Americans super-size their eating - and their weight
All segments of population are getting fatter, but highest increases are among youth

October 24, 1999

Laura Beil; The Dallas Morning News

If we are what we eat, then Coca-Cola hints at what we've become.

Three decades ago, a Coke came in that shapely 6.5-ounce bottle and held less than 100 sugary calories. Now, the taller, plumper contour weighs in at 20 ounces and delivers 250 calories. Or, for the especially parched, there's the 64-ounce Double Gulp from 7-Eleven. Depending on one's preference for ice, it is a tub of 600 to 800 calories.

Cokes have expanded. So have the people who love them.

Almost 10 years ago, when the number of overweight Americans hovered around 25 percent of the population, public health experts set out to lower that statistic by the century's end. Instead, the population tightened its grip on cheeseburgers and remote controls. Obesity rates soared.

Now, about half the population is at least somewhat overweight. And nearly one-quarter of adult Americans are considered obese, carrying an extra 30 pounds or more.

Instead of dropping off the public health radar, obesity is positioning itself to become the biggest threat to well-being in the next century. If the trend remains on this trajectory, one prediction says all Americans will be overweight in a few generations.

"We are facing a real epidemic of obesity," said Dr. Jeffrey Koplan, director of the U.S. Centers for Disease Control and Prevention. "All segments of the population are getting fatter, but the highest increase is among the youngest ages. ... There is no worse harbinger of what's to come."

Before long, Generation X may be replaced by Generation XL.

10 pounds a year

The road to obesity is an incremental journey: just 100 unused calories a day - that's less than the number in a biscuit or a can of light beer - can add up to more than 10 extra pounds in a year. With too many calories in or too few out, the body has little choice but to stockpile fat.

While piling up fat is often considered a cosmetic problem, obesity is even more of a health problem.

One study of Harvard alumni found that - after considering exercise, smoking and other influences - as weight rose, so did the risk of an early death. About 300,000 deaths each year are attributed to an unhealthful diet and inactivity.

"Obesity's impact is so diverse and extreme that it should now be regarded as one of the greatest neglected public health problems of our time, with an impact on health which may well prove to be as great as that of smoking," a World Health Organization report stated in 1997.

In a world without obesity, a large portion of heart disease and cancer would disappear. Experts believe that excess body fat accounts for more than 80 percent of the cases of type II diabetes. Obesity also raises the risk of gallstones, arthritis and a host of other conditions.

And obesity is a family finance problem. Obesity-related costs exceed $68.8 billion each year in direct and indirect health expenses, such as doctor bills and time missed from work. In addition, Americans spend at least $30 billion a year in desperate attempts to get thin.

Amid the financial and health costs are the psychological costs borne by overweight members of a society obsessed with the slender bodies peering out from magazine covers.

While medical experts agree that obesity can be costly - and deadly - its causes, impact and possible solutions provoke never-ending scientific debate. Doctors as far back as ancient Greece have known that people become overweight when they consume more calories than they burn. But a person's eating and exercise patterns are extremely difficult behaviors to measure.

"I think we have bad data, and we're trying to draw a lot of conclusions from it," said Dr. George Bray, retired director of Louisiana State University's Pennington Biomedical

Research Center.

A nation of fast food

One reason for the meteoric rise in obesity is that calorie-dense food, following customer demand, is cheaper and more abundant than ever. The United States has about 215,000 fast-food restaurants, and industry experts estimate that any one of those probably takes in half its business from people who never open their car doors there.

Plus, food and drink portions have ballooned to the point that marketers need a whole new vocabulary to describe them. Selections no longer stop at large. They're jumbo or supreme. They're monster. They're super size.

"We have this mind-set in America that bigger is better," said Dr. Margo Wootan, a senior scientist at the Center for Science in the Public Interest, a public health advocacy group. And when people are served more food, they eat more food, she said.

With restaurant chains beckoning from almost every corner, Americans eat out more often than ever. Government statistics show that 45 percent of the U.S. food budget is spent for meals and snacks eaten away from home.

No one's diet reflects this more than youngsters'. One study this year found that almost one-third of all the vegetables children eat are in the form of french fries and potato chips.

"The bottom line is that we're eating more calories," said Dr. Margo Denke, an obesity expert at the University of Texas Southwestern Medical Center at Dallas. "Why are people eating the portion sizes we're seeing? I think we're being trained by the restaurants.

"Restaurant owners are not bad people. Restaurant owners are appealing to an American ideal, which is value."

Sedentary work, play

At the same time they're swilling soda pop, too many people are spending their work time, as well as play time, sitting down.

During most of this century, "this was a country in which your work obliged you to be physically active," said Dr. Barbara Moore, president of Shape Up America!, a group founded by former surgeon general C. Everett Koop in 1994.

"Now, we can't even get up and go down the hall to deliver a message," Moore said. "We have to send an

e-mail." The body knows the difference. One researcher estimates that if a 130- to 165-pound office worker spent two minutes of each hour walking down the corridor to have a conversation, instead of sending e-mail, he or she would lose about a pound a year.

Unfortunately, movement of everything but the fingers is gradually being engineered out of American life, said the CDC's Koplan. Consider a typical day for many workers: sitting at a desk until 5 p.m., swinging into the drive-through for a quick dinner, punching the automatic garage-door opener and kicking back on the couch (the cordless phone and the television remote in a close orbit).

"Walk through your house and think about everything that's been changed," Koplan said. "Everything's electric. Rolling down the windows in your car - you name it. Everything has been motorized or electrified, and with it comes the concept that it's work to do that."
Work, after all, is a four-letter word.

Even if people recognize their lack of activity and are seized with the idea of walking, most modern neighborhoods and office buildings aren't built for foot travel. CDC statistics show that only about 5 percent of day trips are taken on foot. This is not necessarily because people are lazy but because living on a cul-de-sac with no sidewalk limits choices. In many neighborhoods, residents might not feel safe walking around.

Recent research has demonstrated that even simple things, such as taking the stairs or parking the car a bit farther away, make a difference in body weight and fitness. Yet the modern environment isn't very helpful, said Dr. Steven Blair of the Cooper Institute for Aerobics Research in Dallas. "We make it difficult, even for people who want to be more active as a part of daily life."

Time-saving devices, such as garage-door openers, may not necessarily be bad, said Dr. Steven Smith of the Pennington Center in Baton Rouge, La. The issue is, "if you save that time," he said, "what are you doing with it?"

Four hours of TV per day

If you're a kid, chances are you're using that time to watch TV, play computer games or surf the Internet.

Almost 30 percent of adolescent boys watch four or more hours of television a day. Kids' increasing lethargy is one reason that about 14 percent of children ages 6 to 11 and 12 percent of adolescents are overweight.

There's no indication that the numbers will improve. In 1991, 42 percent of U.S. high school students got daily physical education. Today, that has fallen to 25 percent.

As schools have lost physical education, they've gained soda machines and food courts. Calorie counts are soaring at the expense of nutritional content, a problem that many pediatricians attribute to children's control over their own menus.