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While the overall prevalence of obesity was high, certain demographic groups were more severely affected. The rate of obesity for females is generally higher than that of males. Black and Hispanic females have a substantially higher obesity rate than white females. While increasing levels of education and income are associated with lower obesity rates, experts speculated that cultural norms and economics played a role in these differences.
Children were also affected. [29] The increase in childhood obesity was thought to have contributed to the development of type 2 diabetes in children. But, after several decades of steadily rising numbers, American preschoolers experienced a decrease in childhood obesity from 2008-2011. Federal experts suggested that the decline might be attributed to increased offerings of fruits and vegetables in SNAP and other federally funded maternal-child nutrition programs, an increased prevalence of breast feeding, and widespread awareness of physical education and health programs. Additionally, some communities encouraged physical activity for children through increased access to safer public parks and playgrounds, indoor recreational play spaces, and larger classroom facilities. [30] In 19 states and U.S territories, the percentage of obese children ages 2-4 fell, with the largest declines in Florida, Georgia, Missouri, New Jersey, South Dakota, and the U.S Virgin Islands. [31] Despite the decreasing trend, in 2011, 1 out of 8 preschoolers in the U.S were obese. Children with weight problems between the ages of 3 and 5 were five times more likely to be overweight or obese in adulthood than their average-weight counterparts. [32]
Overweight and obesity also affected overall health care costs (see Exhibit 2A for health care expenditures and BMI). [33] Obese patients spent 36% more on medical services and 77% more on medications than people of an ideal weight. [34] Incremental sick days were also associated with overweight and obesity. One study concluded that overweight and obese workers incurred 4.5, or $863, more sick days than others at their ideal weight. Although many were concerned with the physical appearance issues associated with overweight and obesity, the primary concern was one of health. [35] (See Exhibit 2B for health issues associated with overweight and obesity.)
There were many models for obesity treatment: foods; dietary supplements; support-based; medical supervision; drugs; and surgery. Ornish wanted to understand their key success factors and apply them to his own work.
Among the largest business models that relied on the sale of food products were Slim-Fast (over-the-counter meal replacement), Weight Watchers, and Jenny Craig (calorie-controlled meals).
Slim-Fast A privately held company purchased by Unilever, it sold a full line of nutritionally balanced meal replacement products that included ready-to-drink shakes, powders for milkshakes, meal and snack bars, and ice cream. [36] The shakes and bars were sold in various flavors. At the time of its sale, Slim Fast earned $611 million in revenues, spent $142 million on advertising, and had a 21% operating margin.
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