October 11, 2004
Monday

Joann Flora

Ketchikan, Alaska - Greetings, Sitnews readers. It's good to be back with you after a summer layoff. In the coming months, I plan to present some new and relevant topics concerning health and welcome your ideas for new columns. The first is a series on weight management. In September, I had occasion to attend a national conference on the treatment and prevention of obesity. I have been concerned about the ever increasing weight of our population, particularly among our children, and wished to understand the cause of this epidemic and which options are currently being employed. As you may imagine, this is a pretty expansive topic and one article will not address it all. Let's begin by trying to understand the nature of obesity and identifying the problem.
 
Obesity and overweight have become truly epidemic in the US and are contributing factors to heart disease, diabetes, colon cancer, high blood pressure, and other life threatening conditions that are lumped under the heading, Metabolic Syndrome. The Secretary of Health and Human Services, Tommy Thompson, has identified the need to treat obesity as a condition of ill health,  before its complications threaten our lives. Obesity is defined as having a Body Mass Index (BMI) of 30 or more. Your BMI is determined by taking your height in inches times itself,  dividing that figure into your weight in pounds, and multiplying the result by 703. The formula looks like this:

For those not mathematically inclined, you can compute this automatically by going to the National Institutes of Health - National Heart, Lung, and Blood Institute web site at
http://www.nhlbisupport.com/bmi/

In 2002, it was estimated that 20-24% of Alaskans were obese. In 1991, less than 10 our residents fell into this category. Since 1991, we have surged ahead of many other states, though the national trend is just as striking. Obesity is at an all time high in adults as well as children. It is on the verge of passing tobacco use as the number one cause of preventable death. Why is this happening? We could spend a long time sifting through the mounds of materials addressing this issue, but the nutshell answer is that as a society, we take in more energy (food/calories) than we expend (burn up); we eat more than we move.

What factors influence our food intake? The following have been identified as some of the reasons we over eat: large portion sizes (12 ounce steaks, grande mochas) make us think we must consume the entire serving; extra large sizes of food offerings (1/4 pound burgers, super size fries) feed our belief that bigger is better; inexpensive foods tend to be high in fat and refined carbohydrates; soft drinks (big sugar) serve up whopper sized servings of sugar; fast food, junk food, recreational eating (let's go out for a pizza), pre-packaged meals (high fat) all add up to 'more and bigger'. While our food intake has steadily gone up, our ability to burn off excess calories has gone down. We have become encultured to hours and hours of TV watching (especially children); physical education has been cut from many school programs;  we are a society of automobiles and tend to drive even when we can walk; we spend countless hours in front of computers and video games; our communities are  designed to place residential areas away from business and activities, which puts us into our cars to get to work, services, and recreation. In short, our intake of calories has been on a steady increase as our activity levels have steadily declined. For most people, most of the time, it is a dietary law that we must burn 500 more calories than we consume in order to achieve a negative energy balance and thereby, lose weight. Our current food culture and activity levels as a society do not support this. Add the fact that as we age, we tend to gain one to two pounds per year and you can easily see how we got into so much trouble with our weight! But let's not overlook some other significant factors. There is evidence that some of us are simply predisposed to having more fat  than our friends. Some of the common considerations follow.

• Fat Cell Theory  states that the number of fat cells we carry is determined by our eating behaviors by the age of puberty and that we keep the same number of fat cells throughout life. As we gain weight, the fat cells simply enlarge; when we lose weight, they become smaller. When children overeat, they increase their number of lipid (fat) cells, increasing their ability to become overweight through sheer number of cells. Therefore, an obese adult may be said to have developed a greater number of fat cells in childhood and a thin adult.
• Set Point Theory states that each person has a unique weight (set point)  that the body will try to maintain regardless of our eating or activity patterns. The basal metabolic rate (BMR) is automatically adjusted to maintain the set point. This may explain why one person can eat large quantities of food without gaining weight, while another eats like a bird and gains.
• Hypothyroidism is a condition of reduced thyroid function. The thyroid gland regulates metabolic activity in the body. Low function in this gland results in low or slow metabolism of nutrients. A slower metabolism allows more calories to be stored than burned.
• Psychosocial Barriers  to maintaining a healthy weight comes in a variety of packages. Some are given to us by the media who use waif-like models to sell the current fashions. Most of us could never (or would never want to) look like the skin and bones "ideals" we see in magazines and on TV. Our culture constantly reinforces the message that thin is in/good and fat is out/bad. The diet industry would have us all eating special meals and drinking meal replacements, while we take pills designed burn fat faster, block fat from becoming stored, and satiate our appetites. Research has shown that a thin, under-qualified job applicant is more likely to be hired than a large, well-qualified person. Research has also shown that thin medical patients receive higher quality care than their larger counterparts. Medical offices don't always have waiting room furniture, scales, exam tables, or blood pressure cuffs to accommodate  a big patient. Obese patients have actually been sent to the freight dock to be weighed. We have a fat prejudice in this country that simply shames some of our overweight friends into believing that they are not able to be thin, do not deserve to be thin, and must forever live discouraged and in despair of ever feeling or looking normal. They are in an endless loop of self-defeatism.

Consider these thoughts as you think about your weight and the weight of your family members. Are you facing a psychosocial barrier? Are you just too sedentary in your personal lifestyle? How many times per week do you find yourself in the fast food drive through asking for double or supersized items? Click over to the National Institutes of Health sight and compute your BMI. If it's 24 or less, you are in the normal, healthy weight range for your height. A BMI of 25 to 29 falls in the overweight range and you could develop high blood pressure or another factor of Metabolic Syndrome. If your BMI is 30 to 39, you fall into the obese range and are definitely at  risk for Metabolic Syndrome occurrences. A BMI of 40 or greater is considered Extreme Obesity; your risk of life threatening health conditions is very real and should be  taken very seriously. Anyone with a BMI of 30 or more should consider seeing their medical provider for a check up and consulting a nutrition counselor or dietician for guidance.

Part 2 of this series will address food. We'll look at diets, including the vogue diets, meal planning, portions, macro nutrients, energy balance, and meal replacements. Between now and then, you are invited to submit your questions about food so I can address  your concerns in the next article.

flora@sitnews.org
 

©Compliments To Your Health
Joann Flora 2004

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