In the twenty-five years I practiced medicine I don't believe a week went by that a patient didn't beg me to help them lose weight. And for every patient that actually asked for my help, I am sure that there were dozens more that didn't have the courage to ask or had simply given up. Why is obesity such a big problem these days?
There are several reasons. Food is plentiful and relatively available in affluent societies like ours (a blessing and a curse); people eat more than they should (we Americans aren't much into denying ourselves of the things we want when we want them); we eat the wrong foods (taste has pretty much replaced nutrition); and on top of all this, most people exercise less than they should (most people are too tired, too busy, or too burned out).
Increasing caloric consumption while at the same time decreasing energy expenditure (i.e. exercise) is a prescription for disaster - and we are now seeing the effects of this bad behavior. Consider this: the incidence of obesity in adults has tripled over the pasty 30 years! I wish my stocks were doing that well!
And our children are not faring any better - they too have seen a 300% increase in obesity over the past twenty years (video games and Nachos - bad combo).
What is Obesity?
Obesity is defined according to the "BMI", or body mass index. You can calculate your BMI by taking your weight in pounds and dividing it by your height in inches squared, and then multiplying that number by 700 (wt/ht2 x700). If you would like the computer to calculate your exact BMI you can go to www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm. A normal person has a BMI less than 25. A reading of 25-30 means you are overweight but not obese. A reading greater than 30 is medical obesity.
What Causes Obesity?
The body digests and absorbs food particles, which provides the source of energy it needs. Different foods contain different amounts of energy, the measure of which is calculated in calories (a measure of heat in physics). The body uses energy (calories) to run its various functions (breathing, pumping blood, sweating, and so on - this is called the basal metabolic rate, or BMR). In addition, the body uses energy to do the extras, such as running, jumping, dancing, and other body movements.
Obesity results when more calories are eaten than are burned up via the basic metabolic functions and the extra activity of the body. Excess calories which are not burned off are stored in our bodies in the fat cells as triglyceride, to be used later when needed. Weeks, months, and years of excess caloric intake versus caloric expenditure results in more fat being stored than the body will ever need - hence a person literally becomes awash in fat cells.
But wait, you say. I don't eat that much, yet I am still overweight. Surely genetics must be playing a part in this. My parents are heavy, my kids are heavy, and my dog is heavy!
Yes, genetics does play a factor, but not as much as your would think. Consider the less affluent countries where excess food is not as readily available and people are much more active. In those countries we simply do not see the obesity problems that we have in the U. S. and other western solidities. So no, we can't just blame mom and dad for our obesity.
Could it be the types of food we eat as well as the amounts?
Yes. We eat poorly in this country. For all the money we spend on food, you would think we would be getting the healthiest and most nutritious foods around. But that is not the case. We, in our advanced and affluent cultures, tend to consume the wrong types of foods. We eat more refined starches (white bread, white rice, potatoes), more sugars (candy, donuts, chocolates), and more fats (chips, French fries, processed meats like sausage and bacon, beef, cheese - the list goes on) than we should. We have a love affair with soft drinks (200 calories per can of pure sugar). And we wouldn't be Americans if we didn't "super-size" our fast foods.
The types of foods mentioned above are loaded with calories and fat, are stripped of their natural fiber (because our generation doesn't like the taste of fiber), and are cooked in too much fat (trans fatty acids, saturated fats, etc). I was appalled to find out that a recent study discovered that many fast food companies here in American purposely add more saturated and trans-fatty acids to food sold here than they do in the exact same menu items when sold overseas. Why? Because we love fat, and fat sells!
Lack of Exercise
In addition to this craze towards bigger and tastier portions, we also have a more sedentary (effortless) life style that we had just a generation ago. Gone are the days when kids walked to school and then played outside when they got home. Gone are the days when we parents walked rather than rode, or when we shoveled, or raked, or hoed, or hiked, or threw a football with the kids (the kids are inside playing World of War craft). Desk jobs have replaced many physical labor jobs - a sure sign of an "advancing" society.
But the costs have been tremendous. We are not burning off the extra calories we are consuming. And the result is skyrocketing obesity rates, along with its complications (coronary artery disease, diabetes, stroke, hypertension, joints wearing out prematurely, sleep apnea, chronic tiredness, and the list goes on).
OK - I know you are either getting mad or depressed at this moment. But take heart. I have the answers for you, and it's free of charge!
Obesity Prevention and Treatment - for Adults and Kids
1) Dietary change.
We have got to change the way we eat. And we have to make it permanent! I am not talking about anything radical here (remember the grapefruit diet)? I am rather suggesting some simple and common sense ideas that, if implemented, will really make a difference.
First and foremost - quit drinking regular soda pop. Studies show that a child who consumes one soft drink per day raises his or her risk of obesity by 60% within just 19 months!
The ideal would be to drink more water and fewer soft drinks all together. I know the soft drink companies are going to hate me for this advice, but it is true. However, if you must consume soda pop, then sugar-free soft drinks are a much better choice. But be aware: they too have drawbacks (primarily the high acid content).
Also, we are consuming more and more fruit juices and fruit drinks and thinking we are making a healthier choice. True, we are getting some extra vitamins, but that is about it. Fruit juices consist of super concentrated fluids that have all the fiber wrung out of them. So what you end up with is sugar (fructose), flavoring, and a few vitamins.
Next suggestion: Eat out less and at home more. Simple, cost-effective advice - but can we do it? Teenagers these days have more freedom and more money to spend, and so they drive to the mall and consume fast foods, foods that are high in tasty fats and sugars and empty calories. You know the result - childhood obesity. For example, a meal obtained at the local fast food joint consisting of a double cheeseburger, French fries, a Coke, and a desert typically contains more than 2000 calories - one would have to run a marathon to burn off these extra calories.
Studies also show that home-cooked meals are consistently higher in fiber and lower in fats than meals consumed at a fast food restaurant.
Next, try and quit eating between meals. Snacking is bad for you. It is a source of a lot of extra calories that most people don't even think of.
But if you must snack, then choose a healthier food. Don't just grab a donut or reach for a bag of chips. Instead, consider this alternative: grab a handful of nuts. One study showed that a person who had a handful of nuts five days per week was not only thinner, but had a 50 % reduction in heart disease.
Other alternatives for the snacker - fruits. What ever happened to eating an apple or an orange or banana for a snack? My kids think I just flew in from Mars when I tell then to eat an apple rather than their Doritos.
And consider this trick that I have discovered: Get a glass and fill it with Fiber Choice Sugar Free fruit-flavored tablets. Set it on your desk. The next time you are in the mood for a quick snack, grab two tablets and eat them instead. You get 4 grams of pure fiber, no sugar, and they expand in your stomach so you feel full. And they taste great!
Next on the hit parade: red meats (e.g. beef). Try and gradually make a switch by increasing your consumption of white meats while decreasing the red meats. For example, replace a hamburger with a chicken breast cooked on the grill - yummy. Try a serving of fish rather than a steak. You don't have to do this all the time - just try and make a partial switch.
Next, try and eat more unrefined starches. Brown is better than white. Go for whole grain or whole wheat breads and rice and pastas. Eat more vegetables and fruits rather than potatoes or noodles. Simple and effective.
Pay attention to the types of fat you are eating. Gradually reduce your total consumption of bad fats (saturated or "animal" fats, trans-fats, etc). For example, do this by using low-fat mayonnaise on a sandwich (45% less fat-and I swear you can't tell the difference). Use more mustard and less mayo altogether. Use margarine rather than butter. If you are drinking whole milk (contains 4% milk fat) go to 2% milk. If you are drinking 2% milk, try 1% milk (or even better-skim milk). Gradual improvements like these are really helpful and you will hardly even notice it!
Use more olive and/or canola oils in your cooking. They contain mono-unsaturated fats-very good for our HDL cholesterol (the good cholesterol).
Learn about trans fatty acids (so called trans-fat). They crop up in foods that appear to be lower in saturated fats but have trans fat instead - just as bad. Look for them on the label. Trans fat is added to polyunsaturated fats like margarine to make them hard at room temperature.
And try and stay away from deep fried foods. They are loaded with trans-fatty acids.
Conclusion to Part 1
I have probably given you a lot to "digest" in one setting so I am going to stop here. Next time we will discuss prescription drugs that are effective and safe for weight loss.