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Photo of an obese man carrying a plate of French fries.

Although French fries are still wildly popular--the average American eats thirty pounds a year--research shows a trend away from the fat-laden staple. Individual portions, however, continue to get bigger. The original regular serving of McDonald's French fries is now a small serving. And the popular practice of supersizing that small portion, which contains 210 calories and 10 grams of fat, nearly triples its calorie count to 610 calories and its fat content to 29 grams.

Supersizing America

Obesity becomes an epidemic

by Martha Coventry

From M, winter 2004

Americans love to eat. We may not appreciate the taste or beauty of food, but we like to pack in the calories. Six out of every 10 Americans are overweight; nearly one in three is obese. Since 1991, U.S. obesity rates in adults have risen 60 percent. This growth involves both genders, all age groups, all classes, and all income and education levels. In the last decade, the percentage of obese children has doubled to almost 27 percent--and overweight teenagers have an 80 percent chance of becoming overweight adults. The food industry now spends $15 billion a year to form brand loyalty in children. If childhood obesity continues to rise, research suggests that this school-age generation may be the first in U.S. history with a shorter life expectancy than its parents. Even our pets are getting fatter, according to University of Minnesota veterinarian Julie Churchill. "By the time dogs and cats reach middle age now, nearly 50 percent are overweight or obese," she says. But our eating habits tend to make us miserable, as relentless advertising drives us to both eat our fill and be thin. Most Americans consume far more food than our bodies need; then we turn around and feed a ravenous diet industry to the tune of $39 billion a year. (Meanwhile, anorexia nervosa--self-starvation--continues to rise among women ages 18-24.) We rarely sit down together at mealtime anymore, 40 percent of us never get any exercise, and we hardly think twice about ordering a large cafe mocha with whipped cream, not as a special treat, but as a daily beverage. Collectively, we're out of control.

We have become so used to being fat, that we may have accepted it as our new national identity. A women's size 14 in the 1940s is a size 10 today. The average airline passenger now weighs almost 21 pounds more than in 1995... and the extra-wide coffin business is taking off. The question is, how did we end up in what the Centers for Disease Control and Prevention considers a full-blown epidemic, with illnesses like diabetes, heart disease, and certain weight-related cancers on the rise and no end in sight? And how do we, as a nation, find our way back to health? How we got so fat No one factor seems to be to blame for the fattening up of America. The culprit is a potent mix of less exercise, changes in our work life, more meals eaten outside the home, bigger portions, more fats and sugars in prepared foods, an abundance of cheap corn syrup, and the tendency to consider moderation downright unAmerican. The stage was set for the rise in obesity with a major shift in the typical American lifestyle. In 1960, 18.6 percent of women with children under six years old were working outside the home; by 1993, the percentage had risen to 59.6. More women entered the workforce partly because of a personal desire to work and have a career, but also to pay for things that middle-class people were finding increasingly hard to afford--like a mortgage and higher education for their children--according to University assistant history professor Tracey Deutsch.

University resources for eating and weight issues

The University of Minnesota offers a host of resources for individuals struggling with eating disorders, obesity, or other weight management issues. The following are samples of what's available:

> The STAR Center for Eating Disorders and Weight Management serves people ages 12-25 with eating disorders or weight management problems. The center provides medical, psychological, nutrition, and family therapy services. To learn more about the center's services, call 612-626-4260 or e-mail boutelle@umn.edu.

> The University's Department of Psychiatry offers treatment for eating disorders at no cost to eligible research participants. Usually more than 10 treatment studies or research programs take place at the same time. Currently, there are studies on anorexia and bulimia nervosa and binge eating in obese people. To learn which studies are recruiting participants, call Erin at 612-627-1991.

> The Minnesota Obesity Center is a collaborative effort between the University of Minnesota, Mayo Clinic, and the Veterans Administration Hospital to offer education programs for people dealing with obesity and seminars to inform the public about obesity research. For information, call 612-727-5698, e-mail mnoc@umn.edu, or see www.umn.edu/mnoc.

> The College of Human Ecology and University of Minnesota Extension Service offer Nutrition Education Programs for underserved, transitioning families. The programs are designed to teach people how to make food decisions that can affect their overall nutrition and physical abilities. For information, call the College of Human Ecology Health and Nutrition Programs at 612-625-8260. "More women working outside the home doesn't cause obesity, but it exacerbates the problem," says Deutsch. "They have less time to cook and plan meals, but they still need to feed their families. Processed and fast food is often the easiest and most affordable option." And because of the consolidation of grocery stores, in many poor neighborhoods it's easier to buy fast food than to get fresh food, Deutsch adds. "Another reason we're seeing this rise in obesity," says Deutsch, "is that this is the first generation of adults that has had access to processed food since childhood. The tastes they developed as children continue to inform their eating choices." Today, nearly half of all meals are eaten outside the home, most at fast-food restaurants. Not only is fast food loaded with more fats and sugar than a decade ago, the portions have grown considerably. When companies discovered that it costs little more to produce a large versus a medium serving, "supersizing" took off as a lucrative practice. According to a study by Lisa Young and Marion Nestle of New York University, the trend toward larger portion sizes began in the 1970s, increased sharply in the 1980s, and continues to rise. Muffins these days are typically 333 percent larger than the USDA recommends; a normal serving of pasta is 480 percent bigger. Young and Nestle also discovered that new editions of classic cookbooks specify fewer servings for the same amounts of ingredients, meaning portions are expected to be larger. But the problem is not just about calories and fat. John Kennedy urged us to get out of our "soft chairs" and get moving when he founded the President's Council on Youth and Physical Fitness in the 1960s. Unfortunately, exercise levels have dropped off dramatically since then, and school physical education programs are being cut. We walk less and sit more--in front of computers, TV screens, and in cars. We have become so used to being fat, that we may have accepted it as our new national identity. A women's size 14 in the 1940s is a size 10 today. The average airline passenger now weighs almost 21 pounds more than in 1995, and airlines have been told to increase their weight allowances. And the extra-wide coffin business is taking off. Fighting back In Italy, where obesity is rapidly increasing, Minister of Health Girolamo Sirchia announced that he would attempt to reinstate Friday as a day of fasting and reduce serving sizes in school, work, and hospital canteens. In America, we're battling this epidemic --that's costing us $100 billion a year in health care--through efforts as broad as a nationwide physical education program and as individual as one person turning down a second helping. Research at the University of Minnesota and around the country is looking into things like how the price of food affects consumer choice, the proliferation of trans fats, the treatment of overweight children, and the marketing of foods. In a recent study to see if price was an issue, University epidemiologist Simone French reduced the cost of fresh fruit and baby carrots by 50 percent in two secondary school cafeterias. The result was a fourfold increase in fresh fruit sales and a twofold increase in carrot sales. Recently, Henry Blackburn, a retired University of Minnesota epidemiologist, joined other notable colleagues in convincing the FDA to require listing trans fats--which double the damage of saturated fats--on food labels. Primary and secondary schools, beset by budget problems, are hesitant to change their lunch menus or get rid of soda machines that often fund sports and other activities. But some schools, like the Valley Middle School in Apple Valley, Minnesota, are making socially and financially bold moves to replace their sugary and fatty a la carte cafeteria offerings with granola bars, yogurt, or fruit juice and to limit soda sales to after school. Schools are also revisiting the role of physical education. On average, children now sit for four hours a day in front of the TV or computer, while fewer than one in four children engages in vigorous daily physical activity. The National Association for Sport and Physical Education recommends that elementary-age children spend at least 60 minutes every day in a variety of moderate to vigorous physical activities. The renewed federal Physical Education for Progress Act (PEP) makes grants to schools to provide physical education courses, purchase physical education equipment, and train and educate physical education teachers. More and more workplaces are noticing that their employees are sorely out of shape and that being overweight or obese can translate into productivity loss and higher medical costs. A healthy adult, according to the Centers for Disease Control and Prevention, should engage in moderate to intense physical activity for at least 30 minutes on five or more days a week. Americans don't like to exercise, but there are incentives. Often we begin if we have a health scare or finally get sick of carrying around extra pounds. Minnesota's Hennepin County, although budget-strapped, designed a new employee fitness program complete with a full-time fitness expert and cash reimbursements for certain exercise equipment. The University's new wellness initiative will promote health through diet and exercise. Companies like Kraft have pledged to decrease the size of their individual portions and cut fat content, partly in an effort to avoid lawsuits from people claiming to have grown obese from eating their products. Whether that will make a difference in our waistlines remains to be seen. "Eating is a complicated issue," says University sociology professor Joel Nelson. "Manufacturers and retailers are at the forefront [of the obesity problem], and they're going to have to play their part. But other things have to happen too, like education and exercise, to support real change in eating habits." Health journalist Kelly James-Enger says the thousands of words she's reported on weight loss really come down to only four--"eat less, exercise more." And the solution to the obesity epidemic really should be that simple. But human beings are wonderfully complex, with myriad motivations and reasons for what we will or won't do. The coming years will be critical if America doesn't want to become a thoroughly fat nation from sea to shining sea.

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