Fixing a fat nation: why diets and gyms won't save the obesity epidemic.

• Author: Farley, Tom
• Position: Health

ON A TUESDAY EVENING, IN A brightly lit classroom at West Jefferson Medical Center in suburban New Orleans, 10 fat people are gathered for their weekly support meeting under the guidance of a physician, a psychologist, and a dietician. One by one, the participants share their successes and lapses. "I lost one pound since last week," says Robert. The group answers with polite applause. Next, Tiffany: "My weight was the same." Sympathetic nods. "But I bought a new skirt and I went down three skirt sizes." Enthusiastic clapping.

Behavioral-modification programs like this one designed to treat obesity can be found across the United States. But the participants in this case are children, some as young as five. The average participant enters the clinic at an astonishing 69 pounds overweight. These children are far from unusual. As of the early 1990s, the National Center for Health Statistics (NCHS) found that 11 percent of children between six and 17 were overweight, twice the comparable percentage a decade earlier. Today there are 5.4 million overweight American children, and another 7 million considered "at risk" of joining them.

The epidemic of childhood obesity is only the latest grim chapter of a burgeoning American tragedy. The NCHS found that the proportion of obese adults increased by two-thirds in the 30 years from the early 1960s to the early 1990s. Telephone surveys by the Centers for Disease Control (CDC) have shown obesity rates skyrocketing another two-thirds since then.

In 1991, when the epidemic was less intense, researchers from St. Luke's/Roosevelt Hospital in New York estimated that obesity killed 325,000 Americans a year--eight times the number who die of AIDS, and more than the combined deaths from alcohol, drugs, firearms, and motor vehicles. It approaches the 430,000 per year killed by smoking. But while smoking rates are going down, obesity rates are accelerating. Soon--if it hasn't happened already--obesity will become the number-one killer in America. The cost of caring for those sickened with entirely preventable obesity-related illnesses tops $70 billion per year, about half of which is paid by government.

Now, here's the scary part: Everything the medical community has prescribed to fight obesity has failed. Even the best programs, like the kids' clinic in New Orleans, do little more over the long term than keep off a few pounds. Since the 1950s, health experts have been warning Americans to lose weight and telling them how: by eating less and exercising more. Over that time, obesity rates tripled. It's about time we admitted that we are losing the battle against obesity.

This isn't news. Individually, we beat ourselves up for lack of willpower or for choosing a night at a burger joint with the kids over a trip to the gym, dramatizing personal failure even though in today's junk-food-laden society, it's nearly impossible to stay thin. The desk job, the television, the Internet, suburban housing developments and their roads to nowhere all conspire against us. Yet we still view obesity as an individual problem, and so does the government.

But the epidemic is spreading at such an alarming rate that it can no more be viewed as an individual failing than 19th-century cholera epidemics could be blamed on poor personal hygiene. Indeed, given the rate Americans are dying, we'd better start treating obesity like an infectious epidemic. Combating obesity and its many attendant illnesses will not require more cholesterol-lowering drugs or even diet books or workout videos, but rather a retooling of our environment to get us moving again and to put the doughnuts a little farther out of reach.

The dangers of mid-management spread

Obesity is not just an image problem. Those who are overweight are more likely than thin people to die from heart disease. They have higher blood pressure and greater risk of stroke and kidney failure caused by hypertension; colon, breast, and prostate cancer; gallstones and arthritis. To this list, the National Institutes of Health (NIH) adds "complications of pregnancy, menstrual irregularities, hirsutism, stress incontinence, and psychological disorders (depression)."

Overweight people are also much more likely to develop diabetes, an increase in blood sugar derived from the body's resistance to the hormone insulin, which itself increases the risk of heart disease, stroke, and kidney failure. By damaging circulation in blood vessels, diabetes can lead to infections of the extremities, usually the feet, necessitating amputations. It causes blindness. From 1958 to 1998, the percent of American adults diagnosed with diabetes increased sixfold. At least 20 million Americans now have diabetes, including millions who are unaware. Related medical care costs, currently $44 billion a year, are rising fast.

These days, it isn't hard to spot truly gargantuan people. Watching a 300- or 400-pounder lumber down a supermarket aisle or struggle into an airplane seat, it's easy--perhaps even comforting--to decide that our own 20- or 30-pound inner tubes are nothing to worry about. But because there are so many more of us than them, far more of those who die unnecessarily are in our group. The epidemic isn't just a problem of the grossly obese; it's a problem for all of us.

Americans know that fat is bad for us. We've been hearing it for a half a century, from American Heart Association warnings in the 1950s to pamphlets distributed by the President's Council on Physical Fitness under Lyndon Johnson in the 1960s, to grave CDC warnings about the deepening problem in the 1990s. For a time, in the 1970s, it appeared as though the nation might overcome its fat problem. After Frank Shorter took the gold medal in the marathon in the 1972 Munich Olympics, road races sprouted up everywhere, some with tens of thousands of runners...