As Beth Walley discovered, obesity is difficult to reverse


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Beth Walley hit rock bottom four years ago after her divorce, her father's death and her mother's decline in health. The emotional toll snowballed, pushing her morbid obesity nearly to a quarter ton.

Over the years, weight-loss plans, medications and doctor's care failed to peel off poundage with psychological setbacks causing her to binge on chocolate and fast food.

In 2009, she already had insulin-dependent type 2 diabetes, high blood pressure, high cholesterol and gall-bladder disease featuring 22 gallstones. Her 450 pounds exceeded the limit of the doctor's office scale. She began preparing to die.

"Food was my drug of choice," said Ms. Walley, 50, of Carnegie. "I turned to food to cope and was stuffing my feelings with food rather than coping and dealing with them. I had burned out all my options and didn't know what to do or where to turn.

"I was eating myself to death," she said.

As Ms. Walley's ordeal reveals, obesity is difficult to reverse with bad habits worsened by psychological issues, stress, life's challenges and constant access to unhealthy food. Packed-on pounds are tough to lose and easy to regain.

But programs could soon be launched in Allegheny County and beyond to address the national obesity epidemic with a focus on prevention in children through cooperative efforts involving government, schools and communities.

Karen Hacker, the new director of the Allegheny County Health Department, announced her intentions to the county board of health to initiate and integrate community programs county-wide, as happened with success in Boston, where she headed its Community Health Institute.

"I put it on my list of priorities," she said. "It feels like something where the time has come, and I, as director, can pull people together and push forward." Obesity can plague people with numerous medical conditions, ranging from emotional problems, cardiovascular disease and cancer. "You can't separate these things," Dr. Hacker said.

On Sept. 25, the Highmark Foundation brought 500 health-care, education, corporate and community leaders, and professionals together at the Omni William Penn Hotel to hear experts explain the best practices available to prevent childhood obesity.

Numbers from the U.S. Centers for Disease Control and Prevention explain the concern. Childhood obesity has more than doubled in children ages 6-11 and tripled in adolescents 12-19 in the past 30 years. The percentage of obese children in the United States increased from 7 percent in 1980 to nearly 18 percent in 2010, with obese adolescents reaching a similar percentage.

"In 2010, more than one third of children and adolescents were overweight or obese," the CDC reports.

Experts say schools nationwide are banning sugary drinks and candy from vending machines and removing other unhealthy food options in school settings. There's also a renewed federal focus on food quality in school cafeterias. Other efforts are encouraging exercise with outdoor recesses and reinstituting physical education to the curricula.

Dr. Hacker said community-based programs can unite people to intervene to encourage better food choices while providing improved facilities for walking and bicycling. "It will require all the pieces, like building blocks, with many people involved, not just the health department," she said. "It must involve the schools, community partners and even the mayor's office."

Successful childhood weight-control programs in Boston could be used here.

One showed that childhood obesity could be reduced or stabilized by making better food choices and providing places where they could play and exercise. Another program provided parents with health report cards for their children that included the child's weight and body-mass index, with programs to intercede to help those with potential weight problems to eat better and exercise more.

That program provided more information to parents and helped motivate them to intervene to prevent weight gain. Other Boston studies showed that weight reduction rates were higher among younger children, emphasizing the need to reach them at an early age. Those facing a higher risk of weight gain were more likely to change for the better than those who already were overweight.

Obesity is epidemic in the United States. No age, race or ethnic group is immune from excessive weight gain.

The CDC says 33 percent of adults in the United States are overweight, with another 36 percent obese. More than two-thirds of the population are too heavy, putting them at higher health risks.

People with a body-mass index of 25 to 29.9 are considered to be overweight. A person 5 feet 4 inches tall is considered overweight at 145 pounds, when the body-mass index reaches 25, with obesity at 175 pounds, when BMI reaches 30. A person 6 feet tall is overweight at 184 pounds and obese at 221 pounds. A BMI of 40 -- indicating 100 extra pounds -- makes the person morbidly obese, which describes 8 percent of Americans.

Too much weight leads to heart disease, stroke, type 2 diabetes and certain types of cancer, leading the CDC to estimate obesity's medical bill at nearly $150 billion. People with obesity face annual medical costs that are $1,429 higher than people of normal weight.

African-American adults have the highest age-adjusted rate of obesity at nearly 50 percent, as compared with 40.4 percent of Mexican-Americans, 39 percent of Hispanics and more than 34 percent of Caucasians.

"For many people, obesity is one of the most difficult things to do anything about," Dr. Hacker said. "To lose weight by yourself -- I haven't seen much success with that. People get involved with different diets. Diets actually work, such as Weight Watchers and Jenny Craig, but you have to stay on them the rest of your life."

The biology of weight gain includes development of fat cells that remain even after the weight is lost and reactivate when a person resumes a poor diet, causing a rebound to an even higher weight.

"Most people are busy and can't spend their entire life losing weight," she said. "The quickest and cheapest food to buy is processed carbohydrates with restaurants serving big plates of food.

"I don't have many options for folks to really get them over the hump and keep off the weight over time," Dr. Hacker said. Endocrine and psychological issues can worsen the problem.

William Dietz, former director of the CDC's Division of Nutrition, Physical Activity and Obesity, said taxing sugar beverages and decreasing a child's intake of fast foods, sugary cereals and whole milk, are necessary to reduce the rate of childhood obesity.

Changing school foods, along with education, have been proven effective in preventing obesity. Dr. Dietz said a national goal of reducing childhood obesity is achievable by reducing an average of 30 calories a day for children 2 to 5, 150 calories a day for children 6 to 11 and 180 daily calories -- a little more than one can of sugary pop a day -- for those 12 to 19 years old.

"I think we need a sustained strategy and must implement different versions of grass-roots support," he said. "Regulation [including taxing unhealthy snack foods] can do a lot, but the effect is unpleasant to many. We need more of a parental commitment.

"This is my key message," Dr. Dietz said. "Parents and children can only make healthy choices if there are healthy choices to make, and many people exist in environments where they don't have that option."

Ms. Walley's adulthood has been plagued by persistent weight gain.

In the 1980s, she gained 100 pounds and added another 100 in the '90s. The trend continued in the new century with yet another 100 pounds. She once managed to lose 100 pounds, but she regained that much and more.

That's when she opted to end the roller-coaster ride with risky gastric-bypass surgery. The various types of bariatric surgery make up the most successful method of weight loss for the morbidly obese, but it carries major risks and potential side effects, including bowel obstruction, hernias, malnutrition and stomach perforation, among others. The surgery also requires the patient to adopt permanent changes in lifestyle. The expense and risks of the surgery limits its use to patients on the verge of deadly health consequences.

At her unhealthy weight, Ms. Walley said, the surgery was particularly risky. In preparation, she cut her weight to 400 pounds, made funeral arrangements and said good-bye to friends and loved ones.

"I was going to die anyway," without the surgery, she said.

On Jan. 26, 2012, Ms. Walley underwent surgery, which led to serious complications. But 20 months afterward, she's now lost 240 pounds -- the equivalent of Steeler quarterback Ben Roethlisberger's weight. At 5 feet, 6 inches tall, she currently tips the scales at 165 pounds, with a goal of 150.

"It saved my life, but now I'm saving it every day by making good, healthy choices with diet, exercise and getting good rest," she said. "This whole thing about food -- We focus on it too much. We celebrate with food. Food is our focus, and it's involved in every aspect of our lives.

"It doesn't need to be."

Calculate your BMI at the following National Institutes of Health web site: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm.

homepage - health

David Templeton: dtempleton@post-gazette.com or 412-263-1578. First Published October 7, 2013 4:00 AM


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