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JOHN HOFFMAN is Executive Producer of HBO’s The Weight of the Nation. He has won Emmy® awards for the documentary series The Alzheimer’s Project and Addiction, among others.
JUDITH SALERNO, MD, MS is the Leonard D. Schaeffer Executive Officer of the Institute of Medicine (IOM), the health arm of the National Academy of Sciences. She is a nationally recognized leader in health policy.
ALEXANDRA MOSS is Co-Producer of HBO’s The Weight of the Nation.
America’s ever-expanding waistline: We see it, we hear about it, and we worry about it! But can anything be done about it? Who or what is to blame?
We know all the usual suspects: red meat, dairy, white flour, refined sugar, high-fructose corn syrup, a lack of exercise, too much television, and the list goes on, and on, and on….
Simple! Right?...Not so fast. There’s a lot more going on below the surface when it comes to what America is eating for dinner (and breakfast and lunch and in between). And that’s what The Weight of the Nation has finally done: dug a lot deeper to uncover what’s going on in our minds, in our stomachs, in corporate America, on our farms and in society’s overall love of food and our relationship with our couch.
The obesity epidemic in America has been a long time in the making and has been nourished by many different sources. The solution to America’s obesity epidemic will not come from quick-fix diets or a new national obsession with working out. The problem for our nation and for each of us as individuals is far more complex.
The answer will only come from learning more about why we seek and consume food, how we are designed to conserve energy whenever possible, and how the world around us compels us to eat more than we should and move far less. Once you know that, you can use that information to lose weight and keep it off.
The Weight of the Nation provides you with all the tools you need—and gives you the power—to think clearly, to better understand your relationships with food and physical activity, and to change the way you eat and move for the rest of your life.
The Worse News: It's Making Us Sick
Collectively, Americans carry more than four and a half billion extra pounds— that’s an average of fourteen and a half pounds per person. This excess body fat, whether it accumulates under our skin, around our abdomens, or inside our organs, wreaks havoc on our bodies, which are simply not designed to carry all that extra weight. As a result, obesity is a culprit behind the countless chronic diseases affecting us today. According to CDC estimates, obesity is associated with approximately 112,000 deaths each year.
Did you know that every twenty- fi ve seconds someone in this country has a heart attack? This alarming statistic accounts for heart disease’s rank as the number one cause of death for both men and women. More people die from heart- related problems than from cancer, AIDS, respiratory disease, or even accidents. And if you are obese or overweight, you are more likely to have high blood pressure, high levels of triglycerides and LDL (“bad”) cholesterol, and low levels of HDL
(“good”) cholesterol, all of which are risk factors for heart disease. The bottom line: Being overweight or obese places you at a higher risk of developing heart disease and stroke.
According to Dr. Donald Lloyd- Jones, the chair of preventive medicine at Northwestern University, we shouldn’t be surprised by this. “The heart is a muscle like any other in our body,” he explains. But there’s one important exception: “It never gets to rest.” Your heart— the hardest- working muscle— spends every second of every day vigorously pumping blood to the farthest reaches of your body. The larger you become, the harder your heart has to work to keep blood circulating.
The heart’s smooth muscle walls start to thicken and get bigger. According to Dr. Lloyd- Jones, “pretty quickly the thickened heart starts to weaken and eventually tips over into heart failure.”
Arteries are the smooth, elastic vessels that transport blood throughout the body. When you have high levels of LDL, the “bad” cholesterol, it can stick to inflamed sections of the artery walls and eventually build up into deposits called plaques. Just as gunk in the drain of your sink would prevent water from flowing out of the basin and down the pipe, causing a backup, clogged arteries reduce blood flow, increasing the risk of a heart attack or stroke. If a coronary artery is completely blocked off, it interrupts the blood supply to the heart muscle, causing what we know as a heart attack.
For many of us, there is a genetic component to cholesterol beyond our control that cannot be overlooked. If your cholesterol is too high despite being at a healthy weight and eating a healthy diet, there are other ways to reduce it. The discovery and wide use of statin drugs (like Lipitor and its generics) have been a boon to the heart health of our nation. With changes in diet and drug- induced reductions of further buildup of plaque in the arteries, you can dramatically reduce your risk of heart attack and stroke.
A High-Pressure Situation
As the heart pumps harder with increased body size and the arteries narrow with elevated cholesterol, blood pressure almost inevitably begins to climb. High blood pressure, also known as hypertension, is a major risk factor for heart disease and stroke. Sixty- nine percent of people suffering their first heart attack and 74 percent of stroke victims have high blood pressure. The most common contributors to high blood pressure line up perfectly with the modern American lifestyle: being overweight, not engaging in enough physical activity, and eating a poor diet high in sodium.
7 Steps to a Healthy Heart
Wonder what makes for ideal cardiovascular health and whether you meet the criteria? Give your heart a break and show it some love by trying to check off as many of these American Heart Association factors as possible:
1.Optimal cholesterol (less than 200 mg/dL)
2.Normal blood pressure (120/80 or lower)
3.Not having diabetes
4.Lean body mass index (BMI of less than 25)
Unfortunately, according to the American Heart Association, only 1 percent of American adults meet these criteria. To find out how many you meet, go to mylifecheck.heart.org.
The United States of Diabetes
High blood sugar, the telltale sign of diabetes, is caused by the body’s failure to move glucose out of the bloodstream and into the cells, where it is used for energy. Carrying too much weight, especially when fat is concentrated in the abdomen, makes you resistant to your own insulin, the hormone that moves glucose from your blood into your cells. In response, the pancreas works hard to produce ever- higher levels of insulin in an attempt to keep blood glucose levels from rising.
Type 2 diabetes ultimately ensues when the body’s cells become resistant to insulin and thus cannot properly remove glucose from the bloodstream. And, in some cases, the insulin- producing cells of the pancreas eventually become exhausted, requiring people with type 2 diabetes to take injections of insulin.
Type 2 diabetes affects nearly 27 million Americans and is inextricably linked with obesity: 80 percent of people with type 2 diabetes are overweight or obese. Currently the seventh-leading cause of death, diabetes, if left untreated or poorly controlled, can contribute to a number of serious health problems, including kidney failure, blindness, and amputations. Unfortunately, the somber stats don’t stop there. People with diabetes are up to four times more likely to have a heart attack or stroke than those without it, and 25 percent more likely to die of cancer. The main risk factor for developing type 2 diabetes is weight gain— even going from a BMI of 26 to 27 or 28 can increase your risk substantially.
Type 2 diabetes doesn’t develop overnight. More than 79 million Americans are living with a condition called insulin resistance— also known as prediabetes. As we gain weight, our cells become more resistant to insulin, which results in an inability to transport glucose out of the bloodstream as well as we should. This leads to a high blood sugar level, which can be detected by your doctor with a standard panel of blood work. People with prediabetes are at incredibly high risk of tipping over into diabetes in the near future. But since prediabetes has no symptoms, most of the millions of people with prediabetes don’t even know they have it, which is one reason it’s crucial to have periodic screenings. There are many things that can be done to reverse prediabetes— or even
reverse type 2 diabetes— but you can take action only if you know you have a problem. It’s believed that more than 90 percent of adults with prediabetes and 25 percent of adults with diabetes don’t know they have the disease, because they haven’t been tested for it. For more on the different steps you can take, see chapter 3.
When you gain too much weight for the body to store it under your skin, it begins to deposit in your belly and eventually spreads out into some of your organs, especially your heart and other muscles— and, most importantly, your liver. Fat deposits in the liver are associated with the metabolic abnormalities that drive the development of both high cholesterol and type 2 diabetes. The growing obesity epidemic has been closely followed by another rising epidemic of this new condition, called nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease didn’t even exist until recently. And now it’s estimated that as many as 25 percent of American adults have excess fat in their liver.
In some cases, nonalcoholic fatty liver disease progresses into a form of cirrhosis that occurs almost exclusively in people with severe obesity. Almost all liver transplants in this country are performed as a result of cirrhosis, but it used to be that most of that liver failure could be attributed to the effects of alcoholism or hepatitis B and C. Now, however, the number of liver transplants resulting from cirrhosis caused by nonalcoholic fatty liver disease is quickly rising.
The C Word
Obesity doesn’t just affect your heart, vascular system, pancreas, and liver; it also increases your risk of developing some types of cancer, including cancers of the colon, kidneys, and esophagus. In women, it is also linked to uterine cancer and postmenopausal breast cancer. Twenty percent of cancer deaths in women and 14 percent in men are related to being overweight or obese.
One recent study suggests that being overweight or obese in middle age might increase your likelihood of developing dementia later in life, perhaps by as much as 70 percent. According to Dr. Nora Volkow, a neuroscientist and the director of the National Institute on Drug Abuse, obesity “negatively affects the functioning of the human brain.”
When researchers have compared the brain activity of obese people with the brain activity of those at a healthy weight, studies have shown decreased activity in the areas of the brain that control cognition.
Other Aches and Pains
More than 66 percent of people with arthritis are overweight or obese. The hypertension with which so many obese people struggle makes them 83 percent more likely to develop kidney disease. Obesity also increases adults’ relative risk of health problems such as gallbladder disease, asthma, sleep apnea, and gout.
We know that obesity is a gateway to serious health conditions, but what are the ramifications of having those conditions earlier in life, when your body’s still developing?
Won’t Somebody Please Think of the Children?
In 1970, less than 5 percent of American children were obese. By 2008, that figure had skyrocketed to more than 17 percent. Add in the kids who are overweight, and the number soars to almost 33 percent. In African American and Hispanic communities it’s even higher: 40 percent.
How’s the health of those kids? Not so great. The CDC reports that 20 percent of all American teens, and 40 percent of obese teens, have unhealthy cholesterol levels. Autopsy studies have found that 38 percent of obese children and 13 percent of all children show signs of nonalcoholic fatty liver disease. Pediatricians are now being encouraged to pay close attention to the warning signs of hypertension.
And when it comes to diabetes, children typically aren’t screened at all. Prior to the rise of obesity in this country, it simply wasn’t necessary. Any diabetes seen in children was usually type 1 diabetes (not related to obesity). Type 2 diabetes historically was seen only in adults, and was called adult- onset diabetes. Now that physicians are seeing it in obese children, they had to stop calling itadult- onset,but the health risks are the same.
What will happen when these children who are starting their lives with a progressive disease end up on dialysis before the age of thirty?
Type 2 diabetes typically cuts the life expectancy of a fifty-year-old by six years. The CDC estimates that a ten- year- old with type 2 diabetes will lose nineteen years of his or her life.
A Life Unexpected
There is much speculation— and worry— that the compounding obesity and diabetes crises will actually shorten our national life expectancy. And if that happens, it will be the first time since the rise of modern civilization it occurs not because of natural disaster, famine, or plague, but as the result of chronic diseases.
Whether or not the average life span decreases, the quality of life for many Americans already has. Obesity can deprive those affected by it not only of health, but also of mobility, self- esteem, opportunities, and, in many cases, success and happiness.
Obesity is a national problem, and one that needs national attention in order to fi x it. Every person in this country, even those who are currently at a healthy weight, is or will be touched by obesity in some way. It’s everyone’s problem, and everyone needs to be part of the solution.