America: Land of the Fat

Mary Neal says she has the best of intentions when she goes out to eat, promising herself that this time she'll order a low-cal meal, like grilled chicken and a salad.

More often than not, though, when the waiter asks for her order, says Neal "I say cheeseburger and fries."

American adults are fatter than at any time in history. And their overweight kids are on track to grow up to be even fatter. Neal weighs about 340 pounds.

Obesity has become a national epidemic that rivals smoking as a cause of death, disability and soaring medical bills.

But while most Americans think overweight people simply lack willpower, a mountain of research says that just nagging people to diet and exercise is almost doomed to fail. The real problem is that we live in a society that relentlessly promotes overeating and inactivity.

"The culture has to change," said Marian Fitzgibbon of Northwestern University Medical School. "In a culture with virtually unlimited access to high-fat, good-tasting food in outrageous portions, with no reason to regularly exercise, people will be unable to maintain healthy weights."

To change our fat culture, obesity experts are pushing a broad range of controversial measures--including higher taxes on junk food, daily gym classes in schools and a ban on TV food ads directed at kids.

"The future is not hopeful unless we act now," obesity researchers wrote recently in the journal Science.

Two of every three adults are overweight. Nearly one in three is obese--at least 30 or 40 pounds overweight, depending on height.

The percentage of children 6 to 11 who are overweight has more than tripled in 30 years, to 15 percent. The adult obesity rate has doubled. At the current rate, nearly two of five adults will be obese by 2008.

Obesity increases the risk of more than a dozen health problems, ranging from excess facial hair to cancer. The Centers for Disease Control and Prevention estimates one in three American kids born in 2000 ultimately will develop diabetes because of eating too much and not exercising enough.

Neal, 52, suffers from four obesity-related conditions: type 2 diabetes, asthma, arthritis and high triglyceride levels, which might increase her risk of heart disease. The suburban woman knows she has to lose weight.

Obesity causes roughly 300,000 deaths in the United States each year--or about one every two minutes. That's nearly three times the number of deaths from AIDS, murders, car wrecks and breast cancer combined. Obesity expert Kevin Fontaine of Johns Hopkins University predicts that, within 10 or 20 years, obesity will overtake smoking as the leading cause of preventable death.

Obesity lowers life expectancy by as much as 22 percent, depending on age, weight and other factors. For example, an extremely obese white man in his 20s will lose 13 years, a recent study found.

Obesity causes more health problems than smoking, problem drinking or poverty, one study found. Another, published in the journal Health Affairs, found that obese people spend 37 percent more on medical bills--$732 a year.

With obesity-related health care costs now rivaling smoking costs, "It may be increasingly difficult to justify the disparity between the many interventions that have been implemented to reduce smoking rates and the paucity of interventions aimed at reducing obesity rates," researchers wrote in Health Affairs.

Mary Neal's father was trim, but her mother, grandmothers, aunts and brother have been heavy. It's a good bet Neal's weight problem is partly genetic--she weighed 120 pounds at her First Communion. Like height, obesity runs in families. More than 250 genes are involved, and they are roughly 40 percent responsible for determining a person's weight.

Humans evolved fat genes during their hunter-gatherer period, when it was feast or famine. To help survive times of scarcity, early humans evolved a taste for energy-rich sugars and fats and the ability to efficiently convert these calories to body fat. But with the development of agriculture, food supplies became more consistent. To protect against obesity, humans began evolving lean genes that made the body less efficient at converting calories into body fat. Today, different people carry fat and lean genes in different combinations.

"Obesity is not a personal failing," Jeffrey Friedman of Rockefeller University wrote in the journal Science. "In trying to lose weight, the obese are fighting a difficult battle. It is a battle against biology, a battle that only the intrepid take on and one in which only a few prevail."

Neal tries to exercise five days a week. Three days, she works out on an exercise machine. Two days, she walks with her husband, Carlos, in a park near their Bridgeview home. It's just about the only walking Carlos Neal does. He drives everywhere--even two blocks to the corner store. "I don't think about walking," he said.

Of all the modern conveniences, the automobile is perhaps the greatest contributor to the obesity epidemic. Americans take fewer than 6 percent of their trips on foot. Even on destinations of less than one mile, we take 75 percent of trips by car.

Blame television, too. Even reading burns more calories. Also, many people munch in front of the tube, then buy the junk food that's advertised.

A recent study of more than 50,000 women found that increasing the amount of TV viewing by two hours a day increased the risk of obesity by 23 percent: Thirty percent of new cases of obesity could be prevented if women watched fewer than 10 hours of TV a week and walked briskly for 30 minutes a day.

Technology continues to engineer physical activity out of our lives. Thanks to drive-throughs, remote controls and e-mail, you can get a Big Mac without leaving your car, change the channel without getting off your La-Z-Boy and deliver a memo without leaving your desk. It adds up. Over the course of a year, you'll burn roughly 4,000 fewer calories taking escalators and elevators and 800 fewer calories using the remote.

"The dark side of a technologically advanced society is obesity," said Dr. Samuel Klein of the North American Association for the Study of Obesity.

Just one in four adults does the recommended minimum of 20 minutes of vigorous activity three days a week or 30 minutes of moderate activity five days a week, according to the Centers for Disease Control. Twenty-nine percent don't exercise at all.

Even the workplace is becoming more sedentary. Early in his career, Carlos Neal walked all day delivering the mail. Now, he delivers letters from a postal vehicle.

Sixty percent of the rise in obesity can be traced to declining physical activity at home and at work, according to a study by economists Thomas Philipson of the University of Chicago and Darius Lakdawalla of the Rand corporation. The other 40 percent, they estimate, results from agricultural innovations that have lowered food prices. Food is cheap, delicious and sold everywhere. A Coca-Cola annual report boasted the company's ice-cold brands are "within reach wherever you look: at the supermarket, the video store, the soccer field, the gas station--everywhere."

Carlos Neal, 55, has gained 80 pounds since he married Mary 34 years ago. He's trying to slim down from 235 pounds, and recently lost a few pounds. Still, it's difficult to resist the cornucopia of sugar and fat. For lunch, he sometimes eats three Hostess desserts--Suzy Qs, doughnuts and a fruit pie. And he loves fast food. At Burger King, he'll order a Double Whopper, large fries and vanilla shake--a total of 2,090 calories.

Mary Neal is an area captain for the support group Take Off Pounds Sensibly. With the help of TOPS, she has lost 45 to 55 pounds three times. But, each time, she gained it all back.

The same thing happens to at least 80 percent of people who lose weight. Given the widespread inability to keep pounds off, obesity experts argue that people can't fight fat by themselves. They need society's help.

In a provocative article, obesity experts Marion Nestle of New York University and Michael Jacobson of the Center for Science in the Public Interest have proposed a broad set of social strategies to change the fat culture.

*Require daily physical education in all grades through high school, extending the school day if necessary.

*Require chain restaurants to list calorie contents on menus or menu boards and nutrition labels on wrappers. Require print ads to disclose calorie contents.

*Provide higher food-stamp benefits for recipients who buy fruits, vegetables, whole grains and other healthful foods.

*Build more bike paths, recreation centers, swimming pools, parks and sidewalks, funded by taxes on junk food, TVs and cars. A 2/3-cent tax on each 12-ounce can of soda; a 5 percent tax on new TVs and video equipment; a penny-a-gallon gas tax, or a $65 tax on new cars would raise $1 billion.

Several states are considering taxes on soft drinks and snacks. But the Grocery Manufacturers of America said such taxes discriminate against poor people, who spend a larger percentage of their income on food.

"You can't mandate good eating habits," said grocery association spokeswoman Stephanie Childs. "Government can't force us to eat the foods we 'should' eat."

Mary Neal's first diet failed because she went about it wrong, starving all day, then gorging at night on a burger, shake and fries. Her second effort faltered when she turned to comfort foods to cope with the stress of caring for her ailing parents. The third time, she said, "I just got tired of it."

But Neal isn't giving up. She recently began her fourth attempt to lose weight. Now, when she goes out, she eats only half her meal. At breakfast, she'll order fruit with her eggs, rather than hash browns. At lunch, she puts mustard on her sandwich, instead of mayonnaise. She and her husband have stopped going to fast-food restaurants, and he has cut back on Hostess junk food.

A month into her fourth attempt, Neal has lost more than 17 pounds. She hopes to get below 200, then keep the weight off for good.

Carolyn Schmidt, who is very heavy, was buying chips and dip for a party when another shopper approached, started putting Schmidt's snacks back on the shelf and nagged, "You should not be eating these."

Schmidt was hardly shocked. That sort of thing actually happens to her a lot. When she goes out to eat, strangers urge her to try their diet plans. She's convinced that she lost out on job interviews once prospective employers saw how big she is. And she dreads going to the doctor, knowing she'll be badgered to lose weight.

Schmidt, who lives in Tinley Park, belongs to the National Association to Advance Fat Acceptance, whose aim is to "eliminate discrimination based on body size." In a society that worships thin, members of the group have a different view--that it's OK to be fat.

"I've always been a large individual," said Rebecca Jedlicka, president of the Chicago chapter, which claims about 75 members. "To imagine myself thin is like imagining myself tall. It's just not me. I'm happy with who I am, and my husband is happy with who I am."

Being fat has its advantages. "It gives you a certain presence, and a certain power in that presence," Jedlicka said, and little kids "really love cuddling up to fat people."

The fat-acceptance group dismisses reams of studies about the health risks of obesity. Yo-yo dieting is a bigger risk than being heavy, the group argues, and fat people are made to feel so bad when they go to the doctor that many hesitate to seek treatment when they need it.

And thin people also get diseases associated with obesity, Jedlicka said, such as cancer and heart attacks.

White Hen was offering customers a bargain: a 64-ounce cup of Pepsi for 49 cents, the same price as a 22-ounce cup.

The recent promotion illustrates value marketing, in which you get more calories for little or no extra money, possible because the drink constitutes a small percentage of the total cost of the product, which also covers things like labor, advertising and packaging.

Such "supersizing" encourages people to gorge. Psychologically, one three-ounce jumbo Kit-Kat seems like less than two 1.5-ounce regular Kit-Kats.

Between 1977 and 1996, portion sizes in homes and restaurants increased for desserts, soft drinks, salty snacks, fruit drinks, french fries, hamburgers, cheeseburgers and Mexican food, according to a recent study. Only pizza portions got smaller.

Another study found portion sizes of many foods and beverages are two to five times larger than when the items were introduced. The original Hershey's bar weighed 0.6 of an ounce. Today, Hershey bars range from 1.6 to 8 ounces. McDonald's originally sold one size of french fries--2.4 ounces. Today, that's a small fry order. The supersize is 7 ounces.

"This trend toward larger marketplace portions parallels the rising rates of obesity," an American Dietetic Association spokesman said.

Most people could prevent weight gain just by walking an extra mile each day, according to a recent study in the journal Science.

James Hill, of the University of Colorado, and colleagues calculated that 90 percent of Americans could hold the line by eating 100 fewer calories per day or by burning 100 more calories. That's not enough to lose weight, but at least you won't get fatter.

One hundred calories amounts to 4 to 5 percent of the daily intake for a typical adult, who eats 2,000 to 2,500 calories a day. It equals about three bites of a premium fast-food hamburger.

To burn 100 calories, you could walk a mile, which takes most people 15 or 20 minutes. And you don't have to do it all at once.

Add steps throughout your day. Take the stairs, park at the far end of the lot, walk on your coffee break, don't use the car for trips under one mile, return your grocery cart to the store, and avoid drive-throughs, airport people movers and TV remotes.

Depending on your stride, one mile generally equals 2,000 to 2,500 steps. You can keep track with a step counter (pedometer), a battery-operated device that clips to your waist. Basic models sell for $25 or less at sporting-goods stores and on the Internet.

Inactive people take 2,000 to 3,000 steps a day. People trying to lose weight should increase their daily count by 500 steps every week until they reach 10,000, says Dr. Robert Kushner of Northwestern Memorial Hospital's Wellness Institute.

Last year, Greg Wintroub enrolled in a weight-loss program at Northwestern Memorial Hospital's Wellness Institute. When the pounds began melting away, he persuaded his son to join, too.

Greg Wintroub, 56, has lost 90 pounds and is down to 310. His son, 24, has lost about 50 pounds and is down to about 280.

"We compare notes and are very supportive," Jeremy Wintroub said. "There is even a little healthy competitiveness."

The father no longer eats 16-ounce steaks, and the son has given up McDonald's Double Quarter Pounders.

They both walk more and wear pedometers to count their steps. And Greg Wintroub no longer summons assistants to his office at All Products Automotive in Chicago, even though he's the boss. He goes to their offices, which boosts his step count.

Between one-third and one-half of all pets are estimated to be overweight. Like people, they eat too much and don't get enough exercise. The health risks are the same, too: heart disease, breathing difficulties, diabetes, arthritis.

Weight problems are more likely in pets that have been neutered or are older than four years old. Mixed cat breeds are more susceptible, as are Labradors, cocker spaniels, hounds and shelties.

In Arlington Heights, Linda Eckles' dog, a three-year-old, long-hair dachshund named Hogan, got up to as much as 17 pounds--more than 20 percent above the dog's ideal weight. "He likes to lay around the house," Eckles said.

Eckles is overweight, too. So she and Hogan enrolled last year in a Northwestern Memorial Hospital study dubbed "People and Pets Exercising Together."

Studies have shown you're more likely to lose weight if you do it with a friend. Dr. Robert Kushner, who runs Northwestern's Wellness Institute, wanted to see if the same would hold true for those who lose weight with a pet.

The one-year study is comparing people trying to lose weight on their own with people trying to lose weight with their dogs. At the six-month mark, dog owners had lost slightly more than the other group, though the amount wasn't statistically significant. But the dogs are doing great: 79 percent had reached their target weight in four months.

Eckles takes Hogan for a 15- or 20-minute walk four or five days a week. So far, she's lost 17 pounds. Hogan has lost three pounds and reached his target weight.

"It's been very good for me," Eckles says. "I was just about as lazy as Hogan. I think everyone should go out and take their dog for a walk."

> I have a tin of sardines packed in olive oil or a banana.

Thank you for the reminder! I used to eat sardines regularly when I was a punk 'cause I loved 'em. I don't know why, but I stopped a long time ago. They would be a perfect food.

If people had to chase a gazelle every time they wanted a snack, there would be much less obesity.

Anyway, I gave up stuffing my face when I gave up watching TV a quarter-century ago.

Giving up a lot of bad food was easier than giving up tobacco, I'll say that.

I'd still rather smoke than eat--in fact, I think I'd rather smoke than have sex. (I gave that up, too. Unsanitary.)

that guy Jacobson ... If he could get headlines and adoration by the press from hounding fat people on a one-to-one basis like he does corporations, he would.

LOL! Excellent point, well said.

I used to work at a dot com office that had free sodas and ice cream

that and plain old walking and hiking dropped my belt size by about 5-6 inches.

carbs aint the problem...sitting around doing nothing is while eating too many carbs/anything is...if carbs were the problem, people in asia/etc who eat mostly carbs like rice and or noodles would be the fattest of all.

Started on Atkins 6 days ago, at 210#.

Lost 17 lbs, to 193, in SIX DAYS.

I am six feet tall. No way do I want to weigh less than 180 - or more than 190, I guess. So I set a target of 185.

This morning, I got up, had a shower, weighed myself, got dressed. Put on clothes, wallet, keyes, et al.

Clipped my cell phone to my belt - my pants fell off.

Why in the heck am I doing this??

Seems to me that a lot of our obesity problem is due to an obsession with obesity and food. It's a catch-22 - you worry about getting fat, so you think about each bite you eat, and those junk foods become even more tempting when you're not "allowed" to eat them.

My parents never prohibited me from eating junk food - even cookies before dinner. I was rail-thin, at least till my mid-20's. Genetics? Maybe - my dad was the only thin person in my family, though. Food didn't have much significance to me beyond simple enjoyment till I was in my late teens and surrounded by dieters.

I could lose a few pounds - well, more than that if I wanted to meet magazine model standards :) but I'm at a healthy weight. I personally feel that the key to keeping at a healthy weight is to eat a wide variety of foods.

I don't prohibit my kids from eating junk, either. I just make sure they have lots of healthy options. When faced with a choice between a box of donuts and a garden-fresh cucumber, my 7 year old will take the cuke sliced up with some low-fat dip any time.

Then again, maybe she's weird. ;)

Yeah, no food on its own is the problem. My next door neighbor, a vegetarian, once got on his soapbox and informed me and his wife that it was all that meat we ate making us fat. Joke's on him, though - four years later, he's still a vegetarian but looks like he's about 8 months pregnant. Yep - it's inactivity.

Just a comment on the huge portions served up in restaurants. I've lost 44 pounds since April 1 and on Friday night, I went to a popular Mexican restaurant (On The Border) and ordered Blackend Chicken Fajitas. The portion was so huge that it came on three separate dishes.

Better a huge portion than not enough. Plus, if you can't finish, at least there'll be leftovers for the fridge the following few days.

I've lost 30 lbs on the double cheeseburger diet plan.

I'm occasionally on that diet as well. My favorite is a double King chili cheese bacon avocado egg burger at Fatburger (in L.A.). ....3/4 lb of beef, and 5000 calories

It's fantastic, and I'm going to see my wedding weight on my scale again! :^)

Hey, congrats! My wife just passed below her "wedding weight," which was pretty thin to begin with. I just went below my "wedding weight."

I've probably been doing this for a couple of months now, and eating the Atkins way seems completely "normal." Junk food just doesn't have the appeal that it used to.

The nicest surprise is the boost in energy. Have you noticed that? I used to die after lunch. No longer.

Now go and make disciples of all the nations... ;-)

Clipped my cell phone to my belt - my pants fell off.

Two recent studies published in the NE Journal of medicine confirm your experience, in case you don't believe your own eyes. Of course, this is 30 years after the diet became popular...

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