Dr. Nils Hoernle is board certified in internal medicine
and is currently accepting new patients.
This is the third in a series of articles on small changes you can make in your everyday life that can lead to big improvements in your overall health.
The Perfect Storm of Obesity
How we got here, and how we can reverse it
Part I: The Problem
On average, Americans are 50 pounds heavier than they were 100 years ago. Most of this increase occurred after 1970, when America underwent a change that has resulted in a very rapid weight increase – the so-called Obesity Epidemic. Ever since, we have been trying to figure out what that change was, so that we might reverse it. Thirty-five years and numerous theories later, there is still no agreement on the exact cause. It seems apparent, however, that the big change was really a series of many small changes - changes in our culture and changes in our lifestyles. It will be necessary to understand these changes in order to succeed in losing weight permanently. This is particularly important because we now know that the old weight loss strategies don’t work. Starvation diets, exercise binges, and even diet pills fail to produce lasting results. In order to keep the weight off, we have to see the big picture, and we will need to tackle each contributing component.
The powerful forces that changed America from a normal weight society to a predominantly overweight and obese one in just 30 years amount to a perfect storm for obesity. Let’s consider how these changes in our culture inadvertently conspired to fatten us up. Human nature is such that we subconsciously seek the path of least resistance, or of greatest comfort, of best taste, and of ease of function. We prefer to sit in a recliner to sitting on a rock or to standing, and we prefer to use a car over walking or riding a bike. We prefer tasty treats to tough vegetables, and 70 degree air conditioning to being outside in the heat or cold. We generally prefer watching TV to reading books or playing games, and relaxation over physical work. Thus, one of the biggest ways in which our society has changed is that we now have affordable technology which has effectively engineered physical activity out of our lives.
Elbow grease has become obsolete. Inside our homes, work has been automated by washers, dryers, vacuums, microwaves, dishwashers, electric can openers, mixers, blenders and food processors. We now expend much less energy than if we had to do these things by hand. Outside, yard work has become motorized by leaf blowers, weed whackers, riding lawn mowers, snow blowers and hedge trimmers instead of rakes, brooms, clippers, push mowers and snow shovels. Power tools have replaced hand saws, drills and screw drivers, and even hammers are giving way to nail guns. Escalators and elevators have replaced stairs, and the proliferation of cars allows us to travel from door to door without ever getting off a comfy seat. We can even push a button to open the garage door. In fact, we have numerous remote controls so that we won’t have to leave our seats. If we are hungry, we can drive up to a window to get our food and eat it all without exercising more than our two arms – one to eat with and the other to steer the car!
This brings us to the second major thing that has changed – the food itself. Our great-great grandparents hunted and gathered and planted their food, expending large amounts of energy in the process. Even our grandparents got food from farms and ranches, generally vegetables and fruits and meat and dairy, and these were all single-ingredient whole foods without much alteration or processing. Cheese and bread were still made from a few simple ingredients. The fruits and vegetables and whole grains were unrefined, and all had lots of natural fiber. In my opinion, the single biggest change to our food, and the one that has had the greatest impact on weight gain, was the near total elimination of fiber from the plant foods, and hence the birth of the refined carbohydrates. This was a double blow. First, because natural fiber has zero calories, and is very filling, and because it slows the breakdown of carbohydrates into sugars and slows the absorption of these sugars into our bodies, keeping us full longer and supplying a slow steady stream of fuel at a pace at which we can readily burn it.
And second, because the refined carbohydrates themselves are directly harmful to our metabolism. Their rapid digestion and absorption leads to a gush of sugar entering our bloodstreams. This triggers a surge of insulin, which not only promotes rapid fat storage, but causes insulin resistance and diabetes. The insulin-induced low blood sugars then make us feel hungry again 2 hours after we’ve eaten, despite the fact that we’ve just accumulated a large amount of fat! And to make matters worse, refined carbohydrates have an addictive quality that leads us to eat past the point of feeling full, overloading even more on high calorie, low nutrition fuel. Unfortunately, the once abundant fiber had numerous other benefits, including lowering cholesterol, blood pressure and blood sugar, and protecting our digestive tracts from ulcers and keeping our bowels healthy and running smoothly. It may even prevent cancers of the digestive tract. You might say that we’ve thrown out the baby and kept the bathwater!
Instead of backyard gardens and local farms, our food is now largely supplied by the food industry, a business enterprise geared towards generating profits. The farms and ranches are now replaced by factories and feed lots, and the food is engineered for looks, taste, shelf life and profitability. The refined carbs are ideal for these, as they are often colored, flavored, preserved, heavily marketed and highly addictive (not just cheetos and twinkies, but also most cereals, breads, cookies, crackers, pastries, snack foods, soft drinks and pasta). The fats are often the long shelf-life but artery clogging trans fats and saturated fats, and the corn and potatoes and produce have been genetically engineered to grow better, look better and last longer at the expense of health and nutrition.
Even worse is the booming Fast Food Industry, with it’s own unique selection of high calorie, low nutrition foods. Gone are the days of reasonable portion sizes and having to return to the counter to order seconds. Now we automatically get super-sized meals with super-sized drinks and endless refills of super sweet high fructose corn syrup, itself notable for the fact that it’s loaded with calories yet never makes us feel full. Fast food is also devoid of filling fiber, and the refined carb buns and fries and desserts are combined with high calorie trans fat fryolater grease and high saturated fat burgers.
While the fast food industry provides high calorie meals, there is also a fast drink industry and a fast dessert industry. We can drive through Dunkin Donuts and Krispy Kreme and Starbucks to get giant drink concoctions and high calorie pastries any time of day. The number of calories in our beverages alone is staggering, and we now seem to be drinking them all day long.
There is, in fact, an overabundance of food these days, and it is getting harder to avoid eating extra meals. Donuts and cookies and bagels and cream cheese have crept into the workplace, and while they used to be small snacks, they have now swollen to massive sizes, sometimes with as many calories as an entire meal. Desserts are no longer just consumed after dinner, but also after lunch, in-between meals, and in place of breakfast. Soft drink machines and snack machines are now in schools, stores, workplaces, gas stations, and even in the YMCA and at the gym! If all of this weren’t enough, Taco Bell just introduced a “fourth meal,” the meal between dinner and breakfast, for those who want to squeeze in some extra calories during the night.
Fast food aside, Americans go to restaurants more than they used to, and the restaurant portions have also increased in size. It is rare these days to leave a restaurant without having over-eaten. A steak portion is no longer the size of the palm of your hand, it’s the size of your plate! And hiding under it are potatoes and bread dredged in butter or grease. An appetizer, a couple of drinks and a dessert later, we’re dragging ourselves back to our cars to sit some more, so that when we get home we can sit in a recliner in front of the TV, converting all those calories into fat.
In fact, TV is it’s own contributor to the obesity epidemic in America. Not only is it supremely sedentary, but it compounds the problem by marketing unhealthy foods and constantly reminding us to eat, eat, eat. And by preoccupying and distracting us from what we’re doing, it’s been shown that people generally overeat in front of the TV without knowing how much they’ve consumed, because they’re focused on the programs and not the eating. The more time we spend relaxing in front of the TV, the more we’re likely to overeat. Repeated overeating stretches the stomach, leaving it large and baggy. This means it takes more and more food to give us the sensation of fullness, and because we never get this important “stop eating” signal, we begin to overeat chronically.
Despite having more free time and more expendable income, Americans are now busier and more stressed than ever. Stress is a major contributor to weight gain, in that it interferes with sleep, makes us eat more, and eat more of the high calorie comfort foods. It also makes it hard to pay attention to or to care about our health, since we’re focused on more immediate matters of self-preservation. The steroid-like stress hormones turn up our body’s weight set-point, presumably to help rebuild our bodies down the road, since stress is a degenerative process. And by interfering with sleep, it leaves us with more waking hours in which to get hungry, and to eat. Studies have shown an inverse relationship between hours of sleep and weight. Sleep is rejuvenating and restorative, with stress hormones being at their lowest levels of the day.
There have been many subtle changes in America since the 1970’s, and it is now readily apparent that the combination of these factors has created a perfect storm for obesity. While some of these factors may apply to a given person, few are likely to apply to everyone. This means that there is no one formula that will work for everyone, and it will be necessary to go through all the factors and figure out which ones apply to your situation, and to work towards combating those. In Part II, I try to generate a list of strategies to use to help to reverse some of the fattening forces in modern America.
Check back for Part II.
Read the previous article, "You Are What You Eat."
Return to "An Ounce of Prevention" Main page