U.S. falls behind on exercise, gets fatter

Americans got fatter last year and were more slothful too — two closely related outcomes reported in an annual analysis of the USA's health out Wednesday.

After encouraging improvement in last year's report, this year's data returned to the steady increase in obesity that's marked America's Health Rankings in the 25 years since it was first released.

The rankings, which are issued annually by the United Health Foundation, the American Public Health Association and Partnership for Prevention, is the longest-running state-by-state analysis of the nation's health.

Hawaii came out on top for the third year in a row. Vermont came in second and Massachusetts was third. Mississippi ranked last, preceded by Arkansas at 49 and Louisiana at 48.

The obesity rate increased from 27.6% to 29.4% of adults, Nearly a quarter of people report doing no physical activity or exercise in the last 30 days, which may be partly to blame. That number increased from 22.9% in the 2013 report to 23.5% in this year's report.

Obesity, a leading contributor to death in the USA, has more than doubled over the last 25 years, the report shows. Obesity is also closely tied to chronic, costly diseases including diabetes and high blood pressure, which are bedeviling the health care system.

Nearly 10% of adults now say they have diabetes, which is more than double the number from 20 years ago when the rankings started tracking the disease.

"What people are not focusing enough on is that we are producing an extraordinary number of people who are unnecessarily sick," says Reed Tuckson, an Atlanta internist who is senior medical adviser to United Health Foundation. "They are pouring into medical system; it's a total crisis."

There were bright spots. The number of Americans who smoke continued its downward trend, dropping 3%. Immunization coverage for adolescents was also up 5% and infant mortality rates dropped 4% compared with last year's report.

The report's digital tools are increasingly sophisticated, allowing state public health officials to drill down to details about individual states such as the difference in obesity by income, education level and race. It also shows state health care officials how much changes to programs and policies can cut obesity and inactivity and boost their rankings.

The American Council on Exercise, which represents personal trainers, including those who work in community centers and boys and girls' clubs, has targeted 2035 as the year it hopes to end "the obesity epidemic."

Anthony Wall, director of professional education for the group, says it is also pushing policymakers to consider safer places for young people to walk and play after school, as well as well-lit walkways for both children and adults to use for walking and running.

But all that exercise isn't going to help much unless people eat smarter and more healthfully, he says.

"Obesity is a condition people suffer from, so one of the areas we're trying to spend a lot more time on is trying to understand the behaviors and why people make certain choices" when it comes to food, says Wall. "They need tools to make a change themselves."

The 2014 report uses data from 2012 and 2013 so doesn't include people who became insured under the Affordable Care Act starting Jan. 1.

Ezekiel Emanuel, an oncologist who is widely considered an architect of Obamacare, says the effect of having many more people getting health care may not be evident in the national rankings until closer to the end of the decade. He notes it took two to five years to see results in Massachusetts after that state's health care reform.

"We all want to know how it's (the ACA) doing, but health doesn't change that radically that fast," says Emanuel, a former special adviser for health care at the Office of Management and Budget

But Emanuel says he takes heart in slower sales at McDonald's and Coca-Cola, as announced in their recent earnings reports.

"The fact they're not doing well in the domestic market shows there's clearly something going on with the eating habits of Americans," says Emanuel. "If the sales reports are accurate, that's a pretty important shift in behaviors in the country."