There is one reason the weight loss centers in this country are thriving. The number of overweight and obese people steadily is climbing, and they hope running to a weight loss center magically will shave off pounds from their bodies. But that may not be the final answer. So it's time for us to think through the problem, understand the physiology of weight gain and come up with the right answers.
In the community free clinic where I volunteer, guess what the two main factors that account for the majority of the illnesses are? Obesity and cigarette smoking, of course. With this bad combination, the stage is set for the development of all the major diseases like high blood pressure (BP), diabetes mellitus-type 2 (DM), heart attacks, arthritis, frequent infections and cancer. One middle-aged woman who couldn't understand why her diabetes was not improving mentioned to me when I started lecturing about her weight, "Doc, I live on just $8 a day. How could I get fat on this allowance?" Sadly, the fast food she eats three times a day plus a couple of cans of Coke would be enough to make her put on the extra pounds and bring on all her medical problems.
Worldwide obesity rates almost have doubled since 1980, especially in the United States. Currently about two-thirds of Americans are obese or overweight. And we have the dubious distinction of being the fattest nation in the world! In my practice, it is not uncommon to see 300 and even 400 pounders coming in with multiple ailments. In fact, most of them are in the overweight category with a body mass index (BMI) of over 25. And when I ask, "What do you think is the reason for your weight gain," they give me answers like, "It's the stress, you know; ever since I lost my job, I've been putting on pounds;" or,"I don't have a clue, I eat very little." They would blame anything except their unhealthy lifestyles. One of the real reasons for the problem is that we all love our food - what can be euphemistically be called "food addiction." But people don't like to talk about it nor do they want to believe it themselves. Regrettably, obesity in children also is steadily climbing, and that doesn't bode well for the future fitness of the nation. Contrary to common belief, medical issues like hormonal imbalance, genetic factors or fluid retention account for a small minority of the cases.
The economic and health consequences of obesity are staggering. The American Medical Association has declared that obesity itself is a disease because of the litany of illnesses it leads to. The direct costs incurred in the diagnosis, treatment and prevention of all these diseases alone amount to more than $300 million a year! And indirect costs resulting from frequent absenteeism at work, motor vehicle accidents related to sleep disorders and loss of productivity also are high. Then there are other hidden costs. Apparently obesity and smoking each would account for about nine to 10 percent of all health care expenditures in the United States. Only when you consider this is a totally preventable economic loss do you begin to realize the true magnitude of the problem.
According to a 2012 report by the Robert Wood Johnson Foundation, "If obesity rates continue on their current trajectories, the number of new cases of DM, coronary heart disease and stroke, hypertension and arthritis could increase by 10-fold between 2010 and 2020 - and double again by 2030. All this comes with a current annual price tag of $190 billion."
The only way to control the problem is through education about healthy living. That would include healthy cooking, making the right choices, calorie restriction by diligently observing portion control and exercising regularly. It's a simple matter of caloric imbalance - too many calories in and too few calories out. This is why our first lady, Michelle Obama, launched the ambitious national program "Let's Move" - especially to combat rising childhood obesity. She encourages people of all ages to "eat more fruits and veggies, become physically active and make healthy changes like planting a community garden." There are many workout plans out there like easy-to-do-exercises, curb-your-appetite-yoga routines, etc., which can help you get your body back in shape. Drugs to reduce appetite may be useful, too, but they do have side effects. Bariatric surgery like "bypassing the stomach" is helpful but comes with a heavy price tag.
The main difficulty in my practice is to get patients to accept the idea that their mindless eating, especially of high-calorie foods, is the main culprit. My usual refrain to them is, "Calories don't come from thin air; they come from only your food." I often ask them: "Instead of eating hamburgers, hot dogs and junk food, why can't you pick on salads and low-calorie foods?"
"Oh, I will tell you, the answer is simple," said one. "What else can you get on the dollar menu at fast food places? Vegetables are quite costly, you know," she added.
That's probably the truth, and our government and grocery stores might have to come up with subsidies and incentives to encourage the general public to consume more fruits and vegetables. Also, our love affair with sugar, salt and meat products need to be curbed a bit. In my mind, the only way to cure the problem is to change our mindset and fully understand the nutritional value and caloric content of the foods that we consume, so we can make wise choices. Everybody should know the basics of healthy eating and acquire some weight loss wisdom. It's time that we started a well-coordinated national campaign to control this epidemic of obesity, so we can change our nation from the fattest to the fittest.
M. P. Ravindra Nathan is a cardiologist at Crescent Community Clinic in Spring Hill. He is the author of "Stories From My Heart."