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		OBESITY EPIDEMIC IN THE US by Eva Urbaniak, N.D. The statistics are truly shocking and sobering, almost enough to take your appetite away. Obesity in the United States population has now officially become an epidemic and front-page news. The mainstream media, from the news reporting on "fat suits" (lawsuits against the fast food manufacturers), to the "Dr. Phil Show's" newest format, trying to get at the psychological factors of why people become obese in the first place, reveals to the general public that this problem is very real, is not going away, and actually, seems to be worsening at an increasingly alarming rate. Although both sides of this obesity "revelation" are significant regarding who is actually at fault, the fast food companies, or the consumer who purchases and eats the fast food, the causes of obesity go far beyond just fast food, because the food (or non-food) choices that people make, processed, fat-laden snack foods, soda pop, white flour, white sugar, salt and alcohol consumption, and the increasingly sedentary American lifestyle can most certainly be implicated. The typical American lifestyle, driving up to eat a meal which contains more calories than a person should eat over a period of two days, 80 to 90% of those calories coming from FAT, or sitting in front of the T.V. with a six-pack and a bag of chips, both sources of empty calories, by no stretch of the imagination can be considered healthful. American children eat sugar coated cereals for breakfast, drink a cola as soon as they get to school, eat cookies and candy for snacks, and now teens have begun to drink espresso coffee, and parents and teachers want to medicate them because their behavior is out of control. To make things worse, the proportions of schools offering physical education, overweight people who report dieting and exercising to lose weight, and primary care physicians who counsel patients about behavioral risk factors for obesity have all declined since the late 1990s. Yes, there truly is something wrong with this picture. Now, advertising wizards for the fast food industry have created new ads to convince consumers that a salad with a hunk of deep fried chicken on top is going to make you slim. Granted, salad IS better than a side of fries, but the fat calories from the deep fried chicken are still there, and add up, nonetheless. And although it is a move in the right direction for people to face their self-defeating addictive behaviors around food and drink, Americans are unfortunately continuing to get fatter and sicker. For the benefit of those who may not know, a person is considered obese, who has 20% or more in excess weight for their age, height and type of build, or a BMI (Body Mass Index) or 30 or higher. That means a person who normally weighs 150 lbs. is considered obese if that weight climbs to 180 lbs. Anything between these two amounts is considered overweight, with a BMI of between 25 and 27.3 for women and 27.8 in men. The BMI is the measurement now used by the NIH (National Institutes of Heath) and the AOA (American Obesity Association), and is considered a more accurate measurement of body weight relative to height, rather than the old height, weight, frame size charts used in the past. A person is considered morbidly obese who has 26% or over excess body weight, with a BMI of 40 or more, is 100 pounds overweight, or 80 pounds overweight with diabetes, sleep apnea, or any other life threatening illness. Taber's medical dictionary makes distinctions regarding obesity classifying it as exogenous, meaning caused by excessive food intake or lack of exercise, and endogenous, caused by some abnormality within the body like hypothyroidism, adrenal hyperfunction, testicular or ovarian hypofunction, or hypothalamic obesity, which is caused by malfunction of the hypothalamus, the appetite-regulating center of the brain. Most charts calculate BMI in kilograms and meters, but here is a simplified chart in pounds and inches to easily calculate your BMI:

BMI: 25 30 35 40 Height (inches) Body Weight (pounds) 4'10" 119 143 167 191 5'0" 128 153 179 204 5'2" 136 164 191 218 5'4" 145 174 204 232 5'6" 155 186 216 247 5'8" 164 197 230 262 5'10" 174 207 243 278 6'0" 184 221 258 294 6'2" 202 233 272 311 6'4" 205 246 287 328

If you weigh less than the range given on this chart, you are in good shape. If you are significantly above the ranges given, consider that over 300,000 deaths per year are caused by obesity and diseases linked to obesity, and that a BMI of 30 or over is the point at which risk of death increases from excess weight. Also worth noting, and easily measured, is a waist circumference of 40 inches or more in males, and 35 inches or more in females significantly increases risk of obesity-related disease. For those of you reading this who are in shape, here is another chart, more detailed for the lower ranges of BMI:

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Height (inches) Body Weight (pounds) 58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287

Obesity Now Considered a "Disease" and Public Health Problem #1 The American Obesity Association states that obesity is a "chronic disease," and it could also most certainly be classified as a nutritional / metabolic disease, although it is closely related to behavior, whether a person is eating more than is needed for daily energy needs, or leads a sedentary lifestyle, or both. Just as other diseases result from the behaviors that lead to them, such as problem drinking, a behavior, leading to the disease of alcoholism; smoking, a behavior, leading to cancer or emphysema; or sunbathing without sunscreen, a behavior, potentially leading to skin cancer; overeating and lack of exercise, both behaviors, can and do lead to the disease of obesity. But the problem is not that simple. Once obesity takes hold, a myriad of other problems and diseases can develop much more quickly such as arthritis, heart disease, hypertension, stroke, cancers of all kinds, insulin resistance / diabetes, gallstones, liver disease, low back pain, and decreased life expectancy, not to mention the psychological impact of the obese person being a victim of disdain and discrimination. The National Academy of Sciences Institute of Medicine states that obesity is "one of the most pervasive public health problems in this country, a complex, multi-factorial disease of appetite regulation and energy metabolism involving genetics, physiology, biochemistry, and the neurosciences, as well as environmental, psychological and cultural factors. Unfortunately, the lay public and health-care providers, as well as insurance companies, often view it simply as a problem of willful misconduct - eating too much and exercising too little. Obesity is a remarkable disease in terms of the effort required by an individual for its management and the extent of discrimination its victims suffer." The American Society of Bariatric Physicians states that: "Recognized since 1985 as a chronic disease, obesity is the second leading cause of preventable death, exceeded only by cigarette smoking." And the American Academy of Family Physicians has adopted a policy on obesity, stating: "The AAFP recognizes obesity as a disease and a national health risk for premature death; will support CME programs on childhood obesity; and promotes nutritionally balanced meals, decreased TV viewing and increased physical activities for obese children." Children are especially at risk for developing serious problems, both physical and emotional, if obesity develops in younger years. Obesity is a risk factor for diabetes at any age. What used to be called "late-onset" or "type 2" diabetes is now being called "childhood diabetes", although this is still type 2, because what children are eating is literally making them sick. I don't think people have been educated well enough about the fact that diabetes is an absolutely devastating disease and is alarmingly on the increase in the US. Amputation of limbs, kidney dialysis, blindness and heart failure are just a few of the end results of diabetes. The reality about the obesity epidemic is that medical professionals need to get more involved with their patients, educating them about good nutrition and eating habits on a much more widespread basis. Although surgeons have been the main providers of care for the morbidly obese patients, providing stomach stapling gastric bypass procedures, or the new electroshock therapy for the stomach, in which a pacemaker type device is implanted in the patient's body and shocks the stomach to create a sensation of fullness (and it should be noted that these are extreme cases, people who weigh 300 lbs. and higher), the family physician is in the best position to teach and counsel the obese patient. If nothing else, a doctor could and should strongly recommend that the obese patient eat more fiber, in the form of vegetables, and even a fiber supplement, because fiber is a natural way to feel more full and encourages proper elimination. Some people may need a special dietary menu to follow, because they cannot seem to make those healthier choices for themselves for whatever reasons, but the healthiest and medically sound method of weight loss is a calorie restricted diet which provides adequate protein, carbohydrates, fats, minerals and vitamins, and NOT from a fad diet. References: American Obesity Association Shape Up America www.shapeup.org NIH AAFP AABP Center for Science in the Public Interest (Halting the Obesity Epidemic-A Public Health Policy Approach by Marion Nestle, PhD, MPH, and Michael Jacobsen, PhD)

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