Obesity is, well, big. Over the past 30 years, the percentage of overweight Americans has increased from 48% to 65%, and half of those are considered obese. During the same period, the percentage of children between 6 and 19 years old who are overweight has tripled, from 5% to 15%; another 15% are considered borderline. In certain pockets of America, the number of kindergarten children who are obese is 23%, and in some of Chicago’s Hispanic and black neighborhoods, obesity among children aged 2 to 12 is as high as 53%. A recent study in Pediatrics (October 2004; 114:429–436) showed that kids whose moms were overweight before conception were much more likely to be overweight by age 7 themselves. Even our pets are affected; 25% of dogs and cats are overweight. According to Time (June 7, 2004) the total medical tab for obesity-related illness is $117 billion annually and climbing. The AMA predicts that 400,000 Americans will die this year from obesity-related diseases, and within only a few years, obesity will surpass tobacco as the leading cause of preventable death. The key word here is preventable.
Even though Americans know they are overweight, most are not ready to take action. According to a Time/ABC News poll, 58% of Americans say they would like to lose weight, but only 27% say they would actually try to slim down, and only one-third of those are following any specific plan. In addition to the usual discussions of concern that overweight individuals are at increased risk for developing diabetes, hypertension, and heart disease, the Centers for Disease Control and Prevention (CDC) warns that there are consequences of obesity beyond health (Am J Preventive Med, October 2004;27:264). The extra weight of passengers caused airlines, for example, to spend $275 million to burn 350 million more gallons of fuel in 2000 to carry the additional weight of its passengers. This released an estimated 3.8 million extra tons of carbon dioxide into the environment.
Obesity has gained national attention in other ways. On October 19 of this year, NBC premiered The Biggest Loser, a reality-TV show featuring 12 overweight contestants who compete to see who can lose the most pounds over a fixed number of weeks. The biggest “loser” receives a cash prize of $250,000. Earlier this year, Morgan Spurlock filmed Super Size Me, a documentary in which he as a trim, fit person consumed nothing but McDonald’s meals for 30 days. He gained 24.5 pounds, his cholesterol rose to worrisome levels, he experienced impotence, and his liver was damaged the equivalent of sustaining an alcohol binge.
On October 27, 2004, Business Week online reported a story from Reedly, California, where Director Ryan Craig opened the Academy of the Sierras, a boarding school for obese children aged 13 to 18. This and his other businesses, operating under the name Healthy Living Academies, gained revenues beyond $100 million in 2003 helping kids as much as 350 pounds overweight shed their excess.
The reasons for obesity’s growth are complex and multifaceted. For one, we eat too much. According to the CDC, between 1971 and 2000, women’s average intake increased from 1,542 calories per day to 1,877, and men’s daily intake increased from 2,450 to 2,618 calories. This is far more than the government’s daily intake recommendations of 1,600 and 2,200 calories for sedentary women and men, respectively.
It’s also very easy to get highly caloric food. There are over 170,000 fast-food restaurants, 3 million soft-drink vending machines, and untold thousands of convenience stores with rows of candy, trans fatty acid-containing pastry, and colas, all a few minutes from home. Most kids get 10% to 15% of their daily calories from soft drinks.
Then there is the problem of inactivity. Too much TV, too much computer time, too many video games, and too little exercise. Kids view approximately 40,000 TV ads per year, with $13 billion spent annually to ensure they influence their parents’ food buying decisions. Many towns don’t have sidewalks or safe recreational areas for kids, and many parents purposely keep them in the safety of home, plugged into an electronic pacifier.
In this issue of SRM, Dr. Janet Allan points out that there are things we can do better (see “Rampant obesity: What you can do,” page 195). We can screen patients for obesity; only 42% of overweight adults are advised to lose weight by their doctors. We can also offer high-intensity counseling with one or more sessions per month for at least three months. There are also some medications that offer modest benefit such as orlistat and sibutramine, as well as surgical treatment. But there is more that we can do.
We can lead by example. In the 1960s it was not uncommon to see doctors and nurses smoking. Today it is uncommon. Health care professionals must draw a parallel with smoking for obesity and lead by example: stay fit and trim, and exercise regularly. Some offices have dress-down days. We could have fitness awareness days when the staff dresses in exercise clothes to encourage discussion and participation in exercising. More health plans should offer memberships to health clubs without cost or at reduced rates, and incentives should be offered to encourage the use of these memberships. Even a relatively small weight loss of 10 pounds can have significant metabolic benefits.
The government should also help. Twenty-two communities received a total of $35.7 million in 2004 from the Health & Human Services Department to subsidize restaurants and hire nutritionists to assist them with offering healthier choices on their menus. To the surprise of restaurant owners, 40% of customers ordered their kids grilled salmon or chicken with steamed corn and green beans and salad with fruit for dessert. This is a significant start. But in a similar time frame, Procter & Gamble spent $30 million just to advertise Pringles potato crisps, and Coke spent $130 million on its Coca-Cola Classic brand alone. Government has to do more. Invest more money in prevention and education, with more efforts to discourage the advertising of unhealthy foods. We don’t see cigarette commercials on TV any more.
On the plus side, change is happening slowly. Per capita consumption of soft drinks is down for the fifth year in a row, to 53.8 gallons per person in 2003, and the percentage of restaurant orders for hamburgers at lunch is down to 23.3% this year from 26.4% in 1997. Some companies see shifting consumer tastes as a chance to add to their bottom line. Pepsico has removed trans fatty acids from Cheetos, Tostitos, and Doritos and seen a 26% jump in sales, and both Coke and Pepsi are selling popular brands of water with huge success. In 2004, targeted schools have started measuring students’ BMI and administering flexibility tests and will compare results in three years with schools that don’t. We’re also seeing school programs begin to crop up using a variety of innovative techniques to help create awareness and bring home an important message — an ounce of prevention is worth a pound of cure. “How you look’s not the problem Jack, it’s just unhealthy being fat.”
Phat Fat Rap
You’re feelin’ kinda hungry, thirsty too. You open the cupboard, look for somethin’ to chew. You grab a bag of candy, another bag of chips, Then you open the fridge for some soda and dip.
You sit down on the couch. You turn on the TV. Or you chill at your computer with your MP3s. And all day long you’re sittin’ on your big butt Lookin’ at your stomach thinkin’ “Man I got a gut”.
How you look’s not the problem Jack. It’s just unhealthy being fat. I can’t make it any clearer than that. It’s just unhealthy being fat.
Did you know that 1 in 3 Americans struggle with obesity? They get high blood pressure, heart disease, and high blood sugar called diabetes. So turn off your computer. Turn off your TV. Go easy on the junk food; it’s wasted calories.
Go for a walk. Go for a swim. Take a ride on your bike, work out at the gym. How you look’s not the problem Jack; It’s just unhealthy being fat. I can’t make it any clearer that that. It’s just unhealthy being fat.
Lyrics to Phat Fat Rap © Machelle M. Seibel
Music available www.healthrock.com
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