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“Losing weight would improve your health” - I was telling my patient last week during a consultation. His light-hearted response concerned me: “I am not obese, doctor, you’re too skinny. Everybody in my neighborhood is this size. And I like being big.”
Everyone in his neighborhood is indeed getting bigger. As the average size of the typical American grows each year, so does the tolerance for being big. I am concerned that our mass media “experts” have taken the social stigma out of fatness and made people blissfully ignorant of its health risks. Advertising, television programs, and movies that promote obesity as normal directly ignore its threat to health and well being.
Everyday I try to educate my patients about healthy eating, physical activity and healthy weight. In just 15 short minutes at my office I am trying to undo years of bad habits and billions of dollars worth of strategic marketing. As a physician I wish to offer more to my patients than those 15 minutes in my office, but unfortunately my time is heavily outweighed by my competition. Americans are bombarded on a daily basis by fast food, alcohol, and snack food advertisements. It is built into the fabric of our very lifestyles. Convenience over quality is the norm, where busy families are constantly consuming foods too high in fat and with completely unbalanced nutritional value. Even some convenience foods commonly viewed as healthy have hidden fat-producing or potential cancer-causing ingredients. It is a sad fact that most people in this country have no idea what a healthy diet really is, nor do they understand proper portion sizes.
The catastrophic consequence of health illiteracy is our current obesity pandemic. Carl Sagan once said
“When governments and societies lose the capacity for critical thinking, the results can be catastrophic — however sympathetic we may be for those who have bought the baloney.”
Americans are being fed the lie that it is okay to be fat, and this health illiteracy is damaging not only to people who are obese, but also to the healthy population of the United States.
I am not obese - why should I be concerned?
Being overweight or obese increases the risk of illness. Morbid obesity and obesity-related illness can result in decreased job performance, in some cases - to disability, job loss. Thus, those people will not have medical insurance, and may not have means to support themselves.
For example, diabetes in obese and overweight people is almost always considered a “pre-existing condition” by insurance companies, and thus a lot of those patients cannot afford the medical coverage. Having no means to treat diabetes early in the course of the disease, when severe complications (such as impaired vision, kidney failure, and others) are preventable, these patients frequently ignore their disease and end up having disabling complications. They are caught in a vicious cycle:
Given this example a number of people with severe complications of obesity will need public assistance not only for their medical care but also for activities of daily living. So functionally some of morbidly obese people become disabled and unable to support themselves. And that is where taxpayers money is used to care for obesity complications.
In 1990 none of the states had obesity rates above 14%; by now all states have more than 20% obese and approximately 50% of US population is overweight/obese. If in the remote past poverty was associated with under-nutrition, in today’s United States the poorest of us weigh the most. So the potential for medical and disability expenses related to morbid obesity is high and rising. And you, a healthy person, are paying the bill.
By no means have I implied that obese are to blame or be discriminated for this public health issue. Blaming obese for their disease is the same as blaming a person with AIDS for contracting AIDS, or blaming a smoker for developing lung cancer or emphysema. This country needs a solution, and we all have to start with awareness about obesity and its complications.
I am Chicago patriot, and I think that tourism is good for Chicago’s economy. Yet I believe “Taste of Chicago” promotes gluttony, and “PLURES CRAPULA QUAM GLADIUS” (Gluttony Kills More Than The Sword).
Our mass culture is a culture of comfort: after a good day’s work, we dream about a good meal and rest. We are conscientious and ambitious workers - we work even through the lunch hour, we slurp carbonated drinks, and by the end of 10-12 hour day we are too tired to exercise, we still have to take care of kids, pets and the house. Grand meal is a form of entertainment, we take our date for a dinner and a movie (and not just for a dance), we rave about the food was on our vacation, where we lounged under the palm trees, downing exotic drinks. Yes, our mass culture tends to promote overeating, processed foods, carbonated drinks and plenty of passive rest.
Our mass culture and food industry makes money getting 50% of population overweight or obese, and you are paying the bill for the consequences.
Obesity Trends Among U.S. Adults BRFSS, 1990
Source: Behavioral Risk Factor Surveillance System, CDC
Obesity Trends Among U.S. Adults BRFSS, 2005
How can we tell the people that some foods are a slow poison, and that eating became an addiction, and that addiction is bad? What can we offer?
How does excess body weight affect our daily lives?
Obesity results in impairment of the following essential body functions and appearances:
- Sleep (for example sleep impairment and snoring, excessive daytime sleepiness)
- Mobility (less exercise capacity, body aches, easily fatigued, no energy even to start exercising)
- Breathing (shortness of breath) and oxygen delivery into the body, “asthma”
- Digestion (stomach acid reflux into food pipe and indigestion)
- Energy (no energy, excessive fatigue)
- Body aches (joint pain, muscle sprain)
- Mental health (for example, obesity is associated with depression)
- Difficulty having babies (Fertility problems) in both men and women (including problems with menstruations)
- Pregnancy complications (including too big or too small babies, that are at risk for complications)
- Growth in children, growth hormone secretion in adults
- Varicose veins and leg swelling (problem with returning blood to the heart, sometimes referred as “venostasis”)
- “Dirty”, pigmented skin creases (especially neck) and underarms called acanthosis nigricans
- Excessive skin tags
- Excessive hair growth or/and acne in women (especially chin, upper lip, and elsewhere)
- Excessive sweating, heat intolerance
- Fat distribution in strange patterns (so called lipodystrophy) - for example, really fat face neck, hump and trunk, but really skinny legs and arms.
and many diseases and health conditions, including the following:
- Hypertension
- Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
- Type 2 diabetes
- Coronary heart disease - heart atacks
- Stroke paralysis, inability to speak
- Gallbladder disease
- Fatty liver and liver cirrhosis due to fat destroying liver cells
- Osteoarthritis - joint wear and tear
- Sleep apnea and respiratory problems (obesity hypoventilation syndrome)
- Some cancers (endometrial, breast, and colon)
- Vitamin D efficiency and fibromyalgia
- Gastroesophageal reflux disease
- Polycystic ovarian syndrome
- Gangrene of the genitals in men (Fournier’s gangrene)
How do I check if I am obese?
There are several ways to determine if one is obese or have excessive body fat.
- Body mass index
- Waist circumference
- Skin fold thickness
- Body composition measurements
Body mass index one can calculate from height and weight or ask their doctor/nurse to do so. Waist circumference can be measured by your physician or nurse.
Measurement of skin fold thickness requires special calipers.
And body composition measurements requires special equipment.
This is how US Centers for Disease Control Define Body mass index:
“Body Mass Index (BMI) is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.
We also have information on the following:
- About BMI for Adults: Information about BMI and interpreting this number for adults
- About BMI for Children and Teens: Information about BMI and interpreting the BMI percentile for children and teens
- Nutrition and Weight Resources: Links to additional resources for BMI
Note that the information about children and teens is written primarily for parents, but it may also be of interest to others, such as health care providers and the general public.”
US Centers for Disease Control information about Body Mass Index (BMI).
US Centers for Disease Control information about Overweight and Obesity.
Disclaimer: the opinion provided in the articles is solely opinion of Dr. Kazlauskaite and not of Stroger Hospital of Cook County or Rush University.
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