From the San Francisco Chronicle: The Obesity Crisis - a series
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THE OBESITY CRISIS: Weighty crusade
Exercise, healthy eating are hitting stride on global scale
- Kim Severson, Chronicle Staff Writer
Sunday, May 23, 2004
McDonald's went national this month with an adult Go Active! Happy Meal.
No, it doesn't come with a McMartini. People who order it get a salad and water to help cut calories, along with a pedometer to encourage walking.
McDonald's contribution to fighting America's weight problem is just one of thousands of efforts to slim down the nation. Ever since 2001, when the U.S. surgeon general declared obesity an epidemic, businesses, schools, governments and countless individuals have rallied to curb what experts say is an unprecedented public health crisis.
Our weight has gotten so out of control so quickly that earlier this year the Centers for Disease Control and Prevention reported that deaths related to poor diet and too little exercise have increased by 33 percent over the last decade. The agency predicts that being overweight and out of shape soon will top tobacco as the country's leading cause of preventable death.
Like the obesity crisis itself, the fight to find a solution has gone global. On Saturday, the World Health Organization signed off on a plan to help countries improve their populations' diet and exercise habits. Among the ideas: reduce sugar, fat and salt in processed food; improve monitoring of food marketing to children and health claims on packaging; and provide more nutrition information and health education.
In the United States, the scramble to shape up has engaged virtually every corner of the country. And although nutritionists and politicians agree there is no single solution, the best hope for quelling the epidemic will come from a societal change in how we eat and exercise -- a change that requires a mix of top-down efforts like McDonald's and bottom-up grassroots efforts led by determined individuals.
"It's like the moon and the stars aligned now to make things happen," said Pat Crawford, co-director of the UC Berkeley Center for Health and Weight. "It's only been this last decade where obesity has grown so much where people said genetics alone can't explain this. It's clearly something about the environment ... it's how we eat and live."
The recent explosion of new efforts in Northern California ranges from the simple, such as a city-funded class to teach parents in San Francisco's Mission District how to blend fruit and water into healthy agua frescas, to the complex, such as research at UC Davis aimed at unlocking the secrets of a hormone that regulates hunger.
In the California Legislature, 2001 saw the passage of one lone obesity- related bill -- its aim was to eliminate soda and junk food in schools. But in just the first five months of this year, at least 17 obesity-related bills have been introduced. The approaches are varied. One bill would require new schools to have kitchens and gardens. Another would prevent lawsuits against food companies by people who claim their products made them obese.
Parents of school-aged children all over the country, led by groundbreaking efforts in California, are pushing their lunchroom directors to provide healthier food. Architects are designing buildings to make people walk more.
Among the hundreds of millions of tax dollars aimed at the epidemic is a $190 million national multicultural campaign for television, radio and the Internet called "VERB: It's What You Do." The goal of this federal program, according to CDC Director Julie Gerberding, is to help the preteen crowd get active in a "cool and meaningful way."
At Kaiser Permanente, a measure of fat called the body mass index, or BMI, is being taken on every visit, just like blood pressure or other vital signs.
The food and beverage industry is scrambling to reformulate popular junk foods, adjust portion sizes and re-evaluate advertising strategies, all the while arguing that food itself isn't bad, but our lack of exercise is.
Even animal rights groups are getting in on the action. In April, the People for the Ethical Treatment of Animals group launched an anti-obesity campaign that shows an overweight child about to eat a hamburger. The tagline? "Feeding Kids Meat Is Child Abuse. Fight the Fat, GoVeg.com."
At its heart, the reason two-thirds of Americans are either overweight or obese is exceedingly simple -- too many calories and not enough physical activity. But the epidemic is also a complex and vexing reflection of societal changes that took off in the 1970s.
School physical education programs have nearly dried up, but 30 percent of children watch at least five hours of television a day -- much of which features multimillion-dollar ads aimed at selling them food high in sugar and fat.
Meanwhile, Americans snack more than ever and eat more than half their meals at restaurants, shoving down oversized portions and nutritionally corrupt food. We have gotten so sedentary that we don't even roll down our car windows anymore.
As a result, a recent study by the CDC estimates that medical expenditures attributed to obesity reached $75 billion in 2003, with taxpayers financing about half of the cost through Medicare and Medicaid.
The public is taking up the cause with abandon. America gave up the low- fat craze in the early 1990s and replaced it with a low-carb solution. "Dr. Atkins' New Diet Revolution'' appeared on the New York Times best-seller list on April 28, 1996, and hasn't left. In 2003, it was joined by "Atkins for Life'' and the "The South Beach Diet.''
The trend is so strong that 44 percent of American adults say they are "making an attempt to restrict the amount of carbohydrates in their diet,'' according to Opinion Dynamics Corp., a national public research firm.
So which approach will work? It's like a barber who thinks everyone needs a haircut -- whichever field the expert is in, that's the field with the answer. In the end, nutritionists, doctors and public health experts agree, solving the nation's complex weight problem will take an equally complex set of solutions.
Research has proven that a few things do work. Although scientists are still arguing about why, studies show infants who are breast fed have a much better chance of avoiding obesity as teenagers. Other studies show that kids who don't watch much TV are in better shape. Increasing physical activity, reducing portions, and eating more fruits and vegetables all help. The way we plan our buildings and communities also could have significant impact.
Still, some nutritionists warn of an unexpected consequence to all this social upheaval surrounding obesity -- that is, a cultural perception that anyone who is not thin is not healthy.
"This war on obesity has every possibility of becoming a war on the obese. If stigmatizing obesity worked, there wouldn't be an obese person in this country," said Joanne Ikeda of UC Berkeley, one of the nation's top nutritionists, at a recent San Francisco forum on diabetes and weight. "Obesity is simply a manifestation of an unhealthy lifestyle. Not all overweight people are living an unhealthy lifestyle."
Sarah Samuels, a Bay Area public health researcher and policy consultant, agrees, but says it's important to capture the momentum that would drive the nation's largest restaurant chain to start selling pedometers. "We need to act quickly,'' she said, "while we still have the public's attention."
ONE FAMILY
She weighed 240, her daughter hit 230, and Oakland mother Susan Pierpoint realized she had to reverse the trend
- Joshunda Sanders, Chronicle Staff Writer
Sunday, May 23, 2004
For most of her life, Susan Pierpoint had an unbalanced relationship to food. She used it as the solution for everything, especially when it came to her two daughters.
If they whined about going to church, she quieted their complaints with doughnuts. Any other signs of distress could be quelled with ice cream. Once, when her oldest daughter skinned her knee, Susan offered her a cookie.
That's why Susan, an attorney in Oakland, spent much of her adult life battling obesity. When she weighed her heaviest, she was nearly 240 pounds. Her oldest child never had a weight problem, but her youngest daughter, Annie, did: When Annie turned 16, she was about 230 pounds.
"Part of what we've had to deal with is how to express love for each other without saying, 'Let me buy you a treat,' " Annie, 19, said. Annie's love of overeating mirrored her mother's food issues and started when she was just 4 years old. Annie, who described her demeanor as a child as "fat and jolly," often stole Reese's Peanut Butter cups from the au pairs who took care of her. As she got older, she continued to blow up, Susan said.
But a series of fractured wrists sent mother and child to a pediatrician, who warned them of other problems that could surface. Annie could be at risk for Type 2 diabetes if she didn't control her weight.
An endocrinologist later found that Annie had developed polycystic ovarian disease -- a chronic condition that affects some people who are obese. And there was a host of other problems that she could develop if they didn't do something immediately.
"I finally decided that the only way I could help (Annie) was to solve my own problem and not talk about it, just do it," Susan said.
So she joined a 12-step program. She did a lot of research. She tried a lot of different food plans until she found one that she liked. And with a lot of patience and planning, she lost more than 100 pounds -- and kept it off.
Then, she turned her focus to Annie. Together, they found a dietary plan that was similar to Susan's, but more flexible. A physician, Dr. Robert Lustig, who had seen Annie at the clinic when she was morbidly obese, suggested diet, exercise and medicine. Because both mother and daughter were committed to a low-glycemic diet, and because they both wanted success, they achieved it. "Anything short of that won't work, because the sabotage is too easy," he said. Although Annie took Metformin for her special medical needs, Susan helped her daughter through the herculean task of changing her lifestyle. Within 10 months, Annie lost 70 pounds. She has kept it off by staying active -- doing inner tube water polo, for instance, at UC Davis, where she's a freshman.
And she sticks to her food plan religiously, even though she is constantly confronted with greasy temptation in the cafeteria. Her happy-go- lucky peers eat pizza and other fatty foods like they've never seen a food pyramid. Every now and then, she has to escape the pressure by taking herself downtown for salad. But she's good at making adjustments. Instead of indulging in a keg at frat parties, for instance, she would bring bottles of root beer with her to parties.
It's intense for a young woman, she said, but it's worth the effort.
"You get this new life, and that sounds kind of corny," Annie said, "like something they might say to advertise some kind of fad diet. But I went white- water rafting this weekend ... and I had the time of my life. It was something that I wouldn't have even considered when I was overweight." Susan said that for both her and Annie, the lifestyle change is "an act of love -- directed at ourselves."
ONE BUSINESS
Menlo Park firm's fitness program gets big returns for small investment
- Victoria Colliver, Chronicle Staff Writer
Sunday, May 23, 2004
Almost 160 people work at a Menlo Park division of L-3 Communications Inc., and Joan Arico's job is to keep each one of them in shape.
As a "wellness coordinator," Arico leads twice-daily fitness classes, organizes company walks and serves as a personal cheerleader for exercising and losing weight.
Few companies the size of L-3's Randtron Antenna Systems division have a full-time employee dedicated to keeping workers fit, but Arico said Randtron's founders believed a full-fledged fitness program would keep up employee morale and reduce health care costs. That philosophy helped earn the division the California Fit Business Award this year from the state Legislature.
"I can actually see results in individuals, whether it's losing weight or just feeling happier, more confident," said Arico, who has been the company's wellness coordinator for 15 of the 17 years the job has existed.
With rising health care costs relating to obesity, employers are trying creative solutions, such as making cafeteria menus healthier or building campuses to promote fitness.
Sprint spread out its buildings at its headquarters in Overland Park, Kansas, and placed the parking lot on the far side of the complex to encourage walking. In addition, the company made the elevators slow, but built the stairwells to be wide and inviting.
Smaller businesses often lack the resources for such large-scale efforts, but a smaller operation such as L-3's Randtron division shows that money and size don't have to be obstacles, said Jim Carmen, who served on the judges' panel for the award.
With an annual budget of about $8,000, Arico maintains the cardiovascular and weight-lifting machines in the company's gym, and purchases equipment for Pilates, aerobics, and other classes at Randtron, which manufactures microwave antennas for Defense Department contracts.
Additional expenses include the snacks and giveaways that she uses to lure employees to her various programs, such as a recent monthlong effort to get the workers to eat five fruits and vegetables a day. Her programs have a participation rate of about 60 percent.
On a recent lunch break, Arico organized a milelong "poker walk," in which more than 40 employees walked to various points and picked up a playing card. The employee with the best poker hand won.
Technician Tony Valdillez, 41, has lost 40 pounds since October, when he joined Weight Watchers and stepped up his workouts in the company's weight room. He said his supervisors have given him an extra 15 minutes for his lunch break to exercise. Having the facilities at work and the supportive environment, he said, means that "you can come in every day before work, during and after." He's in the best shape he's been in years, he said.
Whether the investment in wellness programs actually translates into lower health care costs is unclear, but some companies are starting to see cost benefits. For example, for every dollar Motorola spends on its wellness program, the company says it saves $3.93.
Absent large-scale studies, health benefits experts say, such programs intuitively make sense.
"If you can get people participating, they (businesses) will save money if it can reduce the incidence of diabetes and heart disease," said Paul Fronstin of the Employee Benefits Research Institute in Washington, D.C. "You can increase productivity and create a healthier workforce that uses less health care."
ONE NUTRITIONIST
Big man on campus at S.F. schools alters the way children eat -- and they like it
- Heather Knight, Chronicle Staff Writer
Sunday, May 23, 2004
When student nutrition directors gather for conferences, Ed Wilkins is the oddball. He's a man in a field dominated by women, has roots in business rather than nutrition, has no children of his own and, at 6 feet, 5 inches, he towers above the others.
But that pales beside his resolve to ensure that San Francisco's public schools never sell students another empty calorie.
No more french fries. No more soda. No more Hostess cakes. No more Gatorade. No more ice cream. No more potato chips -- even of the baked variety. Nothing battered, nothing fried. No more "hot" anything -- hot dogs, hot links, hot wings.
"I remembered how I was able to eat as a child, and in all honesty, I was appalled at what we were serving them," said Wilkins, 56, in his slow Texas drawl.
A group of parents worked to make over the old menu, Superintendent Arlene Ackerman gave her support and the city's Board of Education approved it. But Wilkins, the district's interim director of student nutrition, has been the one to make it all happen.
Now, students can only buy food at school that contains less than 30 percent of calories from fat, less than 10 percent of calories from saturated fat and less than 35 percent sugar by weight. In addition, snacks and side dishes must contain certain levels of vitamins, minerals, protein and fiber.
The standards don't affect the regular lunch line, which must meet guidelines already set by the U.S. Department of Agriculture. But they do affect every other kind of food sold at school -- from cafeteria snack bars to vending machines to fund-raisers during school hours. Yes, even the lunchtime bake sale is no more.
The new policy was launched at Aptos Middle School in January 2003 and has since gone districtwide.
Sales dipped at first, but have rebounded, Wilkins said, debunking the conventional wisdom that school food programs risk bankruptcy if they take away popular, fatty food. Now, kids buy salads, deli sandwiches, soup, fresh fruit, yogurt and 100 percent fruit juice -- and actually like them.
"It's made me change the way I eat," said Aptos student Racquel Kraft, 13. "I don't want to go home and eat a lot of junk food, because if I can't eat it at school, why should I eat it at home?"
Sylvia McClain, 12, said she has ditched chips for salad and lost five pounds. "I felt like a potato -- a couch potato," she said. "I was really lazy and didn't do anything. Now I'm more energetic."
That's Wilkins' goal -- to change the way students think about food and nutrition even outside the cafeteria.
"Maybe the kids will teach their own parents something," he said.
Wilkins isn't done yet -- he is launching a salad bar program at elementary schools. "Kids love it -- it's like a field trip, somehow," he said.
With so many children skipping breakfast for a few more minutes of sleep in the morning, Wilkins plans to start a grab-and-go breakfast program in which students grab a portable breakfast in the cafeteria and eat together in their classroom to begin their days.
Wilkins gets a special kick out of the kindergartners. During a recent lunch break, he folded his big frame into little chairs to sit with them.
"I keep telling them, 'If you eat good food, you'll get this tall too.' ''
ONE doctor
UCSF pediatrician shoulders weight of the world trying to reduce insulin
- Julian Guthrie, Chronicle Staff Writer
Sunday, May 23, 2004
Dr. Robert Lustig is driven by gluttony and sloth.
It keeps him awake at night, gets him up early and makes him log more than 200,000 frequent flyer miles a year. Equal parts scientist, teacher and salesman, Lustig bears an uncanny resemblance to Donald Trump -- only with good hair.
Lustig runs an obesity clinic at UC San Francisco, where he specializes in treating children. His patients range from a 1-year-old who weighs 44 pounds -- twice the appropriate weight -- to a 513-pound 16-year-old.
"I can't change America," Lustig said over lunch earlier this month. "I can only tell people what they need to do to change themselves."
He is angered by what he sees as the simplistic argument that fat is caused by eating too much and exercising too little. He says it is critical to know what causes the overeating.
Obesity, he says, is "not one disease, but many." A pediatric endocrinologist, Lustig believes that effective treatment comes through examining genetics, biochemistry, hormones and lifestyle.
"There are hormonal underpinnings to every behavior," Lustig said, ticking off the hormones affecting appetite -- leptin, insulin, grehlin and PYY. He's also interested in the stress hormone cortisol, which he says may be a trigger for gaining weight.
Lustig says hormones are behind weight gain, loss and maintenance. Insulin, he says, "is the bad guy; the more insulin you generate, the more weight you gain. Insulin shunts sugar to fat."
The goal of Lustig's therapy is to get the insulin down. At his clinic, Lustig takes a four-step approach.
First, he tells patients to get rid of all liquid sugar, which he calls "liquid poison."
"First I say, 'I don't care what you eat, I care what you drink.' "
When meeting with a new patient, he will pull out a calculator and listen to the list of beverages consumed daily. Kids rarely drink water or milk and instead consume considerable amounts of Coke, Gatorade and Kool-Aid. Coke has 150 calories per can, he notes. Liquid sugar typically accounts for more than 500 unneeded calories a day.
"Multiply 500 calories times 365 days a year and you have 250,000 calories a year in liquid sugar," Lustig said. "There are 3,500 calories in a pound so that's 60 pounds a year."
Next, he goes after what he calls the "white and fluffies," the refined carbohydrates without fiber. That includes bread, rice, pasta, potatoes. The white and fluffies should be substituted with "brown and crunchies," he says, referring to beans, brown rice, lentils, nuts and other legumes.
When children ask for second helpings, parents should implement a 20- minute waiting period. That's how long it takes for the body to know it is full. The signal is sent by the intestinal PYY hormone, Lustig says.
Finally, he looks at lifestyle. Television too often goes hand in hand with obesity.
"I have kids tell me they watch 10 hours a day. I say, 'OK, kid, here's the deal. You watch as much TV as you want with one proviso -- you watch it while on a treadmill.' "
Blunt and mediagenic, Lustig is popular on the academic speaking circuit.
Asked whether his message would translate to television or book form, he laughed and said, "I don't want to be Dr. Phil."
ONE QUEST
Woman's desire to trim down turns into communitywide challenge -- and includes walking llamas
- Greg Lucas, Chronicle Staff Writer
Sunday, May 23, 2004
Grass Valley -- At first, all Carole Carson wanted to do was get fit. She ended up mothering a fitness revolution.
Through dietary care and regular exercise over six months, Carson reduced the 182 pounds on her 5-foot, 2-inch frame to 120 pounds. She went from an 18 dress size to a Size 6.
She chronicled her story in her local paper, the Nevada Union, which serves Grass Valley and Nevada City -- Gold Rush Country cities 60 miles northeast of Sacramento.
Last November, she challenged the two cities' 13,000 residents to join her, beginning in January, on an eight-week quest for fitness.
Although other localities like Garden City, Kansas, have organized similar efforts, Carson's is the biggest so far.
The crowd overflowed the Nevada Union High School theater at the organizational meeting of the Nevada County Meltdown Challenge.
By the end of the eight weeks, after receiving national publicity, 1,061 people lost nearly 4 tons of weight.
Carson and her volunteers involved local businesses.
Fitness centers offered two-month free memberships. Restaurants offered Meltdown menus. Spa treatments and other donated gifts were rewards for major weight loss.
Meltdowners were organized into groups of five, so team members could encourage each other and offer tips on what strategies were succeeding for them.
"The big thing was saying, 'You're not alone. Here are some other people in the same boat you're in and, together, you can help support each other toward getting more fit,' '' said Kathy Palmer, who lost 16 pounds.
Meltdowners who wanted to continue after the first eight weeks -- and others inspired by the first group's success -- are now in what Carson calls Phase Two, which has about 500 participants.
"Now people are designing their own fitness programs. There's a lid for every pot,'' Carson said.
Lorene Grassick, owner of Highland Llama Trekkers, is training a new string of 10 llamas for pack trips. Carson hooked up Grassick with folks who wanted to get out and walk more.
"We have 80 people -- and the list keeps growing -- they go once or twice a week, some once a month. We go anywhere from 2 to 10 miles,'' Grassick said. "It helps the llamas because the little ones are getting trained, and the older ones are getting in condition for summer pack trips.''
Everyone wins. Both the Meltdowners and Grassick's herd of 35 llamas -- whose training was too much for her to handle alone, anyway -- get their exercise.
At Nevada Union High, 35 "Melting Miners'' are on a virtual hike across America.
Each day, the "Melting Miners'' record how many miles they've walked -- around the track, in their neighborhood. Based on their mileage, they extend a pink line on a U.S. map in the principal's office. After logging 1,922 miles, the group is cruising through Ladd, Ill. And they're 102 pounds lighter.
Nevada City Councilman Kerry Arnett has publicly pledged to fall from his highest weight of 312 pounds to 190 pounds by his 50th birthday on Sept. 1, 2005. He's down to 287 pounds since January by controlling his portions, drinking a lot of water and "walking, walking, walking.''
From the San Francisco Chronicle: The Obesity Crisis - a series
