Public Enemy Number ONE
By: Rob Wilkins & Mike O'Hearn
"Only smoking exceeds obesity in its contribution to total mortality rates in the United States. The nation can no longer afford to ignore obesity as a major medical problem." -- Dr. William Dietz, Director of Nutrition and Physical Activity Centers for Disease Control and Prevention, Atlanta, GA
A recent study by the American Cancer Society found that the obesity epidemic spread rapidly during the 1990's across all states, regions, and demographic groups in the United States. Like a swift-rising tide, obesity has crept into every corner of our nation. The rate of obesity (defined as being over 30 percent or 35 to 50 pounds above ideal body weight) increased (in the US) from 12 percent in 1991 to 18 percent in 1998. Of the 45 participating states in 1991, only four had obesity rates of 15 percent or higher. By 1998, 37 states had obesity rates of 15 percent or higher.
The highest increase occurred among the youngest ages (18 to 29 year-olds). Though all states showed an increase in obesity, the size of the increase varied greatly. Delaware had the lowest increase (11.3 percent) in obesity rate, from 14.9 percent in 1991 to 16.6 percent in 1998. On the other end of the spectrum, Georgia's obesity rate doubled, from 9.2 percent in 1991 to 18.7 percent in 1998, the largest percentage increase of any state.
It's estimated that forty million adult Americans are 50% above their ideal weight and 22 percent are obese, even though weight-loss products and services are a $33 billion-a-year industry.
The 1996 SURGEON GENERAL'S REPORT ON PHYSICAL ACTIVITY AND HEALTH shows that more than 60 percent of adults are not participating in the recommended 30 minutes a day of moderate physical activity most days of the week. In our present society, "physical activity" consists of 8 hours on the computer and relaxation consists of 2-3 hours in front of
the TV. Due to our lack of physical activity, the insidious spread of obesity seems to be inevitable.
What Is Obesity?
Obesity is probably the oldest metabolic disorder known to man. Evidence of obesity is found in Egyptian mummies and in Greek sculpture. Obesity is a disease that affects at least 70 million Americans: more than one-third of all adults and one in five children. Obesity is determined using body-mass index (BMI), a method of comparing height to weight. A BMI of 25 to 29.9 is considered overweight, and a reading over 30 is considered obese. A BMI of 19 to 24.9 is considered normal weight. Using that standard, obesity researchers have estimated that more than half of adult Americans are either overweight or obese.
Each year, obesity causes at least 822 excess deaths "PER DAY" in the U.S. and costs the country more than $240 billion in obesity-related illnesses. Obesity increases one's risk of developing conditions such as high blood pressure, diabetes, heart disease, stroke, gall bladder disease and cancer of the breast, prostate and colon. The inclination to become fat/obese is increased by the American lifestyle: lack of physical activity, lack of time to prepare well-balanced meals, combined with abundant, mouth-watering, high-fat foods.
Only cigarette smoking kills more Americans than obesity and despite this fact, obesity does not receive the attention it deserves from government agencies, the media, the health care profession, or the insurance industry. Medical research related to obesity is severely limited by a shortage of funds, inadequate insurance coverage for treatment, and discrimination and mistreatment of people with obesity.
"Overweight and physical inactivity account for more than 300,000 premature deaths each year in the U.S., second only to tobacco-related deaths. Obesity is an epidemic and should be taken as seriously as any infectious disease epidemic," says Jeffrey P. Koplan, director of the Center for Disease Control (CDC). "Obesity and overweight are linked to the nation's number one killer?heart disease? as well as diabetes and other chronic conditions."
A national effort is needed to control the epidemic. Health care providers must counsel their obese patients; workplaces must offer healthy food choices in their cafeterias and provide opportunities for employees to be physically active on site. Just as important, schools must offer more physical education that encourages lifelong physical activity. And finally, during a recent interview on "CNBC," bodybuilding icon, Arnold Schwarzenegger stated, "Parents must get involved with their children and fitness, take kids outside, play, exercise, and drop the TV." In general, restoring physical activity to our daily routine is paramount.
The current American lifestyle of inactivity has had a devastating toll on every segment of society, particularly on children. Research shows that 60% of overweight 5 to 10 year old children already have at least one risk factor for heart disease, including hyperlipidemia and elevated blood pressure or insulin levels.
A study published in the October 13, 1999, issue of JAMA, noted more than two-thirds of American adults are trying to lose weight or keep from gaining weight, but many do not follow guidelines recommending a combination of fewer calories and more physical activity. Instead, many often choose fad diets or fat-burning pills that only offer temporary relief. Until their lifestyle is permanently changed, the weight will always return. Obesity has a dramatic impact on reducing life expectancy, mainly due to heart disease, and in increasing the time spent in poor health.
A study conducted at Duke University's Clinical Research Institute, Durham, N.C. tracked more than 9,400 heart patients for 12 years. The results of the study found that overweight and obese patients got heart disease earlier in life than normal-weight patients. They also suffered more relapses and died at younger ages. Patients included in the study had been diagnosed with at least a 75 percent blockage of one or more coronary arteries. Patients were then divided into normal weight, overweight and obese categories, according to definitions outlined in the National Heart, Blood and Lung Institute guidelines (www.nhlbi.nih.gov.guidelines).
The study found that normal-weight patients were first diagnosed with heart disease at an average age of 66. The age of first diagnosis for heart disease for overweight patients was 62, while it dropped to 57 for obese patients. Normal patients on average lived to age 78. For overweight patients, life expectancy was 77; for obese patients, it was 74. Obese patients also had three to four more years of illness than normal-weight patients.
Not only do obese patients die earlier, they will also experience 17 to 18 years of heart disease, which leads to more time in the hospital, higher medical costs and a greater strain on medical resources. These statics indicate that an obese person could add at least 20+ quality years to their life simply by losing excess weight.
Medical Conditions Associated with Obesity:
Men 20% above desirable weight show an overall increase of 20% in the likelihood of death from all causes, a 25% increase in death from coronary artery disease, a 10% increase from stroke, twice the risk of diabetes, and a 40% increase in gall bladder disease. In men age 15 to 39 whose relative body weight when initially measured is 125% to 135% of normal, there is an aggregate mortality of 170% of usual at 15-22 year follow-up. In men 40% above desirable, there is a 55% increase in mortality from all causes, 70% increase from coronary artery disease, 75% increase from stroke, and a 400% increased mortality from diabetes.
"Malignant obesity" is a term now used to define persons 60% above desirable weight or in excess of 100 lbs. With this degree of obesity, there is a minimum doubling of the prevalence of all causes of morbidity and mortality. Weight reduction is also desirable at all levels of obesity if the patient has diabetes, hypertension, heart disease or other cardiovascular risk factors.
Obesity and Hypertension:
Hypertension is a common result of obesity. In overweight young adults, age 20-45, the prevalence of hypertension is 6 times that of their normal-weight peers. Weight gain in young adult life is a potent risk factor for the later development of hypertension.
Hypertension is infrequent in "primitive" populations who tend to weigh less with advancing years.
Obesity and Diabetes:
Even moderate obesity, particularly abdominal obesity, can increase the risk of non-insulin dependent diabetes mellitus (NIDDM) tenfold. Fat tissue apparently has two roles in promoting diabetes: it increases the demand for insulin and, in obese individuals, it creates insulin resistance, and, therefore, hyperinsulinemia. Adipose tissue sensitivity to insulin remains high. It is therefore possible that nutrients are preferably sent into fat for storage. Some of the insulin resistance in obesity can be attributed to a decrease in insulin receptors; there are also intracellular post-receptor defects. Weight reduction in the obese NIDDM will lead to improvement of glycemic (sugar) control as well as improvement of medical problems such as hypertension or hyperlipidemia.
Obesity and Cancer:
Overweight men have a significantly higher mortality rate for colorectal and prostate cancer; men whose weight is 130% or more above average are 2.5 times more likely to die of prostate cancer during a 20 year follow-up compared to men of average weight. Menopausal women with upper body fat localization have an increased risk of developing breast cancer. Overweight women also have higher rates of cancer of the uterus and ovaries.
Obesity and Arthritis:
An increase in body weight adds trauma to weight bearing joints and in middle age women excess body weight is a major predictor of osteoarthritis of the knee. This is a mechanical problem and not a metabolic one. Weight loss will markedly decrease the chance of developing osteoarthritis.
Obesity and Functional and Psychological Disorders:
Often, an obese individual runs across a number of obstacles while in the performance of daily living. Some of the main obstacles are related to sleep, recreation, work and social interactions. Obese patients also have physical incapacity due to back and joint problems and shortness of breath. This contributes to their proneness to fatal accidents. In the severely obese there is an increased incidence of absenteeism and unemployment. Discrimination against obese persons is common in both academic and work settings. Impairment in body image is the major form of psychological disturbance specific to obese persons. However, psychological disturbances do not appear more commonly in overweight persons than in those with normal weight. Emotional disturbances are often likely to be a consequence of obesity rather than the cause.
Is There an Answer?
Most Americans know the importance of physical activity and medical research has shown without a doubt just how important exercise can be. While televisions, recliners, and "PlayStations" may not come with "hazard labels," being inactive appears to be about as dangerous to your well being as smoking.
"If you want to make changes in your life, you need to exercise," said Dr. John Foreyt, director of the nutrition research clinic at Baylor College of Medicine in Houston.
By age 75, one-third of all men and half of all women have no regular physical activity. Unfortunately, most people who want to lose weight start talking only about cutting calories.
"As a nation, we're getting fatter and that's a national problem," said Dr. Richard Pasternak, M.D., director of Preventive Cardiology at Massachusetts General Hospital in Boston, and spokesman for the American Heart Association. "We're eating less fat, but we're more than making up for it with increased calories from carbohydrates, and we're not exercising as much as we used to," he added.
One of the easiest ways to increase movement is to take walks, doctors say. It can be done almost anywhere, and it doesn't call for any special equipment. Health professionals also advise people to set reasonable goals for the amount of time spent walking, and then gradually include other activities such as weight training, swimming, tennis, golf, and hiking. Other ways to burn calories are to get up and do housework during the television commercials, take the stairs instead of the elevator, or resist the temptation of that perfect parking space. Better yet, if the store is nearby, leave the car in the driveway and walk. The bottom line is if you're not doing anything, start doing something?every little bit helps.
The trend toward increasing levels of obesity in the industrial world has to be reversed. Public health measures including education, counseling and possible legislation similar to that done with smoking and aids are necessary to counteract this serious disease.
(To contact Mike or Rob, e-mail them at mailto:%email@example.com or write: Mike O'Hearn, PO Box 2764, Venice, CA 90294. Check Mike out on the web at http://www.mikeohearn.com/)
** Special thanks to Merry Knowlton for her contributions to this article.
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