ON A TUESDAY EVENING, IN A brightly lit classroom at West Jefferson Medical Center in suburban New Orleans, 10 fat people are gathered for their weekly support meeting under the guidance of a physician, a psychologist, and a dietician. One by one, the participants share their successes and lapses. "I lost one pound since last week," says Robert. The group answers with polite applause. Next, Tiffany: "My weight was the same." Sympathetic nods. "But I bought a new skirt and I went down three skirt sizes." Enthusiastic clapping.
Behavioral-modification programs like this one designed to treat obesity can be found across the United States. But the participants in this case are children, some as young as five. The average participant enters the clinic at an astonishing 69 pounds overweight. These children are far from unusual. As of the early 1990s, the National Center for Health Statistics (NCHS) found that 11 percent of children between six and 17 were overweight, twice the comparable percentage a decade earlier. Today there are 5.4 million overweight American children, and another 7 million considered "at risk" of joining them.
The epidemic of childhood obesity is only the latest grim chapter of a burgeoning American tragedy. The NCHS found that the proportion of obese adults increased by two-thirds in the 30 years from the early 1960s to the early 1990s. Telephone surveys by the Centers for Disease Control (CDC) have shown obesity rates skyrocketing another two-thirds since then.
In 1991, when the epidemic was less intense, researchers from St. Luke's/Roosevelt Hospital in New York estimated that obesity killed 325,000 Americans a year--eight times the number who die of AIDS, and more than the combined deaths from alcohol, drugs, firearms, and motor vehicles. It approaches the 430,000 per year killed by smoking. But while smoking rates are going down, obesity rates are accelerating. Soon--if it hasn't happened already--obesity will become the number-one killer in America. The cost of caring for those sickened with entirely preventable obesity-related illnesses tops $70 billion per year, about half of which is paid by government.
Now, here's the scary part: Everything the medical community has prescribed to fight obesity has failed. Even the best programs, like the kids' clinic in New Orleans, do little more over the long term than keep off a few pounds. Since the 1950s, health experts have been warning Americans to lose weight and telling them how: by eating less and exercising more. Over that time, obesity rates tripled. It's about time we admitted that we are losing the battle against obesity.
This isn't news. Individually, we beat ourselves up for lack of willpower or for choosing a night at a burger joint with the kids over a trip to the gym, dramatizing personal failure even though in today's junk-food-laden society, it's nearly impossible to stay thin. The desk job, the television, the Internet, suburban housing developments and their roads to nowhere all conspire against us. Yet we still view obesity as an individual problem, and so does the government.
But the epidemic is spreading at such an alarming rate that it can no more be viewed as an individual failing than 19th-century cholera epidemics could be blamed on poor personal hygiene. Indeed, given the rate Americans are dying, we'd better start treating obesity like an infectious epidemic. Combating obesity and its many attendant illnesses will not require more cholesterol-lowering drugs or even diet books or workout videos, but rather a retooling of our environment to get us moving again and to put the doughnuts a little farther out of reach.
The dangers of mid-management spread
Obesity is not just an image problem. Those who are overweight are more likely than thin people to die from heart disease. They have higher blood pressure and greater risk of stroke and kidney failure caused by hypertension; colon, breast, and prostate cancer; gallstones and arthritis. To this list, the National Institutes of Health (NIH) adds "complications of pregnancy, menstrual irregularities, hirsutism, stress incontinence, and psychological disorders (depression)."
Overweight people are also much more likely to develop diabetes, an increase in blood sugar derived from the body's resistance to the hormone insulin, which itself increases the risk of heart disease, stroke, and kidney failure. By damaging circulation in blood vessels, diabetes can lead to infections of the extremities, usually the feet, necessitating amputations. It causes blindness. From 1958 to 1998, the percent of American adults diagnosed with diabetes increased sixfold. At least 20 million Americans now have diabetes, including millions who are unaware. Related medical care costs, currently $44 billion a year, are rising fast.
These days, it isn't hard to spot truly gargantuan people. Watching a 300- or 400-pounder lumber down a supermarket aisle or struggle into an airplane seat, it's easy--perhaps even comforting--to decide that our own 20- or 30-pound inner tubes are nothing to worry about. But because there are so many more of us than them, far more of those who die unnecessarily are in our group. The epidemic isn't just a problem of the grossly obese; it's a problem for all of us.
Americans know that fat is bad for us. We've been hearing it for a half a century, from American Heart Association warnings in the 1950s to pamphlets distributed by the President's Council on Physical Fitness under Lyndon Johnson in the 1960s, to grave CDC warnings about the deepening problem in the 1990s. For a time, in the 1970s, it appeared as though the nation might overcome its fat problem. After Frank Shorter took the gold medal in the marathon in the 1972 Munich Olympics, road races sprouted up everywhere, some with tens of thousands of runners. Sports like tennis and golf also boomed. By 1978, U.S. News & World Report was trumpeting a "fitness mania." "We believe that America is going through a physical-fitness renaissance that can make a real dent in degenerative diseases," Richard Keelor of the President's Council on Physical Fitness said at the time. But it was about this time that already rising obesity rates started to skyrocket.
A Coke a day makes the fat genes play
Why are we so much fatter than our parents 30 years ago? After all, while dietary surveys over the last 20 years show inconsistent results, none show big increases in the number of calories American adults eat per day. Sports clubs, gyms, and road races seem to be springing up on every corner, at least providing the illusion that some people are working out more than they used to.
NIH researchers are spending tens of millions studying the biology behind this conundrum. They've unearthed some interesting facts: Some people are more prone to become obese than others, and to some extent this bad luck is in their genes. The recently discovered hormone leptin helps regulate appetite and physical activity; a handful of people become obese for lack of an adequate supply. But human genes and metabolism don't trump the basic laws of metabolics: We gain weight when we eat more fuel than we burn. If we eat 2,200 calories a day and burn 2,000, our bodies--programmed for the near-starvation conditions of our hunter-gatherer days -- store fat for the next famine. We tend to eat a fairly consistent amount of food no matter how many calories we need, so high-fat calorie-dense foods make us fat.
Laboratory rats switched from rat chow to a "supermarket diet" similar to the high-fat diets of modern Americans quickly grow obese. And, when we're not hungry, we can still be tempted by foods or drinks that meet our biologic cravings for sweet or high-fat foods.
It doesn't take much caloric imbalance to make people obese, only consistency. For instance, if a person drives instead of walks for only 20 minutes every day for a year he will store about 26,000 calories, thus gaining about five pounds. Researchers at the University of Minnesota estimated that over a year, those who spend only five minutes each workday sending e-mails to coworkers instead of visiting their offices will gain an extra pound. Drinking a single can of Coke every other day will contribute enough calories to add about four pounds. Most of us gain weight this way, a few grams a day, a few pounds a year--but enough to shorten our lives.
Fat Failures
As a nation, what have we done to respond to this epidemic that kills 325,000 people a year?
