CHICAGO -- Nearly 40 million American adults are obese, new figures show, continuing a decade-long climb in numbers despite efforts by health officials to encourage a sensible diet and plenty of exercise.
''Far too many of us are not following this simple prescription,'' said Health and Human Services Secretary Tommy Thompson.
The 2000 national obesity average of 19.8 percent is up from 12 percent in 1991, according to a government survey. Twenty-two states had a rate last year of 20 percent or higher, while no state had a rate that high in 1991, the authors said in Wednesday's Journal of the American Medical Association.
In addition, more than half of Americans -- 56.4 percent -- were overweight, compared with 45 percent in 1991.
The increase has contributed to a parallel rise in diabetes, with 15 million diagnosed adult cases last year, compared with 9 million in 1991.
That adds up to about 1 in 5 American adults who are obese and 1 in 14 diabetic -- twin epidemics that threaten to overwhelm the health care system, researchers said.
''If we continue on this course for the next decade, the public health implications in terms of both disease and health care costs will be staggering,'' said Dr. Jeffrey P. Koplan, director of the Centers for Disease Control and Prevention, where the research was conducted.
Diabetes alone accounts for $100 billion in health care spending each year, Thompson said.
Most cases are likely adult-onset diabetes, which can be brought on by being overweight and, like obesity, is largely preventable, said Ali Mokdad, CDC epidemiologist and study leader.
Obesity related-diseases already are the second-leading causes of premature deaths, behind smoking, implicated in 300,000 deaths yearly, Mokdad said.
His team's findings are based on random telephone surveys with 184,450 adults aged 18 and older. The researchers calculated body-mass index, a height-weight ratio. A BMI of at least 30 is obese and at least 25 is considered overweight.
About 27 percent did not engage in any physical activity and only 24 percent said they followed the government recommendation to eat fruits and vegetables at least five times daily.
While most participants said they were trying to maintain or lose weight, only 17.5 percent were following key recommendation to eat less and increase physical activity.
The study also found that Colorado has the lowest numbers for obesity, while Mississippi has the highest.
''We're a pretty exercise-friendly state. We have access to a lot of recreation -- ski resorts, trails, walking and bike paths,'' said Pat Barnett of Colorado's Department of Public Health and Environment.
And, true to the stereotype, granola really is more popular than greasy, fried foods, Barnett said.
The result? An obesity rate of 13.8 percent -- the only state under 15 percent.
Mississippi's rate of 24.3 percent for obesity and 8.8 percent for diabetes is not surprising, given the state's high number of blacks and less educated residents, according to Dr. Ed Thompson, the state's health officer. Both are linked to increased obesity and diabetes risks.
Alaska had the lowest diabetes rate -- 4.4 percent.
Mokdad blamed the rising problem on the modern lifestyle that relies on long commutes, fast-food and sedentary entertainment like television.
''Basically, we don't have time anymore for exercise, we don't have time to sit down and have a nice meal,'' Mokdad said.
Employers should offer exercise facilities for workers and snack machines with healthy food, communities should provide safe, well-lit areas for physical activity and fast-food restaurants should offer alternatives to fatty, high-calorie foods, Mokdad said.
''We have to do it,'' he said. ''The alternative is increased risk of diseases and death.''
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