NY Times Reporter's File on Obesity: Could you BE more pessimistic?!

Dear Laura,

I received your email re: NYTimes.com: Reporter's File: Obesity. Per your comments concerning the content of said "file", I have responded below in an itemized fashion.

(I would like to note that I am NOT a medical professional, nor a professional of any kind (besides being on the Board of the North American Jackass Association, NAJA). Therefore, my comments are purely my own opinion and do not reflect the established opinion of the Western medical community. However, I would like to note that I have read widely on the subject of obesity in the United States because it is a curious problem and besides, everyone and their mom seems to have their own idea about why the U.S. is so fat, so why shouldn't I?!)

1. Let's start at the beginning, shall we? On the issue of genetics, Reporter's File says:

Diet and exercise do matter, they now know, but these environmental influences alone do not determine an individual’s weight. Body composition also is dictated by DNA and monitored by the brain. Bypassing these physical systems is not just a matter of willpower.

You already knew this. People look different and have different body types and are able to consume different foods to different effects. Some people are going to have an easier time gaining weight that losing it just as others will stay thin forever.

Is this an excuse for obese people? Should we all just get over the fatness because it's genetic?! It might sound like that at first, but I don't think it is. There are several factors at play here, and none of them reign supreme in determining weight. Genes, diet, exercise and willpower are all important parts of the equation here. They are clearly not EQUAL parts of the equation, but they are contributing factors nonetheless.

The article also completely seems to miss the influence of other factors like stress and sleep deprivation, not to mention the higher prevalence of obesity among people with low SES. Maybe those things are considered "weaker" or maybe just more boring. It's hard to say.

2. On the issue of diet, Reporter's File says:

The nation’s poor diet has long been the scapegoat... The recent rise in obesity may have more to do with our increasingly sedentary lifestyles than with the quality of our diets.

It seems there is evidence that we Americans have been eating a lot of crap for quite awhile now, but I would argue that the definition of "crap" has deteriorated to an even lower level of crappiness.

Case in point: The article points to the fact that in 1966, McDonald's had already sold about 2 billion hamburgers. What they don't say is that in 1966, people were washing down those hamburgers with a 10 ounce can of Coke, or more likely, a 6.5 ounce bottle. Today, it's more likely that people are eating Big Macs (not introduced until 1968) which weigh in at 540 calories, a large fries (500 calories) and drinking a 32 ounce Coke (310 calories). Can you do that math? It's 1350 calories. I SERIOUSLY doubt that a meal at McDonald's in 1966 was 1350 calories. Yes, we sit around on our asses a lot more, but there is no doubt in my mind that we are consuming a lot more calories to go along with it.

(Which is to offer no explicit comment on the increasing size of individual soda quantities. A year ago, a Pepsi spokesperson explained the reasoning behind the introduction of 26- and 16-oz bottles into convenience stores: "[It] is about giving consumers more choices, and if that leads to more frequent transactions and greater volume, it's also a win for our customers, our bottlers and us.")

3. On the issue of exercise, Reporter's File says:

The leisurely after-dinner walk may be pleasant, and it may be better than another night parked in front of the television. But modest exercise of this sort may not do much to reduce weight, evidence suggests.

The key word here is "modest." A meandering 20 minute walk will hardly get your heart pumping. Unless, of course, you are extremely overweight and you just ate the McDonald's Big Mac, fries and Coke for dinner and also the walk is uphill. This sort of modest exercise *might* help you maintain your weight so you don't gain any more, but it's not going to reduce weight.

The Reporter's File fails to mention exactly what type of exercise can aid weight loss, so it seems like exercise is worthless. Obviously that is not the case. Have you seen The Biggest Loser? Have you noted how hard they work out? So hard! And how long? Hours! A huge amount of effort is expended to lose all of that weight. And once they get to their "goal weight", whatever that may be, it's going to be more hard work to maintain that weight. This effort does not fall under the "modest" exercise category. It's hard f-ing work, but exercise can help.

However, for the average person, I think that if you only exercise to lose weight, you are going to be disappointed. It takes more than 30 minutes of cardio twice a week to see significant weight loss. Fortunately, the benefits of exercise are far-reaching! Exercising affects your muscles and bones--from your legs and arms to your heart and lungs--is incredibly important to your physical and mental health. The Reporter's File mentions nothing about this (since it has nothing to do with obesity) but it's useful to note that exercising isn't just about weight loss.

4. On the issue of the body's/brain's determination, Reporter File says:

Scientists now believe that each individual has a genetically determined weight range spanning perhaps 30 pounds.

I really don't know anything about this. It's the genetic thing again. Obviously, this 30 pound span is not a hard and fast rule. If that's true, then how does a person grow to be 40, 60, 100 pounds overweight?

I don't want to get touchy-feely, but if this "30ish pound span" idea is correct, there is clearly a pretty big disconnect between what we think our bodies want and what they actually need. People must be seriously ignoring the subtle signs they receive from their body in order to gain so much weight. Does your body really want a Big Mac or is your brain just mesmerized by the fluffy bun, the sizzling patty and the glistening cheese? (Yes, sometimes cheese glistens with delicious cheese sweat.)

5. On the issue of maternal diet and pregnancy, Reporter's File says:

According to several animal studies, conditions during pregnancy, including the mother’s diet, may determine how fat the offspring are as adults. Human studies have shown that women who eat little in pregnancy, surprisingly, more often have children who grow into fat adults. More than a dozen studies have found that children are more likely to be fat if their mothers smoke during pregnancy.

I believe this. This research is fairly new it seems, but it's pretty compelling and scary as hell. The Reporter's File was updated August 2007, and already there have been some new updates in the role of the maternal diet. In January, researchers found that a high-fat diet can lead to fatty liver disease in newborns, which sounds like a fantastic way to start a new life.

Overall, on the first read the Reporter's File comes across as hopelessly pessimistic. But after I read it a second, third, fourth time, there really isn't any content that you haven't heard before. The difference is that you usually hear bits of this information accompanied by tips and tactics to combat the somewhat depressing information. But the File lays the bad news on thick and without relief.

But that's the point. The title is "For the Overweight, Bad Advice by the Spoonful," not "I'm Going to Tell You a lot of Bad News, and Then Make You Feel Better About It." The facts are that it's hard to lose weight and there are a lot of factors stacked against the obese.

A little awhile ago I posted a quote from an editorial in the American Journal of Public Health. Essentially, people are starting to recognize that the epidemic of obesity (and yes, I'd call it an epidemic if 66% of Americans are overweight or obese, according to the File) is not just a personal problem shared by of millions of individuals. It's systemic. The way We eat, the way We teach our children, the way We do business, etc. is quickly becoming one giant, intertwined mess of misinformation.

The File makes it seem like there is no hope for the obese Individual, and maybe there isn't a lot. But I think there is hope for the obese Society, if we start making some difficult changes in the way we live our lives.

Love,
Chloe

Intro to Napping: And finally, a nod to weight maintenance

While we're still on the subject of napping (sort of), I wanted to leave you with this final tidbit from Take a Nap! explaining how a lack of sleep affects metabolism, leading to weight gain.

Sleep-deprived people become more susceptible to obesity, and consequently, arteriosclerosis and diabetes. A University of Chicago study found that subjects restricted to six hours of sleep a night for as few as four nights already showed increases of insulin in the bloodstream similar to what happens in a prediabetic state. When we deprive ourselves of sleep, the brain sends a signal that we are entering a period of overdrive and need extra energy to support our mental and physical functions. This causes us to crave high-fat, high-glucose body fuel--in other words, junk food--another reason why Americans can be both the hardest workers on the planet and the most overweight.

And practitioners of the Zone, Atkins and South Beach diets take note: Inadequate sleep causes decreases in the hormone leptin, restricting the body's ability to break down carbohydrates.

How do you like them apples? I think this also can explain the Freshman Fifteen... along with copious amounts of alcohol and Lucky Charms. Or maybe that was just me.

In any case, this information supports the idea that sleep effects the whole body. According to SleepDeprivation.com, inadequate sleep impairs:

• Our ability to think
  
• To handle stress
• To maintain a healthy immune system
• To moderate our emotions
• To stay awake while making sandwiches (Kidding)
  

But I don't think this is news to you. Obviously, when you don't get much sleep, you feel like crap, can barely function and cry at the drop of a hat. Or again, maybe that's just me. But I doubt it.
Side note: Actually, I am notoriously horrible after not sleeping much. The stories I could tell... If I'm woken prematurely, HEADS WILL ROLL. Not kidding. There may or may not be warrants against me in three states.

To close the napping conversation, I wanted to leave you with a couple napping quotes I came across over the last few weeks. Enjoy!

"No day is so bad that it can't be fixed with a nap."
Carrie P. Snow

"You must sleep some time between lunch and dinner, and no half-way measures. Take off your clothes and get into bed. That's what I always do. Don't think you will be doing less work because you sleep during the day. That's a foolish notion held by people who have no imagination. You will be able to accomplish more. You get two days in one - well, at least one and a half, I'm sure. When the war started, I had to sleep during the day because that was the only way I could cope with my responsibilities."
Winston Churchill (Are we sure this wasn't former President Bush? No.)

Digest a 'la Simone: Thinking=Eating, Excuses

Two recent suggestions from my friend Simone.

From Jezebel, I'm not fat, I'm just smart details the findings of a new study that found that people consume more calories following "intellectual work" than after relaxing. Apparently, doing a crossword or Sudoku puzzle causes people to eat more calories than say, staying at wall. (That is, of course, unless your name is Henry David Thoreau.)

The study's main author, Jean-Phillipe Chaput hypothesized that this could be a contributing factor "to the obesity epidemic currently observed in industrialized countries."

Meh. I don't know about this study. Something seems off.

Firstly, the problem is not just the consumption of more calories--it's the consumption of bad calories. When most people snack during the work day or during finals or whenever, it's most crap food: chips, cookies, and crunchy salty sweet things.

Secondly, this implies that a lot of people (specifically, people with weight problems) are doing a great deal of heavy thinking, if you will. Really? I don't know.

From Lifehacker, Why Your Self-Handicapping Excuses Don't Work (And How to Fix Them) highlights a NY Times article discussing self-handicapping.

Self-handicapping is something that everyone does on occasion, but people who do it regularly are generally seen as annoying. Who wants to hear excuses all the time? (Otherwise known as whining.)

To protect our fragile egos, we've all thrown out the occasional "my dog ate my homework" type excuse, but for people who do it often, it becomes an exercise in self delusion. The Times cites some interesting information:

Studies of college students have found that habitual handicappers — who skip a lot of classes; who miss deadlines; who don’t buy the textbook — tend to rate themselves in the top 10 percent of the class, though their grades slouch between C and D.

It's one thing to miss an occasional deadline, forget an appointment, etc. but when the same thing happens consistently with the same reasons for failure being offered, it's not healthy.

The Times also points out that if someone else is giving excuses for you, people won't hate you. But they don't explain how to get other people into doing it... I suspect the trick is to recruit someone with an extra dose of patience and sympathy.

Good luck with that!

Obesity in the USA

From Jill Richardson on La Vida Locavore.

OBESITY TRENDS 1985-2007 shows a nice little animation of the percent of obese people by state. Watch as each state changes colors through the years, as the residents gain more and more weight.


An interesting way to represent the situation. And also disheartening.

Obesity: Maybe it's not ALL your fault

Finally! Something interesting from this crazy community food list-serve I recently signed up for. Andrew Drewnowski contributed a fantastic article to the November 18 Seattle Post-Intelligencer. The dual burden of being overweight and undernourished breaks down and explains the issue of obesity in concise terms that make a lot of sense and are pretty hard to argue with (although there are plenty of opinions if you check out the comments).

Drewnowski, a professor of epidemiology and medicine at the University of Washington, is a pretty smart guy. I also think it helps that this is his life's work, as the director of the Center for Obesity Research and Nutritional Science Program. Plus, he is a prolific writer of all things edible, cheap and fatty.

In this particular article, Drewnowski dispels three common misconceptions about the American obesity issue:

1. Rising obesity rates are not due to an increasingly toxic food environment, but rather a consequence of a failing economy.
   
2. Obesity and diabetes may have a genetic component, but more importantly they follow a "social gradient"... meaning that economic class is a better indicator of obesity than whether or not your parents were.
   
3. Obesity is not the result of poor choices concerning diet and fitness: "The carefully fostered illusion of freedom of choice disguises the fact that most people have none."

It's pretty standard to blame the obese individual for the fact that they're overweight. People that have financial access to a gym and healthy foods are just lacking education and motivation, right?

Unfortunately, not every obese person is a great candidate for Biggest Loser. In fact, the vast majority of the cast are white, middle class adults. Typical? Maybe not.

As far as kids go, a Time article from June 2008 looks at obesity by demographic (It's Not Just Genetics, 6/12/08):

This [childhood obesity] tsunami, however, is a highly selective one. It discriminates by race: according to the CDC's 2006 figures, 30.7% of white American kids are overweight or obese, compared with 34.9% of blacks and 38% of Mexican Americans. It discriminates by income: 22.4% of 10-to-17-year-olds living below the poverty line--less than $21,200 for a family of four--are overweight or obese, compared with 9.1% of kids whose families earn at least four times that amount.

This is what Drewnowski is talking about. When we talk about obesity and malnutrition as a problem of genetics or "toxic food" or personal choices, we completely miss the bigger picture (and maybe on purpose). Once we're able to admit that obesity and malnutrition are just more consequences of poverty, maybe we'll actually take note of the ROOT of the problem and not just address the various symptoms. I believe thats called "preventative medicine."

Investing in health: Fat-O-Nomics

A blurb about gyms in USA Today caught my eye this morning. First of all, Gyms, spas stress value of fighting stress in hard times is a very terrible headline. I thought I had crossed my eyes when I read it the first time, but no, "Gyms stress stress" is really what they're calling this piece. There may be a section editor job opening up tomorrow at USA Today, if anyone's interested.

Anyway, this article looks at gyms with a different perspective than I was expecting. Since it is in the Money section of USA Today, fitness and health are discussed in a rather dry, cynical way, typical of the manner in which products or profitable services are considered. Which I suppose, makes sense for the assumed audience. We're in the Money section after all.

*Side Note: USA Today doesn't even have a Health or Science section. The closest they get is Life, and the lead story on the website today is "Victoria's Secret brings sexy back to Fontainebleau; video." Yes, very relevant to my Life.

Gyms (and spas) in New York are slashing prices in order to retain membership and lure new members, the article relates. But that's not all they're doing in these tough economic times.

Beyond deep discounts, some are adopting a recession spin: touting services as stress reducers, not indulgences, and highlighting the economic benefits of "wellness."

Ah yes! Give gyms your money and not only will they make you skinny and give you "wellness", (Why is wellness in quotes? Why do the quotation marks seem so patronizing?) but they'll also put money back in your pocket! Some gyms even have catchy names to help the public put two and two together.

A Gold's Gym program — deemed "Fat-O-Nomics" — centers on money people can save by shedding excess weight. One stat: Being 50 pounds overweight burns nine extra gallons of gasoline per year.

Nine gallons of gasoline? Thats IT?! Since gas prices have fallen pretty dramatically since the summer, your yearly savings would be less than $25... that is after you lose the 50 pounds, which could take several months. When you figure that a membership to a decent gym will run you about $80-$100 a month, annualized at $900-$1200, saving $25 in gas is nice, but ultimately your wallet isn't impacted that dramatically. And besides, who wants to admit they're part of a program called "Fat-O-Nomics"? Lame.

It turns out that despite the unfortunate name and much to the chagrin of this USA Today columnist, Gold's Gym is onto something important that is about more than saving nine gallons of gas a year. The Fat-O-Nomics site details the ways in which obese Americans pay for carrying the extra weight. Some of the more interesting statistics:

• Obese men and women earn, on average, $3.41 per hour less than other Americans, which means $7,093 less income across the course of one calendar year.
• Americans spend 4% of their annual income on clothing each year, but obese people pay an extra 25% for their clothes. Obese clothing surcharge: $485
• Obese Americans lose, on average, one-half day of work due to obesity-related ailments. Total lost wages: $93.

When the issue is broken down and considered like this, some important things are highlighted. Why are obese people being paid less? Is it employer's size discrimination, or are obese people less likely to think they deserve (and therefore, ask for) raises? Are obese people poorer employees, or are they more likely to be sick and miss work?

I've read enough literature from overweight people to know that these situations are often more complex than they seem on the surface. Like most minority populations, the relationship that obese people have with mainstream culture is tortured and antagonistic. Society blames the individual for being fat and consequently makes them pay for the extra weight, whereas the individual blames the media, models, McDonald's, high fructose corn syrup, Snickers, etc. Few people on either side will take responsibility and no one wins.

The fact is that there are enormous lifetime health care costs related to obesity. It is commonly known that a sedentary lifestyle and being overweight begets a host of health problems. The US Department of Health and Human Services acknowledges this in the Health, United States, 2007 report.

Of concern for all Americans is the high prevalence of people with unhealthy lifestyles and behaviors, such as insufficient exercise and overweight, which are risk factors for many chronic diseases and disabilities including heart disease, diabetes, hypertension, and back pain. The rising number of overweight children and adults and the large percentage of those who are physically inactive raise additional concerns about Americans’ future health.

Like it or not, there are consequences for being obese. Some come from prejudicial BS, but others, the heart disease, diabetes and such, aren't discriminatory.

So despite the fact that USA Today is annoying and Gold's Gym is primarily in it for the profit, if the financial terms of Fat-O-Nomics appeals to people that have been sitting at home eating Pop Tarts and root beer for 15 years, then by all means, continue the campaign. Ultimately, "wellness" isn't some mystical concept: being healthy and taking care of yourself are practical, obtainable goals... whether or not you are stressed out by our nose-diving economy.