Thursday, January 01, 2004

By Anita Srikameswaran, Pittsburgh Post-Gazette

The tale of the scale grew to nationwide proportions during 2003 as experts weighed in with numbers that were embarrassingly -- and dangerously -- big.

	CLOSE-UP 2003 One of a series TOMORROW: The massive blackout that blanketed the Northeast helped a local man get a liver transplant.

For starters, the U.S. Centers for Disease Control and Prevention estimated that about six out of 10 Americans were either overweight or obese. Furthermore, the prevalence of obesity almost doubled from about 15 percent in 1980 to 27 percent in 1999.

Scientists use a measure called Body Mass Index, or BMI, to take height as well as weight into account. A BMI of 25 or more is considered overweight and one of 30 or more reflects obesity.

A Rand Corp. study found that between 1986 to 2000, the proportion of severely obese Americans quadrupled, going from one in 200 to one in 50 people. That means having a BMI of 40 or greater, equivalent to at least 100 extra pounds.

Children did not fare much better. According to the National Health and Nutrition Examination Survey in 1999-2000, 15 percent of 6- to 19-year-olds are overweight, which is almost triple the number from 1980.

Minority children seem to be particularly afflicted, said Dr. Silva Arslanian, director of the pediatric weight management and obesity center at Children's Hospital.

Two out of five African-American youngsters have BMIs that are above the 85th percentile and one out of five has a BMI greater than the 95th percentile, which makes them very obese. Similar results can be found in the Hispanic pediatric population.

Arslanian summed it up simply.

	Additional information More information and BMI charts can be found online on the CDC's Web site.

"We have an unhealthy lifestyle," she said. "The eating habits are lousy and the activity patterns are lousy, too."

Genetics may play a role in obesity, but heredity isn't the sole cause of the epidemic, Arslanian said.

"Changes in the genetic pool take decades, if not centuries," she said. "It's the environment that's changing."

Even household pets are affected. According to the National Research Council, 25 percent of dogs and cats are overweight.

Dr. J. Michael McGinnis, senior vice president of The Robert Wood Johnson Foundation's health group, said the current weight statistics foreshadow future problems.

"Obesity now will lead to increased deaths from diabetes, heart disease, stroke and certain types of cancer, and increased prevalence of osteoarthritis years down the line," he said.

Cardiovascular disease, cancer and injuries -- the kinds of things listed on autopsy reports -- are usually cited as the leading causes of death. But if one looks closely at what led to those problems, certain behaviors turn out to be deadly.

McGinnis said that out of an average of 2 million deaths annually, tobacco use contributes to 400,000 and alcohol is implicated in 100,000. Unhealthy diet and physical activity patterns claim another 300,000 to 500,000.

While tobacco use has declined and alcohol consumption has stayed about the same over the years, diet and exercise behaviors are getting worse.

McGinnis said we're bigger because of problems on both sides of the simple equation of weight maintenance: calorie intake equals calorie output.

People were able to change their eating habits away from saturated fats to poly-and monounsaturated fats, and that led to drops in heart disease rates since the 1960s, he said. Yet total fat intake hasn't changed much.

Meanwhile, sugar intake has increased and, particularly among children, soda pop consumption has skyrocketed. According to the USDA, sugar and sweetener consumption has climbed from 113 pounds per person in 1966 to 147 pounds per person in 2001.

Some researchers point to high- fructose corn syrup, which is an inexpensive, commonly used sweetener, as a culprit in the obesity epidemic.

Coca Cola Co. and Kraft Foods Inc. announced plans to limit the presence of their products in schools because of obesity trends among children. The CDC noted that about 98 percent of high schools, 73 percent of middle schools and 43 percent of elementary schools have vending machines or snack bars.

"The sheer availability of food has led people to graze throughout the day on foods that are largely nutrient-poor and calorie-rich," McGinnis said.

People are also less likely to cook for themselves these days.

"Now roughly half of [all] meals are consumed outside the home and a substantial share of those are from fast foods," McGinnis said.

He added that fast food marketing often portrays big portions as a bargain. But a supersize soft drink can contain as many as 800 calories, which is about a third of the daily caloric requirement of a large man.

In her lectures, Arslanian uses a slide of a baby whose bottle contained Coke. The pediatrican also recalled a mother asking when she could introduce the soda into her 6-month-old's diet. Arslanian's answer: 'Never.'

"Children can drink tap water, that's what we all need," she said. "Other healthy drinks would be milk and natural juices."

On the other side of the weight equation, activity has been sluggish.

"We have become year-by-year an increasingly sedentary society," McGinnis said. As he put it, we have "inexorably engineered activity almost entirely out of our lives."

A shift from blue-collar, physically laborious jobs to white-collar sedentary ones, elimination of physical education programs in schools and urban sprawl in which neighborhoods are not exercise-friendly are contributing factors.

"People might have previously been willing to walk a half-mile or a quarter-mile," McGinnis said. "Now they hop in the car to go across the street."

And instead of strolling or playing catch during free time, people sit in front of the TV or computer, which is a habit that appears to begin early in life.

The Kaiser Family Foundation found that for children younger than 3, a third had a television in their rooms, 40 percent lived in homes where a TV was always on, more than half changed channels with a remote control and 30 percent loaded videos and DVDs by themselves.

For children of any age, "these are unhealthy habits because their muscles are not moving," Arslanian said. In the past, "they went outside and jumped rope, climbed trees or chased after each other. And transportation has become so easy that children are driven everywhere."

Type II diabetes, once dubbed adult-onset because it was only adults who got it, is now afflicting youngsters. Arslanian recently finished a study that overweight, Type II diabetic adolescents have arteries that are as stiff as those of healthy 50- to 60-year-old men.

"This is a very early functional abnormality that if left untreated over time is going to translate into early heart attacks and complications," Arslanian warned.

Obese children are more likely to have high blood pressure, elevated cholesterol levels, fatty liver conditions that can lead to cirrhosis, kidney problems and other serious health issues.

As McGinnis put it, "We may be raising the first generation of children that is sicker and dies younger than their parents."

So educating the public about healthy nutrition and exercise is essential, the experts said. Healthy policies for school foods and reinstitution of physical activity in curriculums is also important.

Better food product labeling and infrastructure changes, such as investment in building safe sites like parks, walkways and bike paths to promote activity, will also help.

"We've spent 50 years getting rid of these things and we're not going to get them back into our lives in the next two or three years," McGinnis acknowledged. "This is a multi-decade effort, but it can be done."

Meanwhile, manufacturers are making bigger strollers for children up to age 4 or weighing up to 50 pounds, which is one year or 10 pounds more than what had been the convention.

And on the adult side, they're making scales that go up to 1,000 pounds, supersize towels, sock installers and sponges-on-a-stick for hard to reach spots, as well as extra-large coffins.

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