In this era of DVDs and movie theatre opera telecasts, we opera singers are under greater pressure than ever to be slim and camera-ready. Our lifestyles, however, do not always lend themselves to easy weight loss. Here is my analysis of America's obesity problem, as well as my suggestions for resolving it:
Americans spend billions of dollars each year on diet products, health clubs, weight loss books, cosmetic surgery, and other products and services which carry the single-minded goal of bringing us the Hollywood-slim figures that few of us seem to have anymore. In spite of all of our best efforts, however, Americans are heavier than ever before in history. Staggering percentages of our children are clinically or morbidly obese. Americans, once identified abroad by our swagger and our confidence, now find themselves given away by their girth. We are spending vast amounts of money on health care related to our national obesity problem, and yet we seem no closer to a cure for what has become a very real, debilitating disease for many in our society. What are the real causes of this obesity explosion? What can we do to stop it, and to restore our people to good health?
The statistics are staggering: According to Flegal et al in the Journal of the American Medical Association, as of 2008, 68.8 percent of Americans were either overweight or obese. The prevalence of obesity – defined as a Body Mass Index in excess of 30 – exceeded 30 percent among all ethnicities, age groups, and genders. Nearly one in 13 non-Hispanic Caucasian women and nearly one in 8 non-Hispanic African-American women had BMI readings higher than 40 – an indicator of morbid obesity, at which the individual has far greater risk of obesity-related illness and death than at lower BMIs. These numbers have skyrocketed at a rate of approximately 7 percent per decade since 1977 – a trend which is expected to continue if current patterns hold. (Flegel et al, 2010). Childhood obesity has more than tripled since 1980, with the rate of obese children six to 11 years old skyrocketing from 6.5% in 1980 to a whopping 19.6 percent in 2008. (CDC, 2009)
The costs of obesity-related illnesses also continue to rise. According to the Centers for Disease Control, the costs of obesity-related hospitalizations, testing, morbidity, and mortality totaled some $92.6 billion dollars. (CDC, 2002) Americans miss work and lose productivity as a result of their weight-related physical restrictions. Medical costs and health insurance premiums continue to rise. Obesity in America is a genuine epidemic – a crisis which seems to have spun out of control in recent years, with no end in sight. How did we, as a nation, reach this point? Most studies point to a combination of sedentary lifestyle and overeating as a cause of overweight – yet Americans seem to be spending billions more on diet books, weight loss programs, health clubs, fitness equipment, health food and weight loss supplements than ever before. Something else has gone awry – something that must be addressed in order for America to finally get a handle on its obesity crisis.
At one time, Americans were identifiable abroad by their ebullient confidence and Hawaiian shirt-and-shorts sets. Now – as I have experienced first-hand on a number of occasions – we are marked by our fat. I have had the experience in more than one European country of walking into a store or a restaurant and having the sales clerk or waiter look me up and down, then immediately start speaking to me in English. Obesity levels in Europe have not yet reached anything close to the level that they have in the United States, and in fact, I have often heard “fat Americans” used as a Continental pejorative to describe all of us. Clearly, our weight problems are harming our national image abroad.
I realized during these travels, however, that the Europeans I met had a point. Within weeks of arriving in a country such as France or Spain, I found myself losing approximately 15 lbs (7 kilos), simply by living the way one lives in Europe. Upon my return home to the States, the weight would come piling back on. What is the matter with our culture, that it seems intrinsically structured so as to cause weight gain?
For one answer, we may look no further than the beloved cars which sit in our driveways when they are not carrying us to the grocery store, to the gym, or to the office. In Europe, I had no car, and all my groceries had to be carried by hand or by grocery trolley several blocks from the supermarket, up several flights of steps, and across my threshold. This simple difference in convenience dictated that in Europe, I had to limit my purchases only to what was completely necessary for me to get through the week, eating the meals that I planned to eat and gaining the nutrition that I needed on a daily basis. There was no room in my little cart for large bags of chips, for example. It was far too heavy to lug 2-liter bottles of soft drinks a quarter mile from the store to my house. According to the American Journal of Preventive Medicine, “…each additional hour spent in a car per day (is) associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day (is) associated with a 4.8% reduction in the likelihood of obesity.” (Frank et al, 2004) The simple necessity of walking to buy groceries or to get to my workplace was an explanation for my sudden European weight losses.
However, I soon noticed differences in the dietary habits of Europeans vs. Americans which also accounted for the difference in our national girths. In continental Europe, a decent bottle of French Bordeaux costs approximately the same in many restaurants as a 10-oz bottle of Coca-Cola. Portions in European restaurants are markedly smaller than in the US – and unlike in the US, where most diners feel under pressure to fork over an additional 18-20% tip at the conclusion of the meal, tipping is neither as compulsory nor as generous in Europe as it is in the US, because the wait staff are paid a living wage for their services. Even in American fast food establishments like McDonalds, the portion sizes of soft drinks are significantly smaller than in the US, with a “large” beverage served in the same container that suffices as a “medium” in America.
America’s inexorable march toward adiposity began more than a century ago, when the physical-labor-intensive agrarian society which occupied much of America’s heartland gave way to industry and office buildings. Americans who had spent years doing back-breaking work in a field or barn now sat in a cubicle all day, only rising from their seats long enough to visit the lunchroom. In the evening, these new corporate workers sat down to dinner with their families, then repaired to the living room for several hours’ worth of television viewing, followed by bed. Children – whose school year was initially planned to coincide with the planting and harvest cycles of the year, so that they would be available for work on their families’ farms – now spent those summers in front of the television, munching junk food. If their parents were especially enterprising, these youngsters might get in a few hours’ worth of soccer practice or other physical activity per week – however, it was a drop in the bucket compared to the long days of physical labor that children and adults alike experienced in agrarian America. While I am not advocating a return to child farm labor, I note that the marked change in physical activity for all Americans as the farm gave way to the office and school has made a difference in our physical fitness.
However, our European allies don’t spend all day picking peas in a field. They don’t spend all day in the gym. What other factors might there be to account for the differences in fitness? For a possible answer, I return to the questions of portion size and soft drink consumption. According to a study in the journal Obesity, 76 percent of executive chefs believed that they served “average” portions in their restaurants – even though the portions of steak and pasta that they served were actually “2 to 4 times larger than the serving sizes recommended by the US government.” (Condrasky et al, 2007) Even the supposedly “healthy” choices offered by major American restaurant chains have a remarkably high caloric content – Chili’s Southwestern Cobb Salad, which looks so healthy and diet friendly, was found to contain 970 calories, while the seemingly innocuous Lettuce Wraps at California Pizza Kitchen contained 900 calories! (n.a., Wellsphere.com, 2008). Most of the sandwiches offered at fast food outlets contain in excess of 500 calories – not counting additions such as French Fries and soft drinks. Americans are consuming more calories in a meal than they should have in a day, and it is increasingly difficult to avoid a huge caloric intake during restaurant meals.
Americans are eating out more often, as well. The Obesity study stated, “The rise in obesity rates over the last three decades has been paralleled by an increase in frequency of eating out and in food portion sizes. The number of meals consumed away from home in the United States has risen from 3.7 meals per week in 1981 to 5 meals per week in 2000. Frequency of eating out has been associated with higher energy and fat intakes and with a higher BMI.” (Condrasky et al, 2007) With Americans eating out more frequently and receiving the enormous portions served at US restaurants, their idea of what constitutes a “normal” meal is undergoing a gradual shift, so that they feel that they must serve their families meals at home which are comparable in size and high-calorie components to what they would receive in a restaurant, lest their family members leave the table unsatisfied. Thus, the cycle perpetuates itself, and Americans take in higher and higher numbers of calories with each meal, even when they think that they are “eating healthily.”
With those high-calorie meals in many restaurants come liter-sized glasses filled with a soft drink – which are refilled on demand, for free! A liter of Coca-Cola contains some 400 calories. (daily-plate.com, n.d.) Over the course of a large, sodium-rich meal, at which the cheerful waitress may scoop up empty glasses and replace them with filled ones three or four times, we can easily see how we may add more than 1,000 calories per meal simply in the sodas that we drink. Multiply that figure by three meals per day, and the number one arrives at for calories added simply in the form of nutrient-free soft drinks is greater than the recommended caloric intake for an individual in an entire day. If he is consuming, say, in excess of 2,000 calories per day just in soft drinks, in addition to three restaurant meals per day (or the at-home caloric equivalent), it isn’t hard to arrive at a figure of more than 10,000 calories per day consumed by one person! How can anyone, regardless of his activity level, avoid obesity based on that level of caloric consumption? Moreover, that person likely has been lulled into thinking that he eats a “normal” diet, because he is not bingeing or snacking – he is simply eating what is set before him in a typical, restaurant-mandated meal. If he is someone who usually requests the “super-sized” items at fast food restaurants, or if, in fact, he does have a compulsive eating problem, it’s easy to see how he may be on the road to morbid obesity and even death.
An additional hazard for soft-drink consumers (and consumers of other sweetened products) comes in the form of the sweetener that most drink companies use in modern beverages, namely high-fructose corn syrup. A study published in The American Journal of Clinical Nutrition states:
“The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States… The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis. In addition, unlike glucose, fructose does not stimulate insulin secretion or enhance leptin production. Because insulin and leptin act as key afferent signals in the regulation of food intake and body weight, this suggests that dietary fructose may contribute to increased energy intake and weight gain. Furthermore, calorically sweetened beverages may enhance caloric overconsumption. Thus, the increase in consumption of HFCS has a temporal relation to the epidemic of obesity, and the overconsumption of HFCS in calorically sweetened beverages may play a role in the epidemic of obesity.” (Bray et al, 2004)
In other words, high-fructose corn syrup is metabolized differently from glucose, found in cane and beet sugar. It favors the growth of new fat cells, while interacting with the energy-processing and hunger-regulating systems of the body to encourage its consumers to consume even more calories. In a way, it may be like the beer nuts found on bars at taverns, which make the patrons thirstier, so that they buy more drinks. High-fructose corn syrup may help the restaurant and food industries to sell more of their products, but it may well be a major factor in the explosive growth of obesity in recent decades, and it may ultimately be a threat to the public health.
Finally, the dietary guidelines published by the US government may be faulty. They encourage, among other things, eating four servings of fruit per day and 4 servings of cereals (the popular 4-4-3-2 model, with the “2” representing meats and eggs, and the “3” representing dairy products). Based on this model, the US Recommended Daily Allowance for carbohydrates is 130 g (NAS, 2006) – more than ten times the number of carbohydrates allowed on the Atkins low-carbohydrate diet plan in its weight-loss phase (Atkins, 1972).
In my consultations with doctors and dieticians alike, I have had tremendous difficulty convincing such experts that it is impossible for me to lose weight on a diet which is high in whole-grain breads and fruit, in spite of recent studies suggesting that the low-fat diets of the past simply do not do the job as well as low-carbohydrate or Mediterranean diet plans. A study published in the New England Journal of Medicine demonstrated that while low-fat and Mediterranean diets were better at improving blood chemistry than low-carbohydrate diets, the participants lost more weight on the low-carb plan than on either of the other two diet formats. (Shai et al, 2008). Perhaps the USDA and the Centers for Disease Control need to take a closer look at the levels of these nutrients that they are recommending, and formulate specific recommendations which not only serve as effective nutritional models, but which are also easier for the typical consumer to relate to in terms of portion size.
Based on both my research and on my personal experiences with weight loss, I offer several suggestions for conquering the obesity crisis in the United States. First, the government must step in and offer guidelines for restaurants in the portion sizes being offered – perhaps providing tax breaks to those restaurants which give consumers more half-portion and low-carbohydrate options. Somehow – through consumer advocacy, governmental intervention, public awareness campaigns, or a combination – Americans must learn about the impact of soft drink consumption on their health. American soft drink companies must be encouraged or required – as they are, for example, in Australia – to switch back from high-fructose corn syrup to sugar as a sweetener for their beverages, ahead of a possible total ban on the sweetener in all food products.
Organizing neighborhoods in such a way that it is easier to bring in groceries and to do other shopping on foot rather than by automobile would encourage people to exercise while saving energy and lessening environmental pollution – even offering modern, colorful shopping trolleys for sale in more stores might encourage more people to leave their cars at home in favor of fresh air and sunshine.
New guidelines must emphasize that excessive carbohydrate consumption – even in “healthy” foods like fruit juice and whole-grain bread – is something to avoid. And finally, Americans must lose the notion that the food service and agricultural industries are responsible for regulating their food intake, and must take on a much more active role in making choices regarding their diet and lifestyle. Only through such a combination of public awareness, community action, corporate responsibility, and government intervention can we hope to solve our obesity epidemic.
Resources
Atkins, Robert (1972) Dr. Atkins’ Diet Revolution. New York: Bantam Books.
Bray, George, Nielsen, Samara, and Popkin, Barry (2004). “Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity,” American Journal of Clinical Nutrition, Vol. 79, No. 4, 537-543, April 2004. Retrieved from http://www.ajcn.org/cgi/content/full/79/4/537 on May 3, 2010.
CDC (2008) “Childhood Obesity,” National Center for Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/HealthyYouth/obesity/ on May 3, 2010.
CDC (2009) “Overweight and Obesity: Economic Consequences”. Atlanta: Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/causes/economics.html on May 3, 2010.
Condrasky, Marge., Ledikwe, Jenny. et al (2007) “Chefs’ Opinions of Restaurant Portion Sizes,” Obesity. 15:8, pp. 2086-2094. Retrieved from http://www.nature.com/oby/journal/v15/n8/full/oby2007248a.html on May 3, 2010.
Flegal, Katherine, Carroll, Margaret et al. (2008) “Prevalence and Trends in Obesity Among US Adults, 1999-2008,” Journal of the American Medical Association. 2010;303(3):235-241. Published online January 13, 2010. Retrieved from http://jama.ama-assn.org/cgi/content/full/303/3/235?ijkey=ijKHq6YbJn3Oo&keytype=ref&siteid=amajnls on April 29, 2010.
Frank L.D., Andresen M.A., and Schmid T.L. (2004) “Obesity relationships with community design, physical activity, and time spent in cars,” American Journal of Preventive Medicine
2004 Aug; 27(2): pp. 87-96. Retrieved from http://www.ajpmonline.net/article/PIIS074937970400087X/fulltext on May 3, 2010.
NAS (2002) “Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholestrol, Protein, and Amino Acids.” National Academy of Sciences. Retrieved from http://iom.edu/en/Global/News%20Announcements/~/media/Files/Activity%20Files/Nutrition/DRIs/DRISummaryListing2.ashx on May 3, 2010.
Shai, Iris, Schwarzfuchs, Dan, et al. (2008) “Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet,” New England Journal of Medicine. 359:3, pp. 229-241, July 17, 2008. Retrieved from http://content.nejm.org/cgi/content/full/359/3/229 on May 3, 2010,
Thedailyplate.com (n.d.) The Coca Cola Company. Retrieved from http://www.thedailyplate.com/nutrition-calories/food/the-coca-cola-company on May 3, 2010.
Wellsphere.com (2008) “High Fat, High Calorie Salad Shocker.” October 16, 2008. Retrieved from http://www.wellsphere.com/healthy-eating-article/high-fat-high-calorie-salad-shocker/423436 on May 3, 2010.
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