On July 7, the Trust for America's Health—a nonprofit dedicated to improving community health around the country—released a report titled "F as in Fat: How Obesity Threatens America's Future 2011." The findings are disappointing, if not particularly shocking: Across the nation, obesity rates continue to balloon out of control. New Mexico is among seven states in which obesity rates have doubled since 1995. Today, more than one-quarter of New Mexico residents are obese.

According to the World Health Organization, obesity is defined as a body mass index—roughly equivalent to the percentage of body fat—of 30 or higher. But when combined with "overweight" (BMI between 25 and 30), a whopping 60.8 percent of New Mexicans are at unhealthy weights.

The litany of risks is familiar: diabetes, hypertension, arthritis, even depression. But with first lady Michelle Obama's Let's Move program and public health initiatives endlessly harping on our eating habits, why hasn't anything changed?

And if we're truly in a recession, how is it that we continue to gain weight?

According to TFAH Deputy Director Rich Hamburg, the obesity issue is complex, and its many facets are interrelated. In general, Hamburg says, "There's always been some sort of correlation between socioeconomic status and education level and obesity."

To wit: Approximately one-third of people who did not graduate high school are obese, whereas less than one-quarter of those who graduated college or technical college are. It's not that going to college necessarily means additional health education, Hamburg says, but rather that lower education levels coincide with several other factors that contribute to obesity, such as lower incomes and a higher probability of living in what Hamburg calls "food deserts"—inner-city or rural areas without grocery stores or where it's unsafe for kids to play outside.

A recession, Hamburg says, exacerbates those factors.

"Generally, the people who are going to get hit the hardest are the people who can least afford to be hit the hardest, and it can impact how much food is available on the table," Hamburg says. As governments feel the squeeze, too, he notes, they make cuts to "discretionary" public health spending—the very preventive care programs that help combat obesity.

But in New Mexico, obesity rates were climbing long before the recession hit. In 1990, just over 8 percent of New Mexicans were obese; that number has since quadrupled. Hamburg says "changing societal norms"—more driving and less walking, for instance, or diets that contain more fast food than homemade posole—have as much to do with that increase as the economy does.

So…what next?

"We need to think about things like complete streets policies, urban planning…about creating communities that are more friendly, so to speak, to being active," Hamburg says. But the Affordable Care Act (the comprehensive but controversial health care bill Congress passed in 2010) also offers what Hamburg describes as "a very important and sizable commitment to wellness and prevention [and] the idea of having a national prevention strategy."

The idea is that early preventive care—nutrition education, physical education, active after-school options provided by nonprofits or other community-based programs—can more effectively prevent obesity than a visit to a doctor when a person is already overweight and has poor health habits.

The preventive model has a proven track record, Hamburg notes, ranging from anti-smoking campaigns that have reduced asthma to policy changes as simple as putting fluoride in municipal water systems to prevent tooth decay.

"It's a combination of programs and policy change that is not just the purview of the federal government, but it's a public-private, family-individual partnership," Hamburg says. "We need foundation programs and school programs and federal government-funded programs and policies that will really make a difference."

Now, if only Congress could get past this debt debacle…