“Gluttony is an emotional escape, a sign something
is eating us.” -- Peter De Vries
“Don’t dig your grave with your own knife and fork.”
-- English Proverb
Our nation is getting fatter, a lot fatter. That is a blunt statement, but let us talk specifics: How fat? How fast? Is it really a problem? Or, have the “physique police” simply gotten carried away?
The Centers for Disease Control (CDC) in Atlanta, Georgia reports on trends in obesity and the entire spectrum of chronic and infectious diseases, ranging from cancer and heart disease to Anthrax and chicken pox. Using the body mass index (BMI) score, a comparison of body weight to height, the CDC reports an alarming recent increase in obesity rates, nation-wide: from twelve percent of adults in 1991 to almost twenty percent in 2000. That constitutes a sixty-seven percent increase!! And, that only includes the adults who are in the “Obese” category -- their body mass index exceeds thirty (BMI ³ 30). Additionally, it has been determined that well over half of all American adults fall into the overweight category, with a body mass index score of twenty-five or greater (BMI ³ 25)! All subgroups of the adult population in the United Sates, regardless of gender, ethnic group, educational background, or smoking status possess these identical, basic obesity trends. If you are an American adult, then you stand a good chance to be in the same boat.
Perhaps even more alarming is that obesity rates are climbing just as quickly in our children. An ongoing study called the National Health and Nutrition Examination Survey (NHANES) indicates that in the late 1960s, only about four percent of children and five percent of adolescents were classified as overweight. These figures were only slightly higher in the late 1980s, but by 1999 the overweight category had tripled to thirteen percent of children and fourteen percent of adolescents!
These trends are enough to make the CDC label obesity “a public health epidemic”. So, why has there not been an overwhelming national response to this “epidemic”? Maybe it is because obesity is not infectious, or maybe it is a result of the stigma placed on obesity in American society. There are obviously a number of possibilities, but one of the most likely is the fact that the general public does not perceive obesity as a major health threat. The mindset being, “Sure, being overweight might not be great for your confidence, but hey, it is not going to kill you, right?” Wrong. This disease might not kill you tomorrow, but with the long list of chronic diseases associated with obesity, there is no shortage of ways it can help to kill you eventually and prematurely.
Among the most deadly diseases associated with obesity are coronary artery disease (heart disease), hypertension, type II diabetes, colorectal cancer, and stroke. In addition, a number of other less life-threatening conditions, such as osteoarthritis (especially in the knees), snoring, urinary incontinence, low back pain, infertility and difficulty during birth have been shown to have a higher incidence and severity in people who are obese. Some of these problems are more or less directly caused by constantly having to carry the extra weight associated with being overweight or obese. And, others may simply be more likely to occur in an overweight or obese individual, without the same direct connection. Let us take a closer look at some of the conditions directly and indirectly associated with obesity, and how reducing body weight may decrease the prevalence of these diseases in an individual.
When the blood vessels of the heart become clogged with cholesterol and plaque to the extent that blood flow to the cardiac muscle is significantly reduced (greater than fifty percent closure), a heart attack may be triggered. This clogging of the arteries, ranging from partial to near-complete closure, is referred to as Coronary Artery Disease (CAD). Coronary Artery Disease is responsible for approximately twenty percent of all deaths in the United States, annually. How does obesity contribute to CAD and the subsequent heart attacks?
Excess fat stored under the skin as subcutaneous fat and around the organs of the body sets the stage for elevating the amount of fat, or lipids, in the bloodstream. This blood lipid elevation then promotes the accumulation of fat, cholesterol, and other substances on the inside of blood vessels in the heart and elsewhere. Eventually, there is so little room for blood to be transported smoothly through the blood vessel that a part of the heart muscle becomes deprived of oxygen and literally begins to die. Shortness of breath, and pain in the chest and/or left arm are a couple of symptoms that will alert the sufferer that there is a problem. If only a small part of the heart has been affected by the partial closure and reduced blood flow, a good cardiologist and a couple of weeks in a cardiac rehabilitation program will help put the victim on the road to recovery -- this time. Some people may not be so lucky. Studies indicate that for each five people who experience heart attacks, the first symptom of heart disease is sudden death in one of the five. In other words, there is a twenty percent chance that an individual who suffers a heart attack may not get a second chance to start adopting healthier habits pertaining to diet and exercise.
As mentioned above, another chronic disease which obesity significantly impacts is diabetes, the seventh leading cause of death in the United States. Diabetes is a serious metabolic disorder in which the body either does not produce enough insulin, or the cells in the body no longer respond adequately to the insulin being produced. Without the action of insulin, glucose and other fuels are unable to enter the cells of the body in an efficient manner, resulting in a chronically high level of glucose in the bloodstream (high blood sugar), and a lot of energy-deprived muscle and nerve cells! This high glucose level, or hyperglycemia, can result in damage to a number of the tissues of the body, including the kidneys, heart and eyes. Some of the long-term consequences of diabetes are blindness, heart disease, increased risk of infection and lower-limb amputations, and kidney failure.
Scientists are not sure that there is a clear cause and effect relationship between obesity and diabetes, but the numbers do not lie: approximately ninety percent of people diagnosed with diabetes are also overweight. The message becomes clear that even if obesity does not directly cause diabetes, the conditions or behavior that lead to obesity almost always lead to diabetes as well. Fortunately, the reverse also emerges as true: behaviors that lead to weight loss -- exercise and proper diet -- also help to significantly control diabetes. Exercise alone helps the cells of the body to more efficiently remove glucose from the bloodstream, and thus return blood glucose levels back down to a much lower level, certainly closer to a normal range.
In addition to the physiological and metabolic systems of the body, the problems of obesity can also manifest themselves in the neuromuscular system. For example, a less insidious, but perhaps equally uncomfortable symptom of obesity is low back pain. Low back pain is more frequent in obese people simply because there is more body weight pressing down on the bones and other structures of the low back. In obese men, who tend to carry most of their fat in the abdomen area, low back pain can be aggravated because the person must lean back at the waist to offset the added weight on the front of his body. This excessive bending of the low back not only places abnormal stress on the spinal column and the intervertebral discs that provide cushion between the vertebral bones, but, more importantly, significantly stresses the musculature attached to the spinal column. This is especially true if the abdominal muscular wall has become weak, which it probably has, if the individual is obese. Over time, the extra stress on the structures in the low back leads to pain and, possibly, serious injury. Reducing body weight will almost certainly improve posture, relieve pressure on the forward pull of the spinal column, and, provided there has not been permanent damage, alleviate the low back pain dramatically.
As with any physically observable health problem, we should not ignore the fact that there are also psychological problems that may be associated with obesity. These are more difficult to measure and document, but may be just as important for the quality of life of the affected individual. A stigma on obesity and obese individuals in America, perpetuated by magazines, television and virtually every other form of media definitely exists. Thin people are portrayed as the ideal, the paradigm of health, intelligence, success, and overall well-being.
But are obese people less likely to be intelligent or successful? Do they inherently lack the tools to succeed in business, nursing, teaching, acting or even athletics? Certainly not. In fact, one could even argue that many of the models found on magazine covers and on television are so underweight as to be less healthy than their average-weight counterparts, and at higher risk for a number of diseases and conditions. However, limits placed on obese individuals by society can limit their opportunities for employment, education, and ultimately, their success. A range of recent published research showed that obese individuals received lower wages (sometimes significantly), were perceived to have negative personality traits, and were likely to be discriminated against when applying for jobs. Even health care professionals exhibit discrimination against obese individuals. For example, despite the higher disease risk associated with obesity, doctors spend less time consulting with obese patients, and often prefer not to attempt to treat these patients for obesity, instead referring these patients elsewhere. Another study shows that physicians report having negative attitudes towards obese patients, believing them to be lazy and lacking self-control.
Obese individuals often report feeling isolated, being singled out and made the butt of jokes or pranks. It is this ‘acceptable’ stigmatism that separates obesity from most other chronic diseases. Does society ridicule cancer patients? Tease arthritics? Legally discriminate against a child with multiple sclerosis? Obese individuals have reported being turned down for health insurance because of their weight, and one major domestic airline has even started to charge obese people double fare for a coach class seat. It is hoped that legal recognition of obesity as a chronic disease will cast obese individuals in a different light, but changing the attitude of the general public is always a long, difficult road.
Obviously, there is a clear connection between obesity and overall health. However, we would be remiss if we did not shed light on an important question: can you be obese and healthy at the same time? Although this idea seems to swim against the tide of scientific reason, recent research by Dr. Steve Blair at the Cooper Institute in Dallas, Texas suggests that it is not only possible, but likely. Dr. Blair’s study showed that non-obese men with low cardiorespiratory fitness were at greater risk for death from cardiovascular disease than obese men with high levels of cardiorespiratory fitness. This suggests that lack of exercise, rather than simply being obese, is what really makes an individual’s heart unhealthy. Of course this does not mean that obesity is not still harmful in many ways, but it certainly provides a reason to keep exercising even if the pounds are not melting off of your body.
Determining the extent of an individual’s obesity or overweight constitutes the first positive step toward fighting obesity – a “knowing where you stand” approach. The quickest way to find out if you fall into the overweight or obese category is to calculate your body mass index. Remember that this formula may not be a good predictor of health for everyone -- people with a lot of muscle (like a bodybuilder) may be falsely categorized as overweight- but for the general public, it is a good start. Plus, if nothing else, it does provide helpful baseline data to which later information can be compared. For a more accurate assessment of body fat, turn to your local health club. For a handy BMI calculator, point your internet browser to: http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult.htm.
To calculate BMI by hand, use the following formula:
BMI = [WT in pounds ÷ HT in inches ÷ HT in inches] x 703
If your BMI falls between 18.5 and 24.9, you are in the healthy range. Below 18.5 is considered underweight. Having a BMI number of 25 or above is overweight, while 30 or above is obese.
The formula for children is the same, but, due to developmental considerations, the interpretation is slightly different. To interpret a child’s BMI, go to:
http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm
If you are overweight or obese, taking steps to lose weight can be the most rewarding undertaking of your life. There is no quick fix (regard anyone who tells you otherwise with great suspicion), and two-five pounds per week is a worthy and healthy goal. Recall that your excess body weight occurred over a long period of time in a very slow fashion. It can be reduced faster than it went on, but never as fast as we would like. Remember that permanent weight loss must be a lifelong commitment, but by simply following the suggestions outlined in this book, you will hopefully become healthier without sacrificing your quality of life in the process.
