Friday, November 20, 2009

We are eating ourselves to death


I'm taking a risk of offending here, but I don't mean it that way at all. It could be written about much of this country.

This particular post is prompted by an AP story by Mike Strobbe, pointing out that rates of obesity in the United States are highest in the Southeast and Appalachia.

On my recent incoming flight to Kentucky, an MD from the area who was sitting next to me pointed out that I would notice a large number of people with high body-mass indices. I expressed surprise, and said, "You mean noticeably different?" He said, "Yes."

I mentioned this story upon arrival to a number of my hosts at UK, and they confirmed it. They attributed it to the diet in their part of the world, combined with an increasingly sedentary population. Still I wondered, "How different can it really be?"

Then I noticed the breakfast buffet at my talk (seen here). And then a friend sent me a picture of the breakfast she was served after delivering her baby, with eight pieces of bacon.

There is much talk of the cost of health care in America. That talk tends to focus on the costs of doctors and hospitals, but a growing determinant of that cost is the diet and exercise pattern of our culture. I have previously posted slides from the CDC showing this trend over time. Sure, Kentucky and some other states are in the lead, but the whole country is following suit.

If I had taken pictures of the meals available to waiting travelers at Boston's Logan Airport, you would see similar patterns. A single sandwich with 1500 calories. A 32-ounce drink from the soda fountain with hundreds more.

We are eating ourselves to death.

9 comments:

Anonymous said...

Well, I was just going to send you a note that my "before" weight upon receipt of the Dancing Deer chocolate tower auction item was 123, and we shall see what the "after" weight is - then I ran into this post!(:
But seriously, you are right. The southern diet has a lot to do with it. My husband's Florida native family has some of the worst cooking habits I've ever seen - grease with the green beans, everything fried, refrigerator stuffed with high fat snacks,soda every day, etc. When the kids grow up this way, they don't know this is not normal. And the obesity rate is even more noticeable when you travel to other countries, whose residents mostly don't look like this. We should be ashamed, truly - because this IS a matter of self discipline. Even the chocolate. (:

nonlocal

HL said...

A very thoughtful post.

Speaking as one on the slimmer side of things--it's also become socially acceptable and even expected to carry extra weight. The people I share an office with have literally had to defend to other coworkers that "yes she eats."

We've emphasized that bodies come in all shapes and sizes, which is good, but with so many illnesses immediately exacerbated by obesity, couldn't we put a little more focus on healthy shapes and sizes?

And then today, in La Crosse WI they've publicized that obese people are considered high risk and can get H1N1 vaccines first.

http://lacrossetribune.com/news/local/article_717d5a6e-d597-11de-89de-001cc4c002e0.html

We skinny people just have to wait I guess.

Cleary Squared said...

Good post as usual.

I am currently trying to reduce my weight, and I am doing so through a dietician who comes to our work. It is working: so far I've lost about 20 pounds.

I would not deny in the slightest that at one point, I was eating for comfort, and not nutrition. The minute I put high-fiber foods into my diet, I noticed a huge change; no longer did I crave sugar as much as I used to, and in turn I sought foods that were high in fiber and satisfied me. I would have sodas twice a day; the one I had today I hadn't had in about three weeks, and I didn't finish it all.

On the other hand, the healthier foods out there shouldn't cost an arm and a leg, and the food purveyors like restaurants and such shouldn't be gouging health-minded consumers, who will then seek out the cheaper, less-healthy items when they don't want to fork over the premium price. Of course, this can easily be avoided by shopping at a supermarket than a convenience store, where convenience stores will mark up the prices for a handsome profit, but still - why should I pay 75 cents for a single apple where I can buy three pounds for 75 cents a pound - and get far more apples?

Paul Levy said...

Transferring some comments from Facebook:

Jim: This has been going on for a long time. It is not only how much we eat, but what we eat. One organization that I've recently discovered right here in Boston that has been working hard to change this is Oldways. It's time we worked harder to restore balance to our diets. Check out their website at www.oldwayspt.org

Bette: The issue is economics -- time and money. It is much faster and cheaper "get full" on a fast food than it is to shop, prep, & cook a balanced meal from fresh ingredients, let alone organic ones.

Sharon: And part of the reason it costs more to eat healthy than eat junk is U.S. government food policy. Why is it that tobacco and corn production are subsidized but fruit and vegetables are not?

A lot of this is culture - many parts of our society are conditioned to value quantity over quality, so a gigantic plate of mediocre food is "better" than a ... Read Moresmaller portion of quality food.

Few of us are taught to value fresh ingredients and quality meals, or the effort that goes into making them. Michael Pollan has some excellent analysis of this in "In Defense of Food."

Saira:

Indeed! Interesting article and comments. As our former chief medical officer put it: we are now living in ’obesogenic‘ environments, communities, workplaces, schools and homes that actually promote or encourage obesity...and that we have made our generation the most sedentary in history.

And the cost of rising obesity rates are looking grim. e.g. A Canadian perspective only, Ontarians are living longer but not spending all those years in good health (with obesity contributing to a rise in illnesses, diabetes, heart disease, some cancers, etc). About 60% of adults and 28% of youth are overweight or obese in Ontario.

An earlier estimate also shows that obesity costs 2.2% of the total health care cost (roughly 1.6 billion).... Read More

As for food, there are also many systemic features that make a difference (geography & accessibility, marketing, economic status, etc). An example, in the UK, of about 30 odd cereal brands available in grocery stores, the sugar content of most brands exceeded gov't recommendations.

Terry Maratos-Flier said...

As someone who does research in the areas of obesity and diabetes I am very interested in this topic.

I think the cost of food is not the problem. In fact there are many examples where the healthful alternative is less expensive than the unhealthy choice. For example, Oatmeal, purchased in a large container, is less expensive than the usual boxed cereals such as Fruit Loops and Captain Crunch. In fact sugared cereals shouldn't even be classified as cereal, they're high carb/high sugar snacks

In addition items like chicken thighs are very inexpensive. Fresh vegetables may be pricey but almost all are available in a much cheaper frozen form which does not affect their nutritional value.

Even for prepared food, Lean Cuisine is a bargain and is no more expensive than McDonald's.

Of course it doesn't help that the USDA classifies the potato as a vegetable!

I think the problem is education. Many people don't understand portions and portion control or calorie content. Most people don't know that drinking calories as juices or sodas is less satisfying to hunger than eating calories as solid food.

And then there's my pet peeve. Most elementary age students get more sex education than eating education. While a minority of fifth graders are making choices about sex almost all of them are making choices about food, usually several times a day.

Anonymous said...

This is a highly complex topic and I wish that prejudice against the fat weren't so obvious in some of these posts. It's not just about self-discipline and ignorance and the burden that the fat place upon the skinny. I've been skinny and fat and can assert that there are powerful differences in the body that go far beyond something as easy as self-discipline.
I'm signing this anonymously because skinny people really love to send hate mail.

Anonymous said...

Anon 1:27:

I wish to take responsibility for my statement above that it is a matter of self-discipline (which, BTW, is far from easy!). I am speaking strictly as a lay person here as I have not studied the literature and, if you have references, would be happy to read them.
However, to clarify my opinion, I believe that the self discipline lies in not allowing one's self to ever become overweight in the first place. I regard this as analogous to smoking - once the overweight state and the habits causing it are well established, it can be virtually impossible to keep the weight off alone, as it is also rare to quit smoking through only self discipline.
The real tragedy I see here is that many children are denied the opportunity to avoid overweight due to the eating habits already established in their families and the types of foods they are encouraged to eat in childhood. So they have 3 strikes against them before they even grow up.
I won't argue over adults and self discipline, but I feel very strongly that parents should go to the ends of the earth to avoid this fate for their children. Keep the McDonalds and sodas away from them - they won't die without it, but may die from it.

nonlocal

Suzi Birz said...

Am reading David Kessler MD's book - The end of overeating .. Taking Control of the Insatiable American Appetite ... while I am not intending to be a commercial, this book "dissects" the food we eat and why we "can't" / "don't" stop. I find it interesting reading.

Farmer Bob said...

When I first traveled in the Europe, I noticed that most Americans were noticeably heavier. I also noticed that European meals went on longer and involved more wine, smaller portions and fruit. Europeans bought fresh bread daily from a local baker, patronized local butchers, coffee bars and pastry shops. And they walked a lot more.

The American diet is rooted in culture, farming, manual labor and rural life. It was not so long ago that a basket of fresh fruit from a Florida "snowbird" friend was a wintertime miracle in New England. Winter vegetables other than root crops came in cans.

BTW, Terry, potatoes are vegetables, I haven't seen any walking around lately, and we don't mine them. The extra good stuff is preserved by the skin in a baked potato, so it is a near perfect meal of vitamins, minerals fat and starches of about 300 calories. This is only true of baked potatoes.

Over the last score years our supermarkets have become places where agricultural seasons barely matter. We have asparagus year round. But we have lost most of the local bakeries and butchers.

We have a vast, high margin, prepared foods industry that spends much of that margin on advertising 24/7 and building brand loyalty. Choosing a ding-dong over an apple is partly caused by this conditioning. Nobody is doing that for vegetables, for health checkups, or for exercise. The fast food industry didn't invent Super Sizing, they simply named it. The appetites of the American baby boomers and our habit of single course, family-style meals created the demand for ever larger portions when dining out. The single working parent culture promoted bad eating habits in children.

All living results in Death. While I am all in favor of encouraging healthy habits and educating people to real health dangers, I am vehemently opposed to the legislation of all dangerous behavior. Choosing moderation over excess is its own reward. If we continue this trend in legislation, soon insurers will be able to deny care for conditions caused by "dangerous" behavior. No head trauma care for motorcyclists who don't wear helmets. No free insulin for fatsos.

Be careful what you wish for.