the scientific service of the Bundestag.

The RKI conducted three major studies to analyze the level of health in Germany. The first one, called GEDA, includes all health-related aspects in Germany and is conducted regularly. The second one, abbreviated to KiGGS, is only focusing on the health of children and adolescents. And lastly DEGS, which is focusing on the health of adults. In addition to the three studies by

the RKI, the OECD, and other smaller Institutes have their own surveys. This essay, however, will focus on overweight and obesity numbers published by the RKI and WHO, since these numbers are used by the federal government of Germany and most research papers examined for this essay.

Untergewicht (underweight), Normalgewicht (normalweight), Übergewicht (oveerweight) und Adipositas (obesity) nach Alter (age) und Bildungsstatus (level of education) bei Männern und Frauen (male & female) (n = 10.785)

The GEDA study conducted by the RKI in 2014/2015 was first published in the Journal of Health Monitoring 2017 and is based on self-reported data by adults. According to this study, 47% of the female population above 18 are either overweight (BMI 30), and 62% of the male population. Respectively, these numbers can be divided further into 28.8% of females who are overweight and 18% who are obese. Male numbers are around 43% for overweight and 18% obesity. In total, 35.9% of all 24,016 participants were considered overweight and 18.1% obese. Moreover, this survey subdivides females and males into four age groups and into three educational levels, which will be discussed later. Additionally, the survey gives the opportunity to compare the different federal states, which will also be discussed later. The second study DEGS1, published in 2013, is based on interviews and examination of adults and includes the same subdivisions as the GEDA study.

As we can see, the DEGS1 study depicts 53% overweight women and 67.1% overweight men. Obesity rates for women are illustrated at 23.9% and men at 23.3%. Given that the data of the DEGS1 study is based on interviews and examination by professionals and not based on selfreported data, like GEDA or the OECD data.

The table shows that overweight is increasing among women up to old age, but in comparison the prevalence is always lower than it is among men. Most notably are the overweight prevalence rates among 18-29-year-old men (35.3%) and among 30-39-year-old, which have a rate of 62.4%.

Mensink et al. further note for 2013 ‘that the prevalence of overweight and obesity in the adult population […] remains at a high level’ (p.7). In addition, the prevalence of overweight did not increase, whereas the one for obesity did. The WHO report of Germany published in 20132 was used by Mensink et al. as their reference, thus adding the prediction that in 2020 ‘20% of men and 18% of women will be obese. By 2030, the model predicts that 24% of men and 21% of women will be obese.’

The KiGGS study by the RKI is a regularly occurring study, which was last conducted from 2014-2017, thus providing up to date data. This newest study is called “Wave 2” and included samples from a cross-sectional study and a cohort study, which were both carried out by doctors and staff of the institute.

Prevalence of overweight (>90th percentile, including obesity) according to gender, age and socioeconomic status (n=1,799 girls, n=1,762 boys)

Schienkiewitz et al. found ‘that the prevalence of overweight (including obesity) in girls and boys aged 3 to 17 years is 15.4% and the prevalence of obesity is 5.9%.’ (p.17) and Table XX. Looking at the two genders individually, it is to be noted that girl’s total prevalence of overweight (incl. obese) is at 15.3% and boys are at 15.6% - obesity alone is at 5.5% percent for girls and 6.3% for boys. Both genders have their highest levels of prevalence for overweight between 11-13 years of age (girls 20% and boys 21.1%). Reasons for this development might be the change of socialisation and environment, since the children enter secondary school, or because this is roughly the time puberty starts. Schienkiewitz et al., however, follow the statement of the WHO, that childhood and adolescence overweight and obesity is a very ‘complex and a multidimensional problem’4 (p.19). Table XX below shows the trend between the first KiGGS study conducted between 2003-06 and Wave 2 between 2014-2017. As it can be observed the overweight prevalence remained stable overall, but still happens to be at a high level.

Trend for overweight prevalence (>90th percentile, including obesity) by age group (KiGGS baseline study n=7,215 girls, n=7,531 boys, KiGGS Wave 2 n=1,799 girls, n=1,762 boys)

Source: KiGGS baseline study (2003-2006), KiGGS Wave 2 (2014-2017). 4https://www.rki.de/EN/Content/Health_Monitoring/Health_Reporting/GBEDownloadsJ/FactSheets_en/JoHM _01_2018_Obesity_KiGGS-Wave2.pdf?__blob=publicationFile p. 19)

Comparison of Reasons of the US

The main causes for overweight and obesity in Germany are similar to the causes in the US. However, the factor Food Deserts does not really seem to be an issue in Germany according to Jürgens (2016) and Minister (2010). According to both scholars, the distribution and variety of shops and supermarkets is sufficient and access to the shops is provided for everyone. Nevertheless, this could become an issue over the years in many rural areas, because small shops are closing and because of the demographic change in the population. Even though this may cause some issues, there are already projects to tackle said problem. One example is the Dorfladen Dörenhagen (Westfalen-blatt.com), where citizens founded a small shop and provide fundings together with the commune, the state and federal government.

The biggest factors of overweight and obesity among the German population are of socioeconomic nature and the level of education, which is also shown in the KiGGS study in table XX and further supported by Minister (2010).

Both factors are observable in Minister’s case study of the city of Bottrop, where she found out, that the wealthier, although not necessarily anti-obesogenically planned north of the city has lower rates of overweight and obesity then the south. The south has a higher density of population, a better anti-obesogenically infrastructure, but still higher overweight and obesity rates. ‘It was observed that the socio-economic distribution […] affects the number of calories per gram of food and the quality of products purchased.’ Concludes Minister (2013) – supporting the rates from the KiGGS study by the RKI.

In terms of strategies in Germany the focus of the federal government lies on education in schools, with a special focus on physical education as the main factor for obesity prevention. Moreover, we can find nutrition “traffic-lights” on food products, indicating the food’s value. The Federal minister of Health Julia Klöckner (CDU) further presented a “Reduction and Innovation Strategieplan” in 2018 (Schmidt 2018), which aims to limit the amount of sugar, salt, and fat of food products. This, however, should solely be based on voluntary self-control by food industry, which was heavily criticized by ne NGO food watch and numerous scholar’s and doctor’s unions. (Schmidt 2018).

Conclusion

In conclusion, both paragraphs about overweight and obesity show, that these issues do not just affect the US, but also Germany. The common stereotype of the ‘fat American’ as opposed to the ‘normal’ weight German is to be rejected and happens to be misleading. Americans appear to be stigmatized more than Germans, which could be influenced by the number of populations in the US and the quite common portrait of said stereotype on media and especially social media. All in all, both countries are affected by these health issues, which bring similar effects on general health and the healthcare system. However, is it not possible to compare both countries in a complete accurate way since the infrastructure and the culture differ. Nevertheless, both countries could aim to work together in overweight and obesity prevention, for instance through regulation of the food industry.

References:

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