Sunday, December 16, 2007

A Nation Consumed

by Paul Grondahl
Albany Times Union
December 16, 2007

Fat used to be funny.

Some of America's favorite comics from W.C. Fields to Jackie Gleason, Roseanne Barr to Rosie O'Donnell used to get a lot of mileage out of being fat.

Something has shifted in the country's cultural zeitgeist, however, and now "O'' for obesity has become America's latest scarlet letter.

Just 13 percent of Americans were obese in 1960, and the rate has increased every year since. An ongoing study by researchers at Johns Hopkins University found that by 2015 nearly 75 percent of Americans will be overweight. Obesity, basically an unhealthy ratio of weight to height, is becoming the leading preventable cause of death in the United States.

We're burying our heads at a time when more than 280,000 Americans die each year, according to the National Institutes of Health. That's equal to the combined populations of Albany, Schenectady, Troy and Colonie combined dying annually because of obesity-related diseases and chronic conditions.

Talk to pediatricians, nutritionists and surgeons on the front lines of obesity's culture wars and you hear fear, anger and exasperation in their voices.

"Genetics loads the gun. And the environment pulls the trigger,'' said Dr. Sharon Alger, head of Albany Medical Center's Northeast Center for Eating Disorders.

Dr. Jennifer Lindstrom, a pediatrician and medical director of Albany Med's bariatric surgery center, is seeing an alarming increase in the number of children becoming sick and even dying of what had previously been considered adult diseases as the result of morbid, or extreme, obesity.

Crisis and epidemic are Lindstrom's words for what's happening.

Last year, a 17-year-old Albany girl, who was 5-foot-1, weighed 310 pounds and had a 50-inch waist, died from type 2 diabetes, a form of the chronic disease often triggered by obesity.

But Lindstrom does not recommend bariatric surgery for children, because it carries risks and fundamentally alters an individual's lifestyle. The term "bariatric surgery'' refers to several procedures that drastically reduce the capacity of the stomach, making it physically difficult for the patient to eat to excess.

If current trends continue, America's children could become the first generation in more than a century to have shorter life spans than their parents.

Nine million children are overweight in the United States, yet pediatricians concede they're reluctant to warn parents that their child is fat and at-risk for health problems, because the mothers and fathers are obese and in denial themselves.

Don't anticipate a belly laugh anymore after an obese person sits down and causes a chair to collapse. Doctor's offices and weight-loss centers have furnished their waiting rooms with extra-wide, heavily reinforced chairs known as "bariatric chairs.''

Observing an adult obesity support group isn't funny, either. Nobody's giggling as a 400-pound woman in her 50s describes how excess fat in her neck chokes off her windpipe while she sleeps and causes her to stop breathing for a time. If she doesn't lose weight, her doctor told her, the next step will be a tracheotomy cutting a hole in her throat and inserting a tube so she can breathe.

Other men and women attending the Thursday night group have similar stories. They've become prisoners of their own bodies. Being so overweight has also caused many of them to withdraw socially out of embarrassment and shame.

Obesity seems to have joined smoking, drinking and gambling in our collective community wood pile where the addictions, obsessions and compulsions end up because we have failed to deal with such behavior.

"Fat friends'' are the new "drinking buddies.'' Instead of going bar hopping, obese pals are gorging their way across all-you-can-eat buffets.

It turns out obesity may be contagious. A Harvard study found that obesity spreads in ways similar to influenza or HIV/AIDS, across groups of close friends and social networks.

Researchers studied the spread of obesity in a network of 12,067 people who underwent repeated measurements over a period of 32 years. They found that if a person becomes obese, a friend's chances of becoming obese rises 57 percent, a sibling's chances go up 40 percent and a spouse's chances increase 37 percent.

Obesity's annual cost has surpassed $100 billion nationally, and health insurers are scrambling to offer weight loss programs, some with euphemistic names like Weigh 2 Be.

Yet, who wants to be the self-appointed scold when we've become a nation blithely stuffing ourselves in a land of cheap, abundant food. How much and what we eat is a deep paradox: It's killing us and comforting us at the same time. Feeling depressed? Nothing that a triple-scoop chocolate sundae can't fix oh, and extra whipped cream, please.

What was the tipping point in this feeding frenzy?

It now costs three times as much for a gallon of gas as it does for an artery-clogging hamburger or crispy chicken sandwich at ubiquitous fast food chains.

We've passed laws and called out the trans fat police "No Trans Fat'' has become a sign of the times in windows of strip-mall eateries and yet the communal waistline continues to expand.

You can hardly channel-surf without landing on a program about obesity. Reality TV is jumping all over the topic as if it's the next big ratings prize, ready to eclipse Texas Hold 'Em and celebrity chef shows. There was Shaq, barking out orders to fat kids in Florida. "The Biggest Loser'' is still a popular TV show. Celebrity magazines can't get enough of it.

BMI, body mass index, a mathematical computation of height and weight that indicates how overweight a person is, now defines our bodies and ourselves.

And yet this YouTube-ification of obesity feels like the mental equivalent of a super-size order of cheesy curly fries. Salty and appealing. Lots of empty calories. You'll hate yourself in the morning.

Is there a way forward, an exit strategy, for our nation's obesity quagmire?

New research isn't yielding breakthroughs so much as confirming that controlling the nation's epidemic is at once ridiculously simple and maddeningly complex.

"The big, deep dark secret behind weight control is that weight loss and weight maintenance is still 99.9 percent on the patient,'' said Dr. Carl Rosati, a surgeon with Albany Med's bariatric surgery center.

Copyright 2007 Capital Newspapers Division of The Hearst Corporation

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