The obesity epidemic
Flip through old family photos of previous generations and you’ll be struck, as I was, by how much thinner everyone was in the good old days. I came across a group portrait of my grandmother and her seven siblings taken in 1948 on the occasion of their parents’ 60th wedding anniversary. My then middle-aged grandmother and her sisters and brothers are all dressed up – the women in their shirtwaist dresses and the men each in their one good suit.
They are all thicker around the waist than their younger selves. But no paunches or rolls can be seen. They looked like the tough birds they were – still lifting sides of beef (as in the case of my great-uncle Alvin, the butcher) or walking across town to the office, home for lunch and back again, as my grandmother did every day in every kind of Northern Ontario weather.
Family pictures today tell a very different story. Bigger stomachs, more chins, wider backsides. In a group picture of men and women in their 50s and 60s and 70s today, half would appear either overweight or obese. Like everyone else, older adults are getting fatter, much fatter.
Easier to understand than change
Athe moment, understanding how we got into this mess is a lot easier than finding a way out, says Diane Finegood, a scientific director of the Canadian Institute of Health Research (CIHR). But there are solutions at every age, as she knows personally, having shed more than 70 pounds herself in the last five years.
So far concern about the obesity epidemic has focused on the risks to children, but researchers are starting to wake up to the very real dangers facing older adults – not to mention the costs associated with them. People who are obese face a higher risk of heart disease, diabetes, cancer and arthritis, and since those over 50 are already more vulnerable to these diseases, they are at increased risk for the damage that excess body fat can cause.
While current statistics tell us that we’ll live longer than our grandparents and our parents – partly because we don’t smoke as much – our excess weight is actually threatening to cancel out health gains we’ve assumed were ours. In fact, last year the Heart and Stroke Foundation of Canada called fat the “new tobacco” in its annual report card on the health of Canadians. It also reported that between 1985 and 2000, deaths attributable to overweight and obesity nearly doubled.
Medical researchers are telling us that the obesity crisis among over-50s is reversing a trend of older adults getting increasingly healthier. Instead, higher obesity rates will lead to higher rates of disability among the elderly.
One recent American Medical Association study points to just how expensive obesity is for the health-care system. The study examined the relationship between body mass index (BMI) in younger adults with their subsequent health-care expenditures at 65 and older. Adult men who maintained a normal weight through adulthood cost the system $7,205 a year from 65 years onward, whereas severely obese men cost $13,674 a year.
If you’re watching the numbers on your bathroom scales climb, you can take some small comfort in knowing that you’re part of a gargantuan global trend. The World Health Organization calls obesity “one of today’s most blatantly visible – yet most neglected – public health problems,” estimating that globally there are one billion overweight adults, 300 million of them obese.
It’s not just North Americans who are rapidly getting fatter (although we’re fatter than most). Obesity rates have tripled since 1980 in the United Kingdom, Eastern Europe, the Middle East, the Pacific Islands, Australia and China.
Next page: What’s actually unhealthy?
Figuring out whether your weight is healthy or unhealthy means knowing your body mass index (BMI), which is derived from the measure of your weight in kilograms divided by your height in metres squared. Not everyone interprets the numbers the same way, but according to obesity expert Dr. Arya Sharma, who is a professor of medicine at McMaster University in Hamilton, Ont., a BMI under 25 is normal, 25 to 30 is measured as overweight and carries some increased risk of disease.
Over 30 is defined as obese with a fourfold increase in risk for diabetes, heart attack and stroke. A BMI of 40 is classified as morbidly obese. (If current trends continue, it’s estimated that 20 per cent of North Americans will be morbidly obese by the end of 2025.)
Another measure of risk due to overweight is abdominal circumference. According to Sharma, a waist measurement of more than 35 inches for women and 40 inches for men is associated with a higher risk of developing illness. As anyone over 50 knows, waists tend to expand with age. Again, whether this is a result of less exercise, hormonal changes or a bit of both isn’t clear. What is clear is that big stomachs signal increased risk.
Not a simple equation
You may think you’re fatter because you eat too much and move too little, which may be true, but it’s more complicated than that. You’re fatter because you live in an “obesogenic” environment. Obesogenic is the newly concocted word scientists use to describe an environment that “promotes obesity because it promotes over-eating and physical inactivity,” Finegood says.
There is no one cause of obesity; rather, it’s has a multiplicity of causes. Think about your lifestyle compared to that of your parents and grandparents. They were physically active in hundreds of quaint ways that never took them inside a gym. They actually turned a handle on a can opener, they hung clothes on the line, they walked to the mailbox.
“We have engineered activity out of our lives,” Finegood says. In its latest report card on health, the Heart and Stroke Foundation released figures to show that people who live in the suburbs are fatter on average than people who live in more urban environments because they walk less and spend more time commuting in cars.
We have also engineered overeating into our lives. Finegood points to the fast food industry where super-sized portions have become a cheap – and successful — marketing ploy that encourages us to eat more. In Fat Land: How Americans Became the Fattest People in the World (Houghton Mifflin, 2003), author Greg Critser describes research from the new field of satiety – the science of understanding human satisfaction.
The clean plate club
In one experiment, volunteers who all reported the same level of hunger were served meals on four separate occasions. The meals grew in size from 500 grams to 625 to 750 and finally to 1,000 grams. As the size of the meal increased, the volunteers ate more. When McDonald’s introduced its French fries in 1960, a serving was 200 calories. The same serving is now 610 calories. If you order it, the satiety research says you’ll eat it.
At home, the standard dinner plate in North America has also grown, and portions have grown along with it. The plates in the 1940s dinner service my grandmother left me are 10 inches in diameter, but the kitchen plates we use every day are 11 inches. In the bestseller French Women Don’t Get Fat (Knopf, 2005), Mireille Guiliano says one of the simplest ways to lose weight is to reduce portion size by using those smaller dinner plates.
And the food on those dinner plates or in those plastic foam takeout cartons is much more likely to be highly processed food demanded by our time-starved lifestyles that leave no time for cooking from scratch. Processed food is higher in fat and sugar than home-cooked alternatives. One of the reasons that obesity is now a global problem is that there are global markets for highly processed food, Finegood says. Take for example, Kentucky Fried Chicken: since it opened its franchise in Beijing in 1987, it has expanded to more than 1,000 restaurants in China.
Next page: Maintaining a healthy weight
And most processed food contains an evil of modern life: trans fats. Trans fats are found in partially hydrogenated oils, which are added to foods for several reasons including to increase shelf life and to make foods such as crackers crispier. Almost half of foods found on grocery store shelves contain trans fats. But trans fats have been shown to increase the risk of cardiovascular disease.
Last November, the New Democratic Party tried and failed to get a motion passed in Parliament to make Canada the second country in the world to ban trans fats; instead, Health Canada set up a task force of scientists, health advocates and food industry representatives to find ways to reduce trans fats in Canadian foods.
So that’s the obesogenic environment we live in. And when you hit middle age, your body becomes its own obesogenic environment: as we age, our metabolism slows down and we burn fewer calories. This slowdown is mostly the result of a drop in energy output and can be reversed with physical activity, although some slowdown is a result of hormonal changes. Figures from Statistics Canada show the number of overweight and obese people increases steadily with age. Most people gain about a pound a year on average.
Eat less as you age
Dr. Arya Sharma says that a 70-year-old must eat 300 calories less a day than a 50-year-old; otherwise, he’ll gain “significant weight.” Sharma also points out that genetics plays a part in weight gain. “The problem with blaming lifestyle is that it has a disproportionate effect on people. People can have similar lifestyles and their chances of becoming overweight are quite different. It’s a combination of lifestyle and genetics,” he says.
Trying to maintain a healthy weight after 50 can feel like balancing on a knife edge. “If you’re off kilter by 500 calories a day, you’ll gain a pound in a week,” Sharma says. Finegood puts it another way. Eat an extra 50 calories a day – a mouthful of ice cream – more than you expend in energy and, in a year, you’ll have gained five pounds. And if you stop doing one small bit of exercise – your old dog dies and you no longer do an evening lap around the park – you’ll gain some more.
We know we got fatter inexorably, one extra mouthful, one larger portion and one fewer step at a time. But so far no one has figured out how to reverse the trend, although governments and health advocacy groups have started to pour money into research around the globe.
In Canada, a group of agencies including the CIHR and Heart and Stroke Foundation of Canada recently launched Target Obesity, offering $1.4 million in grants to researchers to study issues such as the impact of the media on the risk for obesity and how well various therapies work to control obesity.
No one single cure
What health-policy wonks have already decided and what is starting to filter down to the masses is that there is no one silver-bullet cure for obesity for the simple reason that so many “cures” have failed. In the U.S., consumers now spend $30 billion on the dieting industry, which includes diet foods, books, commercial weight loss programs, fitness clubs – but obesity rates just keep rising.
We’re also seeing a shift away from blaming the individual, although “I often think that overweight people are the last people you can target in the media and not get in trouble for it,” Finegood says.
We have to stop thinking of weight gain as a personal failing but rather as an indicator of an unhealthy lifestyle – and a lifestyle we share with millions.
To collectively turn this ship around, “We’re talking about the small changes method,” Finegood says. If eating an extra cracker a day can cause weight gain, then it stands to reason that not eating two crackers can cause weight loss. Or walking an extra block. Just as we got into this mess one small step at a time, we have to get out the same way, she says.
Small changes, big payoff
Finegood, who has struggled with her weight her whole life, decided as she approached 50 to finally shed the pounds once and for all. Walking up a flight of stairs left her short of breath and she knew that losing weight would also reduce her risk of getting breast cancer, a disease for which she is at high risk because of family history.
In her quest to lose pounds safely and permanently, she turned herself into something of a guinea pig for how to make small permanent lifestyle changes that encourage healthy eating and physical activity. She started by making just one modification – she reduced the amount of fat in her diet by using less margarine and oils, cutting fat from meat before cooking. And the weight started to come off slowly.
Over the years, she introduced other changes. She began a simple walking program, eventually buying a pedometer to monitor how many steps she walked in a day – she aims for 10,000. Next, she tackled eating five to 10 fruits and vegetables every day. Then she focused on reducing her portions. Recently, she started eating food that is less energy dense – food that contains more water.
For example, soup made with chicken and rice is less energy dense that a casserole made with the same ingredients even though portions have the same number of calories. The theory, put forward by Barbara Rolls, a professor of nutrition at Pennsylvania State University, in her book Volumetrics: Feel Full on Fewer Calories (Harper Collins, 2000) is that the bowl of soup creates more of a feeling of fullness than the casserole with the same number of calories. Finegood says she isn’t sure why it works but “my own anecdotal experience is that I’m less hungry after work when I have soup at lunch,” she says.
Over five years, Finegood has dropped more than 70 pounds although her weight still tips into the obese category. Now much more fit, she can climb several flights of stairs without a problem.
“The weight loss gives me peace of mind that my risk of developing breast cancer and many other chronic diseases is reduced,” she says. But she doesn’t focus on weight loss per se. Instead, she focuses on changing her behaviour. That’s why she loves her pedometer because it measures her behaviour, not her weight. As each new behaviour is incorporated into her life, she’s ready to add the next one.
“When I get off the phone from talking to you,” she says from her home in Vancouver, “I’m going to go and do my training for the Vancouver Sun Run.” She can’t believe she’s taken up running. “If you had asked me six months ago if I’d do this, I would have just laughed,” she says.
Is she enjoying it? She hesitates. “Well, I’m happy I’m becoming more active. And I have to admit, I love the feeling when I’m done,” she says.