Fighting Fat Together

Philly’s Fun, Fit and Free Program – It began in 1999 when Men’s Fitness magazine named Philadelphia as the fattest city in America. In response, Mayor John Street designed a comprehensive, community-based intervention to get the city off the top of that undesirable list. With a program called Fun, Fit and Free, Mayor Street and his staff suggested restaurants serve healthier foods, encouraged more exercise, and offered free support groups. The program also included an educational Web site, public weigh-ins, and the Mayor even led daily walks around the city.

Mayor Street also launched a 10-week program, partially sponsored by Philadelphia’s local professional basketball team, entitled “76 Tons of Fun.” The goal of the program was to help city dwellers lose a total of 76 tons of weight. After a successful start, Philadelphia has now dropped to number four on the Men’s Fitness list of fattest cities.

Planet Health – Steven Gortmaker, M.D., from Harvard University School of Public Health has created and implemented a successful school-based program to reduce overweight and obesity. This innovative program targets middle-school students with a curriculum that focuses on improved nutrition, increased physical fitness, and decreased time spent watching television. Planet Health was successful in reducing obesity among girls from 23.6 percent to 20.3 percent. The rate of obesity in boys was unchanged by the program, possibly because boys are less concerned about diet and activity at this age than girls.

Weight Watchers – For decades Weight Watchers has offered balanced diet recommendations and group meetings for weight loss education and support. The Weight Watchers plan encourages people to eat all types of foods in moderation, and allows clients to choose what they eat without focusing on calories. It emphasizes slow, steady weight loss and teaches clients how to maintain an ideal weight.

Internet-Supported Dieting – Deborah F. Tate, Ph.D., from Brown Medical School, found dieters who received weekly advice from behavioral therapists on the Internet lost three times as much weight in six months compared to those who had access to information about dieting on the Internet, but no personal contact.

Activism– Kelly Brownell, Ph.D., Director of the Center for Eating and Weight Management at Yale University has been quoted as saying that he believes the government needs to get involved in the area of weight control, much like it has done with smoking cessation. Brownell would like to see the government subsidize the sale of healthy food, increase the cost of non-nutritional foods through taxes, and regulate food advertising to discourage unhealthy eating.

Along the same lines, the Center for Science in the Public Interest (CSPI) is urging the government to collect small taxes on soft drinks and snack foods to help pay for expanding nutrition-education campaigns.

Government Intervention – According to Marion Nestle, Ph.D., from New York University, the US Government intends to meet the Healthy People 2010 goals to improve the health of Americans. On their priority list are weight loss and increased productivity. Partnerships have been formed among many federal, state and local government agencies to help reach these goals.

Overweight and Obese Nation

Today Americans are moving less than ever before, yet the amount of energy we consume has not decreased accordingly. The result is a staggering trend toward overweight and obesity, shocking doctors, insurance companies and the government into action. However, a significant reduction in the number of overweight and obese Americans will only occur when individuals become willing to control their weight. Until then, chronic disease and treatment related to excess weight will cost the US billions of dollars each year. Prior to the 1980s, most epidemiologic studies in the United States defined obesity as weight that is 20 percent over a person’s ideal weight as indicated by the Metropolitan Life Insurance tables of weight for height. It was not until 1998 that the first Federal guidelines to identify, evaluate and treat overweight and obesity were released by the National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD). Three key measures were incorporated into the obesity equation – body mass index, (BMI) waist circumference, and a person’s risk factors for illnesses associated with obesity.

How Fat Are We?

Overweight is defined as a BMI of 25 to 29.9

Obesity as defined as a BMI of 30 or higher

61 percent of American adults are overweight

26 percent of American adults are obese

To calculate body mass index, the following equation is used: weight in kilograms divided by height in meters squared. Overweight is defined as having a BMI between 25 and 29.9, obesity is defined as having a BMI of 30 or higher; and morbid obesity means a BMI greater than 40. To estimate the prevalence of overweight and obesity across the nation, the Centers for Disease Control and Prevention (CDC) use data collected from the National Health Examination Surveys (NHES) and the National Health and Nutrition Examination Surveys (NHANES). According to the latest report released in 2000, 97 million adults in America are overweight. In the past decade, the prevalence of obesity among American adults has increased by nearly 61 percent. Experts were shocked to see that the nationwide rate of obesity rose 6 percent between 1998-1999.

In 2000, the prevalence of obesity among adults was about 19.8 percent (38.8 million people). When the statistics were broken down into subgroups, it was found that Black, non-Hispanic Americans, and Americans between the ages of 50 and 59 had the highest rates of obesity.

Childhood Obesity Statistics

Most people are born with a natural instinct for feeding the body what it needs. Babies eat when they are hungry and stop when they are full. If they eat too much at one feeding, the excess is spit up. Pediatricians attribute marked increases in hunger signal a growth spurt.

But sometime between infancy and childhood, we lose the ability to respond naturally to hunger and satiety cues, and eat because it’s the right time or because the food looks good. This loss is responsible for the alarming increase in childhood overweight and obesity.

The rate of obesity in children and adolescents has doubled since 1980. The latest findings from the CDC’s National Health and Nutrition Examination Survey (NHANES) show that 13 percent of children ages 6 to 11 are overweight, and 14 percent of 12 to 19 year olds are overweight, an overall increase of 2 percent since 1994.

Researchers recently studied a large number of pediatric patients in 49 primary care practices. They found 35 percent of children were either at risk for becoming overweight or were already. Their findings matched those of the CDC, and were published in the June 2000 issue of Archives of Pediatric and Adolescent Medicine.

A recent study shows 35 percent of children are either at risk for becoming overweight or are already.

Source: Ivanhoe

Cardiovascular Disease

Cardiovascular disease (CVD) is an umbrella term used to describe any abnormal condition characterized by dysfunction of the heart and blood vessels (including arteries and veins).

The most common cardiovascular diseases in the United States include

• Coronary heart disease (including myocardial infarction or heart attack, and angina pectoris, or chest pain)
• Stroke
• Heart failure

Most cardiovascular diseases are associated with atherosclerosis, a slow and progressive process in which arteries narrow and harden. During atherosclerosis, excess amounts of fat, cholesterol, calcium, and other substances build up beneath the cells that line artery walls and contribute to the formation of plaque. Over time, as plaque builds up, it narrows the opening of blood vessels, limiting the amount of oxygen-rich blood and nutrients that can flow to the heat or the brain. When blood flow to the heart is blocked, a heart attack occurs; when blood flow to the brain is blocked, a stroke occurs. Harmful blood clots can also break off and block a vessel.

Although they’re much less common, some forms of cardiovascular disease are caused by abnormal heart rhythm or heart valve function, or infection or toxins that make it harder for the heart to pump blood (as in cariomyopathy).

Cardiovascular disease (including high blood pressure) affects an estimated 81 million people in the United States. It is the leading cause of death and a major cause of disability among both men and women in the Unties States; it causes an estimated 700,000 deaths each year.

Although specific genes contribute to the development of some forms of cardiovascular disease (including congenital heart disease, an inherited condition present at birth), most often genetic tendencies (including family history), environment, and individual lifestyle factors interact and contribute to the development of cardiovascular diseases. Key risk factors for cardiovascular disease include

• High blood pressure
• Overweight and obesity
• High total or LDL cholesterol
• Low HDL cholesterol
• High triglycerides
• Diabetes
• Smoking
• Physical inactivity

How to Interpret Blood Values

A simple blood test taken after 9- to 12-hour fast can reveal your total, LDL, and HDL cholesterol and triglyceride levels.

Because cholesterol and triglycerides cannot dissolve in blood, they are carried in the blood and throughout the body by lipoproteins. The three main types of lipoproteins are as follows:

• Low-density lipoprotein (LDL)
• Very low-density lipoprotein (VLDL)
• High-density lipoprotein (HDL)

LDL cholesterol makes up most of the cholesterol found in the blood. It is known as “bad” cholesterol because high levels indicate an unhealthy buildup of cholesterol in the arteries; the more LDL in the blood, the greater the risk for heart disease. Too much saturated fat, trans fats, and (to a lesser extent) dietary cholesterol can contribute to high LDL levels.

HDL cholesterol, also known as “good cholesterol”, carries cholesterol from other parts of the body back to the liver; the liver is in charge of moving “bad” LDL cholesterol out of the body. Having low HDL cholesterol levels increases the risk of cardiovascular disease. Consuming too little dietary fat (less than 15 percent of total calories), having high triglycerides, being overweight or obese, and having hyperglycemia or diabetes all contribute to low HDL levels.

Almost all the lipids found in foods and in our bodies are in the form of triglycerides (made up of a molecule of glycerol attached to three fatty acids). Having a high triglyceride level increases the risk of cardiovascular diseases. Uncontrolled diabetes, kidney or thyroid problems, or a diet that’s low in protein and high in refined carbohydrates or alcohol can contribute to high triglyceride levels.

Some experts recommend using a ratio of total cholesterol to HDL cholesterol to estimate risk of cardiovascular disease. The goal is to keep your ratio below 5:1, but 3.5:1 is considered desirable. The National Cholesterol Education Program (NCEP) recommends that the following children be screened for high cholesterol starting at age 2 but no later than age 10:

• Those with a parent whose total cholesterol level is > 240 mg/dL
• Those with a family history of cardiovascular disease before age 55 in men and 65 in women
• Those who are overweight or obese or have diabetes, high blood pressure, or other risk factors

Children with “acceptable” cholesterol levels should be rechecked in 3-5 years; those with “borderline” levels should have their levels rechecked in 1 year.

Two other measurements that can be useful in determining a person’s cardiovascular risk include C-reactive protein (CRP) and homocysteine.

C-reactive protein is one of the proteins release by the body in response to an injury, an infection, or anything that causes inflammation. There’s evidence that high CRP levels predict future heart attacks or other cardiovascular events. A blood test called a high sensitivity C-reactie protein (hsCRP) assay is currently available. This test is used with people who have already suffered from a cardiovascular “event” (e.g., heart attack, stroke) to predict their risk for additional events or in those at high risk for them. If after consulting with a doctor you decide to have your hsCRP measured, what your values indicate:

• hsCRP < 1.0 mg/L – Low risk for cardiocascualr disease • hsCRP between 1.0 and 3.0 mg/L – Average risk for cardiovascular disease • hsCRP > 3.0 mg/L – High risk of cardiovascular disease

it’s important to note that those with autoimmune diseases, cancer, or other infectious diseases can have falsely elevated hsCRP levels.

Homocysteine is an amino acid that may provide you with a glimpse of your future risk for cardiovascular disease. Recent research has linked high homocysteine levels to a greater incidence of stroke and chronic heart failure, increased death from cardiovascular disease and other adverse diseases and conditions. Although population-wide testing of homocysteine levels is not currently recommended by the American Heart Association (AHA), many researchers and practitioners believe it can be quite useful for those at high risk for cardiovascular disease; discuss it with your physician.