By Michael Fumento

USA Weekend, September 14, 1997
Copyright 1997 Gannett Company, Inc.

Listen carefully. You can almost hear it. The sound of zippers tearing, buttons popping, Spandex expanding. America is getting fatter by the day. We may soon see our beloved Stars and Stripes replaced by a yellow flag declaring "Extra Wide Load."

Americans as a whole have gained about 12 pounds in the past decade. According to the old definition of obesity, whereby you had to be 20 percent overweight, a third of all Americans are obese. But on the basis of new medical evidence that anything over your ideal weight is unhealthy, almost three-fourths of American adults are too fat.

It's "a 25 percent increase in six years," says former surgeon general C. Everett Koop. "We just can't afford to go on like that. If I had stayed on longer [in office], I would have launched the same assault on obesity that I did on smoking."

It is my belief, after two years of researching this topic for my new book, The Fat of the Land, that yes, Americans must attack obesity in the same way we did smoking, when the number of smokers was cut in half.

FIRST, FACE THE FACTS

Obesity is a terrible problem and, unlike other epidemics, such as a flu epidemic, it won't go away on its own.

Some would have us believe that there is nothing wrong with being fat, that people just find it distasteful and therefore assume it's unhealthy. Actually, doctors believe fat is unhealthy because a multitude of studies for decades has shown it to be so.

"We know," Koop says, "that excessive weight fosters everything from diabetes and heart disease to breast cancer, colorectal cancer and osteoarthritis."

A recent University of Wisconsin study found a direct correlation between extra weight and increased breast cancer in women. Another study, at Brigham and Women's Hospital in Boston, found that women 44 pounds overweight had 2.5 times the chance of developing common strokes. Obese people are less likely to survive surgery. They are more likely to develop cataracts, arthritis, gallstones.

According to the World Health Organization, 300,000 Americans die prematurely each year because of obesity. Among lifestyle-related illnesses, only cigarette smoking (an estimated 400,000 deaths) has a higher toll. But smoking deaths are declining, while obesity deaths will continue to climb as long as obesity does. Meanwhile, adolescent obesity has jumped 40 percent in a little over a decade.

Americans are the fattest people in the industrial world (see box above). We eat too much. We get too little exercise. We never run out of excuses for both. To name a few:

• "It's all in my genes" or "I have a slow metabolism." A few studies have shown some people are genetically disposed to burn calories more slowly. But this difference ranges from one-fourth to three-fourths of a single can of non-diet soda daily. Further, genetics hardly explains why Americans are so much fatter than Europeans, or why we get fatter by the year.

• "You can be fat and healthy." Yes, you can be relatively healthy for a fat person – or relatively healthy for someone with AIDS, for that matter. Obesity attacks your body in ways that won't necessarily show up in a cholesterol or blood pressure test. Among such assaults often not detected until too late are the cancers linked to obesity, says obesity specialist G. Ken Goodrick of the Baylor College of Medicine in Texas. Among these are not just breast cancer, but cancer of the colon, rectum, prostate, gallbladder, cervix and ovaries. Yes, some obese people may live long lives, but so do some heavy drinkers and smokers.

• "It's OK. I'm a 'pear,' not an 'apple.' " This refers to whether fat is stored below the waist (this pear shape is commonly thought to be safe) or in the abdomen (this apple shape is said to promote heart disease). But recent research shows this may not matter nearly as much as has been thought. Moreover, as a person ages, fat tends to shift up, turning "pears" into "apples."

• "I only ate a muffin – and it was low-fat." Probably nothing has done more to make America the Land of the Fat than the low-fat/no-fat fad and the incredible growth of portion sizes. Study after study has shown that hips, thighs and bellies couldn't care less whether calories are from fat, carbohydrates or protein. Only calories count. Part of the confusion is because foods naturally low in fat, like vegetables, fruits and grains, are also usually low in calories and very satiating. But that low-fat banana muffin eaten this morning was packed with so much sugar it had more calories than eight bananas. And far better to eat one satisfying cookie teeming with fat than half a box of no-fat, high-sugar ones that taste like chocolate-flavored Styrofoam.

  Portion sizes have exploded; muffins now are many times larger than just a few years ago. The original Coca-Cola bottles meant for individual consumption contained 6.5 ounces. In Europe, they're still around 8. In the USA, machines now dispense 20-ounce soda bottles, while convenience stores routinely dispense 64-ounce buckets of drink - 10 times the original serving size.

• "It's useless trying to lose weight; after all, 95 percent of dieters just put the pounds back on." That figure applies only to people in certain government studies of dieters who repeatedly failed in the past. Everywhere there are people who have taken off large amounts of weight and kept it off, including your humble writer, who lost all his excess weight (25 pounds) and has kept it off two years.

SECOND, CHANGE SOCIETY'S VALUES

Long before waistlines began to balloon, we began to build a society that promotes values that themselves promote obesity.

"This population-wide problem" of obesity, says Northwestern University's Jeremiah Stamler, M.D., "is best comprehended as a societal problem."

"The root of the problem," according to the respected Institute of Medicine, "must lie in the powerful social and cultural forces that promote an energy-rich diet and a sedentary lifestyle."

One of these forces, in my view, is the victimization fad, in which everything wrong in our lives is the fault of someone or something else. I'm not to blame for being obese; I must have a slow metabolism. It's the restaurant's fault I ate a portion big enough for the "star" of the Jurassic Park sequel. Nobody's arguing it should be illegal to be so enormous that, like chef Paul Prudhomme, you can't get around without an electric scooter. But neither should it be seen as a choice on par with picking a Ford over a Chevy.

Moderation and setting limits could work. "If social and cultural forces can promote obesity, these same forces should be able to control it," concludes the Institute of Medicine.

This doesn't mean "oppressing" fat people. Rather, it means combating that which pushes us in the direction of fatness. On top of the barrage of health warnings and limitations on tobacco advertising, our society made smoking uncouth, nasty, inconvenient. "Thank you for not smoking" became a common demand. No one took away the right to smoke; society took away the right not to be embarrassed about it.

But America isn't fighting obesity. It's adjusting to the problem – indeed, institutionalizing it. A generation ago, physical education was almost universally mandatory. But by 1995, only 25 percent of high school students had mandatory phys ed.

It used to be that no food maker in its right mind would use a fat person to advertise its products. Now Wendy's runs ads about a "Big Eaters Club" in which everyone is obese – and nobody cares.

Manufacturers are doing everything possible to make being fat as easy as possible. From subways to stadiums, seats are becoming bigger to accommodate bigger bottoms. Clothing makers change their sizes to flatter buyers, and sales of euphemistically labeled "women's" clothes are growing twice as fast as sales of other apparel. The newest trend: stores catering to obese kids, such as the "Pretty Plus" line at Sears. Generation X is fast becoming Generation X-Large.

Society could learn to sneer at calf-sized steaks, sodas that could float a battleship and chocolate syrup ads that say "just pour it on" because, though it has 50 calories per tablespoon, "it's virtually fat-free."

Saying obesity is a societal problem in no way gets individuals off the hook. Yes, we live in a nation that is a conveyor belt to fatness. But some of us have gotten off, and all of us have an obligation to try, not just for own sake but to save the lives of our children and other family members.

Like smoking, drug abuse and violence, obesity is a socially contagious disease. The more you have, the more you get. Even taking genes into account, fat parents are more likely to have fat children. Research shows that if you improve your eating and exercise habits and lose weight, there's an excellent chance other members of your family will, too.

HEALTH CAN PREVAIL

Health and safety campaigns often fail, but they can succeed if efforts persist year after year.

For example, seat-belt use steadily rose even before many states made it the law; the number of smokers has dropped by half; illegal use of hard drugs and hard liquor has dropped among adults. Americans have significantly lowered their cholesterol intake.

Obesity may be the toughest beast to slay. But after all, if we can put a man on the moon, surely we can get through doorways without greasing down our sides.

10 REAL WAYS TO LOSE WEIGHT

In researching his book, Fumento pored over thousands of articles in medical journals to find what works and doesn't. His top 10 conclusions:

• Lose slowly. It improves your chance of not seeing weight come roaring back.

• Low-fat is NOT the answer. Nothing is making us fatter than the "low-fat/no-fat" fad. Many studies have shown that, for practical purposes, 1 calorie of fat is no worse than 1 calorie of protein or carbohydrate. Because we've been lulled into believing low-fat is better, we eat far more food than we otherwise would.

• Reduce sugar. Americans consume 150 pounds of sugar and corn sweeteners per person per year, 33 pounds more than 20 years ago.

• Pump fiber into your diet. It fills you up and speeds food through your body, cutting calorie consumption.

• Portion control is vital. Let appetite dictate consumption, not package sizes, restaurant portions or what others eat.

• Calories are all that count. (Many will disagree.) Don't obsess over each one, but do eat only small portions of high-calorie stuff.

• Cut out little things. Say you drink a 280-calorie bottle of juice five days a week. Drink water instead to cut 73,000 calories (18 pounds) a year.

• Exercise. There's a clear connection between regular vigorous exercise, losing weight and keeping it off.

• Turn off the TV. Watching fattens you, studies show.

• There is no weight-loss magic.

GIRTH OF A NATION

How Many Americans are Overweight?

Weights Around the World

Country	Average Weight (in pounds) of 5-foot-4 Men and Women
North America	162
Southern Europe	156
Eastern Europe	150
Western/Central Europe	147
Northern Europe	146
South/Central America	145
Africa	137
Asia	128
Source: Per Bjrntorp and Bernard N. Brodoff, eds., Obesity

Body Mass Index: Does your weight put you at risk of health problems?

How they rate: We calculated each model's "Body Mass Index" using the chart at right, developed by health researchers. Model 1, at 5 feet and 170 pounds, has a BMI of 33. Model 2, 6 feet and 195, has a BMI of 26. The BMI of Model 3, 5-foot-91/2 and 175, teeters at 25.5. Scientists have determined that appreciable health risks begin at a BMI of 25, so all three models are above their optimal weight for health, however slightly in the case of Model 3.

How you rate: To determine your BMI, multiply your weight in pounds by 705, divide by your height in inches, then divide again by your height in inches. Calculate your BMI to see if you are obese. What the scores mean:

• 24 or under: Minimal health risk
• 25-29: Low to moderate risk
• 30 or over: High risk

THE OTHER SIDE

NAAFA members hold rally during 15-minute break between breakfast and lunch.

"For millions, this approach will be a great disservice."

"It's true that overweight and obese individuals can benefit from improvements in their diet and exercise patterns," says Michael Steelman, president of the American Society of Bariatric Physicians. (Bariatrics is the study of obesity.)

"However, Fumento's view seems simplistic and denies a plethora of medical evidence. For people with minor weight problems his suggestions may be fine, but for millions of obese individuals this approach will be a great disservice. Very few obese individuals are able to reduce to their 'ideal' weight. Obese people need to be directed toward improving their health, not pushed toward a mythical ideal weight."

"To encourage stigma against fat people is size-ist," says Sally Smith, executive director of the National Association to Advance Fat Acceptance (NAAFA).

"We have to separate weight loss from health issues. What message does it send that no matter what changes I make in my lifestyle, if it doesn't result in weight loss, I'll drop dead? I just turned 39. I'm fine." - Cesar G. Soriano

Read Michael Fumento's additional work on obesity.

Michael Fumento is author of the The Fat of the Land: The Obesity Epidemic and How Overweight Americans Can Help Themselves (Viking, $ 23.95). Previous books: the controversial The Myth of Heterosexual AIDS (1990) and the award-winning Science Under Siege (1993). He is a University of Illinois College of Law graduate and has been an AIDS analyst, a U.S. Commission on Civil Rights lawyer and a medical journalist for 10 years.