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Health Talk 

Tom Farley, chair of the Community Health Sciences Department at the Tulane University School of Public Health and Tropical Medicine and chair of the Leadership Team of Step Together (see Health News) discusses what he terms the epidemic of overweight and obese Americans.

Q: What is the definition of obesity and morbid obesity?

A: For the purposes of tracking the epidemic in the population, the Centers for Disease Control and other health authorities have defined obesity as having a body mass index (BMI) over 30. That ... would be like a 5-foot-8-inch person weighing 197 pounds. The National Institutes of Health defines morbid obesity as a BMI above 40.

Q: Are we all as fat as people say?

A: In rough terms, one-third of Americans are obese and another third are overweight. When people think about obesity, they're thinking about the 400 pounders, but the bigger health problem is the overweight and mildly obese. It is a medical problem for people to just be overweight.

Q: Are those conditions equally prevalent in adults and children?

A: Now about 15 percent of children are overweight. We consider this to be an epidemic of overweight among children.

Q: What are the greatest physical dangers associated with obesity?

A: The disease that it's most strongly linked to is Type 2 diabetes; we are experiencing an epidemic of diabetes. It also increases risks for many other diseases, including heart disease, breast cancer, hypertension and stroke, colon cancer and prostate cancer.

Q: What about the psychological aspects of being overweight?

A: It has been shown that people who are overweight are more prone to depression.

Q: How do physicians find the right treatment for the obese?

A: In general, physicians are going to recommend diets ... taking in less calories and increasing physical activity. The fundamentals of what causes obesity are no mystery to anyone: it's taking in more calories [than you burn]. The problem is getting people to reverse that.

Q: What makes it so hard?

A: The problem is we are all in a world that makes high-calorie snack foods available to us everywhere and makes it difficult for us to be physically active, even if we want to be. It makes it too easy for us to be sedentary. There is food everywhere. ... None of us really has the will power to avoid all the food around us. Another side of the equation is the lack of activity. We used to walk everywhere; now we have labor-saving devices like cars and elevators. If we really want to solve the problem of this epidemic, we need to rearrange the way our world is organized. ... We need to make sure that every neighborhood has sidewalks, that there are bike lanes, and that we build buildings where the stairs are easy to find and attractive so people will take the stairs instead of elevators. Get the soda machines and the candy machines out of schools and workplaces.

Q: Do most people stick to diets over the long run?

A: Across all diets, typically, in six months people will be right back where they started. People will be more successful if they take up regular physical activity. If you lose weight just by going on a straight diet, you lose not only excess fat but also muscle. When your body loses muscle it's starving and it doesn't like that, and it sends out a message to eat more. If you're being physically active, you're actually building muscle mass and your body doesn't see it as such a problem. The key for people who want to lose weight is that the changes they make need to be consistent and permanent.

Q: If you have an obese patient do you generally find the rest of their family members also are overweight?

A: There is a genetic aspect to overweight and obesity; their family members are more likely to be overweight and obese as well. But the genetic aspect of this can't explain the epidemic that has occurred over the past 25 years. It's not due to genes, it's due to changes in the environment. People's sense of their safety in being outdoors has changed dramatically, and it's been shown that the amount of physical activity is directly related to how much time they spend outdoors.

Q: What's the culprit inside?

A: Television watching is central to this epidemic. No. 1, people eat when they watch TV, and No. 2, your metabolism slows down and you expend fewer calories than if you were just sitting in a chair doing nothing.

Q: Why is weight such a problem in Louisiana as compared to other places in the country and world?

A: Obesity rates are higher among the poor than the wealthy. It's not entirely clear why, but some of the reason may be simply because of the environment the poor live in. It could be that they are more surrounded with supermarkets with more junk food in them. In Louisiana, we have more poverty than in other states. As to why America has more, we are much more dependent on our cars to get around places. We are more likely to be snacking throughout the day than in, say, Europe and Asia, who have set meals. Also, food is more available, making it possible to snack all day.

Q What is to blame for the weight problem?

A: Many people think of this as a failing of individuals who can't control their appetites, but this is a population-wide problem. We should look to the solution in the world all of us face all the time. We should think: How should we reengineer our world where we take in fewer calories and expend more energy? People often think that being physically active means taking up a jogging program ... but it can be as easy as walking daily. It doesn't have to be radical changes; it can be small as long you're consistent.

Q: What about special diet foods?

A: Humans evolved as hunter-gatherers, and that is what we are healthiest eating ... plenty of fruits and vegetables, lean meats and whole grains.

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