The battle begins here. This article is the first in a 12-part series focusing on the problems associated with obesity and what clubs can do to help.
"We're too fat, and it's killing us."
This chilling comment comes from Eugenia Calle, an epidemiologist with the American Cancer Study. And her statement is not hyperbole. Approximately 300,000 deaths are attributed to obesity every year, making it the second-leading preventable cause of death in the United States, after smoking.
As a nation, we are growing heavier. Based on data gathered during a telephone survey, the national Centers for Disease Control and Prevention (CDC) concluded that 20 percent of Americans are obese - and that's a conservative number. Ali Mokdad, an epidemiologist with the CDC, points out that people tend to underestimate their weight during phone surveys. In his opinion, the actual figure is 25 percent, meaning that one in four Americans is obese, not one in five. And that's not even counting the people who are simply overweight.
In an age where people prefer not to shoulder personal responsibility, some may point an accusatory finger at genetics, claiming that our metabolisms have lowered, thereby placing obesity beyond our control. In actuality, few people have low metabolisms - and even they can't blame obesity on genetics. A low metabolism may make you overweight, but it won't make you obese. "The reality is that obesity is not genetically determined," says Dorene Robinson, director of nutrition and health education with Beyond Fitness, div. of Peak Performance.
If the problem isn't genetics, then what is the culprit? The "toxic environment" in which we live, according to John Jakicic, an assistant professor of behavioral medicine at Brown University. "Our environment is reinforcing high-fat eating, high-calorie eating, fast-food eating and a sedentary lifestyle," he says.
Findings from the CDC support this. According to a CDC study, 30 percent of Americans are completely inactive, and another 30 only get moderate exercise. Common activities, such as walking, are on the decline. Inventions of convenience - riding lawn mowers, automatic garage-door openers - have replaced calorie-burning work. "We keep engineering activity out of our life with gadgets," Robinson says.
As our culture grows more sedentary, our appetites seem insatiable. Food is cheap, abundant. Commercials encourage us to "supersize" our meals. Robinson points out that America has a generation of people who don't know how to prepare something as simple as rice or a baked potato; they either buy fast food or microwave "heat and eat" meals. "Whenever you buy prepared foods, they are loaded with excess fat and calories, and they lack the nutrients of fresh foods," Robinson says.
An Uphill Battle
How do we combat obesity in a society that cultivates it? Some pharmaceutical companies have come forward with medications that target the problem. However, Mokdad believes that drugs are not the ultimate solution. He refers to what epidemiologists call "competing morbidity." Common risk factors can lead to a number of diseases. Medication may control some of these diseases, but others will surface. The only way to stop the diseases is to eliminate the risk factors.
For example, consider poor nutrition and inactivity. These risk factors caused high blood pressure, which many people chose to treat with medication. The medication controlled the high blood pressure, but people still weren't exercising and eating sensibly. As a result, the risk factors caused other problems, such as high cholesterol and diabetes. More drugs came along, as did more diseases. Obesity is one of them. And if obesity is cured with drugs, there's no guarantee that poor nutrition and inactivity won't lead to other diseases.
"Medication is not going to solve this," Mokdad says. "What's going to solve this is a change in lifestyle."
This may seem obvious, but, truthfully, many people don't understand what it takes to develop a healthier lifestyle. In a study of people who were trying to lose weight, the CDC discovered that fewer than 20 percent were doing what they were supposed to do - that is, increasing physical activity and lowering caloric intake properly.
The trouble is a lack of knowledge. CDC research shows that Americans have cut back on fatty foods, but they aren't counting calories. Many don't realize that reducing caloric intake is crucial to weight loss. Eating low-fat or fat-free meals isn't enough.
Another common misconception is that people can get their weight under control through exercise alone. "If you just exercise without taking care of other things related to your weight, your chances of losing weight and keeping it off are fairly slim," says Brown's Jakicic. "You need to use exercise in combination with dietary modification to have the biggest success."
Also, exercising for weight loss may take longer than previously thought. Research from Brown indicates that 60 minutes of daily activity may actually be required. In the past, 30 minutes was the common advice. "We're not saying that half an hour isn't OK," Jakicic says. "It's just that for the management of body weight, it looks like it is going to be more than that."
Jakicic adds that the 60 minutes don't need to take place in a single workout; people can break routines into 10-minute intervals throughout the day. This is especially good for people who are new to exercise. The goal is to get sedentary, overweight people exercising between 150 to 300 minutes per week. Once people start on a program, they can work up to longer sessions if they are able.
Some professionals point out that obese people who don't lose weight can still gain health benefits from working out, so any exercise is better than no exercise at all. Robinson believes this "fit and fat" message has been overblown, spread to make people feel OK about being overweight. She points out that a smoker who exercises may be healthier than an inactive smoker, but he would become healthier still if he quit smoking. Likewise, an obese person who sheds weight and exercises gains the most benefits.
Joining the Fight
Unfortunately, shedding weight through exercise and diet is more difficult than it sounds. Living in a culture in which eating is encouraged and activity is discouraged means that maintaining a healthy body weight requires skills that most people don't possess. But there is a place where they can learn: health clubs. "Clubs can teach these skills," Robinson says. "Club people have these skills."
Health clubs specialize in showing people how to integrate exercise into their daily lives. But that's not enough. Weight management is a behavioral issue, and exercise is only one of the behaviors that must be taught. The other is sensible eating.
Robinson's favorite guidelines come from the DASH (Dietary Alternatives to Stop Hypertension) diet. The DASH diet emphasizes whole grains and recommends more fruits and vegetables than the current dietary pyramid. Its daily nutritional guidelines are 20 percent protein, 25 percent fat and 55 percent carbs. "It will help people with losing weight," Robinson stresses.
Another way the industry can help people lose weight is to dispose of some common metabolic myths. For example, some people think that dieting ruins metabolism. Not true. "When people lose weight, their metabolism at their new lower weight is normal for that weight," Robinson says.
Another fallacy centers on skeletal muscle. Some exercise buffs think that increasing lean muscle mass will raise your resting metabolic rate significantly. That also isn't true, according to Robinson. The average male would need to increase skeletal muscle mass by 20 percent to increase metabolic rate by 5 percent, she claims.
In addition to disposing myths, the industry needs to dispose the barriers that keep the overweight out of health clubs. Don't make the overweight feel unwelcome. The obese won't feel at ease around scantily clad instructors and trainers, so put dress codes into effect (if appropriate). Also, the staff shouldn't frown on people who can only do brisk walking or other beginning forms of exercise. "Have an environment where the people don't feel ashamed to come to try changing something about their behaviors," Jakicic says.
Once you get the overweight and obese into your club, positive reinforcement will keep them on track to a healthier lifestyle. Robinson believes that monitoring and tracking accomplish this goal. For that reason, tell people to keep records of what they do. Also, encourage people to exercise every day - even if it's outside of the club. Yes, you do want these people to frequent your facility regularly. However, remember that if you truly want to help the obese, you must inspire them to be active wherever and whenever they can.
"Encourage people by saying, 'On days when you can't get here, at least try to do something, so you can maintain those levels of fitness,' " Jakicic recommends.