The Big Problem
By William Rawlings, MD, MSHyg, FACP
In the future, we may celebrate July 26, 2007 as the day when we finally found the solution to the problem.
Have you peeked in the dark recesses of your closet lately, wistfully remembering when you could actually slip into that slinky black cocktail dress without having to deny a forthcoming visit from the stork? Or if you’re a guy, not having to buy those pants with the elastic hidden on the sides, or looking down and being able to see your belt buckle. Being a shade heavy (I dare not use “obese,” the dreaded “O” word) is—to say the least—inconvenient if not down right embarrassing.
Well, rejoice! According to an article in the July 26, 2007 issue of the prestigious New England Journal of Medicine, obesity can spread from person to person, “much like a virus,” according to commentary in the New York Times. In fact, the Times goes so far as to suggest that “…the way to avoid becoming fat is to avoid having fat friends.”
But, hey, let’s back off for a second and take a look at this. Are you going to try to explain those extra 25 pounds to your spouse and friends by saying that you “caught it from someone at work?” What is this, obesity is now a social disease, complete with all the implications that go along with that term? Of course not! Let me explain.
If you, like me, are a resident of the state of Georgia, there’s a good probability that you’re fat. Unlike your grandmother’s assessment (“Aw, honey, you’re just big-boned.”) there is an objective measurement to define the terms overweight and obese. It’s called the Body Mass Index (or BMI). Simply put, it’s a measurement that only looks at your height and weight. If your BMI is below 25, you’re at a good weight. Between 25 and 29.9, you’re “overweight.” 30 or above, “obese.” Classification is a no-brainer.
So, we’ve reduced obesity to a number, but what do the numbers mean? Basically this: Increasing weight is associated with an increasing occurrence of medical problems, including diabetes, high blood pressure, elevated cholesterol, coronary heart disease, stroke, several types of cancer, etc. These illnesses are associated with a shortened life expectancy. The higher your BMI, the more likely you are to develop chronic illness. Bottom line, the more you weigh, the greater your risk of dying at a premature age.
There are social implications. Compared to a person with a normal weight, an obese individual is less likely to be married, is more than two and a half times more likely to live below the “poverty level,” and is much less likely to complete high school and college.
And there are monetary costs also. Lost time and disability costs in the United States from obesity-related illnesses are estimated to be in excess of $100 billion per year. From an income standpoint, obese people have less job advancement (and lower salaries) as compared to those of normal weight.
But people have always been overweight, you may argue. Perhaps, but not to the extent that they are today. Health officials now refer to the “Epidemic of Obesity.” Have a look at a few revealing figures:
% of Obese Americans | 1971—14.5% | 2004—30.9% |
# of Americans with Diabetes | 1980—5.8 Million | 2002—13.3 Million |
% of 12-19 year olds who are obese | 1980—5% | 2004—15% |
Average Woman’s Dress Size | 1950—8 | 2002—14 |
Estimated # of Bariatric Surgeries in US | 1992—16,200 | 2004—144,000 |
In
Georgia, the problem is especially acute.
As of 2006, 25.5% of the population had BMIs of 30 or greater, meaning that one out of four persons is obese.
If you add in those who are simply overweight, the group includes nearly two-thirds of the state’s population.
We are the 12
th heaviest state in the nation.
The Georgia Department of Human Resources estimates that in 2002 some 15% of all deaths in the state were “attributed to overweight and obesity.”
They report that the average hospital stay for obese individuals is 85% longer than those with normal weight.
I could go on, but you get the idea.
Why, you ask? What happened? The answer has to lie in either heredity or environment—or a combination of the two. To a degree, we all have the ability to become overweight, but you can’t blame it on bad genes. This country has not suffered a famine in generations, so if we inherited the tendency, theoretically obesity would have been the norm. The answer is the environment, that is, what we eat (both quality and quantity) and how we do—or don’t—burn calories.
Let me diverge for a moment and talk about weight loss. It may be easier to understand than weight gain. If you want to try to understand the concept, go to your local bookstore. There are shelves and shelves of diet books, most purporting the have discovered the magic secret to shedding pounds. There are high-protein diets and low carbohydrate diets, diets with the names of people and towns like Atkins and Scarsdale, diets with the names of universities or regions of the country and world. But, and this is big “but” (okay, sorry about the pun, there), the one thing they all have in common is that the dieter eats a few number of calories over a period of time. In fact if you go out, say, six months and look at weight loss resulting from a given diet, the ONLY factor that is correlated with a decline in weight is the decrease in the number of calories eaten. You can be in an Atkins-approved Zone with NutriSystem, but if you don’t cut the calories, you won’t lose weight. That should be simple enough to understand.
Okay, the converse is how we gain weight. The more we eat, the more we gain. Let me give you some numbers taken from a National Geographic article on obesity. In 1954, a Burger King hamburger had 202 calories. By 2004, it had 310. The six-ounce Cokes of our childhood (with less than a hundred calories) are now 20 oz. in size at a lower cost. We eat more. In fact, in the thirty years between 1970 and 2000 the average American’s dietary intake increased by 19%. We may be eating “better,” with proportionally less fat, but the sheer volume of increase in food more than makes up the difference.
Food composition has changed, too. The advent of high-fructose corn syrup and tropical oils has dramatically increased the shelf-life of foods, but at the cost of adding calories. We may eat less fat, but the “rebound” effect of a diet high in carbohydrates may make us hungrier sooner, so in the end we eat more.
How about exercise, you ask? That’s a good way to “burn” those extra calories. Sure it is, and we do less of it. As our cities grow and we engage in more passive activities, we do spend less time in calorie-burning physical exertion. But with that said, you may be forgetting one very basic thing—the human body is a very efficient machine. Say you go out to dinner and opt to have a single serving of tiramisu for dessert. It might weigh about 4.2 oz. and have 390 calories. Got that? That figure exceeds the number of calories that a 190 lb. man would burn in an hour of leisurely bicycling, an hour of golf, an hour of dancing, an hour of walking the dog at a moderate pace, or an hour of moderate weight lifting. Exercise is very important—it “speeds up the metabolism”—but in the general scheme of things it has less to do with weight loss than does limiting what one eats.
So, back to the article in the New England Journal of Medicine. You may have overweight friends—I certainly do—but I don’t intend to ditch them for fear of “catching” obesity. Unless they’ve been holding you down while forcing Twinkies down your throat, the idea of shifting the blame for your weight problem to others is patently ridiculous. It’s what you eat, silly, the classical Deadly Sin of Gluttony. Think about it the next time the waiter asks if you’d like to see the dessert menu.
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Want to Know if You’re Overweight?
The Body Mass Index (
BMI) is easily calculated by dividing your weight in pounds by the square of your height in inches, and multiplying the result by 703.
For those of us who are math-challenged, a far easier way is to use a calculator on-line.
The National Heart, Lung and Blood Institute (a division of the National Institutes of Health) has an easy to use site at
www.nhlbisupport.com/bmi/.
You can calculate your
BMI, and click on links for more information on the health effects of obesity, as well as advice on weight loss.
(This article originally appeared in the Fall 2007 issue of Splash magazine.)