WE’RE FAT — AND NOT JUST a little fat. We Americans are downright obese. In a land with a “be all you can be” philosophy, we seem to have taken it too literally.
More than 60 million American adults — almost a third — are obese, or more than 20 percent above their desirable weight, according to the Centers for Disease Control and Prevention (CDC). That’s up from a quarter of Americans only 20 years ago.
Perhaps even more frightening: the percentage of young people who are overweight has more than tripled since 1980. Among children and teens ages 6–19, 16 percent — more than 9 million — are considered overweight.
“I’m worried about our younger generation,” says Lisa Sasson, a registered dietitian and an assistant professor of clinical nutrition at New York University. “Good habits need to be in place when you’re young, but our kids think a 16-ounce soda is small and huge portions are normal. Plus, it’s socially acceptable to eat on the run. And whenever you have an urge, there’s something within reach.”
Yet the pudgier we get, the more obsessed we are with our weight and body image, as pop culture constantly reminds us of the vast gap between our desires and reality. Television spotlights starlets with pelvic bones so prominent they could slice denim, while supermarket tabloids keep us updated on which celebs have dropped below 100 pounds.
It’s not surprising that Americans spend about $30 billion yearly on “diet” foods and drinks. But that’s a drop in the bucket compared with the cost of treating obesity in the U.S. — health care expenses and lost productivity totaled $117 billion in 2000, according to the CDC.
What concerns health care institutions, however, is the cost in lives. The obese are three times as likely to develop diabetes or high blood pressure and more than twice as likely to suffer heart disease as a person of healthy weight. All those conditions shorten lifespan, notes Ellen Rome, MD, head of the Adolescent Medicine department at the Cleveland Clinic. Diabetes is the sixth leading cause of death in the United States and the major cause of kidney failure, blindness, and nontraumatic leg amputation. “These are scary statistics — especially for a preventable crime,” Rome says. “It’s far easier to prevent obesity than to treat it.”
Morgan Stanley Children’s Hospital of New York–Presbyterian took action two years ago, after observing the rise in weight of students at a nearby elementary school. A full 60 percent of the students were either at risk for obesity or already obese. “When we first brought up the obesity epidemic, we expected people to be
outraged with the trend,” says Mary McCord, MD, co-director of community pediatrics for New York–Presbyterian (NYP). “Instead, they reacted by hiding their eating habits.”
NYP began a two-front assault on the problem. Outreach organizers and three doctors are working with teachers and parents at seven area elementary schools to talk about eating habits and nutrition — consulting daily with staff, organizing obesity prevention programs, and running regular workshops for teachers and parents. The team also encourages participating schools to boost physical activity for each child to two hours a week. “Our goal is to change the culture,” says McCord.
The workshops give parents helpful food information, pointing out, for example, that some juice products have even higher sugar content than sodas and that the only difference between whole and skim milk is fat content. NYP organizes running and jump rope sessions during recess and helps teachers plan exercise breaks between classes. Students also learn tai chi, take field trips to farmers’ markets to learn about nutrition, and are encouraged to wear pedometers to count steps.
“It took us a year, but we’ve seen an attitude shift, and physical activity rises steadily,” McCord says. “Time will tell if we have an effect on the obesity epidemic.”
At the Cleveland Clinic, a creative approach started in the kitchen. The clinic’s executive chef, Jim Perko, came up with Food Is Knowledge, a program of 10 weekly sessions that uses food as a medium to teach kindergartners. For instance, kids are shown how fat can change from liquid to solid — and then they discuss how eating certain foods will harden arteries. The Cleveland Clinic and partner hospitals offer overweight youngsters and their parents one-on-one and group sessions to learn healthy eating habits and activities. “If you want to change childhood obesity, you’ve got to get parents involved,” Rome says.
The Cleveland Clinic’s new Bariatric and Metabolic Institute provides outpatient care as well as in-hospital treatment for severely obese patients with acute medical problems, such as congestive heart failure, severe apnea, or uncontrolled diabetes. “Our center will 
be an incubator for new ideas in treating obesity,” says Philip R. Schauer,MD, the institute’s director. “It will be among the first to use new drugs and surgical techniques specifically for the bariatric patient.”
A doctor-supervised high-protein diet is designed to help obese teens and adults lose 30–50 pounds within a few months. Doctors monitor dieters closely to ensure they remain healthy. “It’s the fastest way to lose weight safely without surgery,” Rome says.
Houston’s Methodist Hospital has a similar program, available to those with a body mass index of 30 or higher. In addition to following a medically supervised 800-calorie-a-day liquid diet, patients come to the clinic for two hours weekly to have their weight and blood pressure checked and learn about nutrition, exercise, and behavioral changes. Once a month, patients get a blood test to make sure their body is tolerating the diet well and also meet with the program’s director. It is up to the patient to decide whether he or she wants further treatment.
“Our goal is to help people lose weight, but also [give them] the tools and knowledge to maintain the weight loss,” says Kathie Nelson, manager of Methodist’s Medical Weight Management Program. “When they get close to their ideal body weight or can’t tolerate the fast anymore, then we transition them to food gradually over several weeks.” Finally, patients go through the maintenance phase, which, the center stresses, lasts the rest of their life.
“To keep weight off, it’s about making changes in the food you select and the way you lead your life,” Nelson says. To help patients in this phase, Methodist provides emotional support through monthly visits with the doctor and weekly group sessions that focus on behavior changes and healthy eating. They receive encouragement in their weekly sessions with the nurse and the dietitian and in one-on-one and group sessions with a counselor.
All these efforts come not a moment too soon, according to Schauer, who points out that a 20-year-old male with a BMI of 40 will live 12 to 14 years less than a peer with desirable weight. “If this epidemic continues, for the first time in many decades, today’s children might not outlive their parents,” he says. Today’s hospitals are trying to change that, by providing the means and the knowledge for all patients to live more healthily.
— Michele Meyer
