Jody Patterson, Times Colonist
Here’s the skinny on a mass dilemma: About half of all Canadians are either overweight or obese
Trans fats. Atkins diet. Lite. Low-carb. The words roll off our tongues easily, as familiar in our weight-obsessed culture as a bacon-and-eggs breakfast was to a previous generation.
Diet books blaze to the top of bestseller lists. Vitamin stores bustle with newcomers drawn in by the writings of the latest weight-loss guru. If talking about it was all it took to lose weight and get fit, we’d all be poker-thin and rippling with muscle by now.
But the talk has turned out to be much easier than the walk. The diet industry is bigger than it has ever been, but so are our waistlines. Around the world, in all but the poorest countries, people are growing fatter.
The U.S. leads the world, with 63 per cent of Americans now either obese or overweight — a 17 per cent increase over the last 40 years. Young Americans are experiencing weight gain at an even faster rate; their numbers have tripled to 15 per cent.
With half of all Canadians now either overweight or obese (the former refers to body-mass indexes over 25, the latter to 28 and up; see box at right for how to calculate), our country is not far behind. A recent Health Canada report says weights have been on the rise for at least a decade.
Rising health costs and mortality rates linked to obesity are catching the attention of developed countries that have suddenly found themselves with a weight problem.
Britons, Asians, Europeans, North Americans: All over the world, people are gaining weight.
The continuing rise in obesity is a particular blow to the U.S., which set a goal in 1990 of reducing the prevalence of obesity to 20 per cent within the decade. Instead, the rate rose to 27 per cent.
“Unfortunately, current body-weight trends are leading us farther away from rather than closer to [national] goals,” noted an article in November’s on-line edition of Restaurant and Institutions magazine.
How can a world that talks so much about weight seem so helpless to do anything about it? The answer is extremely complex and the problem not easily solved, says UVic biochemistry professor Tom Buckley. While the essence of weight gain is simple enough — too many calories in, not enough out — people’s relationship with food is anything but.
“If we don’t understand how complicated it is, we’re never going to fix it,” says Buckley. “It’s not just chemistry. It has a lot to do with economics, sociology, all kinds of things that make us people. Why is it that the poor are more obese? Why do women perceive weight problems differently than men? And why are we all so gullible?”
Governments of the past have tended to view body weight as a personal issue and left it up to individuals to make their own decisions. But the disease burden from obesity has become too obvious of late — high blood pressure, Type II diabetes, certain cancers, and a far greater risk of death from all causes. The kind of talk that led change two decades ago when cigarette smoking was first being considered for regulation is now being heard around the subject of obesity.
Linked to cardiac problems, hypertension, Type II diabetes and several cancers, obesity-related disease now costs Canada about $2 billion a year. In the U.S., the tab is approaching $120 billion.
“Overweight and obesity may soon cause as much preventable disease and death as cigarette smoking,” cautioned U.S. Surgeon General David Satcher this fall. “People tend to think of overweight and obesity as strictly a personal matter, but there is much that communities can and should do to address these problems.”
Definitely, say health and fitness experts. But they stress that there’s no silver bullet. Battling the global bulge requires a little regulation and a lot of self-policing, says regional medical health officer Dr. Richard Stanwick.
“Super-sizing our meals is OK if we’re prepared to super-size the health system right along with it,” says Stanwick. “If these trends continue, the new dialysis unit we opened in September 2002 at Royal Jubilee will be at capacity in five years.”
B.C. Restaurant and Foodservices Association president Geoffrey Howes agrees. His members hope they never see a day when the government tries to tackle obesity by forcing restaurants to feature detailed nutritional breakdowns of their ever-changing menus.
“We’re taking the attitude that it’s calorie in, calorie out,” says Howes. “If you’re eating a lot of food, a lot of carbs, then you’re going to have to exercise.”
What’s missing is daily attention to diet and exercise, says local nutritionist Rosemary Quinn — just what the quick-fix generation doesn’t want to hear. People typically underestimate the amount of calories they’re taking in and overestimate their level of activity. Burning off an extra 150 calories in a day, for instance — the amount in a can of pop, or three Oreo cookies — requires two kilometres of walking.
The population is also aging, a major factor in weight gain if people don’t stay active.
“After age 20, the body automatically loses half a pound of muscle every year. That’s the one mechanism that helps us burn fat,” says Quinn, of Fitness Works. “When you consider that every pound of muscle burns 40 to 70 calories a day just existing, you could end up storing 200 to 350 extra calories a day by age 30.”
Less understood are the emotional components of obesity. Food is entangled in our lives from birth on, says local hypnotherapist Lani Andrews, of Mindful Solutions.
“From the time a baby is fed when it cries, there’s a relationship between our feelings and food,” says Andrews. “Maybe the baby just wants a cuddle or a hug, but instead it gets food. The child starts to associate food with comfort.
“And then one day you’re an adult. In an emotionally empty moment of your life, what else would you turn to but food?”
While our cultural relationship with food is complex, the body’s reaction to it is simple enough. All food is eventually broken down into sugars by the systems of the body, and what isn’t used soon after for energy is converted into fat and stored for later use.
Carbohydrates and proteins both contain four calories per gram, while fat contains nine. (Alcohol contains seven.) The combined calorie count of what you eat and drink in a given day, regardless of its source, is ultimately what matters; surplus calories from any source are stored as fat if the body doesn’t require them for energy.
But while a calorie is a calorie no matter where it comes from, there are certain facts of body chemistry that have put the high-carbohydrate Western diet in the spotlight as a factor in rising obesity. While carbohydrates are vital for sustaining life — and happiness, as they’re used in the brain to produce mood-regulating serotonin — too much of a good thing is turning out to be bad.
Here’s why: While protein and fat take longer for the body to break down, carbohydrates — particularly the ones abundant in sweet or processed foods — convert easily to sugar in the body. They provide the closest thing to instant energy, which is what endears them to athletes.
Unfortunately, most of us aren’t athletes. Excess carbohydrates not only add pounds, but require the pancreas to put in extra time producing insulin to level out the subsequent rise and fall of blood sugars from eating. Over time, that can dull the body’s insulin response and lead to Type II diabetes.
The spikes in blood sugar also trigger feelings of hunger, sending people back to the kitchen cupboard to do it all over again.
“We’ve spent many years trying to reduce our fat intake, but that has led us to eat more carbohydrates. And carbs are the way to Type II diabetes,” says Reg Mitchell, a UVic chemistry professor now controlling hi s own diabetes through diet and exercise.
“Eating fats at least means your body has to do some hard work to break them down, move them around and store them. You don’t get the blood-sugar rush. But that happens with carbohydrates, especially the sugars.”
While genes definitely play a role in determining body weight, researchers doubt that the current rise in obesity is about changed genetics. It began around 1980, and tracks along with a growth in fast food, eating out, larger portions and sedentary office jobs and leisure activities.
People now put their dishes in the dishwasher and their clothes in the automatic washer. They drive instead of walk, spend hours at computers, and regularly dine out at fast-food restaurants and vending machines instead of making meals from scratch.
The number of meals eaten away from home in the U.S. has nearly doubled in the last two decades to almost 30 per cent in 1995, reports the U.S. Department of Agriculture. Where people eat really shouldn’t matter, but convenience foods and restaurant fare are frequently high in carbohydrates.
Health Canada recommends consuming 55 per cent of daily calories as carbohydrates — about 330 grams a day on a 2,400-calorie diet. Low-carb adherents suggest far less: the popular Atkins diet prescribes just five grams of carbs a day to start out with, and it’s not uncommon for seasoned Atkinsonians to level out at around 20 to 50 grams a day.
But the bigger issue is whether people are even managing to hold their intake to 55 per cent, and are balancing their overall calorie consumption with the amount of activity in their lives.
If they’re eating fast food with any regularity, the answer is likely no. As well as being extremely high in fat, fast foods are also high in carbohydrates. As Corinne Netzer notes in her Complete Book of Food Counts, the standard fast-food burger starts at around 38 grams and climbs as high as 60. A medium-size chocolate milkshake at Burger King contains 105 grams of carbs; super-size fries at McDonald’s contain 61. And watch out for those low-fat muffins and pastries, some of which contain almost 70 grams.
Gram for gram, junk food is even higher in carbs, particularly pop. It’s no coincidence that children’s obesity rates in the U.S. have tripled right along with their daily consumption of pop in the last three decades, which has risen to 520 grams a day for boys and 337 for girls.
But even those who avoid fast food can still end up eating more carbohydrates than they’re burning off. Fruit juice is high in them, as are a surprising number of low-fat products in which sugar has been added to make up for the lack of flavour from fats.
“I think carbs are the closest we’ve come to understanding the problems of the Western diet,” says Ken Peters, senior nutritional consultant at Lifestyle Market. “Carbs first thing in the morning or last thing at night are the worst, because you get that blood-sugar spike. Starting the day with a glass of orange juice is like starting it with a cup of Coke as far as your pancreas is concerned.”
A trip every couple of months to the fast-food counter isn’t going to hurt anyone, says Stanwick, who admits to the occasional foray himself. “But one in every three meals, that’s a little different,” he says.
He saw an old TV episode of The Honeymooners recently that highlighted just how dramatically body types have changed over the years.
“Back in those days, Ralph Cramden was thought to be a really fat guy,” says Stanwick. “Now, he’d blend right in.”
Unfortunately, fast food is the only restaurant meal affordable to lower-income families, and the simple carbohydrates found in macaroni and white bread are all that they can afford for their kitchens. In developed countries, that reality is resulting in a disturbing link between poverty and obesity, especially for women.
In the United States, the ongoing National Longitudinal Survey of Youth has found that adult women who were obese by late adolescence on average went on to have less post-secondary education, a lower rate of marriage, smaller incomes and higher rates of poverty. The social handicap lingers even among those who eventually lose weight.
Negative attitudes toward the obese are seen in children as young as six, Pediatrics magazine reported in a 1998 issue.
Michelle Morand, head counsellor at Victoria’s Community Eating Disorder and Related Issues (CEDRIC) Centre, meets a disproportionate number of women who eat to hide self-esteem issues.
“There’s such a prejudice, so much shame,” says Morand. “People are reaching for food when they’re not hungry because they’re using it as a coping strategy. It’s like spending all your money, or gambling, or alcohol — people are ‘numbing out’ using food. And that can become a problem in itself, but our focus is to view the weight gain as a symptom of something else.”
Another kind of poverty — in this case, that of cash-starved schools looking for money to pay for after-hours sports activities and equipment — has dramatically increased young people’s access to snack foods in the past decade. Schools in the capital region and throughout North America earn tens of thousands of dollars a year by selling junk food to their students.
Claremont Secondary counsellor Lizanne Chicanot looks forward to the day when “it’s just not going to be acceptable” to have vending machines in schools. Reynolds Secondary principal John Harris, however, says his school can’t afford to give up the $10,000 a year it makes on snack-food sales. A large mainland school with a name-brand pop contract faces giving up three times that much if the practice was prohibited, he estimates.
“One hundred per cent of that money goes to helping kids do extracurricular activities,” says Harris, who worked with Ryan Vending a year ago to reduce the prices of the healthiest fare in the school’s vending machines. “We paid for 18 fall-season teams in the first three months of school here at Reynolds with money from our sales. Where’s that money going to come from?”
Such social and emotional considerations quickly complicate the debate around obesity, says UVic biochemistry professor Tom Buckley.
People eat when they’re lonely, and when they’re bored. They eat to forget a broken heart. They eat because that’s what they saw their parents do.
Race is a factor as well. A “thrifty” gene in Canadian aboriginals, biologically intended to help natives fatten up quickly for lean times ahead, converts even normal caloric intake into excess fat among First Nations populations, says Stanwick. In the U.S., obesity rates are rising particularly fast among those of African and Latin American descent.
Buckley has taught nutrition for more than 30 years, but admits to being no closer to unravelling the mysteries of controlling a population’s weight gain.
“One of the laws of the universe, the real universe, is that if you take in more energy than you use, you’ll gain weight. Energy can’t be created or destroyed, and that’s that,” says Buckley.
“But it’s getting people to accept it that’s impossible. We’re people. We believe what we want to believe. We have to find better ways of telling people that they’re taking in huge calories from some of the things they’re eating.”
Aware of a growing chorus of criticism around its own role in rising obesity rates, the food industry is attempting to take action before regulators step in.
“An increasingly volatile debate has arising around one question: What responsibility, if any, do the nation’s foodservices operations have in addressing this problem?” asked Restaurants and Institutions magazine.
Snack-food manufacturers are currently scrambling to eliminate trans fat, a hydrogenated oil linked to heart disease that’s common in everything from crackers and chips to raisins and Fruit Roll-Ups. Meanwhile, the public’s growing inte rest in low-carb diets — first popularized in the 1960s under monikers including the Air Force Diet and the Drinking Man’s Diet — is being duly noted and acted upon by entrepreneurial bakeries and restaurants.
In the capital region, Villages is testing low-carb pizza, and a number of bakeries are selling low-carb breads. Restaurants are highlighting low-carb and low-cal entrees.
At the Fish House in Stanley Park, executive chef Karen Barnaby is such a devotee of reduced carbs after losing 70 pounds herself that she now offers low-carb desserts and afternoon teas at the restaurant, and teaches low-carb cooking.
“A lot of people think it’s going to be boring to watch your carbs, but it’s not boring at all,” says Barnaby, whose recent Japanese tea featured low-carb yam noodles and miso-broiled eggplant.
She came across the book Protein Power four years ago and credits it changing her life: “I knew I was going to die by 60 if I didn’t do something.”
South of the border, Applebee’s Neighbourhood Grill and Bar in Overland Park, Kan., now features Weight Watchers points on its menus. Au Bon Pain in Boston has installed computer monitors so diners can check the nutritional content of the sandwich-maker’s products.
Some people don’t want to change their eating and exercise habits, however. They drive the market for the dozens of prescription drugs and supplements claiming to reduce appetite, speed up metabolism and block fat absorption, and a diet industry now worth almost $50 billion a year in the U.S. alone.
But the dizzying array of diet drugs, books, clubs and extreme measures that have come and gone in the past 20 years haven’t stopped the rise in obesity rates. Neither have they made it any more likely that dieters will keep their weight off; 80 per cent regain lost weight within a year.
That’s because the only strategy that works over the long term involves “a very multi-faceted approach that takes time and a conscious attention to detail,” says Ashleigh Gass, medical exercise specialist with Synergy Health Management.
If nothing else, advises Gass, “increase the vegetables and decrease the processed foods. Right away, that eliminates a lot of what’s in the grocery store.”
In terms of health improvements, even a little weight loss makes a big difference. In a U.S. study that tracked women with existing obesity disease for 12 years, even those who lost 20 pounds or less still saw their mortality rates drop by a fifth. They also saw a 30 to 40 per cent reduction in diabetes-related death, and a 40 to 50 per cent drop in death from related cancers.
Ultimately, the simple formula of eating less and exercising more — Health Canada recommends an hour a day — is what it takes to lose weight. But convincing people to adhere to that is the challenge, says Stanwick.
“Is that going to be easy? No. But on the other hand, is this a serious issue? Absolutely,” says the medical health officer.
“This is the next epidemic that’s going to hit us. A generation from now, when we’re seeing life expectancy plummeting because people are dying younger, we’re going to ask ourselves why we didn’t do something.”
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WHAT’S YOUR BMI?
The gold standard for body weight in North America has long been the Metropolitan Life insurance tables. But the more accurate standard these days is body-mass index, or BMI.
A BMI of 25 or more could mean you’re carrying more weight than is healthy. A BMI of 28 and up signals obesity, although you’re not at a high risk of obesity-related disease until your BMI hits 35.
What’s yours? Figure it out by dividing your weight in pounds by your height in inches squared, and then multiplying by 703. Or divide your weight in kilograms by your height in metres squared.
Or if all of that seems too much, go to www.halls.md/ideal-weight/body.htm and let the computer do it for you.
A BETTER LUNCH?
A nutritrious lunch menu by aspiring cooks at Spectrum Community School:
– Egyptian feta cheese style omelette;
– Spicy garlic pepper-style shrimp accompanied by pasta and braised cabbage;
– Beef crostini accompanied by hot German potato salad,
– Rainbow pasta salad
© Copyright 2004 Times Colonist (Victoria)
Jody Patterson, Times Colonist