By Dr. Priscilla Diffie-Couch
Introduction by Bob Aronson
Obesity is an equal opportunity disease. It is no respecter of age, gender, race or religion. It is deadly and growing so that it now affects more than a third of U.S. adults (nearly 80 million people). According to the Obesity Society, 69 percent of American adults are either affected by obesity or having excess weight. http://www.obesity.org/resources-for/what-is-obesity.htm
The National Institutes of Health (NIH) says the combination of poor diet and physical inactivity cause about 300.000 deaths a year, the second leading cause of preventable death in the U.S.
Obesity puts individuals at risk for more than 30 chronic health conditions including: type 2 diabetes, high cholesterol, hypertension, gallstones, heart failure, fatty liver disease, sleep apnea, GERD, stress incontinence, heart failure, degenerative joint disease, birth defects, miscarriages, asthma, and numerous cancers.
Priscilla Diffie-Couch E.E.D. has been researching and writing about health issues for over two decades. Her reporting is factual, objective, helpful and frank. She is a frequent contributor to Bob’s Newheart.
A Better Way to Combat Obesity
By Priscilla Diffie-Couch E.E.D
Obesity is more than an abundance of food and a shortage of exercise. It is more than the substitution of sugar for fat or the easy access to cheap fast foods. Few would question the ever-increasing obsession with food or need to get to the root of that problem. But too few treat obesity as a genuine threat. Yet what good does it do to make the world safe from terrorism while we watch millions of people being held hostage by food until they eat themselves to death?
What caused Americans to get so fat? Research is replete with the absolute proof that eating fat does not cause us to get fat ( www.wnyc.org/story/eating–fat–doesnt–make–us–fat). In fact, we have learned that the introduction of low-fat food into our diet was one of the greatest health mistakes ever made. We have only learned lately that, with the exception of transfat, fat is not a culprit in causing disease. On the contrary, when we remove fat from our diet, we deprive ourselves of vital nutrients that prevent disease, in particular, vitamin D ( medicinenet.com/ vitamin_d_deficiency/related…/index.htm ).
A shocking number of diseases are associated with low levels of vitamin D: Alzheimer’s, dementia, diabetes, fatty liver, high blood pressure, Chron’s disease, allergy, MS, depression, osteopenia, cancer, rickets, cystic fibrosis, celiac disease and obesity itself. Reliable recent evidence shows that many Americans are short of vitamin D (health.usnews.com/…/many-americans-fall-short-on-their-vitamin–d).
Making matters worse, obese people do not make as much vitamin D3 in their guts as normal weight people do. That exacerbates the shortage of vitamin D. In one study obese subjects had significantly lower basal 25-hydroxyvitamin D concentrations and higher parathyroid hormone concentrations than did age-matched control subjects. Evaluation of blood vitamin D3 concentrations 24 hours after whole-body irradiation showed that the incremental increase in vitamin D3 was 57% lower in obese than in non-obese subjects (ajcn.nutrition.org/content/72/3/690.abstract).
Besides the fact that low levels of vitamin D contribute to obesity and obesity further reduces levels of vitamin D, we are caught in another vicious cycle. Omitting fat deprives us of the unequalled satiating power of full-fat foods. That circles us right back into further weight gain.
Another result compounds the problem. Food without fat loses much of its flavor. So food manufacturers fill that void with added sugar and
salt. But neither the presence of sugar or salt is independently responsible for the fattening of America. Our bodies have always been able to tolerate salt and sugar in controlled amounts. It is the unregulated unparalleled quantities of sugar in our foods–not ingested fat–that turns to fat in the human body.
Upon closer observation, it is not just the quantity of sugar that causes our bodies to lose essential metabolic control. It turns out that simple carbohydrates in any food form are treated the same as sugar when we ingest them. Table sugar and white bread work equally efficiently to impair our body’s ability to use insulin. And that causes constant hunger and disease and bulging bodies. Bulging bodies crave food.
So someone came up with the brilliant idea of replacing sugar in food and drink. Along came the introduction of sugar substitutes, possibly the second biggest health mistake ever made. Recent research strongly suggests that sweeteners cause blood sugar spikes. (See the study published in Nature, September 17, 2014 “Artificial Sweeteners Induce Glucose Intolerance by Altering Gut Bacteria.”) The negative consequences are the same–possibly worse. Drinks sweetened with sugar substitutes have zero calories. So we happily consume greater quantities of sugar-free food and drink with abandon, never realizing how much this contributes to our weight problem.
That still does not fully explain why we are getting more and more obese as a nation. Obviously, easy access to abundant food and drink of any kind makes it harder to control our weight. The super-sizing of everything we eat is now so common that we feel cheated if we are offered what once was a normal sized hamburger or portion of fries. The original six ounce soda now seems like a drink intended for a small child. Just as we have readjusted our view of what is overweight because there are so many more overweight people than ever before, we have readjusted our view of portion size. That results in eating far more calories than ever before.Is quantity then the real culprit in packing on the pounds? Without a doubt, it is a major contributor to obesity. A summary reported in April of this year by Whole Health Source charts the rise in calorie intake and its impact on obesity. “Calorie Intake and the U.S. Obesity Epidemic” points out that Americans increased their total calorie intake by 363 calories a day between 1960 and 2009. Surprisingly, during this time obesity has trebled yet we have cut our intake of fat from 45% of total calorie to less than 33%. What is not so surprising is that we now consume mostly simple carbohydrates. (www.hsph.harvard.educ/nutritionsource/fats-full-story/).
Substituting simple for complex carbohydrates changes the food equation. What is almost always missing when we eat the wrong foods in any quantity is fiber. Fiber is a magic agent that prevents sweetened food and drink from causing a sharp insulin spike (www.sharecare.com/health/type-2…/food-and-blood-sugar–levels). Fiber is the friendly element in food that causes us to detect texture and tricks our stomachs into feeling fuller on less quantity. We need from 25 to 35 grams of fiber daily. Yet it impossible to find a single meal when we eat out that offers more than two or three grams of fiber, if that. Even when we eat at home, we fill our plates with everything but fiber.
Eating to stay slim requires daily monitoring of what we put in our bodies. It is not easy. Yet, Americans have continued to search for some simple formula for fighting the fat that creeps on to our bodies more readily with each passing year. Diet pills don’t work. Diet plans are a dismal failure.
It goes without saying that Americans are less active now than ever before in history. The sad fact is that, the fatter people are, the harder it is to be active. Slim people tell fat people to walk. They can’t. Many rely on riding on special carts to even be able to navigate through the grocery store. The amount of effort required to lose only a few pounds causes too many of the overweight and obese simply to give up.
So what is the solution to obesity? No one seems to know. Individually, however, I feel certain that we could make a discernible dent in the problem by doing something very simple. Retrain ourselves and our children to abide by the nutrition rules that worked so well back when obesity was a rare burden. Every meal should consist of single portions on a 10-inch dinner plate (except for salad) consisting of 30% full fat, 30% protein, and 60% complex carbohydrates, which contain multiple grams of fiber. Substantial gains in loss of fatness could be achieved if we asked ourselves before every meal or snack, “Where is the fiber?”
Allowing ourselves and our children dessert only if we followed the rules for healthy eating spelled out above would provide a bonus for maintaining a healthy weight.
But most of us know what we should do individually to avoid getting fat. Having that knowledge has yet to solve the obesity problem. We have been left alone too long. Sporadic solutions are not the answer. Companies that have independently created incentive programs that reward people who lose weight find themselves subject to discrimination lawsuits.
I cringe as I write these words but I have come to believe that we have no choice but to get the government of every nation with an obesity problem directly involved. Independent drug researchers are never going to discover the magic fat-dissolving pill. National research agencies must be fully funded to seek causes and solutions for the world-wide obesity malady. New standards for defining obesity must be based on actual medical outcomes. Validity of using Body Mass Index or waist circumference for predicting negative health effects must be re-examined and adjusted for age. Meanwhile, steps need to be taken to implement workable plans to gain a foothold in arresting obesity. I have never been an advocate of total government intervention. But, when every possible private option has been exhausted, imposing universal programs may be the only answer.
The government must step up to reduce the burden of being fat. There are at least 300,000 reasons why. That is the number of deaths per year in the US estimated to be associated with obesity. More than 78 million Americans can now be classified as obese. That is more than the combined populations of California, Texas and New York. If the current trend continues, by 2030 that number will increase to a shocking 45 to 51% of the population.
Obesity is now the second leading preventable cause of death in our country. It is linked to sixty chronic conditions like diabetes, high blood pressure, stroke, heart disease, osteoporosis, breast cancer and others. It is now safer to smoke, drink to excess, or be impoverished than it is to be obese.
The fatter we get, the less active we are. The less active we are, the sicker we get. The sicker we get, the greater the demand for costly drugs and hospital care and doctor visits. The more we spend on medical care, the more stress we feel. The more stress we feel, the more we turn to food. Clearly, the problem of obesity has ballooned into a never-ending cycle.
This cycle is not easily broken. Sadly, in a routine trip to the grocery store, we can see a disturbing number of people so obese that they could have been found only in “freak” shows fifty years ago. We are no longer surprised to see a rack of size 5X clothing on display at Wal-Mart. Ironically, the fatter we get, the fewer of us see ourselves as fat. By current definition, an ordinary person six foot tall who weighs 221 pounds is classified as obese. But because one in three Americans is now overweight, our perception of “fatness” has changed. Fat people look at fatter people with disgust. Other people are fat. We just need to lose a few pounds.
Losing pounds is not easy. Studies show that most of us underestimate our calorie intake and overestimate our level of activity. Fat people sit on the sidelines while others ride bikes, hit tennis balls and swim. Fat kids watch TV and sit in front of computers while their slimmer counterparts run and play. The multi-billion dollar diet industry has failed. The misguided low-fat diet craze has failed. The only success story we can point to is the supersizing of America.
What will it take to break this supersizing cycle? Thirteen years later, we are still aware of the changes in our lives prompted by the attack on 9-11-2001. If terrorists had killed 300,000 Americans that day—as obesity does each year–it is hard to imagine the extent of government intervention in our lives aimed at protecting our safety and well-being.
What will it take to wake us up? Obesity now claims more lives than illicit drug use, car and plane wrecks combined. In 2009 alone, obesity cost our nation $152 billion. These enormous costs are borne by us all. They show no signs of abating. Individual efforts to curb obesity have failed. That leaves little choice but to turn to the government for solutions.
The specific role of government should take the form of incentives, not mandates like those used in national security. Medical research needs to be funded to provide clear guidance for designing programs that can break the cycle of disease and disorders resulting from being fat. Government must first focus on finding out why we are fat and then on prevention. Providing specific incentives associated with being fit not fat must be incorporated into the infrastructure of our lives. A massive campaign must be mounted to make the public aware of these new programs.
Such government programs should begin early in our public schools. Required physical education classes should be reinstated from primary through the twelfth grade. Physical fitness should be given prestigious treatment among honors awarded to students of all ages. Teachers in every field of study should be rewarded for creating curricula that require students to get up move around the classroom. School systems should receive monetary incentives for the number of students they graduate that are not fat. Government recognition of healthy fit kids should once again become a central concern of Health, Education, and Welfare.
Nutrition courses should be required at all grade levels. Schools should be rewarded for increasing the number of students who stay on campus and eat nutritious meals. Healthy snack breaks should be a part of daily school ritual at every level so that teachers can verbally reward students who actually eat their fruit. Tax payer money should not be spent on school lunch programs that compete with fast-food fare. Advertisements of non-nutritious foods—as has been done with alcoholic beverages and cigarettes–must be banned from television and certainly in the schools. Deals between schools and the soft drink industry must be ended.
Programs for adults must also be designed to provide incentives for not being fat. Providing discounts for drugs required because of conditions caused by obesity is counterproductive. Doing so not only fails to discourage weight gain, but it also ignores what studies show to be the number one medicine to prevent and treat common diseases. It does not come in a bottle. It is called exercise. Exercise, we now know, is superior to Prozac for treating mild to moderate depression. Exercise can reverse certain kinds of heart disease and do away with the need for medicine to control blood sugar. Abundant research shows that even light weight-lifting can enable elderly people to get up out of their wheel chairs and walk after only few weeks. A proper diet and exercise can free many people with high blood pressure from medication. Something as simple as daily brisk walks can produce far more dramatic results than drugs in how fat and fit we are.
Ways for identifying people eligible for health discounts can be established. People who get a driver’s license must pass written and driving tests. Safe drivers and home owners get discounts on insurance. Similar systems can be set up to reward fit people when they apply for health insurance. A certificate from a doctor can show the results of blood tests, blood pressure readings and other health measures that indicate fitness. Scales can easily give readings on site. Just as cars are given a sticker showing they have passed inspection, centers of fitness and nutrition can be certified to provide evidence of completion of nutrition tests and other requirements that must be met for various levels of discount entitlement. Discounts for proven health supplements, as opposed to drugs to treat the maladies associated with obesity, can be awarded as part of the fitness incentive program. Obviously, such programs would demand universal fitness standards based on valid current research and updated upon discoveries in medical science. For example, safe limits for cholesterol need to be reviewed just as blood pressure limits have recently been changed for older folks.
Goals and measurements must be stated in language that confronts the negative consequences of our present behavior. As a communication specialist, I know that words influence behavior. We have to stop beating around the verbal bush. “Fat” and “obese” must be clearly defined and used openly to denote where we are and what we need to change. We must stop fooling ourselves and our children. Fat is not fun or funny or beautiful. Fat is costly and risky. And too often deadly.
The failure rate in managing our fatness and fitness has remained too high for too long. We don’t need to spend more tax dollars on helping people buy more drugs or use more health care. We should not be handing out tickets to help people end up in an early grave. Exercise is free and eating right can be done without extra cost. Doing both will save us all billions of health care dollars each year.
Federal intervention sounds like a nasty solution to some. To the contrary, it can be accomplished by built-in rewards for those of us who successfully assume greater personal responsibility for our health, nutrition, and fitness. And those of us who are already fit and healthy reap our rewards by not being forced to subsidize those who are not.
An award winning high school speech and English teacher, Priscilla Diffie-Couch went on to get her ED.D. from Oklahoma State University, where she taught speech followed by two years with the faculty of communication at the University of Tulsa. In her consulting business later in Dallas, she designed and conducted seminars in organizational and group communication.
An avid tennis player, she has spent the last twenty years researching and reporting on health for family and friends. She has two children, four grandchildren and lives with her husband Mickey in The Woodlands, Texas.
A message from Bob Aronson.Bob’s Newheart was established to support and help everyone, but particularly those who need or have had organ transplants. Some of our blogs are specifically related to donation/transplantation issues while others are more general, but they are all related. Because anti-rejection drugs compromise immune systems, transplant recipients are more susceptible to a variety of diseases. We provide general health and medical information to help them protect themselves while at the same time, helping others live healthier lives and avoid organ failure.
Bob’s Newheart mission is three-fold; 1) to provide news and information that promotes healthier living so people won’t need transplants; 2) To help recipients protect their new organs and; 3) to do what we can to ensure that anyone who needs an organ can get one. About 7,000 Americans die every year while waiting for a life-saving organ. I am sure you will agree that should not happen.
In the U.S. the great majority of people support organ donation, but only about 40% of us officially become organ donors. Many have good intentions but just don’t get around to it. It is hard to accept, but no one knows how long they will live. My transplanted heart came from a 30 year old man. I’m sure he had no intention of being a donor at that age. If you are not yet a donor, please register at www.donatelife.net it only takes a few seconds. Then, tell your family so there is no confusion when the time comes to donate. One organ donor can save or positively affect the lives of up to 60 people. There is no nobler thing you can do than becoming an organ donor.
Bob Aronson Founder of Bob’s Newheart Established November 3, 2007