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Arthur Agatston, M.D.

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What Do United Airlines, Obesity, and Preventive Medicine Have in Common?

Posted: 04/21/09 12:52 PM ET

The recent press about United Airlines joining the ranks of other major carriers in establishing a tough policy about seating obese passengers brings up the larger issue of what we can do to stop the epidemic of obesity in this country.

As a preventive cardiologist in Miami Beach and the author of The South Beach Diet Supercharged, I see the consequences of the obesity epidemic every day in my practice. Not only am I treating patients with high blood pressure, high cholesterol, metabolic syndrome, prediabetes, diabetes, and advanced heart disease, but also patients with related ailments like sleep apnea, joint issues, and depression.

Today an unbelievable two-thirds (66.5 percent) of Americans are either overweight or obese and that number appears to be growing, not shrinking.

3 Steps to Preventing Obesity

I firmly believe that the first step in stopping this epidemic lies with the insurance system, which currently pays more for doctors to perform procedures than to listen to and educate patients. Today primary-care doctors often find themselves having trouble meeting overhead and so they try to see more people in less time, leaving the patients feeling rushed and neglected. Doctors have little time to practice preventive medicine--to teach obese patients, for example, about the value of a proper diet and exercise program or to get to the root cause of a person's weight problem. This simply can't be done in a typical 10-minute doctor visit. Until incentives for prevention can be built into our health-care system, until doctors can afford the time they'd like to spend with patients, the problem of obesity and so many other chronic diseases will continue to persist in this country.

The second step in halting the obesity epidemic lies with getting rid of our fast-food, supersized-is-better mentality. Do I need to say more?

The third step lies with families themselves. The U.S. Centers for Disease Control and Prevention estimate that by 2020 a third of all children in this country will be overweight or obese. As we know, fat children often become fat adults. In fact, a child who is overweight during adolescence stands a 70 percent chance of being overweight as an adult and an 80 percent chance of being overweight if his or her mom or dad is. There is no question that our empty-calorie, sedentary lifestyle (kids not only need to eat right, but they also need to also exercise on school playgrounds and in the park, not on video games) may be trumping medical advances in the prevention and treatment of coronary disease, and that this generation of kids may have more heart disease and die earlier than their parents--unless sustained changes are made.

Overfed Yet Undernourished

I often say that our children are overfed yet undernourished. That's because most children are not getting the foods they need to thrive. Like their parents, these children are eating a steady diet of nutrient-deficient, highly processed foods that are high in sugar and saturated and trans fats and very low in fiber. And they're washing it all down with a glass or two of sugary soda. If we are to stop the epidemic of obesity in this country, parents must take a good look at what kids have on their plates.

Regardless of a person's age, an optimal diet is one that contains whole grains, fresh fruits and vegetables, lean protein, good fats, and plenty of fiber. I am not advocating that an already overworked parent needs to prepare a special meal for every member of the household, but no extra work is required to make a sandwich with whole-wheat bread instead of refined white bread, or to make spaghetti using whole-wheat pasta instead of refined white pasta, or to offer a piece of fresh fruit instead of chocolate cake for dessert. The point is--good nutrition begins at home. Our President is leading by example by establishing a vegetable garden on the White House grounds.

But while parents can begin to work on this problem now, changing our health-care system and weaning ourselves off of fast food are clearly going to take some time. In the meantime, we need to support, not discriminate against, the obese in this country and we need to urge our government to provide the incentives to stop this health crisis in its tracks.

 
 
 
The recent press about United Airlines joining the ranks of other major carriers in establishing a tough policy about seating obese passengers brings up the larger issue of what we can do to stop the ...
The recent press about United Airlines joining the ranks of other major carriers in establishing a tough policy about seating obese passengers brings up the larger issue of what we can do to stop the ...
 
 
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10:21 PM on 04/22/2009
One thought to add, obesity is a product of multiple causes. It cannot be reduced to one or two principles that will fit everyone. I believe that a contributing factor may be the abysmal quality of American produce. For those too young to know the difference, strawberries are not supposed to be the size of a golf ball, equally as hard, without scent, and flavorless. Tomatoes should be soft, richly colored, and full of flavor - not rock hard, flavorless tennis balls. Peaches should be soft, golden with a slight blush of red, firm of skin, but not of flesh, so juicy that it runs down your chin when you bite in to it, heavily scented, and very sweet. If none of that sounds like anything you have eaten lately, it is because vegetables and fruits in this country are harvested unripe and have been "engineered" to be next to imperishable. No waste equals more profit. I think that it also equals a need to make them palatable by adding sugar and fats to provide flavor. It is time we stopped buying this trash. Shop local farmer's markets and insist they bring ripe produce to market. Once you taste the difference, you will never turn back. Children LOVE good fruit, but who wants to eat tennis balls?
05:18 PM on 04/22/2009
No offense Dr. Agatson, but the people in your profession are part of the problem. They have too much faith in drugs and have been brainwashed (or just bribed) by big Pharma to actually tell people to eat right. How many times has the medical establishment told people that simply eating better won't heal their problems, but miracle drug from Pfizer will? Maybe if people stopped listening to these drug pushers, we'd all be better off.
04:48 PM on 04/22/2009
It's all about personal responsibility. And it's not rocket science. Eat less. Eat better. Move more.
Talking about airline seats and big passengers (which the article touched on) brings me to my own particular bete noir. Why weigh the bags and not weigh the passengers?? Where's the logic - or the fairness - in charging me for a couple of extra pounds of baggage, when together with my bag I weigh less than the fat guy next to me who is seeping into my seat?
04:33 PM on 04/22/2009
Why is it that if you have low self esteem, severe depression and make yourself throw up, you have a disease called bulimia; if you have low self esteem, severe depression and starve yourself you have a disease called anorexia; but if you have low self esteem, severe depression, and are obese, you're just a fat lazy pig with no self control? If Karen Carpenter died of heart disease brought about by obesity, would anyone have given a damn? Why is it that the "skinny diseases" have a mental disorder that is treated with deprogramming and intense therapy while obese people are being sent to surgeons or being made to read stupid diet books? Stop using these people for your personal financial gain sustaining a diet industry that is as evil as tobacco. Stop embarrassing these people in public and making them continue to spin out of control into deeper depression and self-loathing, and start treating them like people with severe problems that require just as intense recovery as those with the "skinny diseases." Shame on everyone for turning a blind eye to the real problem!
05:26 PM on 04/22/2009
I totally agree with you, Sarah. I have struggled with my weight all of my life. I have been quite obese, and quite thin. Without a doubt, people treated me differently fat versus thin. Every job I was every offered, was offered to a thin me. Heavy me got turned down more often than not. Same resume. Go figure.
So, I had baratric surgery. That was over 16 years ago. 15 years ago, I became an alcoholic. Today, I am glad to say that after almost dying from bulimia, dehydration, and oh, by the way alcoholism, I am in recovery for alcoholism. But I am also in recovery from severe food addition. Yes, I look "thin". But ultimately, it's how I feel that's important. Thin me was very, very unhappy until I dealt with the issues of why I use a substance to calm me rather than face my demons.
Our society is very cruel to people who they can "see" have a problem. Those of us who hide their problems are far more accepted, but probably worse off.
I think that the diet industry only cares about making a buck. Having been a yo-yo dieter for over 30 years, I can attest to the fact that diets do not work. What works is making life style changes forever. What works is trying to find out why I eat significantly more food than my body needs.
10:31 AM on 04/22/2009
There are some good practices that improve weight loss by releasing stress and emotional dependence of food. Meditation has been found to improve cardiovascular health and reduce depression and anxiety. Becoming self sufficient in creating inner peace and happiness, a person no longer is effected as easily by the media and societal trends of eating fast foods. Prevention starts from within. Doctors are recommending Transcendental Meditation as a stress buster and adjunct to healthy lifestyle habits. I find it helps me to get rid of stress by meditating rather than dull the anxiety by eating.
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Janice Taylor
09:22 AM on 04/22/2009
Hi there! Excellent blog post. You and I seem to be on the same page. Saying it differently - but nevertheless in alignment. I hope you'll take a moment to read it!

http://www.huffingtonpost.com/janice-taylor/united-airlines-double-yo_b_188848.html
United Airlines: Double Your Fat, Double Their Pleasure.

Thank you.

Spread the word ... NOT the icing!
Janice Taylor
08:00 AM on 04/22/2009
This reply isn't about obesity, but all airlines. The seating should be regulated if that is what it takes. The seats and leg space should be large enough to comfortably seat the average adult, not the space it takes to accomadate a six year old.
08:20 AM on 04/22/2009
I'm 5'4" , 122 lbs. and even I feel cramped in economy seating on planes. I try to get an isle seat so I can stretch my legs. On a long flight, my knees ache if I can't. I look at over 6 footers and just wonder how they stand it. We NEED regulation on let room, as blood clots in the legs is an all too common event after air travel. We will be charged more for flying, but we need this.
I would like if my wt. and that of my luggage could be combined. After all, for safety, it's all about the total wt. of the plane and contents.
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Halsey
"There is a price to pay for speaking the truth. T
10:48 AM on 04/22/2009
mz...yes...everything in coach is for waifs....but let's be frank....in order for more room in coach...WE have to be willing to PAY more for each and every ticket...airlines are for profit...and were nearly destroyed when oil prices skyrocketed... we just can't have it both ways; i.e., more space AND cheap tickets....

the author of this post made good and obvious points..but did NOT address the current issue....a person who cannot, due to girth, occupy just one seat.... there was another similar post..that airline should offer fruit instead of pretzels...okay...good idea..BUT...that will cost more since shelf life of fruit...not quite that of a bag of pretzels...see my point..until then...as sad as it is...an obsese person should have to purchase two seats or upgrade (two seats in coach would be cheaper)...THEN..we can work on changing the eating habits of 60% of America...
What makes NO sense is TV ads for cigs are outlawed (fine)..but Carl's Jr can show a surgeon chowing down on a bourbon burger (probably 1500 fat calories)..in between surgeries...and damn..if he doesn't make it look delicious....just like cigs looked cool way back inthe 60's...
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quindy
quindy
07:04 AM on 04/22/2009
The first step in preventing obesity is home cooked food. In this country cooking went out of fashion long ago. How can young parents bring up healthy kids when they never ate home cooked meals themselves? How many times do we hear or read when somebody says 'my mother never cooked'. There are generations of people who never ate anything healthy at home. Healthy cooking should become part of every school curriculum. Also working three jobs to stay alive does not help the situation. It might be convenient to pop a frozen dish in the microwave now, but you'll pay with your health later.
05:04 AM on 04/22/2009
The first step to preventing obesity is to undermine the ego and its greediness for all things me-centred, whether that be food, money, alcohol/drugs, holidays, etc. And this is a big problem for the US in general, which is the most ego-centric country on the planet. No surprise then that it's also the fattest. The fundamental values of the nation are skewed and this is constantly reinforced by the insular news and media. Get out. Get outside your head. Get outside your country.

And diets don't work. None of them. Calories in vs calories out (expended). Simple.
01:21 AM on 04/22/2009
PLAVIX given to all patients at risk of stroke of MI. But if you have a variant ABCBA 1 gene you can't absorb PLAXIX and there's another gene that if you have a variant of you can't break the PLAVEX into the active form that makes platelets un-sticky. So now we know why one drug does wonders for some and kills others. Pharmacogenomics seeks to find the link between your genome and drugs. We want to set up registries of all human genome variants to make and study the linkages between disease prevention, cure and effetive treatment. But so long as your genome makes you a risk that HMOs whon't make big profits because of genetic risk, you can't allow your genome to be made public, even if that leads to PERSONALIZED MIRACLE CURES. So medicine and drug tests are done with you and rats each an equivalent "n" in safety statistics-- CRAP!. Well VIOXX was killing too many of us. Genetics could tell who these are so the rest can take it and live happy normal pain-free lives. But no, the profit motive caused MERK PHARMA to take it off the market, leaving milions disfunstional pain tormet for profit. Just as Mao began his revolutions killing all disease carrying flies, we should begin killing all profit for cannibal HMOs, PHARAM Companies and docs for sale. Listen docs: you can't get sick cannibalizing the sick, only obese, and that's not good. .
12:47 AM on 04/22/2009
In doctors offices across this land (Canada) are countless magazines extolling the virtues of a proper diet. If it's education that is necessary then perhaps it should concentrate on literacy.
Same goes for smoking. Surely by now everyone has been educated in the perils of smoking and yet still the habit continues.
Perhaps a better education goal would be on the subject of entitlement. We live in an age where Wall-Street three-piecers (You use this term ?) feel entitled to their millions (or billions). Where those that litter expect that someone else will pick up their garbage.Where those that abuse their health (and the health of others) expect society to fix the problem.
Perhaps we should have education that reinforces the idea of contribution to society rather than what we can get out of it.
05:05 AM on 04/22/2009
I totally agree.
12:43 AM on 04/22/2009
I fought HMOs and cancer-- two powerful allies of death, and retired. I volunteer in the practice of a young guy I wanred not to be a doc. Now the HMOs know they face experienced and well trained, hanging on for 2 hrs. to finally get a HMO physician who can competently debate why the HMO "no" must be "yes." I have yet to fail a debate. But I lost a lot of what's my old age just to make possible diagnostic tests. I also waste hours with patients talking about a new ways to longer life. But it is like being a poster on the wall of a de-tox clininc. The worst are the 30% obese of America. That's because high carbohydrate snacks calm them down as do cigarettes. I might as well urge the to get high on heroine. Molecular medicine has made advanses. It turns out that the macromolecules prove what Hippocrates said all along: INFLAMMATION IS THE ROOT OF ALL ILLNESS. Fat cells don't just store fat but infamme blood vessels, killing end-orans. You can't do medicine for profit. Make de-tox for obese non-profit as for the junkies. Treating sicknesses for profit motive is cannibalism. US doctors can say: "I cannibalized my patients; I chewed but didn't swallow like HMO insurers. " The profit motive makes us killers, not healers. If Obama only wants to make murder by HMOs affordable then he is a fool, not a reformer.
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11:58 PM on 04/21/2009
Exercise and dieting have a five year success rate of less than 5%.

Gastic bypass surgery kills.

No subject is full of so many lies and so little hope.

Read about adenovirus-36
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KJLSanDiego
12:32 AM on 04/22/2009
wow! a virus that attacks your body so that its glands do not function correctly, and your body stops being able to metabolize normally! this thing is really scary! I do know that a lot of weight issues are because of glandular malfunctions, are these caused by this virus? can someone be genetically predisposed to contract this virus? I am genuinely freaked out, and I want more info., especially on symptoms of this virus, and how to avoid it altogether!
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HealthHabits
10:57 PM on 04/21/2009
I was nodding along with this article right up until the end - Instead of waiting for our gov'ts to do something productive, we should be taking advantage of web 2.0/social media to get some real grassroots change happening.

There are things WE can do - http://healthhabits.wordpress.com/2009/03/04/a-better-way-to-health-and-weight-loss/
09:49 PM on 04/21/2009
If i took up more than one seat i should be made to pay for it!