Thanksgiving Gluttony

FITNESS AND FATNESS BOOM?

THE NEW AMERICAN PARADOX:
EXERCISE AND THE BALLOONING OF A NATION

The New Human Condition

For tens of thousands of years, starvation was the natural human condition. Chiseled by scarcity and hunger, the human body was very likely an unpleasing silhouette of gauntness, desiccation and distention. But in pre-historic times, people had no choices.

Today we have many choices, and superabundance in the Third Millennium has abolished the unsightly pre-historic figure — but only to evolve an equally displeasing profile of flesh, girth and rotundity. To be sure, the new American form does not portend the brief life expectancy of our ancestors; but the evidence is mounting that obesity will shorten our lives and undercut the quality of much longer life spans promised by souped-up medical science of the 21st century. And most remarkably, our new national figure has been cut within the last twenty years — well after the "me-decade" of the 1970's and the paradigm shift we call the fitness boom.

With overwhelming statistical evidence, the Surgeon General has proclaimed an obesity epidemic in the United States. A national survey conducted in 2002 by American Sports Data, Inc. revealed that 61% of all adults in the U.S. felt that they were overweight, 19% admitting that they were "considerably" overweight. In 2001, the Centers for Disease Control (CDC) — using a more rigorous self-report measure of "Body Mass Index" (a ratio of bodyweight to height) in the Behavioral Risk Factor Surveillance System (BRFSS) — determined that by virtue of a 30.0+ BMI, 21% of the population is obese. This is in stark contrast to 1991, when only 12% of the population was so categorized. In the even more objective National Health and Nutrition Examination Survey (where people's height and weight are actually measured), obesity levels soar upward of 30%. 5% of all people are extremely obese, as are 15% of all black women.

To the extent that children represent our future, the findings are even more dismal. According to the CDC, the percentage of overweight children 6-11 has nearly doubled since the early 1980's, while the percentage of overweight adolescents has almost tripled.

The Surgeon General has further declared obesity responsible for 300,000 deaths every year — a toll surpassed only by tobacco, to which 400,000 deaths are attributed. And if this budding epidemiological nightmare is not a sufficient wake-up call, we have an even more provocative statistic: the most commonly purchased woman's dress size in America is 14. In 1985, it was a size 8!

Goliath Casket is a specialty manufacturer of oversize coffins. Since the company's inception in the late 1980's, sales of its triple-wide models have increased exponentially.

The airline industry has been warned to factor in the increasing American bodyweight in the calculation of maximum loads. Some restaurants are adding inches to chairs… Enough said.

Obesity and the Anti-Smoking Campaign: Déjà Vu All Over Again

The obesity scourge of 2003 has an historic parallel — the war on tobacco, begun in earnest with the original 1964 Surgeon General's Report on smoking. This famous clarion call decreed smoking hazardous to one's health, and — in a judgment reserved for future medical historians — ranks as a supreme landmark in the history of public health. The analogy is irresistible; if smoking cessation has saved millions of lives, the conquest of obesity is a candidate for equal glory in the pantheon of public health. Surgeon General Satcher's 2001 report on obesity went practically unnoticed; but neither was the initial volley of the 1964 report on smoking heard round the world. It took several years to rouse public opinion and muster the anti-smoking campaigns that ultimately raised American consciousness.

The similarities between smoking and the overweight condition end here. Both remedies require discipline, but smoking cessation is a simple binary, on-off proposition. Weight loss is more complicated; we can't simply "stop eating."

The obesity epidemic is well-documented, but not fully documented. Its origins remain complex. We know that excess food intake minus inadequately compensating physical activity equals increasing average bodyweight; but beyond this simple physical calculus, no one has offered a cogent, comprehensive explanation for the Ballooning of America. Just as America's plummeting crime rate remains the greatest unsolved sociological mystery of the late 20th century, the rise of the obesity epidemic in America emerges as a great riddle of the early 21st.

Obesity and the Falling Crime Rate: The Search for "Superfactors"

From 1994–2002, violent crime victimization rates in the U.S. plunged by 55%, the massive decline cutting a nearly equal swath across urban, suburban and rural areas.

Is there a mayor or police chief in the country who has not taken credit for the drop in crime — so eerily uniform throughout the land? A new resolve to fight crime, beefed-up law enforcement budgets and other efforts certainly contributed to the mysteriously waning crime rate; but so did other factors, such as an improved economy, favorable demographic trends, a rising prison population (fewer criminals on the streets) and a disappearing crack epidemic. And now Steven Levitt, a pragmatic, untraditional young economist at the University of Chicago drops an analytical bombshell — Roe v. Wade. Legalized abortion, says this refreshingly bold thinker, was an unmistakable antecedent of a falling crime rate 15-20 years hence. His thesis is stunning, macabre and elegant: the millions of unborn babies in the wake of Roe v. Wade were precisely the unwanted children and high-risk demographics, that — had they come to term — would have committed the crimes! Levitt's theory has absorbed the full gamut of abuse and acclaim: simplistic, wrong-headed and repugnant; also ingenious, brilliant and seminal. The superfactor underlying the falling crime rate may be crack or abortion…or it may be neither.

Compared with crime, the phenomenon of obesity at first seems an easy subject to dissect and quantify, but ultimately proves to be a more complex subject for analysis. The superfactor that explains obesity may be overeating — but neither is that a certainty.

Root Causes of Overweight and Obesity: Peripheral Suspects

Were Levitt to train his socioeconomic lens on the obesity question, he would magnify a daunting problem — one more complex and much less conducive to the type of dominant-factor, blockbuster solution that according to his divination, now explains at least 50 percent of the drop in crime. He could easily identify the familiar lineup of suspects, but in 2003, forensic social analysis cannot yet produce hard evidence:

• Genetics…Fat people beget fat children…and unless the environment is to blame — there isn't a thing anyone can do about it. But changes in DNA structure caused by mutation take a lot longer than 20 years; so we need to look elsewhere for the root causes of a recent obesity epidemic.

• Population Trends…If certain overweight segments of the population (i.e. Hispanics, low-income groups, senior citizens) are growing faster than the general population, we have some easily identifiable correlates of obesity, but still no root causes.

• Harried Lifestyles…Working Moms, Single Dads and a generally time-starved populace have fueled the take-in, eat-out and particularly, the fast-food industries. With half of all food budgets spent outside the home, there is no question that the obsolescence of the traditional dinner table has taken a toll on health and bodyweight. But how much?

• High-Carbohydrate Diets…A shibboleth of the fitness boom of the 70's and 80's was a low-fat, high-carbohydrate diet — not an easy way to lose weight, we now realize. With the star of the late Dr. Atkins now very high in the firmament, eating habits are already changing. Not all agree, but the new trendiness toward high-protein diets may be one of the few bright spots on the horizon.

• A Less Demanding Workplace?...While technology has always been the natural enemy of physical activity, this favorite adage rings most true from the Industrial Revolution to about the 1950's and 1960's. Since that time, technology has continued to eradicate manual labor, shifting millions of jobs to a physically undemanding service sector. But paradoxically, the surviving legions of a once-trim blue-collar army (donut-munching policemen and beer-quaffing iron-workers) are less fit than their sedentary upscale counterparts! White-collar jobs may be proliferating, may require a lower caloric expenditure, but in the present social context, desk workers — though theoretically at risk — are not inordinate casualties.

• Smoking Cessation…Weight gain is an immutable law of smoking cessation: quit smoking, add avoirdupois. According to the CDC, in 2001 ex-smokers registered an obesity rate of 23.9% versus only 17.8% for current smokers. Since 1979, smoking has declined from 33% of the adult population to 22% in 2002, so we have apprehended another minor (but clearly guilty) offender.
  
  Poetically, the greatest triumph in the history of public health (the anti-smoking campaign), becomes a minor impediment to a second monumental challenge 40 years later! Indeed, this offender is by far the most noble of obesity villains.

• TV: The All-Purpose Whipping Boy…In that people who watch a great deal of television are physically "heavier" than those who spend fewer hours so engaged, TV viewing is said to be "related" to obesity. But these two factors are also intercorrelated with other surrogate variables such as income, fitness behavior and food consumption — any one of which pre-empts the "causal" relationship thought to exist between TV watching and being overweight. In other words, it is true that fat people spend more time in front of the tube than leaner ones; but it is equally true that less affluent households log more TV time, and that less affluent households have higher obesity rates than their upscale counterparts. It can therefore be argued that people are transfixed to the TV screen simply because they have less income and education — and not because
  
  Television is also accused of breeding physical inactivity and
  
  For children, TV time has actually declined during this period. From 1988 – 2001 teenage viewing dropped from 3:18 per day to 3:04, while younger children reflected a similar fall-off — from 3:22 to 3:12. Naturally, all of this slack (and probably more) has been absorbed by the internet, CD's, video games and email — activities which may be less amenable to snacking.
  
  In any case, for neither adults nor children is there even a remote causal connection between increases in TV viewing and rising obesity. We can't blame television any more than the automobile — they've both been around too long! they also happen to weigh more than less rabid TV viewers. Remarkably, this sloppy muddle of correlation and causality has never been challenged. encouraging that most insidious form of overeating — snacking. Yet overall trends in TV viewership are absolutely uncorrelated with recent gains in American girth. In 1988, according to Nielsen Media Research, adult males watched television an average of 3 hours and 59 minutes per day; for women, the mean was 4:41. By 2001, the numbers were 4:19 and 4:51: respective increases of 8% and 4% — certainly not enough to implicate TV in the adult obesity crisis.

• Social Class…The relationship between social rank and body type is not a recent discovery. As early as 1983, in a snippy, but erudite sociological treatise/pop culture funbook titled "Class", writer Paul Fussell observed that both humans and canines who inhabit the upper crust of society are far leaner than those in the lower strata.
  
  Less amusingly, recent indicators point to a widening of this paradoxical gap between have's and have nots…For Black and Hispanic inner-city populations, a growing reliance on junk food, the absence of nutritional counseling and a dearth of preventive medical care add up to a greater-than-average risk for both obesity and general health problems.

A Strong Contender: The Unraveling of American Discipline?

America started gaining weight in the early 1980's, and has been adding poundage ever since. Our first instinct — and it may turn out to be the correct one — is to blame our rising per capita food intake; as a nation, we're just eating more and more. But then there's another guilty-looking suspect — physical inactivity. We could simply correlate physical fitness participation with weight gain over the past 20 years, and quickly trap the culprit…if we had reliable and consistent survey data reaching back to 1980.

Quite remarkably, even after such major initiatives as the 1996 Report of the Surgeon General on Physical Activity and Health, Healthy People 2000, and Healthy People 2010, fitness research remains a very low governmental priority. The well-known "national health" studies conducted by the Federal Government touch upon fitness behavior, but these efforts are sporadic — with inconsistent methodologies that all but negate their tracking value. Indeed, this monumental public health concern is not deemed worthy of dedicated, on-going tracking research that would monitor the nation's progress (or lack thereof) in this vital area of preventive healthcare. For example, the best federal tracking estimate of physical activity (BRFSS) begins in 1990, does not include children, and asks respondents only about the two physical activities they engage in most often.

This informational void has been partially filled by American Sports Data, Inc. which noted that from 1987–1990, the fitness boom was still climbing — presumably along an upward trajectory launched ten years earlier. But from 1980–1990, according to the CDC, Americans gained weight — concurrent with rising levels of fitness behavior.

According to annual tracking surveys initiated in 1987 by American Sports Data, Inc., the fitness revolution reached its apogee in 1990. Since that time, the number of frequent fitness participants in the U.S. has fallen imperceptibly from 51 million in 1990, to 50.9 million in 2002. But factoring out population growth, there has been a per capita decline of 15% in frequent fitness participation (100+ days per year in any one activity). Among children 12-17, the plunge is 41% — hard evidence of a monumental neglect that mirrors the dilapidated state of physical education in U.S. public schools.

A more comprehensive approach factoring in all recreational sports as well as fitness activities reveals only a minor drop in aggregate per capita participation days — from 159 in 1990, to 153 in 2002 — a drop of 4%. But for children aged 6-17, the decline is much sharper — a plunge of 11% in just 4 years. For older Americans (55+), per capita participation has increased 12% from 1998 - 2002, raising the not so tongue-in-cheek suggestion that grandparents may soon be fitter than grandchildren.

Obviously, this methodology is based on only the total number of days of reported activity, and does not attempt to measure how long or hard people exercise — two factors essential to the quantification of total energy expenditure. Nor does ASD research account for the calories people burn outside of structured sports/fitness behavior. Still, even in a state of perfect quantification, the existing hypothesis would probably not be threatened: for the entire population, per capita sports/fitness activity (and therefore caloric expenditure) has declined somewhat since 1990 — but not nearly enough to account for the fattening of America. And it is doubtful that the casual, informal, unstructured physical activity required from work, daily chores or any other aspect of everyday living would compensate for the drop in sports/fitness behavior. If anything, the vanishing energy requirement of mundane, routine behavior is contributing to the sedentary lifestyle; but according to the scant, fragmentary evidence available from CDC studies, overall inactivity trends cannot begin to explain the magnitude of our obesity problem.

While these data do suggest a flagging of the national spirit, our collective fitness-consciousness is highly evolved and surprisingly strong. In three separate tracking studies since 1996, ASD has documented that while only 20% of the population are frequent exercisers, many more (around 80% of all adults) are persuaded of the virtues of fitness, and most think they should exercise more. To bolster a weakening resolve, millions of Americans — in the face of an overall lackluster fitness movement — are flocking to health clubs and personal trainers. Health club membership in the U.S. now stands at 36.3 million, dwarfing the 1987 count of 17.4 million by 109%. In 2002, 5.4 million Americans paid for the services of a personal trainer — up 30% since 1999.

Physical fitness activity, as it relates to bodyweight, is a complex issue. For the 1990's, we have a slight erosion of sports/fitness behavior, rising obesity levels, but at the same time — a major plea for help, evidenced by skyrocketing health club and personal trainer usage. Americans are very fitness-conscious, but are constantly struggling to overcome a perennial lack of discipline. Fitness behavior simply lags enlightened attitudes.

The coin of discipline has a flipside — food consumption. Tracking data are unavailable, but according to American Sports Data, Inc., in 2002 7 out of 10 adults (72%) attempted either to lose at least five pounds or maintain their present weight. Only 7% went on a formal diet, while 49% claimed to "watch what they ate" as a weight control strategy. While a fairly large percentage reported short-term success, only 30% of those who attempted to lose weight through dieting or physical activity were able to keep off the excess poundage.

The Prime Candidate: Overconsumption

In the war on obesity, American discipline is hopelessly overmatched by two formidable adversaries: superabundance and mega marketing.

Greg Critser, author of "Fat Land", has popularized the idea of a gigantic corn surplus as the lowest common denominator (if not dominant superfactor) behind the current obesity epidemic.

Now, as in Revolutionary times, a massive surfeit of corn is responsible for a great societal ill. Two hundred years ago — to the great moral detriment of a young impressionable nation — the same cornucopia was distilled into a huge overabundance of cheap corn whiskey.

Today, the nearly infinite largesse of corn is distilled into limitless quantities of high-fructose corn syrup, resulting in much larger bottles of Coke and Pepsi at still-affordable prices. Cheap corn — converted to both animal feed and direct food ingredients — is a cornerstone of profitability for various other industries: processed foods, chicken, beef and fast-food, to name a few.

Rather than grace the American people with lower prices, courtesy of this dirt-cheap commodity, Big Food has chosen to rebuff a rare public service opportunity in favor of the bottom line. Instead of cutting prices, food companies opt to increase profits by making more food available.

Agribusiness, according to Dr. Marion Nestle, Professor and Chair of the Department of Nutrition and Food Studies at New York University, now produces 3,800 calories of food a day for every American, 500 calories more than 30 years ago — but at much lower per-calorie costs. Fast food restaurants are multiple blights on every zip code in the U.S., while food conglomerates are force-feeding a none-too-reluctant population calorie-packed meals with larger portion sizes. The Public Health Service — aided and abetted by the food lobby — has, in the past, deliberately suppressed reports issuing "unfavorable" guidelines; unfavorable that is, in the recommendation of lower food consumption or selected food products. U.S. food and beverage giants have transformed school cafeterias into fattening pens, breeding a gargantuan health problem which now, is merely an epidemic; but when our children reach maturity, it may evolve another order of magnitude — to public health disaster!

But repentance may be at hand. McDonald's, Kraft, and Coca-Cola — in the early stages of social awareness — are planning to mend their ways. Presumably, other industry behemoths are also on the fast-track to redemption, which, of course, is far more important than whether or not a Steven Levitt ever officially indicts the arch-villain of this impending public health calamity.