family practice issues and general life events

Posts tagged ‘obesity’

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?

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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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Obesity epidemic and school lunch standards

About 5 days ago, the USDA set guidelines for healthier school meals.  As a physician, I should get totally excited about that, but upon hearing the full story, I think my reaction is more of a what?  As the obesity epidemic reaches dramatic proportions, our children are not left out.  According to the American Academy of Children and Adolescent Psychiatry 16- 33% of children are obese.  This is a startling statistic but based on my patient population, I would estimate the number is closer to the 33% rather than the 16%.  But then again, I live in southeastern Oklahoma, and see a patient population of 45% Medicaid.  That is their primary insurance, it does not include those who qualify for Medicaid as a secondary insurance.  During medical school, I never imagined that I would be consulted by parents regarding their underweight child, only to determine he is the only one in the family that is on the growth chart and of a normal weight with respect to his height.  Or the number of children dragged in by their parents sure that their child has a thyroid problem, because it could not be that the only exercise the child gets is to get up off the couch to go to the bathroom between commercials, or that a large pizza is considered a serving size for them.  So I understand that obesity is a problem in our youth.  And I would applaud any efforts to help curb it, should those efforts actually make sense.

This is not an argument for whether I want to subsidize school lunches, food stamps or other government agencies.  These programs are in place, and for the moment, if we are to continue with them at least let their policies make sense.

Per the report found in Reuters  “The guidelines double the amounts of fruits and vegetables in school lunches and boost offerings of whole grain-rich foods. The new standards set maximums for calories and cut sodium and trans fat, a contributor to high cholesterol levels.”  And while I fully understand that, and the attempts to offer only fat-free or low-fat milk, and assure that proper portion sizes are given to children, I doubt that this is even possible to enforce much less implement.

My experience with cafeteria workers is that few if any realize what a proper serving size for an adult, much less a child.  I spend quite a bit counseling patients that serving sizes are roughly the size of their hand (since it is much easier to grasp and compare than carrying around a scale).  And currently, I have heard of schools allowing 2nd and 3rd servings to children.  With few exceptions there is not a child that ever needs a third tray of food.  (Those rare exceptions of underweight and active children this applies to the population that are not at that end of the spectrum)

Not to mention, the black market aspects that could foreseeable pop up.  Who is going to keep kids from bringing food from home?  I know it is being attempted in Chicago, but I remember sneaking brownies and gum into the classroom, where we weren’t allowed to eat as a child.  How are you going to determine if this is food from home, or from the cafeteria itself.

And the biggest reason that this will not work, the original proposal was blocked because potatoes were not initially allowed as a vegetable.  And pizza was also not allowed as a vegetable.  I like french fries and pizza as much as the next person, but let’s be real, health food they are not.  When the food manufacturers selling the food are allowed to dictate what constitutes health foods and what does not, there is a problem.  What child is going to pick an apple over french fries?  Will the school lunch still be able to meet the nutritional standards?  How precisely would those two be considered nutritional equivalents?

As a physician, I spend a lot of time talking to new diabetics and obese patients about their diets, and well pasta and potatoes appear to be the biggest contributors to the caloric intake.  It is what they learned from the USDA and their food pyramid.  The very same organization setting these standards.   The same organization which allowed the lobbyists to dictate the new standards.  And at what cost?

While I agree we have to start somewhere with educating the public and attempting to change the dietary habits of children before the suffer the health effects of obesity, including early onset Type 2 diabetes, hypertension, and high cholesterol, I don’t see this actually being effective.  Substituting whole wheat for white flour in pizza and spaghetti, while it looks like a wonderful idea on paper, may instead be thrown away in favor of other offering either by the school, or an entrepreneurial student.  And while I am in full support of the potential economic lesson this might lead to, it most likely will do little to help.  Nationwide standards have not helped to improve our education system, and without getting input from local officials and parents, I doubt that this will be much different.

Had change been truly desired in the school lunch program, input would have come from the parents, teachers, physicians, dietitians rather than the food industry who would have seen their potential profits cut.  The making of a pizza a vegetable merely because of its tomato paste (which is incorrect, since most use sauce which has a lesser concentration of tomatoes and tastes better) shows just what kind of answers we get from Washington.

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