family practice issues and general life events

The Obesity Epidemic

I don’t know if epidemic is the right word, since it is not an infectious disease, but the rate of growth that it is spreading (no pun intended) certainly mimics an epidemic. From “The Weight of a Nation” documentary recently shown on HBO 1 in 3 children that was born in the year 2000 will develop Type 2 diabetes” Those numbers may seem ridiculously large to the general population, but in my patient population in rural America, lower socio-economic population, it is hardly surprising, other than I might estimate it closer to 1 in 2. Scary, isn’t it? And I don’t think it is because I am a bad doctor, and I don’t think it is because of bad parenting (or at least not intentionally). It is a combination of a lack of education, loss of physical education, a loss of parks and ability to play outside, and the easy availability of fast food and other quick processed foods.

In my practice, I see all ages from 2 weeks to 94 (I think that is the age of my current oldest patient) And throughout the group there is a definite problem that spans the generation. Now am I going to focus on diet and nutrition with the 94 year old, probably less so, but on those that are younger it is very necessary. Today, I had a long talk (or three of them) with patients who told me that they didn’t know why they gained weight or didn’t lose this month. They aren’t eating anything. First of all, I am going to call you on that one. It is physically impossible to gain weight, if you don’t eat anything (I including drinking in the eating). Now once you become morbidly obese, your metabolism does slow down significantly, and it is more difficult to burn the calories that you do take in, but really you have to be honest with yourself about the intake.

Please stop saying that you eat a normal diet. You don’t. How can you? I don’t even know what a normal diet is anymore? The diets that get described to me when I finally get them to tell me what they are eating are far from my typical diet. A large slice of Cheese Pizza from Pizza Hut has 390 calories. (One slice) Multiple that by 8, and 3180 calories are found, which is more than anyone needs in a day, much less a meal. (And yes, I do have patients that eat that as their meal. Well, no, I don’t, it is a supreme pizza or pepperoni) And I am not saying that I never eat pizza, merely that it needs to be in moderation, it is not a terrible food, but really needs to be done in a portion size.

And a portion size can Fit in the palm of your hand. (Give or take) A serving size of meat is about the size of a deck of playing cards. I don’t care it you can eat the 72 ounce steak from the big Texan, that is 12 serving sizes of meat. Hardly healthy. I find that the type of meat you eat is less important than the size and method of preparation. Frying fish, takes out all the heart healthy benefits that are found in the Mediterranean diet. Those Omega 3’s are drowned in a sea of saturated fat.

If you go to the grocery store, a nutritionist that I know, told me shop the edges. All the unprocessed foods are on the edges, fruits, vegetables, milk, cheese, deli, etc. Even the frozen food section with the frozen fruit is often on the edge. You don’t need the mac and cheese, the canned meats, and the like. If it can’t go bad, it probably should not go into your body in any significant amount.

And at the very least keep track of the calories you are taking in. We are terrible as adults in estimating the amount of calories we consume. The journal of Clinical Nutrition estimates that we underestimate our calorie consumption by as much as one third. So if you think you are eating 1800 calories, it is very possible that your intake is closer to that of 2400 calories. Over time that adds up. We are not as bad as kids. Think about it, children who are not forced to clean their plates, tend to stop when they are no longer hungry. Those children tend to be leaner.

We have shut off our thirst mechanism, and instead believe it to be water. It takes 20 minutes for your body to realize that it is full. So if you eat slower and chew your food, you are bound to get up from the table eating less calories. However, during the day, that hunger pain you feel? Well if might not be a hunger pain at all, but your thirst mechanism. By the time you feel thirsty (dry mouth) you are already partially dehydrated. So I tell all my patients, make sure that you eat, in portion sizes, but if you feel hungry, take an 8 ounce glass of water and drink it, wait 30 minutes. If you are still hungry, then eat. This would cut down on quite a bit of intake.

I also see several people who say that they can’t eat until 10 pm, so that is why they retain their weight. Well, I am not quite as tied to the rule of no food after 7 pm for them. Why did this weight loss gem come about? Think about what the “typical” American does after 7 pm. They are tied, so they sit down and watch television. (For those of you whom this does not apply, well that is great) And what do you grab while in front of the television? Fruits and vegetables? Hardly- that is when the junk food comes out in the greatest quantity. Eating an apple at 9:02 pm is hardly going to ruin your diet, but eating a whole tin of Pringles and washing it down with a 20 ounce Mountain Dew, well that is not so good. There are legitimate reasons for not eating that late- reflux tends to be worse in those that eat within two hours of bedtime, and your activity level does decrease so their is some slowing of the metabolism, but seriously if you eat 1200 calories throughout the day, you will probably lose weight, regardless of whether you have your dinner at 10 pm or 5 pm.

And those sodas- just stop. They are empty calories and sugar. And the diet ones are less calories, but artificial sweeteners and both trigger your appetite and make it difficult to manage your portion size.

And for those of you in the South. That sweet tea, which is mostly sugar, well that is not helping either. It is not helping you hydrate, and there is little benefit from it. So other than occasionally, really don’t down it thinking that it is healthy.

And then the gorilla in the room, EXERCISE. At some point we as a nation stopped exercising. Our kids no longer get to play outside, Physical education programs are cut, and with the lack of exercise they see their parents doing, is it any wonder that our kids are growing larger? Type 2 Diabetes, a disease previously named Adult Onset diabetes is becoming more and more common in this group. And if they are not diabetic, they are insulin resistant so they are within 5 years of the diagnosis of diabetes. We have got to get our kids (and parents) moving. Kids learn more from watching their parents then from anything that they say. You can’t expect your kid to exercise, if you don’t get yourself moving. And it doesn’t have to be running. Walking is good, Bike riding, roller blading/skating, swimming or anything else that you find enjoyable. But get up and move.

I like to suggest a pedometer. They range in prices from around $5 to the $99 one from FitBit. I actually own the Fit Bit one, and while you might ask, “Why would anyone pay $99 for a pedometer?” I like mine because I can keep track of it online. Add to it the FitBit app for my iPhone, and I can keep track of my meals and my exercises, and they recently came out with a scale that will link with the site. Allowing for all of the sats in one place. It is nice, and convenient. But regardless, a pedometer is nice, because you can shoot for 10,000 steps a day. It is difficult not to lose weight if you take 10,000 steps in a day. And if you have that goal, you know where to shoot for. And that is something that everyone can do.

We all need to worry about obesity. Especially as it helps to escalate health care costs. There are great bariatric surgeries available but they are not without risk, and really wouldn’t you rather prevent the need for surgery and the complications of obesity for both you and your children?

;

My data on the calories from a single slice of cheese pizza of 390 appears to differ from that posted on the Pizza Hut website of 360 calories. I should have gone to the website itself than using a different more general website.
As for the statement that diet sodas have less calories, it is true that they have no calories. I was more illustrating that drinking them over regular soda you eliminate the empty calories but recent studies are showing increase in the risk of heart attacks and may stimulate your appetite, and may cause you to gain weight in the long term. This is the result of a recent study from Harvard University

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Comments on: "The Obesity Epidemic" (6)

  1. This post is crap. One of the first pieces of actual information given in it took me 5 seconds to google and invalidate. A large slice of cheese pizza from Pizza Hut is 360 calories, not 390. I know it’s a tiny difference, but the lies add up. Diet sodas have “fewer calories” — it’s true — they have zero calories. Criticizing diet soda for anything but the added sodium is silly. Your snooty commentary about processed foods here and there is nonsensical too.

    You mention portion control, but you also mention exercise as if it’s contributed to the epidemic, and it hasn’t. Please get your facts straight, this is a good place to start: http://www.nytimes.com/2012/05/15/science/a-mathematical-challenge-to-obesity.html?_r=3

    • Looking at the Pizza Hut site your number does differ from mine on calories. I used another site which allows me to track different food sources. http://caloriecount.about.com/calories-pizza-hut-large-pan-cheese-i54324
      Probably in error, but I will admit to it.
      As for diet soda not deserving criticism for anything other than the calories, you appear to have missed the Harvard University study linking it to increase risk of MI, and weight gain. It appears to stimulate your appetite and causes people to gain more weight with time. While these studies are yet to be conclusive, there appears to be a link.
      http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-vs-diet-drinks/

      As for decrease in exercise not contributing to the increase in obesity, the CDC would be to differ with you as they track the statistics.
      http://www.cdc.gov/obesity/data/adult.html
      As for calling me a snob regarding the processed food Nature discusses the trend between the increase in processed foods and obesity.
      http://www.nature.com/oby/journal/v12/n11s/full/oby2004277a.html

      He does not cite his source for physical activity not changing. The NIH, CDC and other groups that measure these statistics plus other medical scholarly journals, they all cite decrease in physical activity. These journals include the Lancet, the New England Journal of Medicine, and other accepted scholarly peer reviewed journals. And no offense to the New York Times, but it hardly counts as peer reviewed. However, if he could cite his source I would be glad to read and study it.
      Exercise is not the only problem, nor is the food that we are eating. The two together with quantity of food, quality of food and some genetics are all coming together to cause a problem which needs to be addressed.
      I an sorry that you found my blog so lacking, but other than the caloric error on the slice of Pizza Hut Pizza and one mathematician’s opinion you have yet to illustrate with accepted peer review data your opinion. No exercise is not the full answer, but to suggest that as a country we have not become less active is less than genuine.

      If you can show me his source that we have not become less active, I am willing to read it. And if you can find accepted sources that the rest of my information (minus the calories in a slice of pizza) is incorrect I will look at them. But without such data, I will not answer you again.

      • Great response, Melissa! And I am 100 percent in agreeance with you on this matter. It’s sad for me to see this epidemic rising, and sometimes the best defense against it is the hard facts. Great post!

      • Thanks. It has been weighing on my mind for a while and I don’t know which illustrates it more the fact that the amount of patients that I have gained that were too big for my original scale (350 pound Max) or the number of kids that I have had to tell their parents that their children were very insulin resistant and would be diabetic in 5 years if changes were not made now. And education is the only weapon we have today

  2. Lots of things have changed since I was a kid, we used to be outside all the time running free(there was no fences back then)and we rarely ate at restaurant, fast food were not present in my area and almost every meal was made from scratch. We didn’t hear about health so much but we were healthier.
    I am trying slowly to get back to the basics because it only makes sense. I like what you said “If it can’t go bad, it probably should not go into your body in any significant amount.” The picture I had in my head when I read that was a big pot of cheez weez sitting on a non-refrigerated shelf but still supposedly good to eat. Great post! 🙂

    • Thank you. You make a good point that we didn’t used to eat out so much. I didn’t put that in but that is part of the problem. Fast food is convenient and chain restaurants are there (and other restaurants) and we have no control over what is put in our food by eating at these places regularly. I am just as guilty, choosing convenience over health, but am trying to take the steps necessary to fix that. It is a process, and we all have to do what we can to fix it.
      I find the picture of us sitting on a mound of Cheez Whiz funny

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