OTC: Specialists in Obesity

The Chinese Perspective of the U.S. Obesity Epidemic

One of the more fascinating views of the obesity epidemic came to my attention today.  It came from a Chinese news service (China View) and discusses the “corporate and industrial benefit” of the obesity epidemic.

The article started with a historical perspective. It said there have been changes in our work style and food technology that contribute to the epidemic.  However, their conclusions arise from a very capitalistic perspective:

"Put simply, there is a lot of money being made, and to be made, in feeding both oversized stomachs and feeding those enterprises selling fixes for oversized stomachs," … "And both industries -- those selling junk food and those selling fat cures -- depend for their future on a prevalence of obesity."

Wow!  To have a developing nation tell me that I am in this for the money is just shocking.  My passion for treating obesity focuses me on a complex disease without many allies.  Yet, am I secretly hoping to perpetuate the problem?

The answer is a resounding NO!  As a physician, I see the challenges and struggles of my patients—life-limiting disease, emotional turmoil and societal bias. I ask a lot of them to endure a strict diet, regular attendance and accountability to manage this disease.

The reality is that obesity is a significant disease that deserves attention and effective treatment.   This is my part in the battle, and I also appreciate the major efforts that are being developed for obesity prevention.  My utopian vision is “Star Trek: The Next Generation” where none of the characters had weight problems. I’m an optimist so I sincerely hope that it will not take this long.

But back to the article. I couldn’t imagine why it was written until I read the last paragraph:

“Nobody wants to sweat at work for 10 hours a day and be poor. Yes, you're obese, but you have a life that is much more comfortable.”

I did some further research and found that the rate of obesity in China has doubled.  Nearly 30% of the Chinese are either overweight or obese (a total of 200 million people), and their rate is climbing rapidly.  I suspect that China is still conflicted over their changing society and mourns the loss of an agrarian society.  Yet, their obesity rate is still far less than that in the U.S.  Rather than lashing out at us, they should focus on obesity prevention.  While I am proud of the work we do at OTC, I would be thrilled to never have to open a clinic in China. 

Obese and Invisible

From: Maureen Allen, M.P.H.

                              

I always read two parts of the newspaper without fail - the obituaries and the  classifieds. I’m neither morbid nor looking for a new job but habit compels me to those sections regularly. The Sunday paper is like hitting pay dirt with pages and pages of help wanted ads.

A few weeks back, there was an article on the front page of the job section about a federal law that prohibits discrimination in hiring. Among the reasons you can’t refuse someone a job are the usual suspects: race, sex, religion, age and country of national origin. The law says that you cannot ask questions of a job applicant to get the answers to those questions either.

That makes sense. If an employer wants to know someone’s sexual orientation they could ask questions about marriage or kids. They could ask where or if a person worships to determine religious affiliation. When I worked for the American Lung Association they asked me if I smoked because they did not hire smokers. Yes, we have a right to smoke but we don’t have the right to be hired.

In the article weight wasn’t listed in the litany of things you can’t ask a person about. But does an employer have to ask someone who is grossly overweight how much they weigh to discriminate against them? One look at the applicant is sufficient. An employer may view an overweight applicant as illnesses and absenteeism. Or worse.  They could plain old not like fat people.

The irony is that some overweight people describe becoming “invisible” the bigger they get. Many patients know the exact weight they hit when no one noticed them any longer. It’s long been felt that some victims of rape and incest actually use weight so as not to get attention from men.

W. Charisse Goodman wrote about weight discrimination in her 1995 book The Invisible Woman: Confronting Weight Prejudice in America.  When applying for a job a person is protected from intrusive questions that may hurt their chances for employment. But if you’re 100 pounds overweight, no questions need be asked.

Overweight and Healthy?

From: John Hernried, M.D.

      

There is significant debate about the danger of being overweight or obese in the absence of medical problems.  Many people say it is OK to be overweight and fit—that you aren’t at a significant risk for  disease.  This has caused many people to ignore their weight issues.

However, a recently published study in The Journal of the American Medical Association finds being overweight dramatically increases your risk for heart disease and diabetes after age 65.  The study followed 17,000 people who were “middle aged” meaning over 30 years old. The results were striking: Those who were obese but “healthy” in their middle years were 43 percent more likely to die from heart disease and 11 times more likely to die from complications from diabetes. 

It is important to reduce weight earlier in order to avoid heart disease and diabetes later in life.  I see a wide variety of patients at OTC with various amounts of weight to lose.  I am gratified knowing that I am helping them make a significant positive impact on their health by helping even the “healthiest” of our patients.

If you have a family member or a friend who is obese and under the false impression their health is not compromised, please, show them this article and tell them you care and want them to live a long and healthy life.  Often, an article such as this can be a kick start to making a significant lifestyle change.

New Year’s Resolutions

               

There’s nothing like opening your calendar to January and planning a new start. Many of us surrendered to the holidays after the first party in December. I know. I was at that party too.

So if you haven’t already made your 2006 resolutions or you want some fine tuning, there are a few things to consider before committing yourself.

The big enemy of any plan, whether it’s improved health or reading more, is vagueness. People will describe their behavior in terms of “good” or “bad” and it has no meaning. What may be a “bad” dinner portion for you may be just right for a linebacker after the big game. It’s all relative. So instead of making a resolution to be more something or better something, be specific about the behavior.

Don’t just say you want to read more. Choose a number of books will you read a month and how much time you’ll read on a daily basis. Instead of saying you’ll lose weight, say how much you want to lose, how many calories a day you will have and how much exercise will you need to achieve that goal.

Resolutions without details are just daydreams. And that’s fine if daydreaming is your New Year’s resolution.

From: Maureen Allen, M.P.H.

Got Milk? Lose Weight?

From: John Hernried, M.D.

    

Over the several years, I have heard scientific claims that milk promotes weight loss.  The promoters, scientists with funding from the National Dairy Council, describe milk as a weight loss miracle.  Yet, . national obesity scientists are very quiet on the subject.

The theory is that calcium and other components of dairy products help to increase fat breakdown in the body.  To date, the Dairy Council points to one human trial that lasted only 24 weeks and was highly structured.  Incidentally, the journal it was published in notes that it must be labeled as an “advertisement” due to bias from the dairy council.  Yet, this study anchors the large-scale advertising campaign to consumethree servings of dairy per day.

The debate also exists between government agencies.   The USDA used tax money for promotions to drink more milk, while the Dietary Guidelines Advisory Committee (the non-sponsored committee who developed the New Pyramid) did not find evidence to support increased dairy consumption:  “Because of the lack of large-scale, randomized trials or controlled feeding studies designed explicitly to test the effect of milk group intake or calcium consumption on body weight and the limitations of the studies reported above, at this time there is insufficient evidence on which to base a more definitive statement regarding the intake of milk products and management of body weight.”

What’s the harm of consuming more wholesome dairy products?   My major concern is that serving sizes and types of dairy are not quantified.  It took me a long time to find the serving sizes on their website.  The Dairy Council recommends three servings of dairy products a day.  A glass of milk can vary between 86 and 150 calories depending on its fat content.  A cup of yogurt can add another 230 calories.  Four cubes of hard cheese can be as much as 460 calories.  Based on their recommendations, it is easy to consume 850 calories just from dairy, not to mention a large amount of saturated fat.

So, what should you do?  I think the jury is still out on whether dairy is an effective tool for burning fat.  However, dairy can be an important source of nutrition in terms of bone health and protein intake.  You can enjoy dairy products by including them as part of your daily calories, sticking to nonfat dairy products, and not using cheese as a source of dairy intake. Happy cows may make happy cheese, but I wouldn’t look to them for dieting tips.