Tuesday, December 26, 2006
How do I get people to care about obesity?
One of my professors in medical school once told me that being overweight or obese is linked to just about every chronic disease there is out there. It seemed to make sense, because heart disease and strokes are pretty well linked, as is diabetes. Those are the most common chronic diseases. In addition, diseases such as degenerative arthritis as well as cholelithiasis (gall bladder disease) and gout are also associated with obesity. Today, the American Cancer Society definitively added another one to the list - prostate cancer.

After studying 70,000 men for more than a decade, researchers concluded that not only does carrying around extra weight increase your risk of prostate cancer, it increases the likelihood of developing the most aggressive or high-grade forms of prostate cancer. In case you are wondering what a little extra weight means - generally, a 5-foot-10-inch man who weighs 180 pounds is considered overweight, and if he weighs 220 pounds, he is obese. A quick point of clarification though: Those numbers are based on the body mass index scale, which is by no means a perfect scale. And I am not just saying that because I have added a few pounds over the years... Still, the message is clear: My professor was right and obesity is linked to just about everything.

The struggle I have when reporting these stories is giving our viewers a take-away message. My guess is that most people already know that they should lose some weight. And, if they are like nearly 80 percent of Americans, losing weight will be a part of their New Year's resolutions. Still, I am not sure a story about prostate cancer and obesity will even make an impression on a typical viewer, because so many have seemingly accepted that America has become an overweight nation. What do you think it will take to start sending a message that actually provokes action when it comes to our waistline and our health?
Little will change without a major national rethinking of the social and political environment: television and advertising; sugar and fat content in foods; transportation options based on foot and bike; participatory sports rather than watched sports; reviving our committment to parks and open spaces. AND halting and even moving back the rise in hours per week worked required to keep ahead in an economy that reduces the share of national productivity alloted to the poor and middle class.
You need to report on a treatment for obesity that has a reasonable chance of long term success.

Diets don't work. If there really was a diet program that worked we wouldn't be getting so many new diet books being published.

Short term dieting leads to a rebound effect and more fat. Yo-yo dieting is worse than no dieting.

Bariatric surgery has a real chance of complications including death.

It's not that people don't care, it's that an effectiove long term treatment doesn't exist.
I understand how you feel, as a Personal Wellness Coach. I go through the same questions. Here is what I have experienced...some people will never get it. Those who do are usually in action in order to improve their immediate and future health.
Unfortunately, a lightbulb moment or wake up call are very personal things. Maybe if we required everyone to have bathing suit photos and heart, lung and artery photos, that would do it! I just visited "The Bodies" exhibit on X-mas Eve and I think it should be a requirement for everyone!
I also think this is a time to warn those "skinny" unhealthy people as well.

My fiance who is 33 years old just learned his cholesterol is 292 and his blood pressure is sky high.

By the way, he stands 6 feet tall and is a lean 165 pounds.

Dropping the doughnut a day habit is key in turning around his heart health.
I'd like for him to last a long time so my homeade oatmeal and berries is my holiday gift to him this year.
Many employers give safety bonuses when the work force reaches a "no-accident" safety goal. How about lower insurance rates, lower co-payments, and/or employee bonuses for people reaching & maintaining healthy weight goals? The almighty dollar sign does get our attention so well -- maybe a few financial incentives would help people stay on track with weight-loss goals -- especially if they could see real-dollar differences in their insurance costs.
I believe the only way some people will even think about losing weight is if it "hits them in the pocket book". What I mean by that is if they can see an immediate "return". One way is to raise one's health insurance costs for people who are overweight. They can start with, say, anyone who is 30% over their ideal weight, would pay a 30% higher premium. We are ALL paying, indirectly, for overweight people. I have been saying that for years. Incentives to join YMCAs and other health clubs by giving rebates is just a small step, although a good one, to get people to start excersising. We need health insurance companies and our own employers to stop being polically correct and get own health costs down by increasing premiums of overweight people.
It is absolutely useless to hector people about something that, short of the gastric bypass, is so nerve-wearing and high-maintenance to keep in control...and ungratifying, because a diligently exercised and starved endomorph STILL doesn't look like the American ideal long and lean mesomorph/endomorph type. I spent my adolescence on 1200 calories a day, and in case you don't understand how that feels, that means HUNGRY ALL THE TIME. Long-term, it makes a person a little crazy and, I'm convinced, creates the kind of carbohydrate craving that does prompt really pathological eating habits, binging and bulimia and the like. If you starved an alleged terrorist to this extent over several years for information-gathering purposes, you would be in violation of the Geneva Convention in no uncertain terms. Day in and day out hungry, as thin as I could make myself, I still heard the usual from my peers, until the day came when I said, "F*** this." I am willing to eat reasonably and exercise reasonably, and I do so, but I am not going to live hungry, and my experience has made me an angry person over this issue - I consider it a point of honor to rip into anyone, doctor or otherwise, who gives me grief about it. I am saving for the gastric bypass, which reduces normal sensations of hunger to near-nothing. Meanwhile, I will walk two or three miles a day, but I will not go to some filthy loud gym. It didn't change things appreciably while I did.

If you don't understand people's resistance to expending this much effort on masking their genetic endowment, just consider how you'd respond if told to change something about yourself that is genetically determined, especially if the action involved makes you constantly low-level uncomfortable and takes a chunk out of your day and rededicates that time to something boring - repetitive exercise or the time-intensive cooking involved in making most low-calorie dishes that taste good. In addition to the practical inconveniences, there's that implication that something intrinsic about you is bad, so you are due to be penalized with such practical inconveniences. How would you like that? I bet you'd resent it. I bet you wouldn't comply for long. That's how most people respond.

Also, think about it this way: the endomorph physique's medical problems with this particular environment simply haven't been solved. The ectomorphs among us are so healthy because they're alive now, as opposed to any other time in history. In any nontropical climate, during the nineteenth century and before, without central heating, their high metabolisms were an active disadvantage, and they died like flies from tuberculosis and pneumonia. Maybe that's why they're relatively uncommon now - they got winnowed out early on. Antibiotics and central heating and good nutrition are the only things between this body type and being "unhealthy," which was how people thought of them in premodern times. (Dr. David Lykken, an expert on psychopathy, has identified the mesomorph body type as overwhelmingly characteristic of imprisoned criminals and psychopaths, so maybe they are unhealthy for the rest of us and we should stigmatize them or just imprison them on a pre-need basis?...only kidding.)

There are a lot of heavy people around now because their physical endowments enabled them to survive serious privation and pass their genes down. Their ancestors survived the famines, plagues, concentration camps, and other serious challenges that killed the weak or the unlucky. These genes are only a problem in a society that emphasizes desk work and offers plenty of food, much of it processed. So, find some convenient solution in a pill, because that's what most of us can work into our schedules, or get some nice laws passed to make insurance companies cover weight-loss surgery, or get cracking on some techniques to eliminate the genetic propensities that are regarded as so problematic. Don't be lecturing people who already cope with their share of pressure about something that involves such an enormous amount of effort in return for so small and conditional a return.

Laura Argiri
Durham, North Carolina
I don't think so many have seemingly accepted that America has become an overweight nation as much as they have realized dieting doesn't work. There have been so many fad diets and diet pills (many times endorsed by medical doctors) that only set people up for failure. We need to endorse a healthy lifestyle message that promotes good nutrition and activity. This needs to start in the medical/health community offices. People who do not lead lifestyles that promote healthy weight simply are not effectiving in teaching/promoting it. Many people are also under so much stress they don't have the desire to invest in what they are eating today for their health tomorrow. We need to send the message that healthy eating and moderate activity today will help us with today. If insurance companies felt preventative health care was important enough to pay for more of those services that would send a huge message of importance!
What will it take to provoke action in Americans to lose weight? When employers, insurance companies, the medical community, the pharmaceutical industry, and lawmakers take the need to develop strategies and therapies for weight loss management on a national scale seriously.

Losing weight is extremely difficult, and requires a tremendous daily effort of the part of any person trying to lose weight. With longer work days, longer commutes, and fewer vacation days, finding time for exercise is dufficult indeed. Couple that with the sad fact of the numbers of Americans lacking health insurance, and therefore access to medical halp with weight loss, it's no wonder we've got an epidemic on our hands!
I don't think that you can do anything, or blame anyone about obesity in this country. I think that natural selection will take care of the problem, and correct itself over a number of years. Evolution of the human body, so to speak.

I don't have a weight problem. I eat whatever I want, in moderation. I get it. I am 38, 30" waist, and weigh 160 pds...I fluctuate between that and 155 pds. I am 5'8". I also don't feel sorry for obese people, as I think that the major problem with them is their lack of making sound decisions. I do sympathize with them a little, because of the way Americans live. We work so much, commute too much, rush too much, that we simply don't have the luxury of preparing good and nutritious food. Also, many communities don't have a Whole Foods around the corner, and even if we did, we wouldn't be able to afford it with the high cost of living.

I do think that after all the obese people eat themselves to death, they will leave a more healthy race behind.
Americans will be motivated to lose weight when the cultural norm is a healthy population. We are probably a generation or two away from this happening. Hopefully the "Gen-Xers" will be healthier cohort than the Boomers. We've seen this happen with smoking; the Boomers were the one's who changed the norm from smoking to non-smoking.

If you really want to provoke action with messages, we'll need campaigns similar to the anti-smoking campaigns and messages. Are we willing to go there and target "fat people" as being physically unattractive, unhealthy, and sometimes socially unpopular? That is often the cruel truth...and we "can't handle the truth" ...at least not yet. Maybe that is the task for our next generation. And maybe the next generation is where the current effort and communication should be focused.
A magic pill to the problem. A lot of americans know they're overweight and have even come to understand they need to lose weight, but most currently see the options for losing weight as being more of a burden than carrying the weight (and all it's nasty side-effects).

Eating healthy is a pretty obvious magic pill in my book, but it's not easy and cheap enough for most people yet (right now, it costs you a lot in time, money, and/or immediate-gratification/enjoyment). Until they can have all three, it's easy to just not bother.
Dr Gupta, you do a pretty terrific job of getting people to care. I think that showing the impact of obesity on your health spots do make a difference. I think about my weight every time I watch one. Thanks
The reason most people I know have for not losing the weight is that they can't. Not that they actually can't, but that being overweight and feeling the hopelessness of that has made them feel that they can't.

Obesity is a psychological problem first...it is something that has to be addressed from that viewpoint first, I think.
I would think that people were overweight or obese because they lacked the will power and motivation to make changes in their lives. Losing 20 pounds is difficult, but when you think of needing to lose 100+, it's easy to get overwhelmed and just not try even when you know it's what is best for you and what can ultimatelly save your life. I have seen people diagnosed with Diabetes and told if they don't start eating better they can lose limbs and it doesn't seem to make a difference. There is a bigger issue at play than just needing to lose weight. If only it were that easy. Your not just dealing with bad eating habits and lack of exercise. There are far bigger issues at hand than those. If we can get past those issues then I'm sure the weight will handle it's self.
I know many obese people who have changed their lifestyle...and many more that have not. Of the few who took the plunge, I believe the main motivating factor was actually (sadly) a threat on their life. One of them was told by a doctor that he wouldn't live to see his 10 year old daughters' graduation if he continued to smoke and eat like he was. Another just believed she would be alone for the rest of her life if she didn't do something. Others had heart attacks, strokes, fainting episodes. Few, if any, realize that their weight is an ongoing, longterm health problem until it becomes something that needs immediate attention. Prostate cancer, diabetes, and strokes are all diseases that take a while to appear. If you can prove to people that their immediate health is what's at danger, that what they do *right now* is what matters NOW and in the future, then I think you'll be able to hit a chord. Also, if you emphasize the immediate benefits of being thinner (being able to care for children better, feeling better emotionally, feeling stronger physically, etc. etc.), there's more motivation to do something right now instead of waiting till next year to fulfill the resolution.
Do physicians tell their patients that they should lose weight, and then give them instructions on what do to lose it? Or, do they avoid having that uncomfortable conversation? Do doctors get enough training about nutrition? It may be that your efforts need to go toward helping other doctors deliver these messages to their patients on a more personal level. Part of the conversation can also address the benefits of losing weight -- more energy, better stamina, etc.
As I study visceral fat and its direct correlation with diabetes in my masters program I realize that the medical community has founded the importance of obesity in many disesaes. However as you said , Dr, Gupta the average person thinks that obesity is all about looking fat. If only people could see the adipose fat tissue on the inside and how it wreaks havoc on the body will the importance of obesity be stressed. I hope ther people armed with information will take better care. Keep up the good work!!
There seems to be public outrage about taking away the rights of people to gorge on unhealthy trans fats, high fructose, and the empty calories found in drinks, desserts, etc. The same people who would never drink tap water think nothing of eating large amounts of unhealthy food and almost eliminating healthy green and yellow veggies and whole fruits.If they thought of these unbridled excesses with food as poison to their bodies' organs they might reach some sobering conclusions.
We need to somehow get them to see that obesity unless checked is likely to cheat them of health and happiness and also shorten their lives. Recent polls show how ignorant a large percentage of young people are about risk factors for heart disease.The obese and overweight plead genetics, yet in looking back to high school yearbooks from the forties and fifties I see very few overweight teenagers. Look at old newsreels or news magazines and you'll see minority groups who are slender and healthy looking.
We really need to get manufacturers to phase out trans fats, high fructose corn syrup and the snacks containing empty calories We need health classes in school which hammer out the straight facts and risk factors. A student could assess his health status and set goals for life style changes. School cafeterias need to offer more healthy food choices. As a nation we have become so politically correct that no one wants to tell the obese that they have a problem, so we literally allow them to permanently harm themselves rather than risk embarrassing them. We legislate smoke alarms, motorcycle and bicycle helmets, but yet can't seem to confront obesity which will kill far more than by fire or accidents. accidents.. We protect babies with infant car seats, immunizations, monitors, but doctors are afraid to tell parents their babies are overweight. We need to make it politically correct to fight obesity. We need to think of it as an epidemic and make some startling and unpopular changes. Greed and profit in the food industry has gotten snack machines into the schools and television program sponsors for children run snack ads. We have been irresponsible in allowing this. As a nation we drag our heels and usually react only when a problem becomes extreme. We are poor at preventive measures.
Let us compare this to the problem of cigarette smoking a few decades ago before laws were passed about where cigarettes could be sold, where people could smoke, etc. places people are allowed to smoke. The naysayers thought this would have no impact, they screamed about individual rights, but the percentage of Americans who now smoke has shrunk drastrically. Also the suits against the tobacco industry have further forced the industry to stop targetting youth. People looked at ugly anti smoking ads, but gradually they got educated except for the diehards.
A campaign has to be honest, unremitting and politically correct. It will be costly if schools are to t take up the fight. Industry could be recruited to contribute in this fight. Voters need to see how expensive caring for the 25% of our population of obese will be if something isn't done
Hello Dr. Gupta,

I think most people do understand that many of these chronic diseases are linked to obesity. However, many people put off taking action because the onset of these diseases may seem a bit too distant. It could be more effective to emphasize immediate benefits of losing weight. Viewers would then see how much their lives can improve today if they were to loose weight.
I think the lack of commentary in response to your post says it all, Dr. Gupta. People either don't know how, or don't want to care about their weight. With all of the major focus on losing weight to look good to other people, a lot of people are easily disenchanted... and, let's face it, losing weight isn't easy- and we Americans are not really known for our patience. Maybe the medical community could spend more time debunking the so-called "miracle" pills, and actually come up with some cohesive research as to the proper way to lose weight so that people aren't faced with tons of useless information to sort through. Then, maybe they'd be more likely to take it upon themselves to make a change. Right now, it's overwhelming- much too much so for many people.
Dr Gupta is right - I lost 15kg and every health problem I had, however minor, such as constipation, unexplained headaches, backache, swelly feet, etc simply vanished. I followed the weight watchers regiment and still on the maintenance program. I think education is the key - blasting MacDonalds or suing fast food restaurants is like chasing the wind. They are there to make money, and the choice is ours. Education, choices, moderation. Thanks Dr G for your informative web postings.
Many of the patients that I see simply don't realize that it is a threat to their life - they know that they are obese, but in a nation of obesity, they see themselves as average. This is especially since they can go to out in public to see people that are more obese than they are, who aren't in acute distress. There are also health books - written by "physicians" - that say that your body should have a significant amount of fat, suggesting an ideal BMI ~30. Yes, if we could get everyone down to 30, that'd be great, but we can't.
How about suspending health insurance benefits if you are 30% over your recommended body weight? Benefits would return to you after reaching your recommended weight.
It's probably akin to sending the message about global warming in time. Most people aren't willing to give up their normal way of life until something begins to seriously break down. By then it's often too late. Human are born with normal eating habits. Those are modified over time by cultual conditioning, and for many, those modifications mean extra calories they don't need. Normal eating habits can be re-established, but trying to do it by dieting is usually counter-productive. Becoming a hunger "Nazi" and eating ONLY when hungry, no matter what, can make a big difference.
Ok this message is to the Posted By Mike from Nashville, Tn : 9:47, I�m ashamed to hear you say that considering not all people that are over weight have total control over they�re condition. There are some people who become overweight because of other medical conditions. Like people who can�t exercise because they�re paralyzed, or patients who retain water because of poor functioning kidneys. There are many things that contribute to being overweight or obese including genetics. Reducing health insurance benefits if you are 30% over your recommended body weight, is just to darn cruel in my opinion. In fact I believe insurance companies should help obese people by paying more for diet education, medical health programs and surgeries that can help the overweight or obese people live more productive and healthier lifestyles. Just my opinion. This is coming from a woman who was once obese at 310 lbs, because of pregnancy complications, high blood pressure, and poor functioning kidneys. So don�t be so hard on us once obese fat people, and a Happy New Year to you too bud. I hope you some day get fat and show a little empathy.
Pardon my simplification of this issue, but obesity seems to be a direct result of two very American ethics: conspicuous consumption and uber convenience.

We seem to operate on the idea that it is unacceptable to not have everything we want every time we want it and immediately then. No need or time for waiting.

This seems particularly obvious in our eating habits.

Our lives in the US are set up around convenience. It won't work to wait until you get home to have a healthy meal - McDonald's or Taco Bell are right around the corner and you can get some of those yummy fries or a coke while you're at it, adding a few hundred extra calories.

You can worry about that extra weight tomorrow or you'll go on the diet in the new year, but right now, you have to get back to the office and you're craving a big mac.

Until our collective mindset is that health is a priority, not time and not immediacy, I don't think we can effectively deal with this problem.

Another conversation we really should be having is that obesity is very inequitably affecting low income individuals. The convenience and low nutritive foods are targeted heavily in lower income areas.

I live in a well educated, fairly affluent area and there are scant few fast food places (mostly sub shops). However, once you cross a main artery into a low income section of our town, there's a KFC, McDonald's, Pizza Hut and Dunkin Donuts within 6 blocks.

Food for thought...
I am 10 kgs overweight. I track my BMI regularly. I feel the pressure of the body weight on various parts like knees, back, shoulders etc. Body and the brain are not in the same wavelenght when it comes to sports. Despite these realisation, I am unable to take weight reduction and mainteance measures. How do i get to care about my overweight body? I am planning to convince myself that this is a medical problem and i must act as i would in that case. I hope my brain cooperates. Brain decides the food and lifestyle but the consequences fall on the body!!
Look, from a sociological standpoint, something will always come along to kill us. Wars, disease, childbirth (in lots of parts of the world), etc. We eliminate diseases (polio, for example) but then something else comes along (AIDS). Old diseases adapt and find new ways to be lethal (tuberculosis). Right now, we are supposedly eating ourselves to death.

We have stone age bodies well adapted to crave sweets (which are rare when you're a hunter-gatherer) and store fat. However, we don't live in the stone age anymore.

From an economic standpoint, it's cheaper (in the short run) to eat unhealthy food (fast food value meals - insert your favorite chain brand here) and more expensive and time consuming to eat vegetables, healthy proteins and fat.

Ever see a vending machine dispensing carrot chips? Not many!

Anyway, why such a war on fat people? There are lots of people in the world who have self-destructive habits (i.e. smoking) and some people will never give up their bad habits, whether it's food, or gambling or whatever.
I think nearly every person in America knows that they should be more healthy.

I myself am completely frustrated by the lack of a real long-term solution. There is no doubt in my mind that our bodies fight back when we lose weight. It's NOT a simple matter of motivation and discipline. We are swimming against the tide.
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