Physicians Speak Out on Obesity
Obesity is one of today's leading public health issues, with more than half of all Americans considered overweight or obese.
In a recent study by Epocrates, over 500 physicians shared their opinions on the severity of the crisis, contributing factors, proposed solutions and health risks caused by the “most severe public health issue” facing America.
We encourage you to view the survey results and share your opinions below.
View the survey results »
Which of the following public health issues do you consider “extremely severe” or “severe?”
| Obesity | Chronic disease | Smoking | Uninsured population | AIDS | Malnutrition | Bird flu |
|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||
| 94% | 93% | 90% | 62% | 53% | 21% | 17% |
How Severe is the Obesity Crisis?
- Physicians rank obesity as the most important public health issue, followed by chronic disease, smoking, uninsured population and AIDS
- Bird flu and malnutrition were not viewed as severe public health issues
Approximately what percent of your patients do you consider to be clinically overweight?
What Percentage of Americans are Overweight?
- More than half of physicians believe at least 50% of their patients are clinically overweight
- Nearly 90% of physicians believe this percentage has increased in the last five years
- The American Obesity Association (www.obesity.org) reports 65% of U.S. adults are overweight and 31% are obese
Note: None selected below 10%
For the patients that you consider overweight, please estimate the percent with whom you have discussed weight loss?
Are Physicians Discussing Weight Loss?
- Overall, physicians are likely to discuss weight loss with at least 30% of their overweight patients
Approximately, what percent of your colleagues do you consider to be clinically overweight?
Are Physicians Obese Too?
- Obesity also appears to be an issue among physicians
- Eighty-eight percent of physicians believe at least 30% of their colleagues are overweight
Who do you believe is primarily responsible for
causing and solving the obesity crisis?
| Individuals | Food industry | Family | Government | Physician | |||||
|---|---|---|---|---|---|---|---|---|---|
| Cause | Solution | Cause | Solution | Cause | Solution | Cause | Solution | Cause | Solution |
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | |||||||||
| 51% | 44% | 29% | 6% | 9% | 11% | 1% | 15% | 0% | 19% |
Who is Responsible for the Obesity Crisis?
- Overall, physicians primarily view individuals as responsible for obesity; However the food industry was also viewed as a key contributor
- Nearly 20% of physicians view their profession as responsible for helping to address the obesity issue
- While not viewed as responsible for causing the obesity crisis, physicians see a role for government in addressing the issue
Note: “Other” responses omitted
What factors do you believe help motivate obese adults to make lifestyle changes to improve their health?
| Education | Fear of long-term health risks | Physician consultation | Societal pressures | Family intervention | Fear of death | New medication therapies |
|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||
| 69% | 68% | 64% | 58% | 45% | 44% | 30% |
What Will Drive Lifestyle Changes?
- Physicians view education and fear of long term health risks as factors which will drive lifestyle changes
- New medications are not viewed as a powerful motivator
Note: participants may select all that apply; includes responses above 10%
Which of the following initiatives do you believe will have a significant impact on addressing obesity?
| Banning soda machines in schools | Eliminating fast foods in schools | Educating lower income families about nutrition | Higher health insurance premiums for overweight adults | TV ads about better nutrition | Portion control “snack packs” | Banning transfats in all foods | Minority focused obesity campaigns | Banning transfats in restaurants | Gastric bypass or laproscopic surgery | TV shows (e.g. Biggest loser) | Movies (e.g. Super Size Me) | New OTC drug Alli |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||||||||
| 36% | 33% | 25% | 20% | 19% | 13% | 11% | 9% | 8% | 5% | 5% | 4% | 3% |
What Initiatives Will Have the Most Impact on Reducing Obesity?
- Physicians rated school focused initiatives as having the highest potential impact
- Physicians are least optimistic about the impact of new OTC drug Alli in reducing obesity
Note: includes responses above 10%
Which factors do you believe contribute the most to obesity?
| Lack of physicial activity | Portion size | Poor nutrition knowledge | Genetics | High-fructose corn syrup | Stress level | |
|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||
| 83% | 59% | 20% | 13% | 7% | 7% | |
What are the Leading Causes of Obesity?
- Physicians view lack of physical activity as the leading cause of obesity
- Nearly 60% of physicians view portion size as an important contributing factor to obesity
Note: participants may select two
What do you view as the best weight loss program?
| Weight Watchers | South Beach Diet | Jenny Craig | Atkins Diet | Glycemic Index | Slim-Fast | The Zone Diet |
|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||
| 93% | 52% | 16% | 16% | 12% | 6% | 5% |
What is the Best Weight Loss Program?
- Physicians rated Weight Watchers and South Beach Diet as the best weight loss programs available (www.weightwatchers.com and www.SouthBeachDiet.com)
Note: participants may select two
Which of the following do you believe to be a health risk for clinically overweight children?
| Increase in type 2 diabetes | More likely to be an obese adult | High cholesterol & blood pressure | Increase in sleep apnea | High incidence of orthopedic problems | High incidence of liver disease | High incidence of asthma |
|---|---|---|---|---|---|---|
| Scale in percentage of respondents: 20% 40% 60% 80% 100% | ||||||
| 94% | 90% | 78% | 65% | 57% | 29% | 23% |
What are the Most Recognized Childhood Obesity Health Risks?
- The majority of physicians were aware of increased health risks such as type 2 diabetes and high cholesterol/blood pressure
- However, many physicians were not aware of the increased risk of liver disease and asthma among obese children
Note: participants may select all that apply
Notes: Obesity Survey Background
Survey includes 580 Epocrates physicians comprising of Primary care physicians, Endocrinologists and Cardiologists.
- Primary working regions:
- 15% Rural
- 48% Suburban
- 37% Urban
- Primary clinical setting:
- 51% Group practice
- 12% Solo practice
- 12% Academic center
- 12% Outpatient clinic
- 11% Hospital
Thank you for viewing the results of our obesity survey
We invite you to share your thoughts on the topic and view the opinions of your colleagues in the discussion below.
- What have you found are the best ways to address the obesity issue with your patients?
- What initiatives have the most chance of helping to reduce the obesity rate?
We look forward to sharing additional insight from Epocrates users with you in the future.
The Epocrates Team
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Interesting thoughts on this topic. I appreciate everyones feedback.
Kristal L. Rosebrook
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Is this comment offensive? Let us know.Obesity, as some in the above commentary have noted, is a problem that has many factors involved in it’s development and continuation. There has been a lot of research in the last 5 to 10 years which points to the fact that for many, obesity is a phenotype which gets switched on to a functioning genotype by lifestyle factors. Once that genotype is operating, losing weight and maintaining weight loss is extremely difficult because of abnormal hormonal signals from fat cells, the stomach and other areas along with a down regulation of response to these hormones in the hypothalamus. Obesity is a disease. Yes, those of us who are obese need to decrease our intake and increase our exercise, but the response to these actions is never going to be as great as it is for those who do not have the obesity genotype switched on.
Is this comment offensive? Let us know.In addition, there are some people who do not have the phenotype in their genetic material and will never have to worry about having an activated obesity phenotype.
Obesity is a big problem in the USA. The main problem is the lack of want to cook inside the house. There are McDonalds commercial on television every other commercial break, coaxing people to leave their homes and get food instantly at a fast food resturaunt. McDonalds Served extremely fatty foods, even though they claim to be getting better. The reason they are claiming to be getting better is because they added salads and “healthy” foods to their menu. This is true. They have in fact added a few healthy items to the menu. There is only one problem… Nearly every obese person will CHOOSE the fatty foods over the healthy foods. And even if they DO choose the healthy food, they will have a different food with it that is extremely fatty. Or, they will have so much of the food that it will cause extra fat. Americans need to stop, and actually pay attention to what they’re doing. Go outside, run. Then all the overweight kids say, “I can’t run! It hurts! I’m too fat to run, the fat makes me heavier, which makes it harder for me to run!”… Here’s the catch… I am a runner… IT HURTS FOR EVERYONE!! Running causes physical pain. A fact. GET OVER IT. If you run MORE, it won’t hurt as much, and some of that fat will go away! I don’t understand all these people who say they “barely have anything” and they gain lots of weight. This is simply implausible. I am in fact underweight, and have been for most of my life. I don’t understand HOW you gain so much weight.. I actually wish I could, I weigh very, very little. I actually diet to GAIN weight, and I can’t. America needs to get their act together. Soon. Obesity causes more than 300,000 deaths every year. This is a huge problem. Get on the ball, USA.
Is this comment offensive? Let us know.Does anyone know if laproscopic lap band surgery can be performed if I continue to take Plavix and 325mg aspirin as my cardioogist instructed? I had a stent successfully put in my right corronary artery in April of 2006. I have no other risk factors as my BP is typically around 120/70 and I have no indications of diabetes.
Thanks for any insights.
Is this comment offensive? Let us know.My wife Dorothy Cleveland Grupe submitted her comments earlier in this forum. My youth was similar to my wife’s in dealing with weight issues. At age 11 I weighed 190 pounds. I have yo-yo’d for years. Until my doctor gave me the bad news in 2005 that I had become diabetic (7.5) and my BP was 165/105. At that time I weighted 307 pounds. Since 2005 I have changed my eating habits, taking out “empty” carbs, increasing protein and taking up a consistent exercise program including resistance training. I was ADDICTED to food. It was my emotional friend and release valve. I am now 223. I have slowly lost over 80 pounds and am maintaining the new weight. Many have ask me how. So many in fact that I have published a book: BUILDING SAND CASTLES - a Baby Boomer’s Journey Through Addictions outlining my weight loss experience. Personally, I believe permanent weight loss and maintenance is a matter of deep psychological change as with true release from any addiction. I’ll be 60 next year. My A1C is now in normal range (5.3) and with Lotrel, my BP is in healthy range (118/65). My website http://www.drgrupe.com provides more background information about my challenge with food addiction.
Is this comment offensive? Let us know.The obese child is unfortunately becoming the norm rather than the exception.I recall from my childhood that seeing an extremely overweight child was unusual.This is not to “glorify” the good old days as we certainly don’t want to go back to diseases like polio,measles,rheumatic fever,etc.When i was a youngster the fast food chain industry was just getting started.If you lived in certain parts of the country and in less urban areas this stuff was just not available.Now it’s practically inescapable.The co-marketing between Hollywood and the fast food chains attracts the kids and probably has had far more impact than “Joe Camel”.And while the kids are wolfing down the trinket laden meals the parents are gorging themselves on the the fries and burgers.The unashamed and blatant appeal to come in and get a burger with 3 slabs of meat,with extra slices of cheese,bacon and “special sauce” is downright disgusting.No one needs that much food and especially that type of food.And the drinks-loaded with corn syrup-32 or 64 onces worth!-doesn’t any one drink water anymore?This is a phenomonon i’ve seen in my practice over the years that seems more and more prevalent and usually accompanied by loads of excuses-e.g-”i don’t like the taste of water” or “the water has so many impurities” or the best one-”i’m allergic to water”-As a family physician i try to cover some of these areas in a “compressed” fashion but lately i’ve gotten into advising more of the ‘do’s” rather than the “don’ts”-trying to emphasize the importance of regular exercise,consumption of anti-oxidant foods and beverages and stress management.Hopefully these few words of advice will have a positive impact.
Is this comment offensive? Let us know.I am a board certified Family Medicine specialist extremely concerned with the obesity problem in the United States. I have dedicated the past 5 years to researching and developing a program to get people started on a healthier weight loss and anti aging lifestyle without using surgery or drugs. I have created a free diet website based on real science as well as my clinical experience and overwhelmingly I am hearing that it really works. Please visit my site and if you like it, feel free to send all of your overweight and obese patients as well as your staff and family members there. The name of the diet is commical to make it sound less severe, but check it and you’ll see it is all well founded and beneficial to the patient.
Please go to 5fingerdiet.com for the unique program full of free information on weight loss and lifestyle modification. The book called the 5 finger diet and anti-aging lifestyle will be coming out later this year and I am sure you will all be asked about it by your patients very, very soon. I have written it in a selfhelp and highly motavational format that gives the patient the tools they need to take responsibility for their weight loss and actually accomplish their weight loss goals. Please let me know what you think of it. My email can be found at the free website, 5fingerdiet.com
Is this comment offensive? Let us know.There are a lot of complex psychobiosocial issues surrounding obesity; however, the individual is ultimately responsible for their own health.
Is this comment offensive? Let us know.I think more attention should be on alcohol and give the smokers a break for awhile. (No I don’t smoke). This almost obession with smoking, while ignoring alcohol and recreational drug use by comparison is a serious error in my opinion. I have alot more patients that are seriously impacted by either their or a family member’s use of drugs and alcohol than smoking.
National health care will not become a viable reality until the for profit insurance companies are taken out of the loop. I mean, really, how many physicians or hospital administrators do you see with the income of insurance administrators? That comes from unpaid claims for work done and patient paid premiums.
Our Dr. son sent the me the link to this site. I have read page one with interest. I shall continue, after I tell our story.
The BMI chart would have called me obese. Back in a snowstorm Nov 30th I fell, tucking my knee under me in an unusual manner. I felt a pull. Since I could walk, and didn’t fancy trying to make it to emergency to sit there all day amid other snow related accidents, it wasn’t until after Christmas (still hurting) that I told our family Dr about it. EX-rays proved there is no bone damage.
Meanwhile tidying up the living room one Monday morning, I picked up a copy of Reader’s Digest. It opened at a page showing Tylenol for Arthritus. Because I do take these as required (we live on the WET end of Canada) I glanced at the article, and out popped ONE sentence. “Losing only 10 lbs takes 40 lbs pressure off the knees.
Wow! Really!?! I think I will test this!
That afternoon my husband came home from a Dr’s visit to say the Dr had told him to lose his front porch (he has a stent in his heart).
At this I told him what I had read and said, I think it is time for me to go to WW. Since I do the buying and preparing, he would be on a WW diet, like it or not.
ONE month later… Ten pounds of pressure didn’t cut it. Better, yes, but still pain, so I asked Dr. son if losing 20 lbs would take 80 lbs pressure off. He gave a too quick yes (the kind where you knew he was grinning inside) so I knew what his game was. Our Mathmaticion son spoke up and said.. Mom, I am the one to ask that question, not the Dr…. and at that he went into a detailed explanation about since we carry most of our weight above our knees it is funneled through, and yes, if I lost 20 lbs I would take 80 lbs pressure off.
TWO months later..and 80 lbs pressure off that knee I went on a day trip with our camera club that consisted of uphill, down dale, over and under trees. Nary a twinge from my knee. I was delighted.
And while I was working on this, my husband lost his front porch.
No, this is not a success story.
I am telling you this simple tale because I don’t think the “obesity” problem is as complex as some highly educated “thinkers” see it.
If my great grandparents both weighed 400 lbs as did my grand parents and parents…that says a gene problem? Well maybe… But I tend to think that “bad habit” inheritance factors in there as well. Or we can HOPE so, for the other thing they all had in common was they all died before age 50.
Children who live with, learn to.
The bricklayer, he takes two sandwhiches and 3 cookies in his lunch box, then comes home to heap a plate for his evening meal. He has three well rounded children. Why? Because the children are learning to eat what Dad does, but aren’t moving bricks all day.
Perhaps Mom is obese too. And this is where it becomes sad. She is cooking for a “high energy consumption guy”… serves big portions and all become obese, and not necessarily for the love of food. Lack of education or AWARENESS. Habits after all are something we do because it is done, not because we gave it any real serious thought.
Habitual=you car is on auto pilot to the nearest drive through where they have fancy coffee and muffins to shoot your eyes open with.
I don’t have to carry on to say that there is a habit worth finding a subsititue for.
Habit… getting up from the table to turn on the telly for the evening.. commercials being food breaks…. Definitely one we could come up with a number of healthier substitutes for..
It really doesn’t matter how many great ideas we come up with…. action hinges on the person in question becoming AWARE and WILLING to kick the less healthy habit.
And maybe it takes medics asking blunt questions. For leg problems for example….. dare one ask the patient.. “Do you want the MASK, or the CURE?
Is this comment offensive? Let us know.Several things jumped out at me from reading the posts here: the constellation of factors for which obesity is a red flag or symptom; the complexity of addressing that constellation of factors; the seduction & comfort of simplisitc solutions (fat people are morally deficient).
I am an ecological artist, who studies how sites become degraded and what can be done to restore systemmic change. It strikes me that obesity is the mirror of what and how we degrade our large landscapes. Questions about hormones in food, safety concerns for young children outdoors, being unable to set boundaries in an abundant society: these factors refelect a culture that prioritizes consumption and isolationism. But numerous studies in many fields clarify the depth of our limitations and interdependence. Could it be that “fat” people are the embodiment (literally) of what RD Laing once described as the designated “patient” simply being the reflection of the dynamic system’s dysfunction? The other half of “nomral people’s “Divided Self”?
I was fascinated by this site. I came across it by accident because I’m on a blog list serve for tech problems. I was curious about a post and that person’s blog led me here. I read the posts after attending a 12-step meeting (overeaters anonymous). That system proposes that internal serenity is the answer to compulsive relationships to food and body image. It is, as they say, a simple program that works if you’re honest.
This other stuff, is pretty damn complex and certainly needs to be addressed. Strikes me, reading the posts, that a way into some of that complexity is more ethical than the self-righteous condemnation of lazy fat people: like humility, self-honesty and social responsibility.
Is this comment offensive? Let us know.I agree the obesity seems multifactorial. Our children no longer play outside, as a kid I spent from sun up to sun down running around outside playing with my friends, now it is video games, TV, and stacks of homework. Most also have no idea what a proper portion size is or should be. I am still always suprised when I counsel a patient that a majority of their health problems could be averted by 1.getting up and moving and 2.pushing away from the table, the response I get is “just give me the pill doc”, to fix their hyperlipidemia, blood sugar or hypertension.
Is this comment offensive? Let us know.We have become lazy. We don’t have to leave our chairs to shop, go to movies, or even get help for yard work. The more we cut back on making people go out and do something, the less people will move to do anything. People on welfare are overweight due to not having to work to get their food. Make them work to get their cards. Monitor their weight and health. If they don’t take care of themselves, then why should we? Everyone needs to get out and do more, less video games and television, more outdoor games or walks outside. Yes, we make it easy for people to be lazy, but it’s up to you to take pride in the way you look. Eating well costs more, you need to change that.
Is this comment offensive? Let us know.The statement “obesity is due to ingest more calories than we consume” is a platitud. It is certainly a multifactorial condition, the lack of will is not enough to explain it, there are slim people who smoke and do other silly mistakes against their health, or at least never care about how they eat.
Is this comment offensive? Let us know.It is necessary to look in two areas: 1) Metabolic factors and 2) the use of hormones and some nutrients in feeding animals who are our protein sources.
Of course diet discipline and phisical exercising are necessary but the results show that they alone are insufficient.
The notion that solving obesity is as simple as counting calories and exercising is absurd. Like many growing problems in prosperous nations, obsesity is a bio-psycho-social issue. Aside from the genetic component, there are societal factors. Living with abundance, access to transportation, a blending of the line between gender roles, and the opportunity for families to have two sources of income has its benefits but also its risks.
There are more two income families, latch-key kids and a lack of supervision over what our children are eating. There is a great deal of anxiety about the safety of children in any neighborhood, so kids don’t go out and play like they used to; especially when there are so many indoor sources of entertainment like video games, television and the internet. Its also much easier to drive the kids to school than to worry about if they’re going to get there. Kids who don’t exercise and have no one to tell them “no more cookies” get fat. Unfortunately, fat kids, tend to become fat adults.
Anxiety is also fuel for the fire. Why is it that after 911 obesity skyrocketed? When people feel afraid they try to nurture themselves any way they know how. Food is a source of comfort. With so much of it available and so much anxiety people feel over crime, the “war on terror” and the day to day stressors of work and family, its no wonder obesity is becoming more of an issue.
Commutes have also gotten longer. The more time spent on the freeway (another source of stress and anxiety) is less time spent taking care of ourselves and our families. With two parents working who is cooking dinner? Especially when its so much easier to pick up a bucket of chicken or a few happy meals…or better yet, go to a restaurant. Any of these options are usually not great if we are looking for low fat, well balanced or portion control. People tend to eat what’s presented to them. We’ve been conditioned to clean our plates.
These are just some possible reasons. The bottom line is this: People don’t want to be fat. It just sort of happens and it isn’t immediate, it’s gradual. A pound here, a pound there, before they know it, the BMI is over 30. Those of us who are of normal weight can not possibly understand what goes through the mind of someone who is obese. Chastising a patient who is obese isn’t only insensitive, and unprofessional, its harmful. What patient is going to seek the care of a health care provider who sees only the obesity at an office visit when the patient has come in complaining of a sore throat?
Our job, our obligation is to help, to offer a solution, to encourage and follow up. If our own personal biases do not allow for this, then we must refer appropriately, keeping in mind that nutritional counseling, psychotherapy, exercise, and regular follow up visits in a nonjudgemental atmosphere are all key components to trying to solve this issue. Sound expensive? It is. But, as we’re all aware, the cost of treating hypertension, coronary artery disease, type 2 diabetes, cancer, and depression, (all more common in those who are obese) is breaking the health care bank.
Is this comment offensive? Let us know.Nice site!
Is this comment offensive? Let us know.I read with interest the comments. Living and working in the UK we now have the honour of being the fattest and nmost obese nation in Europe.
Is this comment offensive? Let us know.Like many of the previous contributors I am of the opinion that obesity is a reflection of the wealth of our society and the easy, cheap availability of food. When I was a child, just after the last war, we ate what we were given and as we say in the UK, ’seconds’ or extra portions were almost unheard of. Since then we have seen the rise of supermarkets, imported food, which we did not have until the late 1950’s. There has been a rise in the average size of women in the UK it has increased from a size 12 to size size 16. This represents a 4 inch increase in bust size from 34 to 38 inches. Waist and hip sizes have increase too.
In men, the average waist size for the median has increased from 34 inches to 38 inches.
As a practitoner dealing primarily with musculo-skeletal problems obesity has lead to an increased occourance of hip, knee, anlle and low back arthrotic changes with an ever increasing incidence of knee and hip replacement.
Obesity is not purely an American problem but wherever there is abundant food, there will be obesity.
As I tell my patients, and I may say this as it affected my family, there were no obese inhabitants in Belsen or Aushwitz, except the guards.
In order to treat the majority of obese patients we need to re-educate them simply to eat less, leave the table hungry or to put it more simply, KEEP THEIR MOUTHS shut.
We are a prosperous nation(which is a good thing) and there are side effects to this. But, there are a couple main issues to weight.
1) We need to get aesthetics out of the issue. Many people these days get labeled as “obese” when they are very healthy. It doesn’t take much weight on an adult to be labeled as obese. And I have read a lot of responses here that are more about aesthetics than health. Not everyone is going to have that perfect, idealized body of our cultural times. And that perfect body isn’t necessarily healthy. I’ve treated many perfect body weight Bulimics that demonstrate this. If our culture were not so prosperous we would all want to be over weight and obese since it would then be the symbol of wealth. However, we are in a very prosperous culture so it is not difficult to have a little weight on a person. Due to our prosperity it is then the symbol of wealth when a person is thin, meaning they have the wealth to attend a gym and have a personal trainer and cook, etc.
2) We really just don’t have much information as to when an individual’s health is actually at risk. Most of the tools are not very accurate.
I have seen the BMI used often to label patients as obese when they are perfectly within a healthy weight range. I have also seen patients who aesthetically appeared over weight (and even obese) but were in far better health than many patients in a low weight range. I have also read many studies pointing out that it has less to do with weight and more to do with activity. As long as the person is getting certain amounts of activity they are healthy. And I have seen this evidence in practice. When a health care provider chastises a patient about their weight rather than discussing with them their health the person who is obese (though usually just over weight) will stop returning and attempt to avoid the health care system. There are several studies pointing to this as well. Even here I use the terms over weight and mean what the BMI or our aesthetic scales determine them to be. More likely than not, with research, we will find out scales are too small. And that it is more than just weight that determines health.
As far as what we eat, well, the comments about people not eating the same thing in the past is not accurate. Many of the foods consumed in history are far worse than what is being consumed now. It is that food is in abundance and cheap. Again, we are prosperous.
Bottom line, we will have no answers until aesthetics are removed from the issue and science and health only take its place.
Is this comment offensive? Let us know.Our culture and the “just out to make a buck” American business model coincide to make this a bigger and bigger problem. While our jobs are becoming more sedentary and time is more crunched, the American food industry produces enough calories for each and every person (including babies!) to have 6000 calories a day. Nobody needs that amount! We really do need to “grow our own!”
Is this comment offensive? Let us know.Obesity in America is a cultural phenomenon. A corporate culture where a large segment of the food industry is run by Tobacco CEO’s (Phillip Morris, Oscar Meyer meats, Ritz, Philadelphia Cream Cheese), where corn syrup, aspartame, processed carbs, hydorgenated oils are universal ingredients for everything. Where drug and food lobbyists have co-op the FDA, and the Fast Food Industry keeps promising “healthier choices” reminiscent of the auto industry’s 40 year-old promise of an electric car. The new food pyramid is actually 6 pyramids, and as unreadable as a Richard Powers novel.
Obesity in its weightier part is a political problem.
Is this comment offensive? Let us know.I believe the overall problem of the obesity epidemic is multifactorial, but that’s not to say that all or most of the factors are at work in any one individual (ie. different factors may predominate for different people). Here are some I think are the main culprits (some of these have been widely mentioned by others):
- the modern American lifestyle for many people demands greater productivity & allows less time outside of the workplace and other (family) obligations. Despite working more, the type of work done by most people, most of the time (& these other obligations) involves less physical activity than ever before. Lack of appropriate amt. of sleep is also linked with obesity (although correlation is not causation; and even if there is cause & effect, which is causing which).
- another effect of the modern culture is media streaming a constant litany of messages that intentionally (marketing) or not (news) feed us an up to the miniute & never ending list of things to be uneasy about - crime, natural disaster, identity theft, financial market fluctuations, do we need to buy those replacement windows, or that long term care insurance, etc, etc.
I believe the average man, woman & child has a greater level of baseline anxiety and pessimism than in past generations.
Food is a very powerful source of instant gratification and pleasure, appealing to the rewards mechanism in the brain (ie. the behavior of eating is instantly rewarding) and in infancy & childhood was, for most people, also associated with the feeling of being cared for, protected and nurtured by our parents - ie. anxiety reducing associations.
- perhaps due, in part, to the higher productivity demanded of Americans, there is a steady shift in the Amer. diet from basic whole foods cooked at home, to greater use of meals ready made at the grocery store or major components of meals made in factories. This doesn’t even count the greater consumption of fast food takeout.
Factory modified and factory formulated foods have a severe detrimental effect with addition of ingredients to modify taste and texture. This helps the foods (that companies are fiercely competing to market to you) appeal more to the pleasure centers in the brain - esp. sugar, salt and fat). Some snack and convenience foods and canned foods have come to have a greater content of chemical soup than wholesome food ingredients.
We’re starting to understand the detrimental effect of some things that end up in our food - like trans fats and the high fructose corn syrup and of hydrogenation of veg. oils. We’re still being desceived or distracted with marketers’ and manufacturers’ misleading claims (like “low Fat” claim on a food very high in carbohydrate and nutrition labels showing unrealistic serving sizes).
What I say in regard to foods also includes beverages (soda pop is a bad choice, but fruit juices are being doctored so many are just as bad as non-diet soda).
- finally, I believe there may be additional significant problems, even with whole foods, that have justifiably led to the growing organic food demand. Meat from poltry and livestock may possibly contain hormones, antibiotics, drugs and other chemicals included in animal feed.
Is this comment offensive? Let us know.I urge everyone to read (internet) some of the information being discovered about our municipal water supplies. Be aware that a medication’s effect wears off because it is eliminated from the body, sometimes unmodified or little modified. Chemicals in the wastes eliminated from the body can eventually enter the ground water and reenter the water supply. Soluable chemicals are not normally eliminated by filtration and water treatment. Municipal water supplies have been shown to have significant concentrations of, for eg. oral contraceptives. This one class of medications alone could be the cause of many metabolic derangements & health problems in developing children and in adults. It is unknown whether and how much, food and water contaminants could help trigger the metabolic derangements that are part of obesity development.
When overweight, obesity and abdominal adiposity develop, it is likely that the excess body fat exudes factors into one’s system that promotes additional wt. and fat gain and the tendency toward greater obesity becomes self promoting. It is possible that some contaminants initiate or help drive this cycle, (esp. hormones).
Advice: simple lifestyle. Grow your own - organic. Buy organic foods. Read food labels. Avoid manufactured & modified foods. Increase activity and don’t think of it as an exercise program, but a new lifestyle. Get enough sleep. Portion control and sensible food choices (when you go to a restaurant, consider only ordering an appetizer or only a salad, no dessert, water to drink). A diet should not be designed to be a temporary thing to achieve some target, but a sensible lifestyle change to be maintained ever-after. Turn off TV & go for a walk.
The only factor ever discovered to have a definite correlation with increased longevity, in an individual, is caloric deprivation.
Many of the previous opinions imply a character disorder as the reason for obesity. This is an environmental and multifactorial problem. (see many of the previous opinions) Our environment is toxic and until our environment changes, I see little hope for this obesity epidemic to change any time soon. Even those that would like to “move more and eat less” find it almost impossible to do given their particular lot in life. I live in a safe neighborhood, can afford a gym membership, home exercise equipment and can even have a personal trainer. (Now if I could only afford a cook!) I’m not sure that medicine will be able to come up with a realist answer. (I would welcome someone proving me wrong) I have no doubt if these same obese persons lived 100 years ago the majority would not be obese. Same character - different environment. For the most part, individuals cannot control their enviroment, and our “lot” in life could change on a dime. We must always remember the expression; There go I but for the grace of God.
Is this comment offensive? Let us know.Calories in > calories out = Weight gain
That’s it - the job is to find out what’s happening on each side, take account of individual habits and basic metabolism and get people who want to lose weight to make long term changes and then weigh themselves regularly to see if they have the desired effect. If yes, stick with it - if no, make further changes. Professionals can help as can software programmes like DietPower (www.dietpower.com) which I have used myself 4 years ago with great (and sustained) success.
Is this comment offensive? Let us know.When did we start to think that in order to be satisfied after a meal, we had to be STUFFED? Portions are so large and most Americans want MORE. And fast food is the worst. BIGGIE SIZE, should refer to the size you’ll be if you continue to eat that stuff in those quantities! It may only be a fraction of change we’d have to make but it is surely relevant. As a cardiac nurse, I at least have job security because of people’s reluctance to change old habits. Here’s to that!
Is this comment offensive? Let us know.These are the culprits as I see them:
1)automobiles. The year I lived without a car, I had to eat all the time to maintain my weight. In communities where people don’t have cars, sidewalks are full of people, walking is safe, stores are close, and life is more pleasant. The after dinner stroll is a great way to wind down, get out of the house, and mingle with neighbors. (Some urban ghettoes are an exception.) These days anyone on foot is suspect, or prey for hoodlums.
2)television. Getting together with other people for games, dances, bowling is fun and builds friendships. Instead we sit alone on the sofa and snack for pleasure and escape. I would like to see food advertising on TV go the way of cigarette advertising.
3)as a result of the above, neighborhoods and parks are deserted, streets are unsafe for bicycles, children do not walk to school.
4)women no longer control what is eaten by their families and people have gotten used to eating bad food. Time is lacking for food preparation. Marketing for junk food to children has penetrated schools with reading programs and prizes as well as vending machines which, in addition to selling junk, promote constant snacking.
5)we haven’t found a way to compensate for activity lost when jobs became sedentary.
A feed lot puts young cattle in confined spaces and feeds them corn and other starchy foods, often sweetened, so they will eat more. The purpose of this is to produce well marbled steaks. Does this you remind you of school? Do we really want well marbled children? At least the cattle are outdoors exposed to sunlight. Cattle, by the way, have a much lower requirement for exercise than human beings do.
Is this comment offensive? Let us know.Obesity is the result of eating more calories than your body needs for daily activity. Period. Fat and food are both sources of stored energy. There is not a human on this planet who will not lose weight on a 500 calorie per day diet. There was not one person in the German concentration camps of WWII who did not lose weight. Weight loss is not a mystery. Weight loss is difficult because it takes discipline. The problem is not how to lose weight. We all know that if you eat few enough calories a day you will lose weight. The true problem is that our American culture that has taken the pursuit of happiness and individual liberties to an extreme and has thrown personal responsibility out the windown. Medicine and especially psychiatry is especially to blame by allowing people to escape personal responsibiltiy by mislabeling all bad behavior as mental illness and therefore taking the responsibility for the behavior away from the individual. I believe we need to start talking in terms of gluttony and morality when it comes to food. In our pleasure-driven and selfish society food has become just one more addiction, no different from drugs or alcohol. People need a moral philosophy about eating and the role it plays in their lives. Read Solomon Schimmel’s The Seven Deadly Sins chapter on Gluttony if you are interested in this idea.
Is this comment offensive? Let us know.I am a practicing pediatrician and in January 2005, I opened That-a-Weigh Kids which is a weight management program for overweight children and teens. I created and developed the program because of the increasing number of overweight children I was seeing every day in my practice, and I, like so many practicing physicians had no ongoing programs designed exclusively for children. I also have struggled with my weight since I was a child and I do believe that genetics is a strong predictor of obesity. However, if there is recognition by parents and physicians at an early age and appropriate intervention, I believe many families are willing to make lifestyle choices and changes to benefit their child(ren).
I think we all know that many factors play a part in the sad statistic that childhood obesity has tripled in the past thirty years - fast food, computers, decreased physical activity and the overall busy lifestyle of so many of today’s parents. Tackling obesity at any age, from five to seventy-five, is never easy but it can be done! At That-a-Weigh Kids, we have had wonderful success with children at all ages especially when there is committment on the part of all the family members. I still believe in the old fashioned method of losing weight which is eating less and getting more physical activity.
For all the parents who are reading this, I ask you to take an honest look at your child(ren) and seek help if you are noticing extra pounds creeping up on your child(ren) especially if they are between the ages of 5-9 years of age. Feel free to browse our website at http://www.thataweighkids.com for more info.
Is this comment offensive? Let us know.I treat obesity as a chronic unrelenting medical problem. I believe it is 60% genetic and 40% enviornmental. I beleive obesity managment is at the same point that depression teatment was at in the 1950’s or so. I mean “still in the dark ages”. Both conditions have genetic and envirnmental components. Both can be managed medically in motivated patients. In my opinion, neither are character flaws. We now know both conditions are influenced by diferent neruotransmitters, hormones etc. Human obesity is not a homogenous disease. One persons obesity is different from another persons obesity. That is very frustrating. I am a family practice md who is not opposed to using anorectic agents in motivated well worked up patients in a multidiciplinary approach. Some success lots of failures. I have never seen anyone die or be hospitalized because of anorectic medicaions, but God knows I have seen people die of the consequences of obesity. If I can help one out one hundred get better control of this disease process, I believe it is worth it.
Is this comment offensive? Let us know.Well Patrick, I doubt riding bikes and skooters will eliminate our dependence on foreign oil. Even so, industry alone requires the use of fossil fuels and natural gas that easily offsets the ‘green benefits’ of walking to work. But your point is well taken, if people could propel themselves to work rather than sit in a car or mass transit, the benefits to their body, mind and spirit would be uplifting.
Is this comment offensive? Let us know.Simple answer to fat.
Human power transportation. No dependence on foreign energy source, health, happy people.
Provide safe routes and human powered transportation with an economic incentive, we’ll burn our calories and feel better about it.
Is this comment offensive? Let us know.Re: Sbeard comment; very interesing argument, one that certainly fits into the obesity puzzle and one I never considered. Indeed, although it would seem that our young peoples increasing interest in being sedantary and eating junk food, I feel that obesity more likely stems from psychological issues, most importantly depression and, like Sbeard says, some sort of sexual trauma. I remember as a kid growing up practically outside my house ( its easy when you grow up in Hawaii), always playing with my friends. I remember the largest size soda I could have was the 12 oz size. Nowadays I see kids routinely drinking the 20 oz size, thats nearly twice the calories, and these kids are obese.
You can imagine the cylce beginning at this point; a child becomes overweight and is teased or feels left out by other kids because of his or her appearance. The child feels bad about themself, causing them to reach out to the things that make them feel better, like soda, potato chips, candy and icecream. If these things are available in the home, they will be eaten, especially in times of stress or unhappiness. After all, who wants to remain unhappy? This cycle continues, unbeknownst to the child, with ever-increasing cravings for more junk food. The teasing and self-loathing continue into adult hood, when behavior patterns and responses to stress continue to trigger the unhealthy response of poor food selection and eating habits and the resultant depression.
So which came first, the poor food selection, poor self esteem, or poor personal health practices (e.g. lack of exercise)? Throw into the mix any emotional trauma and the issue becomes more complicated. I vacillate between being angry at people who are obese and then feeling sorry for them. How much of it is there fault? How can you fault someone for being in pain, physically or mentally? How can you feel sorry for someone who clearly is making poor choices for themselves and their children?
Clearly this is an issue that needs to be handled on an individual basis, like all health issues. Take into account the individuals personal and health history, understand the dynamics behind their weight issue and then proceed with a plan tailored towards addressing their individual issues. Additionally, institutions can and should help. Schools and employers should provide only healthy foods in vending machines, the government should fund research and public campaigns aimed at educating the American people about proper nutrition and to seek help for depression, all health professionals and their related professional organizations and institutions should promote within, the idea that they should model good health choices (stop smoking, fat loss etc.). Lastly, we all can be more understanding about our own faults, then perhaps we will be more compassionate with others and be better able to help those who have experienced a lifetime of abuse, neglect, or maltreatment to help themselves.
Is this comment offensive? Let us know.I am overweight, obese. I have played the diet games for years. I lose some and then I gain it back. I lose it again, and then gain it back. I’ve tried them all. Pain is part of my problem. I have bad hips and legs. Yes, you say it’s because I’m overweight and you may be right, but how is a person supposed to function when they are in pain. I even had a mental illness that didn’t allow me to eat. I couldn’t swallow food, especially that food that was high in fat, because I thought it would kill me. I lost 115 lbs, but once I got better, I gained it all back and more. I slowly introduced very low fat foods into my diet and the weight started to come back. I can just look at food and the pounds come on. I believe alot of our weight problems are hereditary. Every person in my immediate family and also many in my extended family on both parents sides, are obese. I also beleive I have no metabolism. I have two sedentary jobs plus I go to night school full time. I rarely have time to cook a meal at home anymore and often end up grabbing a quick bite or my husband brings me food at work. My second job is at a hospital and even the foods that they cook there are high in fat and calories. No matter where you look, these things are starring back at you. I say hurray for those people who have the time, the energy, and the healthy bones and muscles to keep up with exercise, but please don’t look down on those of us who don’t have those things. People who are obese don’t like being that way, but often times there are reasons that others don’t know about. I often find myself eating when I’m not hungry, but when I’m stressed, which is a big part of my life right now.
Is this comment offensive? Let us know.I am frankly disgusted with the obesity problem in this country. Of my 8 collegues, 1 is obese, and two are overweight. My experiences have shown that most do not want to hear they are obese, overweight, fat (use whatever term you choose). They are offended when told, and are less likely to return for a follow-up. I’ve been chastized by parents for pointing out the obesity in their kids (parents also obese) and told, “That’s NOT what we’re here for!” What is the solution? I feel it is to strike at the cause. What is the cause? Not sure I can put a finger on that one… too many factors and variables.
Is this comment offensive? Let us know.I think there are a few reasons for obesity. One, there is a sever lack of personal responsibility in this country, not just with food. Two, people in this country are more lazy than ever, with the computer and everything being so fast paced who has time to take an evening walk with the kids when it is 8 pm and everyone needs to get showered and in bed. Three, People in this country are nlooking for a quick fix with pills and a docotr to fix them. Gastric bypass has become a huge success, but how many of those people reagin their weight because they have not changed their eating habbits. Four; people have very bad eating habbits.
Is this comment offensive? Let us know.From a clinical standpoint people are far to caught in the “rush” society of today. Everything must be done quickly,leading to a proliferation of fast-food. Time constrants along with need for more income has forced more and more people to work longer to pay for less. Having a meal at the dinner table is a thing of the past. Just taking the time to sit and talk around the table allows for the body to relax, to calm down, to talk more and eat less. Exercise in the 50-60s was incorporated into the currriculim in the pre-school and throughout high school. Now computers and palms take the place of a walk or playing a game of catch. As a society we must take responsibility for our actions and incorporate our lives into our children, taking the time to go for a walk instead of watching television. Our childcare is technology. We need to take our children back. Become involved in their lives not just there financially. Watching nutrition not just ordering pizza as this is quick, and we are tired from our job.
Is this comment offensive? Let us know.I am reading many comments here from overweight people who say they eat much less than their “normal” weight friends, but still gain weight. There are many components to a healthy lifestyle. Portion control is only one of them. What you eat can be much more important than how much you eat. Healthy weight people, especially physically active healthy weight people, such as athletes, eat 4-6 meals a day. They eat the right amount of the right kind of food. AND they engage in physical exertion. Walk to work, ride a bike, jog, lift weights, swim, whatever, just find an activity you like, and do it! I know this from personal experience. If morbid obesity were caused by a fat gene, or a virus, then this would not be a relatively new phenomenon. If anyone thinks the sedentary life style and fast food habits of the 20th and 21st century don’t play the biggest part in this epidemic, they are ignoring the facts. Type II diabetes is at an all-time high.
Is this comment offensive? Let us know.The tried and true facts are: eat right (amount and type of food), exercise, drink plenty of water (good ole’ plain water), and get enough sleep. Guaranteed. There’s no magic to it. I’ve been on both sides of the fence, so I can speak from experience.
Here is my experience and opinion.
I have experienced losing 35 lbs on altering portions to what they are suppose to be. I did not change what I ate per I generally eat healthy. I maintained this for 2 years and stuck. I also was not consitent with my portion control. Now I have added exercise and portion control and the results are to be continued. So far 6 pound in 4 weeks.
My opinion is that there is no 1 answer for weight loss and reasons for obesity. Everyone is different. I have yet to meet that textbook patient in the past 10 years. I do agree that we put the blame on others a lot in America. We tend not to take responsibility for our own actions. I agree with adding nutrition for school, but this also needs to be consistent and reinforced by parents in children.
For the woman who tried many diets. Followig is what I would ask you from what your opinion says. How long were you consitent?. Also were you just not given the right answer for your body? Were other medical causes researched for you?
I agree with behavior modification and psychological counseling are needed in all weight loss programs, just like what occurs in gastric bypass surgery, smoking cessation, Diabetes education, and the list could go on and on.
Is this comment offensive? Let us know.I appreciate and honor the input of every writer before me.
I do agree that psychology, addiction, genetics, lifestyle, and our consumer culture ABSOLUTELY have much to do with the obesity epidemic…it’s obviously a multifactorial issue.
The tools that I primarily use to combat excess weight are lifestyle accountability, group exercise, enforced self discipline, and motivation. I run a boot camp course termed the Dr. Drill Instructor program, and let me tell you…it actively engages folks in the process of health and they lose weight and feel better about themselves simply becuase they want to.
Passive care such as a pill, procedure or office visit is a bunch of shit…the treatments don’t work and patients mostly don’t comply. Health must be taken, it can’t be merely given. The best kind of help is self-help. We must lead by example in health care…we can’t afford to be smoking nurses and fat doctors. We MUST hold the line for a patient-centered model of healthcare and chronic disease CAN go away. Being politically and medically correct isn’t cutting it…we’re soft…losing the war and your average American is a poor slob as a result.
You heard this from a Doctor of Chiropractic!
Is this comment offensive? Let us know.What is not for the most part being addressed here is that obesity has increased dramatically in the last 20 years. Nearly all the issues mentioned- abundance of food, negative feedback towards obese patients, no good answers to help lose weight, psychosocial issues have been around for 50 years or more. The children of the 70’s had video games, plenty of TV - Iwatched my mandated 5 hours aday- and no pressure to be active, yet there was barely an uptick in obesity vs the historical norms. In med school the first thing the bariatric surgeons tell you is that 80% of their patients have deep rooted psychological issues stemming from abuse- usually sexual. What has been the one thing that has changed dramatically over the last 25 years - PORN! Freely and readily available in the convenience of your home or cubicle via the internet, or local video store- you no longer have to go to some seedy store on the out skirts of town or in the redlight district. Porn was the first and still is the major player on the internet. Each generation has more accsess to the internet.
In the last 5 years as a GYN I have seen Pubic shaving - not bikini shave- go from about 10% of my patients under 30yo to nearly 100%. Its not a “social norm” like shaving arm pits(if it were a societal norm issue then it would not be as equally common in my young amish patients- they are all about defying norms)- its an effect of the popularization and commonization of PORN. Our young people are not trying to be skinny like Paris or Brittany- they are just trying to have their genitals!
I’m not calling the obese pornographers, just saying that we are seeing the effects of this abuse (children viewing porn, or molested by pornos - they are both abuse) on our society, just like the increase in child molesters.
That said - there will likely never be one answer to the obesity epidemic. Ihave seen patients eat their way through their “stomach stapling” (less common technique now) only to be rushed back to surgery to save them. Many have some degree of metabolic sydrome, but as weight goes up so does insulin resistance till nearly 100% have this situation. Not all HTN meds or cholesterol meds work for all patients either- why does everyone think obesity is different? Many abused people don’t have an obesity issue. In the end its a multifaceted epidemic that does come down to an issue of calories in and out, but getting past that and on to something productive is the hard part.
I apologize for the explicit nature of this discussion, but lack of activity and easy access to food do not explain the differences b/w todays kids and tose of 25 years ago.
Is this comment offensive? Let us know.I believe inactivity, portion control and the ease of availability are all major players in this issue. I also believe people need to dink more water to cleanse their bodies and help boost metabolism. I believe there is another factor not investigated thouroughly and that is genetic precursers and biochem. factors. ( i.e. can a person make a true effort and not lose weight or fat)
Is this comment offensive? Let us know.also we need to study more about metabolism and boosting metabolism.Maybe insurance companies need to offer more incentatives to people to exercise more and dixcount gym memberships
I think the evidence favors a cause for obesity that is multidimensional. There seems to be a CNS factor where by the control of appetite and food intake is disturbed, a metabolic factor associated with insulin resistance, a hereditary factor which may be related to the above causes and some kind of hormonal regulation possibly mediated through teh hypothalamus. Whatever the cause it seems that no one knows enough about terh problem to be able to give advise beyond eat less and exercise more.
Is this comment offensive? Let us know.I have through the opinions posted and it seems that everyone is trying to find an excuse or reason why there is obesity today. My question to all of you is were our parents grandparent, grandparents etc. all old beasts as we are today? Of course not they did not indulge in the poor choices of the type of food that we do today. Ryan and Dr. Connor hit the nail on the head by stating we have to take responsibility and to quit making excuses for the obesity/laziness. Everyone is trying to find an excuse of why we have the obesity but no one is looking at the attitude of the patients when they are informed that they must lose weight or their health will deteriorate. Today patients ignore that advice and continue doing what they want to do and be damned with the future outcomes of their choices. I have seen patients come through the critical care units like a revolving door with the same problem over and over and failed to follow through with their instructions upon discharge.
It is my opinion that with obesity left unchecked we are draining our resources that could be used elsewhere. I am a firm believer in establishing a set baseline weight and if patients refused to change their eating habits and with a way of life than their insurance deductibles/premiums should increase. The average American is too lazy to do anything about it unless it is coming out of his own pocket book. Until then we’ll have diseases such as diabetes, CHF, bilateral knee replacements, bilateral hip replacements, etc. not to mention the potential injuries to all medical personnel handling these obese patients. On the average the patient in today’s hospital ways between 200-300 pounds.
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