National effort under way to curb weighty issue
By Nicole Mullins/Tribune-Star
January 11, 2005
Each morning when the alarm buzzes, it's the same routine all over again. Instead of feeling refreshed and ready to face the day, the sleep apnea has left you tired and groggy. Reluctantly, you roll out of bed.
The trip to the bathroom leaves you gasping for air. Before reaching into the medicine cabinet, something in the mirror catches your eye. No longer is it the healthy, youthful person who once stared back. Instead, the mirror reflects someone twice the size.
Inside the medicine cabinet is the multitude of prescriptions for diabetes, cardiovascular disease, hypertension and osteoarthritis. Swallowing each of the huge pills, you remember a life that was medicine-free.
It's even a struggle in the shower. It is more difficult than ever to maneuver, and you can't bend down to shave your legs or reach for the shampoo and conditioner.
Finally, you step on the scale. The number is alarming, but it only affirms your fears -- you're obese.
Regardless of what the scale showed this morning, there is strength in numbers. More than 67 million other Americans go through the same demanding routine each day. In fact, the Wabash Valley is right in the midst of a national epidemic, with 26 percent of Hoosiers and 23.2 percent of Illinoisans weighing in as obese, according to the Centers for Disease Control and Prevention.
Because America is at its heaviest, the focus on obesity has launched a national effort to curb the disorder. Even the Wabash Valley has taken notice, with local doctors and organizations taking strides to halt its effects. The information needed to combat obesity is readily available, whether at your fingertips or in your community.
All it takes, according to the CDC, is a 10 percent decrease in body weight to move toward a healthier life. To get there, the CDC suggests decreasing daily caloric intake by 100 and increasing physical activity by 30 minutes. The American Obesity Association encourages the combination of a low-calorie diet and increased physical activity over a diet or physical activity alone.
Food for Thought
Dr. Isaiah Pittman, an endocrinologist at the Providence Medical Group in Terre Haute, says it is important to focus on dietary choices to ensure healthy weight loss.
"I try to educate people on what a lifestyle change means instead of a diet because a diet doesn't work. I'll be the first to tell you that," he said. Yo-yo dieting does more harm than good, and Americans need to be able to make healthful decisions for the rest of their lives, he said.
He partially blames Americans' weight gain on the ever-enlarging dinner plate. Our parents' small, healthy portions now have doubled and sometimes tripled, he said. A proper meal should fill a dinner plate but leave enough room for the bottom to be seen.
Rather than trendy diets like the Atkins, he recommends controlling portion sizes and calories because "people need carbohydrates."
"The reality is [the Atkins diet] doesn't really teach people about changing their eating habits," he said.
He gives each patient a plan based on specific needs, but favors the Weight Watchers program because it helps patients transform eating habits. Weight Watchers doesn't limit what foods can be eaten, but incorporates a point system to teach about the proper amount and which foods have the most nutritional value.
He also warns patients to stay away from processed foods.
"It was processed to be able to last on a shelf, not to be digested," he said.
The U.S. Department of Agriculture's guideline for healthy eating continues to be the Food Guide Pyramid, which suggests a daily consumption of:
-- fats, oils and sweets used sparingly;
-- 2-3 servings of milk, yogurt and cheese;
-- 2-3 servings of meat, poultry, fish, dry beans, eggs and nuts;
-- 3-5 servings of vegetables;
-- 2-4 servings of fruit;
-- 6-11 servings of bread, cereal, rice and pasta.
Many Americans don't know how to measure a serving, so the American Dietetic Association suggests using everyday items to relate to the appropriate serving size:
-- A teaspoon of margarine is the size of the tip of your thumb to the first joint.
-- Three ounces of meat is the size of a deck of cards.
-- One cup of pasta is the size of a tennis ball.
-- One-half of a medium bagel is the size of a hockey puck.
-- An ounce-and-a-half of cheese is the size of three dominoes.
-- Two tablespoons of peanut butter is the size of a pingpong ball.
-- One-half cup of vegetables is the size of a light bulb.
Pittman also recommends keeping a food journal to monitor daily intake.
"It's probably the most difficult and the most beneficial thing to get an obese person to keep a journal," he said. "Sometimes they don't know how much they're eating."
Get Moving
Deann Knollenberg has made exercise a daily part of her healthy lifestyle by making it her career. As personal trainer and wellness coordinator for the Health Works Rehabilitation and Wellness Center in Crawford Memorial Hospital in Robinson, Ill., she lends expertise to the nearly 300 members who use the exercise facility. The hospital promotes the facility to its employees, who get membership at a discounted rate.
"It increases overall productivity at work," Knollenberg said, because employees are less likely to become ill and call in sick. She said exercise can decrease stress, blood pressure and cholesterol levels.
The U.S. Department of Health and Human Services suggests that work sites should create more opportunities for physical activity as a way to help Americans combat overweightness and obesity. The prevalence of obesity increases health care costs and sick days in the workplace, according to the CDC.
The Health Works program began in 1996 with a couple treadmills and a universal weight unit. The program expanded in 1998 to include stairsteppers, elliptical machines, stationary bikes and army cycles, and just more than a year ago added personal training for an additional cost.
Although Knollenberg acknowledges the benefits of Health Works' equipment, she said exercise doesn't require expensive machinery. Jump ropes, trampolines, balls and even broomsticks -- use them as a weight bar to help with posture and alignment while doing squats -- are convenient and inexpensive items that can be used to get active.
And you don't need anything but a pair of shoes to walk away the pounds. America on the Move, a national initiative dedicated to helping Americans improve their lives, encourages walking as a way to get fit.
"It's just about taking an extra 2,000 steps a day, which is the equivalent of a mile, and decreasing their intake by 100 calories," said Jenn Enloe, public information officer for America on the Move. "Before you know it, you're stopping weight gain. That's what it's all about is stopping putting on that extra two to three pounds Americans put on every year."
Educating the Children
Alarmed by the rising number of obese children, Terre Haute YMCA Executive Director Becky Garvin decided to start a childhood obesity program.
"We're not just sitting around saying something about the obesity problem," she said. "We're doing something."
"Healthy Choices for Life," modeled after other national childhood obesity workshops, is a 12-week program that requires participants and their parents to attend a one-hour session each week to receive information about nutrition, fitness and overall health.
"We're trying to get the kids thinking and get the kids doing," she said. "Hopefully when they see success, they'll know they did that and start to feel better about themselves."
Enrollment in the program is $150, which includes access to all of the YMCA's facilities. Scholarships are available. The first session of Healthy Choices recently concluded, and Garvin said she was pleased with the progress of the 7 children who finished the program.
"The biggest improvement was their cardiovascular endurance," she said. "They could actually run up the stairs without sweating and panting."
Another Healthy Choices for Life will begin today. The program, which will include an additional day of exercise, has an opening for 6-8 more children.
At Healthy Choices, the children are not put on a diet, but taught how to make healthier food choices based on the Food Guide Pyramid. Instructors energize the youngsters with half an hour of activity, which also is encouraged throughout the week.
"We have to instill it in these kids now. If not, they're going to do it for the rest of their lives," Garvin said of unhealthy eating habits. "I don't care if they lose a pound. I want them to be healthier."
The Final Option
Terre Haute resident Terry May will never let herself forget. The picture she carries with her is a constant reminder of how far she's come since weight loss surgery helped her shed 165 pounds.
"I don't think I look that different until I look at pictures from before," she said.
If the picture isn't enough of a reminder, May can always take out an old pair of pants. She and her daughter can now fit inside the pants that were intended for one.
"I was wearing a fat suit and couldn't find the zipper to get out of it," she says.
May is one of thousands who have opted to lose weight with bariatric surgery. To be considered for bariatric surgery, a person must have a body mass index of more than 40, which is at least 100 pounds overweight, or have risk factors for obesity.
Dr. RoseMarie Jones of the St. Vincent Carmel Bariatric Center said patients also go through psychiatric screenings.
"It's got a very rigorous screening process, criteria patients have to meet before patients even see us," Jones said.
There are several different procedures involved in bariatric surgeries, but all decrease the amount of food a stomach can hold, limiting intake to about the size of a golf ball. Patients must be cautious about what and how much they eat, and they must exercise.
"I tell them if they're going to look at it as a magic bullet and that they're not going to have to work at it, it's not going to work," Jones said.
Insurance doesn't always cover the cost of the surgery, which ranges from $25,000-100,000. With the surgery's hefty price tag come several risks, including bowel obstruction, gastrointestinal tract hemorrhage and narrowing and leaking of the stomach pouch. Death is rare, although possible.
Group Effort
The burden to lose weight may not rest solely on the overweight person's shoulders. In fact, according to some health officials, an entire community has a responsibility to make its surroundings as health-friendly as possible.
Joni Albright, commissioner of special projects at the Indiana State Department of Health, said the best approach is to increase opportunities for healthier decisions within a community. She said it is more than the prevalence of fitness centers that require membership fees, but making neighborhoods a safe place to walk, bike or run.
"We can't just tell people you've got to go out and exercise," she said. "We've got to help the communities identify places to go recreate."
Terre Haute's addition of the National Road Heritage Trail is one way the community has shown an interest in more healthy living. Albright said continuous sidewalks throughout neighborhoods are also important for fostering exercise.
Once opportunities are available, communities can nurture a healthier lifestyle in several ways, Albright said, such as staging a community walk or a town challenge for citizens to pledge to walk a certain number of miles through the summer.
Eli Lilly endocrinologist Dr. William Wishner, who is on loan to the state Health Department for an obesity study, believes our entire society must take an interest in combating obesity.
"This is not one group or person's responsibility," he said.
He is measuring obesity's prevalence in children in a study called "Sharing the Responsibility: Shaping the Future of Indiana's Youth," and has concluded that schools are not the only places where children should be educated about making healthy choices.
"Society has to change, as well. The quality of food has to change; society has to provide a place for excellence," he said. "Kids live in their own environments, they live in the community environment and they live in the school environment."
If society does nothing, it will mean even more trouble for decades to come, he said.
"...You're really educating the next generation," he said. "We need to educate all children; otherwise, we will end up with a lost generation."
Nicole Mullins can be reached at (812) 231-4299 or nicole.mullins~tribstar.com.
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National effort under way to curb weighty issue
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