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Obesity: How We Got Here

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Surrounding many behavioral health issues there frequently seems to be a contingency that attempts to downplay and mitigate the severity of a serious health problem -- whether it was big tobacco downplaying the deadly effects of smoking for decades, or even casual drug users making the "everything in moderation" argument -- it seems like there will always be those who either don't recognize the severity of a health problem or, for some reason unbeknownst to me, attempt to discredit the hard data indicting a harmful behavioral pattern. And unfortunately, the most at-risk group participating in a harmful behavior will usually be the first to adopt the argument of those attempting to discredit its ill effects, because let's face it, it doesn't feel good to acknowledge you might be killing yourself!

Such is the climate surrounding the obesity problem our country faces. While the first lady and many others have taken massive steps to help bring awareness and remediation to the obesity issue, there are many who feel there simply is no problem -- that we're crying wolf or exaggerating the severity of the issue for the benefit of the health, pharmaceutical, and weight loss industries.

The truth is that there IS a problem. And the truth is that despite the "benefit" to industries that deal with obesity, if we lose the battle against obesity, everyone loses. We will become a society for whom chronic manageable illnesses become the norm, with poor quality of life... and a lifespan that will likely shorten (though medicine seems to miraculously outpace us with life-sustaining innovations -- note the word "sustain").

I'd like to preface the data I'm about to present with a piece of helpful information: I wasn't always the in-shape trainer, gym-owner, and public health advocate I am today. I was once not only overweight, but in fact obese.

I mention this because I am not a genetically-gifted-washboard-abs-elitist; I'm an empathetic and supporting voice of reason, who has gone through the hardship of obesity and an unhealthy lifestyle, and is now bringing about healthy change supported by scientific fact. And there are over 1,500,000 reasons that make me believe so in Newark, N.J.

As for the "The Big Fat Facts," I find that amongst those who do not believe obesity is a serious health problem there are a few common misunderstandings and errors in logic:

1. "Overweight" and "obese" are not the same.

Just as going 10 mph over the speed limit may theoretically increase your chance of an accident, chances are it's not going to kill you. But we can agree that going 40-50 mph over the speed limit starts to pose some very real risks, and upwards of there, one is really playing with his life.

So, too, is your body composition in regard to body fat. Being 10-20 pounds overweight will not kill you. And no, we don't all need washboard abs to live a long, healthy life. Might it statistically increase your chances for disease and other health complications? Yes, but as some have pointed out, it may actually increase longevity. Overweight is defined as having a BMI over 25 (body mass index -- a crude measurement of body composition based on height and weight). It's not all that difficult to fool the system at this level however; at 5'11, 10 percent body fat, and 195 pounds, I am in fact "overweight."

Obesity, on the other hand, is an entirely different story. Obesity is defined as a BMI over 30. For perspective, at 6 feet tall and over 225 pounds, one is obese, and at 5 feet tall and over 155 pounds, one is also considered obese. We're no longer talking about being a benign 10-20 pounds overweight. We're now talking about a level of fat that greatly raises your risk for a host of medical conditions including: diabetes, cardiovascular disease, cancer, and arthritis.

Understanding this difference is key. Obesity is a medically dangerous condition. The health efforts surrounding obesity are not "a war against body types," as some believe; the efforts surrounding obesity -- note the use of the term "obesity" -- are to improve the medical condition of people who are at extreme risk.

Returning to the speed limit analogy, would it be absurd to deploy a special task force to combat speeders who are breaking the limit by 10 mph? Of course. But if we faced a rampant, widespread wave of speeders going 40 or 50 mph or more over the speed limit, wouldn't we want to actively address and correct the problem?

2. Obesity isn't an isolated condition; it's a lifestyle.

Obesity, or significant excess body fat, doesn't occur in isolation. Obesity is almost always found in the presence of very limited physical activity and/or exercise and a consumption of a surplus of calories, usually of unhealthy foods. In fact, having worked with many obese clients, I can't recall a single client who didn't have these two other components accompanying his/her obesity.

I'm not going to get in a "chicken-or-the-egg" discussion about obesity and its accompanying lifestyle factors, but it's important to understand that the two go together.

Why I am making such a big fuss over this? Well, those seeking to discredit obesity as a public health threat try to focus on fat itself not being the problem, but rather lifestyle factors, that you can in fact be "healthy at every size" if you care for yourself. But this logic is circuitous at best: The day that I see the obese exercising with the same frequency as those who are normal weight or overweight, maybe I'll buy that line of thinking.

3. Obesity kills and makes us sick.

This may surprise you, but I agree with those who argue that we're made to fear body fat, and that fat isn't the monster it's often made out to be. Fat is essential to our metabolic function. Fat is in fact considered the largest "organ" in our bodies. Without fat our brains, liver, muscles, and endocrine and immune systems wouldn't function correctly. So fat is not the bogeyman, but obesity is.

And despite claims that obesity doesn't shorten life spans, the very study that has been used to support these claims -- in no uncertain terms -- says exactly the opposite! "Obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category." And if death isn't enough to scare you, obesity has a very strong correlation with Type 2 diabetes. Notice I said correlation, not causation, but correlative data shouldn't be taken lightly. Let's look at a simple statistic I'm intimately familiar with due to my work with the Let's Move! campaign: New Jersey's obesity rate and Type 2 diabetes rates doubled concurrently. Set aside all of the scientific data we have that stops just shy of causation to explain the mechanism by which obesity causes diabetes, isn't a strong correlation like this strong enough to make you want to avoid obesity? There's a ton of smoke here; I don't need to see the fire.

There are other mechanisms by which obesity makes us sick, including chronic low-level inflammation, stress on our cardiovascular systems, and stress on our joints. Even if I could be "healthy at every size" and maintain health 50 pounds heavier, would I want my poor joints to feel it? And would I want to even exercise at that point? No way!

Despite the above, a few inaccurate arguments have been made to support attempts at discrediting obesity as a serious health issue: that stable fat and even "tummy fat" are blown out of proportion as a health risk, that obesity leading to early death is wrong, and that life spans have lengthened almost lockstep with our expanding waistlines.

Wrong on all three counts: "Stable" obesity shortens lifespans, particularly because of "tummy fat" (a.k.a. "visceral fat," surrounding your organs, mind you!). And considering how skeptical the obesity naysayers are of all the correlative scientific data regarding obesity's harmful effects, I can't understand how they could really believe that our longer lifespans have anything to do with us getting fatter as a population. Could it be that better healthcare and advances in medicine might play a role? And even with these advances, the obese remain in a much greater risk category. Take for instance a well-known study from the New England Journal of Medicine, which found -- over a 16-year study of nearly one million people -- that "Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women." Do you want to roll the dice, or would you want your loved ones to?

Obesity is serious and shouldn't be pooh-poohed. There's a confusion I believe, not just amongst the public, but amongst even health experts as well, about the sometimes unclear line between aesthetics and health when it comes to body fat. We're not talking about the pursuit of six-pack abs; we're talking about preventing the heart disease that is six times more likely in the obese. And we're not talking about "losing the final 10"; we're talking about preventing the diabetes that is 10 times more likely in the obese. We all should care not about our body shape, but deeply, about the shape of our bodies.

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