One Utah

Clearly, I’m thinking about food this week.

On Sunday, the D-News ran a story about childhood obesity - the opening paragraph evokes the lifestyle problem facing many Americans:

There will be no more Monster Tacos from Jack in the Box, no more drumsticks from KFC. No more french fries, Coke, ‘tater tots or anything else from the junk-food menu that nearly killed him.

This passages describes almost everything wrong with the American diet - fast food, high in fat and loaded with sugar and served in vast quantities. 

Nearly one in four elementary-age Utah children is overweight or at risk of being so, according to the Utah Department of Health.

“The alarming thing to us is we are getting fatter quicker than the rest of the nation,” said Dr. David Sundwall, department director.

Nearly everyone agrees — the growing girth of Utah’s average young person is a problem.

“I have a huge concern about the childhood obesity crisis because I believe it is a crisis,” said Teresa Theurer, a member of the Utah State Board of Education who lives in Logan.

From the Tooele County Health Department site:

“If the child obesity epidemic continues to rise, the upcoming generation of children and adolescents will be the first generation since the beginning of time to have a shorter life span than their parents.”

Few speak so pointedly on the topic as Ralynne Purdy, a personal trainer and fitness expert who has started a series of fitness camps and programs for children, adolescents and their parents.

“I think we have got to get really real,” said the mother of four. “These kids are fat. And we are not talking about a little baby fat anymore. They are fat.” 

There is nearly a one to one correlation between lifestyle and weight.  Lifestyle factors are the major cause of obesity. 

Many overweight people can recount the myriad ways in which our society mistreats them - fat people are often treated as if they are stupid, lazy, lacking in self-discipline, as if they are immoral.  Add to that the pressures about body image that a lot of people experience, including body dysmorphia, and discussions about weight quickly become emotional minefields.  There simply is no easy way to discuss such issues. 

Recently, I watched a show on a clinic in New York that treats the super obese.  On the show, a number of people living in the clinic were interviewed.  They demonstrated a shocking level of denial about their weight.  Several of them complained that they were victims of their low metabolisms, while others claimed that they “didn’t eat that much.”  They would then order a delivery of pizza with double everything and four liters of cola which they would consume in a single sitting - in addition to breakfast, lunch and dinner. 

Another show chronicled the experiences of a man who weighed a 1000 pounds; he claimed that he didn’t overeat and attributed his weight to bad genetics, going so far as to say, “I can eat what a normal person eats, and I’ll still gain weight.”  They then showed him eating a double order of nachos, six tacos, two churros and washing it all down with a liter of soda.  When he was confronted about his eating, he was defensive and angry claiming that the situation they’d shown was unusual; he even claimed that they had taken that clip out of context (I’m not sure what in which context his meal counted as reasonable). 

Discussions about food and weight are emotionally fraught.  Being overweight often carries a burden of shame for many people who are unable to be honest about their eating habits or their weight.  They convince themselves that their weight isn’t a big deal.  The issues surrounding body issue and the public portrayal of sexuality drive a huge amount of the denial about wieght and diet issues.  Most people want to have a healthy diet, they want to be fit.  As often as not, people don’t know what that involves - many people have never been taught what constitutes a healthy diet, how to assess calories, how much exercise a person should get, or even how to exercise.  Fortunately, such resources are widely available - the State of Utah has a good site with the information a person needs.

Obesity is a growing health crisis in the US, but despite all the talk, even the terminology is poorly understood.  Technically, a person can be overweight but not obese; but you cannot be obese without being overweight.  Using Body Mass Index (BMI), being overweight is defined as having a BMI above 25 but below 30; any BMI over 30 is considered obese, with gradients above thirty reaching morbidly obese and super obese.  (Calculate BMI here.)  Many experts point out the limitations of using BMI - it doesn’t measure body fat percentage, only weight which is a misleading measure.  Body fat percentage is as important as overall weight.  BMI is also misleading in that is doesn’t measure your actual fitness and activity level.  Some experts in exercise physiology (my brother among them)  believe it is better to be overweight (not obese!) and active than skinny and inactive.  For example, a six foot tall man should weight less than 185 pounds to have a healthy BMI; but it’s better to weight 195 pounds and exercise regularly, go hiking, walking etc., than to weight 175 pounds and be a couch potato.

Experts love to talk about America’s epidemic of obesity.  I think the language is a misleading.  An epidemic is something beyond our control - Avian Flu is an epidemic, spread by a virus.  Epidemic sounds like something requiring a medical intervention.  Obesity is not a disease; it is the result of lifestyle choices.  Some individuals do have physical ailments that lead them to be obese, but they are a minority (thyroid problems can cause obesity).  For most of us, the problem isn’t our bodies - it’s our lifestyle.  We eat too much of the wrong kinds of foods and do too little physical activity.  Obesity isn’t a stand alone disease - it’s not caused by a virus or a bacteria.  Obesity can result in a wide array of ailments and can exacerbate others.  I.e.,  the D-News article talked about the worrying increase in type 2 diabetes among young people who are overweight.  Traditionally an ailment of senior citizens, Type 2 diabetes is increasingly showing up in people in their teens and twenties.  Thus far, every season of Biggest Loser has included at least one person who was diagnosed as pre-diabetic who loses weight and is no longer pre-diabetic.

I have not talked about food addiction.  Addiction in the broadest sense seems to begin in a failure to cope with life; most addictive behavior result in short term good feelings but are self-defeating.  Alcohol and drugs are obvious examples but overeating is similar.  When a person overeats, the brain produces a specific set of chemicals that induce feelings of pleasure.  Chronic overeating, however, causes the brain to produce smaller amounts, which leads to greater overeating for the same result.  If your drug of choice is food the cycle becomes obvious.  The body can only burn so many calories a day - once you’re past that, it stores excess calories.  Using eating as a coping mechanism quickly becomes obesity.

Weight loss is difficult - it may in fact be one of the biggest challenges a person faces.  Because obesity is an outcome of lifestyle choices, to successfully long term lose weight, a person must make long term changes in their lifestyle.  Anyone can go on a radical diet and lose weight.  The minute they go off that diet, the weight will come back.  Successful, long term changes mean understanding that you cannot eat everything you want, you cannot eat massive portions at every meal, you cannot simply eat without awareness.  You also don’t have to give up your favorite foods - you simply have to learn to eat in moderation.  Eating out is always fun but most restaurant servings are enough food for a single person to eat two or three complete meals; the clean plate club needs to be something of the past.

I was in a restaurant the other day and watched as a large couple came in.  The day was warm, but for this couple walking across the restaurant worked up a sweat.  They sat down and ate enough food to feed me for days, downing their meal with generous servings of soda.  It’s not so much that any single thing they ate was bad by itself but in a single sitting as a whole meal it was cumulatively astonishing - their appetizer included melted cheese and sour cream, their main courses included more cheese, more sour cream piled on deep fried entres.  I would guess they consumed three to four thousand calories each.  As they headed for the door at the end of their meal, it was obvious they were not physically comfortable - simply walking across the room required very real effort.

Watching them, I pondered what it require to seriously confront America’s obesity crisis.  America’s current health care system is designed to treat us once we’re sick, but it doesn’t do a good job of preventive measures.  We don’t teach people how to enjoy exercise or how to make healthy eating choices, but we treat them when they get type 2 diabetes at age 40.  In terms of cost, preventive measures would be far lower - both in financial and quality of life terms but we don’t do it.  We’re good at critical care issues; we fix a problem once it’s obvious.  Obesity is a slow moving crisis, though.  I don’t wake up one day with an extre 100 pounds.  Instead, I gain weight over the course of years - adapting to each extra, my functioning slowly curtailed until I have a crisis.  Then our system treats my crisis- my diabetes, my congestive heart failure, my sleep apnea.

At it’s most basic level, being overweight is the result of a person’s choices.  But no one exists in a vacuum - our family, our community, our society all influence our choices and attitudes.  In the course of even a hour of TV, you can easily see four or five ads for food.  When you were a child, you scraped your knee and your mother gave you a cookie.  Unlearning habits, making new ones, takes time and support.

The behaviors of the people in our environment influence us.  If everyone around you is eating burgers and fries, it’s difficult to stick to healthy eating plan.  If there are no healthy foods in the kitchen, it’s difficult to make healthy meals.  Obesity, like many lifestyle problems, is both social and individual.  Once an individual develops weight related health problems, their life affects those around them, which in turn affects the wider community. 

On the show about the obesity clinic, they featured a family in which the mother (in her 40s) weighed 400+ pounds; her sons, one a teen the other in his early 20s, both tipped the scales at 300+ pounds.  During her stay, the woman got her weight down by over 70 pounds and increased her fitness; she learned new eating and exercising habits.  Before they would release her, the clinic worked with her sons to teach them healthy eating, shopping and exercise habits.  By simply changing their eating habits, the woman’s sons began losing weight.  Once the clinic knew the home environment would be one in which healthy choices were being made, they released the woman to go home.

This entry was posted Thursday, June 21st, 2007 at 12:45 pm and is filed under This Blog. You can leave a response, or trackback from your own site.