Obesity in the United States is a chronic health problem. According to the Centers For Disease Control (CDC) and The National Center For Health Statistics (NCHS) approximately 30% of the US population are obese. This includes age groups of >20 up to 65 years of age. This age groups also represent both genders. Even though NCHS has begun to compile statistics on those <20 years of age, this commentary will focus on adults and obesity as a chronic health problem.
According to the CDC, "these increasing rates raise concern because of their implications for Americans’ health." Being overweight or obese increases the risk of many diseases and health conditions, including the following:
* Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
* Type 2 diabetes
* Coronary heart disease
In addition to these health conditions, the financial consequences of obesity in this country is staggering. Overweight and obesity and their associated health problems have a significant economic impact on the U.S. health care system (USDHHS, 2001). Medical costs associated with overweight and obesity may involve direct and indirect costs (Wolf and Colditz, 1998; Wolf, 1998). Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs.
Moreover, the aggregrate spending that reflects the direct costs for obesity and related health conditions in 2002 reached 100 billion dollars (Division of Nutrition and Physical Activity, 2002). The aggregate financial data collected by (DNPA) represents four respective insurance categories: insurance, out-of-pocket, Medicare and Medicaid.
It is no secret that the US population has a significant sweet tooth. According to columnist Catherine Guthrie, the average person's intake of sugar has increased to 20 teaspoons per person, per day. There are several reasons that we can postulate. One is fat and the correlation to taste: Two Processed foods contain more sugar (high-fructose corn syrup). As a result, new research has uncovered a "disturbing" link between sugar and obesity.
According to the Sugar Association, a teaspoon of sugar has 15 calories and is pure sucrose. So the question becomes; What is the difference between sucrose and fructose?
Fructose's chemical name is levulose. Fructose is also called the fruit sugar. Fructose is found in fruits and honey. It is the sweetest of sugars. It is used for preventing sandiness in ice cream. The compound's formula is C6H12O6. It is shaped in orthorhombic, bispherodial prisms. It is sweet due to the stereochemical range. Sucrose on the other hand is ordinary table sugar and is probably the single most abundant pure organic chemical in the world and the one most widely known to nonchemists. Whether from sugar cane (20% by weight) or sugar beets (15% by weight), and whether raw or refined, common sugar is still sucrose.
Sucrose is a disaccharide that yields 1 equiv of glucose and 1 equiv of fructose on acidic hydrolysis. This 1:1 mixture of glucose and fructose is often referred to as invert sugar, since the sign of optical rotation changes (inverts) during the hydrolysis from sucrose ([alpha]D = +66.5o) to a glucose fructose mixture ([alpha]D = -22.0o). Certain insects, particularly honeybees, have enzymes called invertases that catalyze the hydrolysis of sucrose to a glucose-fructose mixture. Honey, in fact, is primarily a mixture of these three sugars.
As I mentioned earlier, new research has determined there may be a link between sugar and obesity. It was naturally assumed by the National Dietary Assocaition (NDA), American Medical Association (AMA) and the (CDC) that dietary fat was the enemy to be considered in the fight against obesity. Hence, sugar had remained under the radar, when examining the issue of obesity. Now research scientists are uncovering this vital link, by measuring the effects of sugar on health and weight.
Holt et al (2000) study compared the effects of equal volumes of sugar-rich and sugar-free beverages on feelings of hunger and fullness and the ad libitum consumption of a palatable, fat-rich snack. The equal-volume preloads initially decreased hunger to a similar degree and potato crisp intake during the first 15 min interval was not significantly different among the three preloads. On average, total energy intakes from the crisps and lunch were not significantly different among the preloads, and by the end of the day, total energy intakes were similar for the three test conditions. Therefore, the low-calorie/low-sugar drinks did not facilitate a reduced energy intake by the lean, non-dieting male subjects. Howard et al (2002) American Heart Association Scientific Statement on Sugar and Cardiovascular Disease Report's purpose; was to review the effects of dietary sugar on health, with an emphasis on cardiovascular disease (CVD) and its risk factors.
Even though the studies mentioned did not yield a promising outcome. It will allow for subsequent studies with larger sample sizes and sophesticated methodologies to examine the same question with more intensity and rigor.
CDC. [Online]. Overweight and Obesity: Home.Retrieved July 5, 2006 from www.cdc.gov.
Guthrie, C. (July/August 2006). Sugar Breakdown. Experience Life. pp. 34-36.
NHANES) National Health and Nutrition Examination Survey 1999–2000
Finkelstein, EA, Fiebelkorn, IC, Wang, G. National medical spending attributable to overweight and obesity: How much, and who’s paying? Health Affairs 2003;W3;219–226.
Finkelstein, EA, Fiebelkorn, IC, Wang, G. State-level estimates of annual medical expenditures attributable to obesity. Obesity Research 2004;12(1):18–24.
U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; . Available from: US GPO, Washington.
Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obesity Research.1998;6(2):97–106.
Wolf, A. What is the economic case for treating obesity? Obesity Research. 1998;6(suppl)2S–7S.
Division of Nutrition and Physical Activity [Online]. National Estimated Cost of Obesity. Retrieved July 5, 2006 from www.cdc.gov.
Holt et al. (2000). The effects of sugar-free vs. sugar-rich beverages on feelings of fullness and subsequet food intake. Int J Food Sci Nutr. Jan;51(1):59-71.
Howard, B & Rossett, J. (2002).A Statement for Healthcare Professionals From the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. (Circulation. 2002;106:523.)