family practice issues and general life events

Posts tagged ‘portion size’

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


Give the gift of health

As Christmas approaches I think about the one thing we should all attempt to give our children- and that is the gift of health.  This does not pertain to those poor children with diagnosis such as cancer, chronic illnesses, or other disease states that have nothing to do with habits that you can control.  Instead this focuses on the rest of the population who can do something to help prevent medical conditions.

Childhood obesity is on the rise.  Mostly due to the readily available fast food culture and the decrease in the physical activity of society overall.  This is not a condemnation of McDonald’s.  I believe in the free market, and if the free market demanded salads and low calorie alternatives, McDonald’s would have one answer within a week and possibly a whole new menu within six months.  But the public does not demand it, so there is no change.

No the answer lies on the parent.  I know, easy scape goat.  But who is ultimately responsible for teaching the child, mom and dad.  And most eating habits are learned at an early age, before the child even enters school.  There is nothing built into the child that makes it demand McDonald’s before it can walk or talk.  In fact, if you never take it to McDonald’s requests for it are limited.  Sure they might see commercials on television, but if you limit the amount of television they watch, there would not be a request.  You may substitute any other fast food establishment you desire in for McDonald’s the story is all the same.

In the parents’ defense, in many poorer areas processed and fast food is cheaper and easier to obtain than fresh fruits and vegetables.  It can be done, it only takes more effort.  And lately I am finding that most parents of obese children that I see, know nothing about serving sizes, how many servings a day or the differences between good calories and bad calories.  Somewhere along the line, this information was lost.  Frequently the parent of a 14 year old tells me how much the child has eaten, and seems surprised when I tell them that is too much food.  And in reality, trying to teach a 14 year old good eating habits (or anything else for that matter) is like hitting your head against a brick wall.  It doesn’t do much good and you end up with a headache.

I like to use the hand as a guide for serving size.  While not exact it is a lot more understandable than gram, ounce or other measuring device.  A hand is always accessible.  Smaller hands, smaller serving sizes

The other thing lost, and probably the bigger problem, is exercise.  While XBOX 360 and Wii have created games that help increase the movements with video games, they do not fully replace the playing baseball in the street, riding your bike until dark, or just having fun playing games with one’s friends.  This I am not faulting parents for not letting your kids out by themselves.  I don’t either.  But unfortunately this fun running without a care has disappeared thus eliminating the burning of calories.  In fact it has probably been replaced in many instances with a bag of Cheetos in front of the television, so not only are we not burning calories we are now increasing the amount we are not burning.

Additionally, parents are under the impression that large amounts of juice is good for the child.  First of all if it is not 100% juice, you might as well give the child a coke.  Secondly, no child needs more that 2 glasses of juice (8 ounces) a day, the rest is just empty calories.  Milk should be limited to 3 glasses (24 ounces total) daily.  Water should make up the rest.  And neither children nor adults need any of the sports drinks unless they are actively pursing a sporting activity.  If you are running a race, ok have a gatorade or a G2.  Sitting on your couch – well you don’t need that 240 calories, you have not lost enough carbohydrates to justify drinking any sports drink.

And I don’t care how hyper your 2 year old is, Mountain Dew is not the same as Ritalin (just because they both are technically stimulants).  You can’t diagnose ADHD that young, current accepted age is 6 with some more recent studies saying 4.  However, they are not the same thing.  Not unless you are hiding the Ritalin in a Cocoa Puff anyway.

Additionally, stop giving coca cola in a baby bottle.  First of all, if they are still drinking out of a bottle there is NO good reason for a Coke.  Talking to the dentists around here it is a toss up between coke in a bottle or putting the two year old to bed with a bottle of juice as being the biggest culprits for tooth decay at a young age.   And unfortunately the earlier we teach these habits, the more ingrained they become

This blog is not anti- any of these foods.  I like the occasional trip to McDonalds, and having pizza delivered when you don’t feel like cooking are nice conveniences.  Additionally, one of the biggest motivators for children is to be like their parents.  So you as a parent need to practice good health.  Eat healthy, with junk food in moderation.  Eat what a serving size is.  Drink plenty of water.  Drink alcohol only in moderation.  Exercise. Find some activity you enjoy doing.  Do it as a family if you can.  Or just find something that you love for exercise and encourage your child to do so.  Don’t smoke, or if you do quit.  Tobacco use in parents is the greatest risk factor for teen to start smoking.  All of these are things that you can do to help encourage a healthy lifestyle in your children.

Please don’t expect the government to help.  Their help has included concepts such as the food pyramid of the 1980’s which many of us grew up with, found later to be flawed and possibly lead to obesity, corn subsidies which has led to an increase in the cost of lean meats, and makes it so that fast food outlets and food manufacturers have cheap, unhealthy products to sell at a cheap cost.  Schools don’t have the time, and from the words of many of my parents their meal options could not be counted as healthy.  And as I was told by one parent, her son was allowed to go back for thirds in the free lunch program at school.  Even overeating healthy foods can lead to obesity when coupled by lack of exercise.  So the answer goes back to the parents.  IT both starts and ends at home.  Please give you child the gift of health, and help change the trend of childhood obesity.  Don’t make me have to talk to another child and explain why their eating habits are killing them.



Tag Cloud