We've all heard the news: Americans are fat. As a matter of fact, we're literally eating ourselves to death.
According to a recent study by the Center for Disease Control, by as early as next year, obesity could overtake tobacco as the nation's number one preventable killer. More than 64 percent, or 127 million, U.S. adults are overweight or obese. That figure reflects a 33% rise in just ten years.
The people of Illinois are tipping the scales at a higher rate than those in other parts of the country. In Chicago alone, the population of obese adults is 24 percent. As much as 56 percent of the state's entire population is overweight or obese. Furthermore, Illinois patients account for more than $3.4 billion of the country's obesity-related medical expenditures. Only five other states in the nation rack up higher bills.
According to Dr. Charles Baum, Medical Director of the Alexian Nutrition and Disease Prevention Center, much of Illinois' obesity problem could stem from geography.
"It's an interesting phenomenon that the Midwest is an obesity belt," Baum says. "There are a variety of issues in the Midwest that are unique to this part of the country. There is a concentration of ethnic groups that have a much higher risk for obesity. In the suburbs, there are environmental risks for obesity because everyone has to drive to get from place to place, so there's much less time or opportunity for physical or leisurely activity. Almost all of the more densely populated states have an obesity rate of higher than 20 percent in adults."
Dawn Jackson, spokesperson for the American Dietetic Association and a registered dietician at Northwestern Memorial Hospital's Wellness Institute, says Chicago's weight problem stems from the fact that bad foods can be found at every turn.
"The recipe that we're dealing with is food accessibility," Jackson theorizes. "The other day I was dropping my dry cleaning off and noticed that there was a candy stand. The fact that I can buy candy at the dry cleaners is the perfect example of the problem I'm speaking of. Food is everywhere. There has also been a big change in lifestyle in America. We don't need to move or go outside and work to get paid. We don't need to get up to turn on the TV. Essentially we are living in this obesogenic culture that makes people have weight problems."
The fact that Americans are living an increasingly more sedentary lifestyle creates an environment that can be catastrophic to one's health. Couple that with temperamental weather patterns and you have a perfect storm for massive weight gain.
"We don't have a climate conducive to physical activity," she says. "The summers are too hot for safe exercise, the winters are too cold and it rains. So you only have 10 good days to get out there and walk.""Part of the problem in our area is the weather," says Dr. Andrew Pavlatos, Medical Director of the Chicago Institute for Weight Management. "Because people don't have the opportunity to walk to do neighborhood errands, weight gain occurs."
Jackson agrees. "We don't have a climate conducive to physical activity," she says. "The summers are too hot for safe exercise, the winters are too cold and it rains. So you only have 10 good days to get out there and walk."
Another factor in Chicago's weight problem can be linked to its large ethnic population. Statistics show that some racial groups tend to be heavier than others. From 1999 to 2000, the CDC found that 69.9 percent of African Americans were overweight and 39.9 percent were obese. Meanwhile 73.4 percent of Mexican Americans were overweight and 34.4 percent were obese. Whites were found to have a 62.3 percent overweight prevalence and 28.7 percent were obese.
A number of doctors and health organizations attribute the racial disparity in weight to the types of foods that are available to the population.
"Access to fresh fruits and vegetables in local supermarkets makes an impact on the health of a community," says Baum. "And many African- American, Latino and lower-income communities have poor options when it comes to food."
According to a study by the Metropolitan Chicago Information Center, approximately 60% of the city's major grocers like Jewel, Dominick's, Cub Foods and Aldi are located on the North Side. That translates to approximately 3.6 grocery stores per 100,000 residents in largely Caucasian neighborhoods. In comparison, there are about 2.6 big grocery businesses per 100,000 people in highly African-American communities and 2.3 in Latino neighborhoods.
As a result of statistics like these, many health care professionals say the lack of access to basic resources could largely account for the spike in obesity in African American and Latino neighborhoods, not race itself.
"It is important to separate environment from ethnicity when you look at the disparity in obesity among racial groups," says Matt Longjohn, MD, MPH, executive director of The Consortium to Lower Childhood Obesity in Chicago. "There is some pretty clear evidence that in some communities in Chicago there aren't supermarkets with fresh, pesticide-free fruits and vegetables. Furthermore, it is hard for people to engage in healthy physical activity if there aren't safe parks nearby. In West Garfield Park, parents say that violence is a barrier to physical activity. Some say that traffic is a barrier to physical activity. So it is easy to see why African-Americans and Latinos can be susceptible to gaining excess weight."
Genetics could also play a role in weight gain as well, especially for Chicago's minority population.
"Part of the preponderance of obesity in African American and Latino populations could be genetics," explains Pavlatos. "The upper-Midwest's population is comprised of a lot of stocky German peasants who are genetically predisposed to gaining weight. But the African-American and Latino population may not be genetically inclined to easily digest the rich foods that are prevalent in Western culture. The same can be said of the obesity epidemic that is prevalent in Native American communities."
But Baum says we should be careful about blaming genes for obesity. "If you look at the trend in obesity, it's grown so much in the last 20 to 30 years that it's unlikely that a genetic mutation has created this problem," he warned. "There are some environmental factors that play a huge role in the proliferation of obesity like high-fat restaurants and foods, a sedentary lifestyle, high-stress lifestyles, etc. There have been lots of genome searches and nothing has come up to finger genetics as the culprit. It is purely a combination of environmental and emotional eating for 95 to 98 percent of overweight people. Only 2 to 5 percent of overweight people have a true metabolic problem that causes obesity."
Learned eating habits could create a mirage that makes weight problems appear to be genetic.
"When people are raised in a family where there's a lot of obesity, they seem genetically predisposed to obesity because they tend to gain weight from eating the foods the rest of their family eats," says Pavlatos. "And once you put on that weight as a child, you never lose those fat cells. All you're doing when you are losing weight is losing the fat in those cells. But the cells remain and are screaming, 'Feed me! Feed me!' They are just waiting to be filled up again. And any food you eat that is not used for energy goes straight to those cells."
Unfortunately, children have not missed out on the opportunity to overeat. According to a recent study by the Consortium to Lower Obesity in Chicago Children, 23 percent of the city's pre-kindergarten and kindergarten-aged children are overweight. That is two-and-a-half times the national average of 10.4 percent of children in that age range.
"Chicago is ahead of the curve in terms of overweight children," says Longjohn. "New York City has done a similar study and their results were basically the same. Traditionally, you hear the statistics that childhood obesity has tripled in the past 10 years. And now that big cities are looking into this phenomenon, it is startling to find that kids as young as four and five years old have numbers as much as two times the national average in these urban areas. They are clearly at the center of this problem."
Many overweight and obese children are beginning to show signs of the dangers of overeating. According to the CDC, one in three children born today has the chance of developing diabetes.
"The other day, I treated a five-year-old with hypertension and full-onset adult diabetes," laments Baum. "He weighed 130 pounds. It is unfortunate that this kind of observation is becoming all too common nowadays. Twenty-five percent of adolescents in a local high school study were at or above the 95th percentile for body mass index. The national average is 14 percent."
"There have been lots of genome searches and nothing has come up to finger genetics as the culprit. It is purely a combination of environmental and emotional eating for 95 to 98 percent of overweight people. Only 2 to 5 percent of overweight people have a true metabolic problem that causes obesity."This could have devastating effects on the future of the nation's children. For the first time in recent history, this generation may not outlive their parents. This is directly attributed to the early onset of obesity-related diseases and illnesses like Type 2 diabetes, high blood pressure, heart disease, hypertension and cancer.
These types of statistics alarm local government officials. As a result, lawmakers have proposed health-related legislation in hopes of combating this growing epidemic.
"I think Illinois government has shown more interest in dealing with obesity as of late than any other state," Baum notes. "Governor Blagojevich talked to House Majority Leader Tom Cross about the issue and together they come up with a number of legislative proposals-from removing vending machines in schools to eliminating the waivers that schools can apply for-that allow them to get rid of physical education."
If Gov. Blagojevich and Rep. Cross get their way, junk food will be banned from school vending machines and will be replaced by healthier options. The Illinois Department of Public Health would be responsible for defining the boundaries of the healthier snack alternatives. All Illinois K-12 schools, both public and private, would be required to make the change by January 1, 2005.
When it comes to physical activity during the school day, children are losing out across the board. Although Illinois is the only state that requires students to participate in physical education classes, many schools are finding a way to skirt the law by continuously applying for and renewing five-year vouchers. As a result, less than 10% of elementary schools are providing P.E. classes. The bill proposed by Rep. Cross would limit schools to a single two-year waiver.
The federal government has taken action as well. In recent months, the Department of Health and Human Services has announced a number of initiatives ranging from public service announcements to proposed labeling changes on food containers and restaurant menus to even redesigning the classic food pyramid.
"The government is doing some different things to try to get the word out on the importance of healthy eating and daily physical activity," explains Longjohn. "For instance the VERB campaign uses PSAs directed to the Tween group, and some good things are coming out of it."
VERB is a national, multicultural, social marketing campaign coordinated by the CDC. It encourages physical activity among people age 9 to 13. A recent CDC survey attributed a 34 percent increase in exercise among young adolescents to the VERB campaign. This could have impacted the government's decision to launch a campaign directed at adults. But the images in these ads do not resemble the colorful VERB PSAs, which are chock full of happy people engaging in a myriad of fun-filled physical activity.
"The ad council campaign that was launched in March of 2004 is problematic in approach," says Longjohn. "It is counterproductive to focus on obese people the way that they do. There are posters that show a big belly or thigh, but there are no faces. This is especially hurtful in an environment where images in advertisements have been getting skinnier and skinnier. There is no need to be dehumanizing in order to get the point across. Obesity is not a cosmetic issue and we need to separate it from that kind of approach."
This sort of in-your-face awareness campaign may be just the right thing to get Americans off their couch and into the gym, Baum argues.
"The government is using a little bit of shock therapy to make people wake up and see that this is an issue," he says. "If seeing these images is going to make people realize there's a problem and that we need to do something about it, then it have served its purpose. People will need to be prepared to deal with the fact that kids will feel bad about the images they see. The reality is we're flying by the seat of our pants. We're trying to figure out an approach to this epidemic while we're already in the process of combating it."
As people become more aware of the dangers of obesity, they will want to know how much fat and calories they are consuming. The federal government hopes to help with this problem by defining the terms "fat-free", "low-fat" and "reduced fat" that appear on food labels. The words "calories from fat" would disappear from labels and would be replaced with the percentage of calories the food will use in a 2,000-calorie a day diet. One of the government's most important proposals targets the serving size aspect of food labels.
"Our portions are much too large. We don't really know what a realistic portion would look like because we are bombarded with plates in restaurants that would feed a family of four.""We have a huge problem with distortion when it comes to food," Jackson observed. "Our portions are much too large. We don't really know what a realistic portion would look like because we are bombarded with plates in restaurants that would feed a family of four."
If the Department of Health and Human Services gets their way, that would all change. The definition of serving size would change to the amount of food in a given container that a person could realistically consume. For instance, a 20-ounce bottle of soda would be considered one serving size as opposed to two and half servings. That would make the number of calories on the label jump from a misleading 110 to a realistic 275.
In addition, legislation has been introduced that would require restaurants to display nutritional information on their menus. If passed, this piece of legislation could help the food industry against lawsuits. They would be protected even further if that legislation were coupled with the Personal Responsibility in Food Consumption Act, aptly nicknamed "cheeseburger bill". This piece of legislation stems from a recent class action lawsuit that sought to blame McDonald's for the involved parties' weight problems. A New York judge threw the lawsuit out citing that it was negligent in proving that the fast-food icon tricked its customers into believing that they served good-for-you foods. As a result, Congress is considering this bill that would shield the restaurant industry from lawsuits that seek to find them liable for an individual's expanding waistline. A similar bill has already passed in the Illinois House.
Pavlatos thinks this is a great way to make people realize that they are responsible for and have the power to take control of their weight problems.
"We're just playing games and pointing the finger in these types of lawsuits," he says. "It's a part of this culture of placing the blame on someone else. If you sue your mother for bad genes, you're actually closer to finding the root of your problem than if you sue a fast-food restaurant. The only thing you're doing by suing them is reinforcing the feeling of being victimized and making your weight issue somebody else's fault."
Not so fast, say some critics of the "cheeseburger bill".
"When a company begins to modify the nature of a food in a way that is no longer nutritious for taste's sake, there could be a problem," Baum says. "There is a study that shows that sugars and fats in foods can create an opiate effect in the brain. This feeling is actually the same one created by nicotine in cigarettes. So I don't think Congress should pass a law that prevents me from suing McDonalds because there may be some accountability there that we have not discovered yet."
In the meantime, McDonalds has announced plans to phase out their ever-popular Super Size portions. This move coupled with their vast array of heavily advertised salads could help their faithful diners eat healthier.
The real cure to America's obesity problem can be found in the tried and true combination of exercise and good eating habits. But don't worry, you can still enjoy your chocolate cake. Just do it moderation.
"The biggest hurdle we have to cross is getting rid of this all or nothing mentality," says Jackson. "Most people believe you have to be on a program that's 100 percent perfect, perfect, perfect. But it's really about the small changes that you make. I call it the B-student mentality. If 80% of the time you're making healthy choices like baking and not frying, eating low-fat dairy and cooking well at home, you're okay. When you have that restaurant menu in your hand, you can have whatever you want. Most people who do well do so because they make small changes and allow themselves to have their favorite food without guilt. Progress is not perfection."
There are obviously no clear-cut answers to America's obesity epidemic. With more than 300,000 Americans dying from obesity-related diseases each year, health care and government officials agree that something needs to be done. Until a quantifiable answer is found, lifestyle changes, realistic goals, a positive attitude and the help of government initiatives could help Americans begin to win their battle with the bulge.
Published: June 01, 2004