Our Big Problem - Obesity - Who Will Solve?

The Wall Street Journal recently published Our Big Problem: Obesity penned by a British physician Anthony Daniels, pen name Theodore Dalrymple, who feels that the weight problem is due to fragmentation of families when it comes to meal times. Families don't prepare or enjoy meals together. Fast and already prepared foods dominate the kitchen table. It is simply a consequence of the modern society we live in. He wishes that the fast-paced fragmented American family life will return to the days of home cooked meals and sit down dinners.

He recognizes that this ideal world is highly unlikely. As a result, he suggests that is that government should regulate and restrict further the food we eat. Sugar and fat content of fast foods would be an area of government intervention.

He'd better be kidding. Anyone who has been watching Jamie Oliver's show Food Revolution has seen how well intentioned government regulations on school nutrition can result in very unhealthy food that fulfills the requirements but not healthful. (Is a squirt of ketchup really a vegetable serving?). Government does have a role in society, but will be unable to fix this problem.

Unfortunately doctors can't stop the obesity epidemic either. Recent reports noted that primary care doctors lack the training and resources to address the issue with their patients, even as they feel the responsibility to provide advice. The problem is that in a survey of 290 doctors found that 72 percent had no one in the office trained to discuss weight management. Of the 90 percent of obese patients who were counseled to lose weight about a third of patients noted they weren't told how to lose weight.

Winning the war on obesity won't come from government regulation or somehow getting doctors to be better in educating and counseling patients. It won't be families resorting to a simpler slower pace of life that existed a couple generations ago.

Winning the war on obesity and turning the tide will be due to the same large multi-national organizations that are being vilified. McDonald's top chef, Dan Coudreaut, will impact more lives on a daily basis than any doctor could ever advise over an entire career based on his latest creation which graces the McDonald's menus nationally. The real question is whether our corporations will begin taking on this new social responsibility in keeping our nation healthy or would they rather wish to continue to kill their customers slowly from inside out and dump the health consequences onto an increasingly dysfunctional expensive healthcare system, other employers via escalating premiums, and ultimately destroy US competitveness by creating an unhealthy fatter workforce that is unable to meet the challenges of the future?

Although there will be people quite skeptical about businesses and corporations fixing the problem which they helped create, it appears that this is the case. The Washington Post noted that large food organizations are committed to reduce the calories in existing products, offer healthier selections and smaller portions.

The Healthy Weight Commitment Foundation, a coalition including Campbell Soup, Coca-Cola, General Mills, Kellogg, Kraft Foods and PepsiCo, will slash 1 trillion calories by the end of 2012 and 1.5 trillion calories by the end of 2015. The 16 members make 20-25 percent of food consumed in the United States. The Healthy Weight Commitment Foundation, a coalition including Campbell Soup, Coca-Cola, General Mills, Kellogg, Kraft Foods and PepsiCo, will slash 1 trillion calories by the end of 2012 and 1.5 trillion calories by the end of 2015. The 16 members make 20-25 percent of food consumed in the United States.

This is an encouraging first step. Maintaining a healthy weight is more than asking individuals to choose wisely every meal. It's about helping the public makes the right desired choices by creating products that are healthy, nutritious, and lower in calories. Restaurants and food organizations must lead the way to slow and then reverse the trend.

Otherwise with the status quo, children born since 2000 will the first generation of Americans not to live as long as their parents due to obesity related illnesses like diabetes.

Secret to weight loss is simply: Eat less. Move more. When companies get it right, eating less will be easier to do.

It will be the private sector that begins to solve the obesity problem.

Secrets To Weight Loss - Part One

It's disturbing that in the United States, two-thirds of Americans are either overweight or obese. As a doctor, it is one of the most common problems I address, even if a patient doesn't ask me to. Got a cold? Feeling stressed? Want a physical? Rolled your ankle?

Has anyone ever discussed your weight? Are you concerned about your weight? What have you tried for weight loss? What did you find successful?

In this series, I'll reviewed my discussions with patients so you understand what it will take to lose weight and keep it off.

Losing weight is hard work and frankly can be a difficult and lonely experience since the majority of Americans are overweight or obese. The problem of heaviness in this country is only becoming worse.

First some basic concepts. Overweight is defined as a body mass index or BMI greater than 25 and less then 30. Obesity is a BMI greater than 30. Morbid obesity is a BMI greater than 40. Calculate your BMI. Although BMI isn't perfect, unless you are a high performing athlete (not a weekend warrior) and have significant muscle mass, BMI is a reasonable way of determining which category you fit into.

Second, the body does not lie. Unless you have some sort of medical problem like a low functioning thyroid (hypothyroidism) or other less common hormone problem, your body does not lie. If you eat exactly the same amount as you burn, then you will not lose or gain weight. Eating less and burning more consistently will cause weight loss. Eating more and burning less will result in weight gain. Simple concept. What goes in must equal what goes out to maintain weight. Any alteration in this simple equation causes weight loss or weight gain. The body does not lie.

Third, I don't think you overeat to the degree you think I do. Patients invariably tell me that they eat very little and certainly a lot less than their friends or family. While I know individuals aren't eating a Thanksgiving dinner or eating an entire large pizza for lunch daily, weight loss requires a caloric intake less than the output. Note the previous point the body does not lie. If a person did eat a lot, he would continue to gain weight, not maintain.

Fourth, you need to understand basic math. Know this number. 3500. An addition of 3500 calories equals one pound. If your body has 3500 calories left over, then you gain a pound. Burning 3500 calories, then you lose a pound. Sounds like a lot of calories, doesn't it? But it's not. If you drank a can of regular soda daily (and yes, diet doesn't count as it has zero calories), then that is an extra 130 calories per day. In 27 days less than one month you would gain a pound (3500 / 130 = 27). In one year you would be 12 pounds heavier.

Fifth, think of calories as money and your weight as a savings account. Your savings account goes up or down depending on how much you save. Put more into the bank and withdraw less? More in your savings account. Taking out more than you put in, the amount in the savings account falls. Your bank doesn't care if you deposit $100 in pennies or in a crisp C-note. Skipping the discussion of nutritional value, your body doesn't care if the 2000 calories you are supposed to ingest comes all via salad greens or the equivalent of a box of chocolates. Money is money. Calories are calories regardless of how you get them.

Sixth, your body is built for survival and isn't stupid. Go back to the previous point. Your weight is a savings account and to keep it level what goes in equals what goes out. If all of a sudden, your income gets cut then to make ends meet you must take withdrawals from your bank account. If the income doesn't return to previous levels, then the savings account continues to get smaller.

Faced with this situation of being unable to restore deposits to previous levels, would you continue to spend as much? Of course not. To avoid bankruptcy you would make hard choices like downsizing your expenses and making adjustments. As a result you slow down the outflow of money so that eventually the amount that you spend is equal to the new decreased amount coming in.

Your body is built for survival and isn't stupid either. Faced with a budget crisis, that is a diet where calories coming in is less than what is burned, initially the body hasn't had adequate time to make adjustments. It depletes its savings resulting in weight loss. But since it is built for survival, it will make adjustments necessary to that its expenditures exactly made your diet. You no longer lose weight. Your body doesn't know whether it is on a desert island or living in the United States where food is plentiful, but all it knows is that its caloric budget was cut. It needs to keep you alive until it can find its next meal. Adjustments are made. Weight loss stops. Naturally, it will deplete fat first, then muscle. So don't worry about that being a reason not to being weight loss.

Seventh, the vast majority of patients I see weren't overweight or obese to being with. Weight gain typically occurred after high school or college, job change which was less physically demanding, after pregnancy, and as they got older. Sadly this isn't the case today where children are increasingly obese and will be the first generation of Americans not to live as long as their patients because of weight related medical problems.

Finally, the success to long term weight loss is permanent reduction in calories and increase in physical activity. It's not a diet but a lifestyle change. You can lose weight in the short-term with fewer calories, which is the reason why gastric bypass works. However, long-term weight loss requires physical activity.