 Dr. Norma Nehren has been writing health
columns for the Tribune-Star the past few years. She weighs in
on the obesity epidemic to follow our series. Read
more
 Tribune-Star Editor Max Jones weighs
in on the epidemic. Read
more |
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COUNTY 'DOES NOT HAVE THE AGGRESSIVE,
COORDINATED NATIONAL STRATEGY NEEDED TO ADDRESS THE OBESITY CRISIS' |
Downsizing America
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One in five carries around at least
30 extra pounds |
Since
opening a private practice in Terre Haute in 1986, Dr. Ruben
Gonzales has treated hundreds of patients with a wide array of
diseases and illnesses. Using his expertise in internal medicine,
Gonzales prescribes medication for his patients' high blood pressure,
diabetes, heart disease, stroke and sleep apnea.
Just more than two years ago, Gonzales realized
many of the diseases he saw, day after day, could be treated
or cured if he attended to the "underlying cause,"
obesity.
"Most of the patients had medical problems in
addition to being obese," he recalled. "Most of them
came already overweight and obese. But there are also patients
who were not overweight and then with time became overweight.
"Because more and more of our patients were
getting heavier and because of the magnitude of the problem it
prompted me to have more interest in the treatment of obesity,"
he said.
Already a doctor of internal medicine, Gonzales studied
to become licensed with the American Board of Bariatric Medicine.
With newfound knowledge, he opened The Bariatric Center of Terre
Haute in March 2003.
If local obesity statistics follow the national pattern,
Gonzales has indefinite job security. The Centers for Disease
Control and Prevention estimated that in 2003, 22.8 percent of
American adults were obese. That means more than 67 million Americans,
or one in five, carries around at least 30 extra pounds.
Tipping the scales
While statistics are not yet available for individual
counties, increasing obesity rates among people in Indiana and
Illinois have landed the Wabash Valley in the middle of the nation's
obesity epidemic. According to the CDC, in 2003, Indiana had
the fourth-highest obesity rate in the country with 26 percent,
while Illinois ranked 23rd with 23.2 percent.
 Both
states' rates are up from 2001 when 20.5 percent of Illinois
residents and 24 percent of Hoosiers were considered obese, a
ranking that placed Indiana fifth in the nation. In 1991, only
12.7 percent of Illinois residents and 14.8 percent in Indiana
were considered obese. That's a 61 and 62 percent increase, respectively,
in a 10-year span.
The CDC uses a Behavioral Risk Factor Surveillance
System, "the world's largest telephone survey," which
tracks health risks in the United States, according to its Web
site.
Because the surveys are self-assessments that rely
on complete honesty, obesity is likely more prevalent than reported,
said Joni Foulkes, health educator and media coordinator for
the Vigo County Health Department. Furthermore, doctors are not
mandated by law to report patients who are obese, she said, which
makes it difficult to gauge each county's obesity level.
"It's really hard because we know that it's
out there. We see it with our own eyes," Foulkes said.
Poor showing
While Indiana and Illinois have a growing obese population,
a recent study shows the states aren't battling the bulge forcefully
enough. In "Report Card: State Efforts to Control Obesity,"
University of Baltimore researchers produced for the first time
an evaluation of states' efforts to fight against fat.
States were evaluated on:
-- Nutrition standards.
-- Vending machine usage.
-- Body mass indexes measured in schools.
-- Recess and physical education.
-- Obesity programs and education.
-- Obesity research.
-- Obesity treatment in health insurance.
-- Obesity commissions.
A state was awarded a point in each category if legislation
was introduced. However, an "A" was given only if the
state passed a law. The scores were averaged to determine a state's
overall efforts.
No state received an "A." Arkansas, with
the 15th-highest level of obesity at 21.7 percent, was the only
state to receive a B. Indiana and Illinois each received a "C."
With regard to states' efforts to curb 
childhood obesity, Indiana received a "C" and Illinois
a "D."
Trust for America's Health, a non-profit and non-partisan
organization aimed at preventing diseases, backed the report
card's findings with its own study. It found: "America does
not have the aggressive, coordinated national strategy needed
to address the obesity crisis - and that threatens to make the
epidemic worse."
The group's study determined that while obesity and
related diseases are increasing, most school food, physical activity
programs and policies need more attention. Also, state policies
and actions aimed at obesity are fragmented and inadequate.
Engaging the battle
Indiana has taken a step toward improving rates of
childhood obesity with its ongoing study, "Sharing the Responsibility:
Shaping the Future of Indiana." In the study, Dr. William
Wishner, an Eli Lilly endocrinologist "on loan" to
the Indiana State Department of Health, is examining the prevalence
of childhood obesity in Indiana. He said everyone involved, not
just the state, must take an interest in curbing the problem.
 "By
the time you're a teenager and are overweight, there's a five-
to 10-time greater chance that they will become an overweight
adult," he said. "You can't wait until the child is
overweight. You need to do something pre-emptively."
Wishner suggests five ways to attack the problem:
create awareness, create or promote opportunities for change,
promote effective legislation, monitor the trend of childhood
obesity and join with those affected by obesity. At the study's
completion, Wishner will design a state obesity Web site so communities
can find all the information in one place on the Internet.
Illinois received $375,000 in 2003 and $406,000 in
2004 from the CDC's Nutrition and Physical Activity Program to
Prevent Obesity and Other Chronic Diseases. As a "capacity-building"
state, Illinois' health department is "gathering data, building
partnerships and creating statewide health plans," according
to the CDC Web site.
Program Coordinator Jeff Sunderlin said the Obesity
Steering Committee has identified five focus areas: physical
activity and nutrition within communities, schools, the work
site, cultural leadership or diversity and health care.
Sunderlin said the state health department already
has determined that Illinois is not teaching the current generation
how to make good choices about food and exercise. He said the
state must promote "health literacy focusing on teaching
skills and knowledge" and then give children a chance to
use that knowledge.
The grant will run out in 2008, at which time Illinois
will seek state and corporate funding. Sunderlin said it will
be critical to continue fighting obesity in his state.
"It is not going to rest anytime soon. Even
if we put our best foot forward, it's going to take 10-15 years
to slow this train," he said of obesity rates. "It
didn't happen overnight, and it's not going to resolve overnight."
More than just 'hand to mouth'
The causes of obesity are complex. Doctors and researchers
have shown that a variety of factors, including diet, exercise,
genetics, environment and medical history contribute.
To determine the likelihood of being obese, Gonzales
suggests, look first at the family tree.
"If your parents are heavy, more than likely
the kids will be heavy," he said. "Your parents are
a mirror image of yourself. You have to start early controlling
your diet, exercising and [making] lifestyle modifications."
Certain ailments such as Cushing's disease, polycystic
ovary syndrome, Froehlich's syndrome, Prader-Willi syndrome and
Laurence-Moon-Biedl syndrome are known causes of obesity, according
to HealthGate.com.
Gonzales also said Americans' lifestyle plays a big
part. Diets often include high-calorie, fast-food meals coupled
with low levels of activity, he said. Federal guidelines suggest
caloric intake of about 2,000 per day.
"We have modern conveniences like elevators
[and] escalators instead of people walking up the  stairs,"
he said, adding that video games have taken the place of physical
activity.
Obesity has been linked to several diseases and conditions.
For both men and women, the incidence of diabetes, heart disease,
high blood pressure, cancers and osteoarthritis increases with
the level of obesity. Obese women also are more likely to be
infertile, according to the American Obesity Association.
Although the CDC recently admitted it overestimated
the number of deaths caused by obesity, the disease remains a
public health concern. Vigo County's Foulkes warns that unless
the entire community rallies around the problem, obesity will
continue to flourish and be detrimental to healthy living.
"It's just a tough issue and it's evolving,"
she said. "Obviously, we know it's something that needs
to be dealt with." |
Tribune-Star Story by Nicole
Mullins - Graphics by Shaun
Hussey |
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