The Fat Land

Obesity is a disease.

About 40 per cent of Canadian forces members consider themselves fat.

About 48 per cent of Canadian children seven to 12 years old eat junk food for an afternoon snack.

About 50 per cent of Canadians are overweight compared to 61 per cent of Americans who are overweight.

About 25 per cent of all Americans under 19 are overweight, a figure that has doubled in 30 years.

World Health Organization estimates that in the most industrialized countries; at least one-third of all disease burden is caused by tobacco, alcohol, blood pressure, cholesterol and obesity.

Compare this to developing countries of the world; underweight alone accounts for over three-million childhood deaths a year.

Some die because they have too much to eat; others die because they don’t have enough to eat.

“Fat Land: How Americans Became the Fattest People in the World,” is a book recently published by Houghton Mifflin and is written by Greg Critser. I saw the book’s review in the British Medical Journal (BMJ) and found the information interesting. Here are some interesting observations.

Critser blames the obesity epidemic on President Richard Nixon and his Secretary of Agriculture, Earl Butz, who in 1970s delivered everything that the modern American consumer had wanted – plenty of cheap, abundant, and tasty calories.

This was done by vastly increasing corn production and thus boosting the manufacture of high fructose corn syrup used in sweetening cola drinks.

New technologies converted cheap imports of palm oil, into a viable commercial fat, one fit for everything from frying chips to making margarine to baking cookies and bread and pies.

Food became cheap. We saw the introduction of “super-sizing” of portions (“value meals”) 12 ounce Cokes, the Big Mac, and jumbo fries.

Fast food companies penetrated school lunch programmes by providing foods high in fats and sugars.

By 1999, 95 per cent of 345 California high schools surveyed were offering branded fast foods as a la carte entrée items for lunch.

Social forces have also expanded our waistline.

We work long hours, spend lot of time commuting, we don’t sweat much at work, we snack a lot, children spend more time watching television, playing on the computer and the video games.

Physical education does not get a priority in schools, and the rates of childhood obesity and type 2 diabetes continues to increase.

What can we do about it?

Critser suggests reform of grade school lunch programmes, more physical education in schools and after school programmes, and involvement of parents of obese children in nutrition education.

What about obese middle aged and older men and women?

In a letter to the BMJ editor, a doctor suggests that obesity may be controlled in older people by more sexual activity which would replace gratification derived from eating and drinking, a sort of reversal of the libidinal shift from genital sexuality to the alimentary tract exhibited in advancing age.

Wow, not a bad idea! Have you tried it lately?

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Battle of the Buldge

Battle of the bulge continues for 50 percent of the Canadians!

Some months ago, I wrote about my own ever increasing girth and my struggle to lose few pounds. I received the following advice from one of the readers:

“It is my experience with ever increasing girth and the reduction of, to eliminate all things white, e.g. white flour, white rice, white fat (turns white when cold and solid), and white sugar (both refined and artificial). I quit sugar to eliminate my migraines (it worked) and lost 34 lbs. in a year. Hope it helps. Good luck, if you try it, that is.”

A good piece of advice.

Losing weight takes time. This point was driven home to me by a cartoon I saw in one of our humor magazines. A kid asks his friend, “How come your mom is so grumpy?” The friend replies, “She’s been on a diet for a month and all she’s lost is her patience.”

You probably remember the story of Melodie Garland published in The Medicine Hat News in May. The headline said: Determination and commitment leads to weight loss success. Garland lost 75 lbs in over a year with a strict diet and exercise. She also attended a local support group.

An article in the New England Journal of Medicine (NEJM) says, “Although 29 percent of the men in the U.S. and 44 percent of the women describe themselves as trying to lose weight, only about 20 percent report restricting caloric intake and increasing physical activity simultaneously, despite recommendation indicating that this combination is effective.” Well, Garland falls in that 20 percent group. She did the right thing.

What else?

In June, the Medicine Hat News wrote a story about the work done by my general surgical colleague, Dr. Carl Nohr. The article had a headline: Winning at the losing game. Nohr does gastric by-pass surgery. His patients lose more than 100 lbs rapidly and are extremely grateful to him for giving them their life back.

In the article, Nohr warns that surgery is not without risks. He says, “People who have a bypass have no protection against being overweight anymore than you and I. This is not a license for people to eat any amount or whatever they feel like. It is more a way of giving them a chance to be like an average person.”

What about pills? No magic pills to lose weight? None.

Obesity is a multi-factorial illness, says Nohr. It is a blend of genetic, metabolic and environmental factors. It is notoriously difficult to treat. There is no one magical solution to obesity. Which ever method or program you chose, you have to work hard for every pound you lose. And have to work harder to maintain the weight loss.

Losing weight isn’t easy but it can be done. Go on a diet (reduce income), exercise regularly (be a big spender), have determination and commitment, give it a good try and be patient. If it does not work then join a support group.

If that does not work then see a psychologist or psychiatrist for behavioral treatment. If that fails then see Nohr. If he accepts you then have bypass surgery and continue with diet, exercise, determination, commitment, patience, and try and try again………….. Winners never quit and quitters never win! The battle goes on!

Now, where is my mirror? And get me Dr. Nohr please!

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How To Loose Weight

How much should Canadians eat?

That’s the question I ask of myself when I look at my girth in the mirror. Or stare at my bathroom scale six feet away from my eyes.

The other day, I took my last dress pants to a seamstress to make room for my ever-increasing girth. She says, “Dr. B, do some exercise!”

I thought I did enough exercise each week. May be I am eating too much! I did not think so. I thought I did both – ate less and did regular exercise. So what am I doing wrong? Why am I not losing weight?

I am not the only one asking this question. Million of Canadians and others in the world are asking the same question. What are we doing wrong?

Dr. C. Laird Birmingham, Professor of Medicine, University of British Columbia and Dr. Peter J. Jones, Professor of Dietetics and Nutrition, McGill University, have published an article in the recent Canadian Medical Association Journal (CMAJ) titled: How much should Canadians eat?

The professors believe that the current methods for assessing energy intake are flawed. These methods underestimate actual energy intake. Does that mean we are eating more than we think? The article also reviews new methods for measuring the energy content of foods and address the problem of energy expenditure in obese people.

Obesity is defined as an excessive accumulation of body fat. The body mass index (BMI) of over 30 is considered to be obese. BMI is measured by dividing the weight in kilograms by the square of the height in meters. Currently, about 20 to 30 percent of North American adults have BMI of 30 or more. These people roughly have 50 to 100 percent higher mortality rate than those with BMI of below about 25.

How do people become obese? When the amount of energy absorbed exceeds expenditure – the net gain of energy ends up as body fat. The authors say that the current wave of obesity epidemic are due to shifting perceptions about what constitutes a “normal” portion size, the increased availability to pre-prepared foods and the more sedentary “couch potato” lifestyles of individuals within developed societies.

The Canada Food Guide provides guidelines for food intake in Canada. Nutritionists follow these guidelines to advice individuals who want to lose weight. “Unfortunately,” says the CMAJ article, “the existing values contained in these guidelines are out of date.” They provide estimates of energy requirement that are erroneously low.

There are also biases in the methods used to measure expenditure of energy. Until these methods (for energy intake and expenditure) have been revised and updated, the energy intake should be individualized based on observation of outcomes based on BMI, blood lipids, and waist measurement, says the CMAJ article.

The most reliable indicator of energy balance or imbalance is individual’s weight. If a person is not losing weight then he is eating more than what he needs and he is not exercising enough – income is more than expenditure!

Whatever methods we use for measuring energy intake and output, one problem will always be there – obese people always underestimate their energy intake.

So, how much should Canadians eat? Is there an ultimate diet plan? Yes, listen to your weighing scale and measure your waist, if it ain’t going down then you are eating too much! And the best exercise you and I can do is to push ourselves away from the table. That is called will power! Your girth and weighing scale will tell you how much you should eat.

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New Year’s Resolutions

Are you one of the millions of people who is planning to go on a weight reducing diet soon after New Year’s eve party? Are you excessively infatuated with being thin?

Are you a retired, non-smoking, healthy man who is wondering: Am I going to live long enough to enjoy my retirement?

Read on to see who is saying what in the medical journals!

Losing Weight – An Ill-Fated New Year’s Resolution:

It is a well known fact that come January, within few days to few months, most people will give up on their New Year’s resolution to lose weight. Why? Because losing weight and sustaining the loss is a difficult task. This leads to guilt and self-hatred.

An Editorial, published in the New England Journal of Medicine on January 1st, 1998 estimates that at any given time, 15 to 35 per cent of Americans are trying to lose weight. They spend about $30 to $50 billion yearly on diet clubs, special foods and over-the-counter remedies. These remedies are not always harmless.

Why do people want to lose weight? First, there is enormous social pressure to look thin. Second, being overweight has some health risks: heart disease, high blood pressure, diabetes, and a variety of other problems.

Why is it that some people cannot lose weight? The old view is that if intake of calories is more than expenditure then the weight goes up. The new view is that there is a “fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age.”

This set point can be changed with extreme measures like diet and exercise. But when this measures are discontinued then the body weight returns to its original level. Heredity also plays a significant role.

So, what is the best approach to weight control and staying healthy?


“Encouraging lifelong, regular exercise in children may well have the greatest effect in terms of preventing obesity, as well as numerous other benefits,” say the authors. This should be combined with healthy eating habits.

What about those who are already overweight? In authors’ views, overweight people should be advised to lose weight if only it would be required to improve their health or if they ask for help.

Want to live longer after retirement?

A study published in the New England Journal of Medicine says that, “Encouraging elderly people to walk may benefit their health.”

Among the 707 men included in this study, the average distance walked was about 2.9 km (1.8 miles) per day. These men had 12 years of follow-up.

Results? Those who walked less than 1.6 km. (1 mile) per day, the death rate was 43.1 per 100 men. For those who walked more than 3.2 km (2 miles) per day the death rate was more than halved (21.5 per 100). Age had negligible effect on the out come. Time for another New Year’s resolution?

Wait a minute! Consult your doctor before you go wild!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!