Fat land : how Americans became the fattest people in the world (24 page)

There is also what might be called the Americorps option. The federal program funnels newly minted college graduates into teaching and public service, providing a small but valuable support system for public schools. Yet almost all of its efforts have centered on aiding schools in the traditional academic areas graded on the SAT-9 examinations, the series of academic tests that have become the holy grail of most systems. What if it were expanded to target physical education and physical activity training? And what if the SAT-9 were broadened to include some form of fitness testing? This might seem a bit impractical, given

WHAT CAN BE DONE

the difficulties of so many districts in showing any progress with the most basic academic testing. A growing body of scientific and educational research, however, is documenting the connection between physical activity and mental acuity. And new studies are also documenting another link. The best academic scores among all high schools invariably match up with those displaying the best fitness scores.

We might also recast our traditional notions about food and exercise as separate pursuits toward the goal of good health. Instead, "we might start thinking of them as unified with one another," says Walter Willett, head of the Department of Nutrition at Harvard's School of Public Policy. Toward that end, Willett — the scholar who fought the USDA's ill-founded 1990 weight guidelines — has come up with an alternative food pyramid. Its principal distinction is that it defines weight control and exercise as the base of the pyramid. Without them — as uncomfortable as that might make parents, school administrators, and health professionals — all the healthy eating advice in the world will likely count for little, at least when it comes to obesity and the chronic disease it spawns. 'And when I say exercise," adds Willett, "I mean vigorous exercise — enough to make you sweat!"

Then there are the "meta" approaches. Of these, the most controversial is the "fat tax." Put forth in 2000 by Yale's Kelly Brownell and Michael Jacobson at the Center for Science in the Public Interest, the proposal calls for state governments to enact small taxes on foods that are nutritionally unsound. The money would then be put into funds dedicated to promoting healthy eating and sound food choices. Despite the fact that the soft drink industry alone spends upward of $600 million annually to promote its trash (compared with the National Cancer Institute's paltry $ 1 million budget for promoting fruit and vegetable consumption), such promotional campaigns can be highly effective. A TV and radio campaign in Clarksburg, West Virginia, for example, encouraged shoppers to switch from higher-fat to lower-fat milk; after seven weeks, the market share for 1 percent and fat-free

FAT LAND

milk jumped from 18 to 41 percent — a change that Brownell and Jacobson note was sustained for more than a year.

But the trend in most state capitals, increasingly beholden to special interests, has been in exactly the opposite direction. There, soda and snack food lobbyists have made the elimination of such taxes a priority. In 1993 the ever-up-for-sale Louisiana legislature halved its existing soft drink tax in return for Coca-Cola's pledge to build a new bottling plant, then repealed it entirely in return for Coke building a bigger plant. At about the same time in Maryland, legislators caved in to threats from the Frito-Lay corporation not to erect a new plant there and repealed the state's snack food tax. The same story has been played out in ten other localities. If anything, these reversals serve notice to parents that the snack food industry will stoop to anything to protect its interests in maintaining their child's expanding belly, despite the medical consequences.

One might reasonably wonder, however, if the food industry might not take it upon itself to do something. It could re-size its portions. This would not require any major re-engineering for most of them. Many large snack food makers already have small-size lines in production, most of which are designed for the European market, where six to eight ounces of a soft drink have long been deemed sufficient as a portion (amusing as it may be to supersize-inclined American tourists). In recent years there has even been active consideration of introducing Euro-sizing into the United States. "But it is always held up by the basic marketing and market share imperative," says John Peters, a longtime obesity scholar who knows the food industry from the inside out. "The major players all know what could be done. But no one — no one — is going to take the first step. No one wants to take the big hit that the first to break ranks will inevitably take. They all know that, by and large, consumers are still stuck with nineteenth-century notions of 'more for less is better' in their heads."

One group of Americans has always known better than that. They are the rich, the more insightful and longer-living of whom have

WHAT CAN BE DONE

understood that the price of abundance is restraint; in their parlance, you can never be too rich or too thin. Yet today almost everyone in America is too rich in the fundamentals: Almost everyone has access to maximal cheap calories, and almost everyone has the opportunity to expend minimal calories. Such is the gift — and the challenge — of global capitalism, the principal legacy of Earl Butz and his war on inflation. That challenge may be one of the most difficult that modern society has ever faced. After all, overconsumption is an intuitive, rational act — at least on its face. Who wants higher food prices? Who wants to sweat? No one. Only when Americans feel the countervailing cost of being fat in their daily lives will they begin to undertake the necessary counterintuitive steps out of the obesity epidemic.

When that happens, watch out. For we need only look to previous eras to see what Americans are capable of when it comes to getting fit. In the late nineteenth century, social reformers in the mold of Jane Addams and Jacob Riis launched the playground movement, which drove hundreds of American cities to build safe, public recreation areas. Just before, German American immigrants proved extremely successful in planting a social institution known as the turnverein, or gym club, in many American communities. Often clustered around a hall and field, the turn-vereins organized community members to meet on designated days of the week to exercise, dance, learn gymnastics, and practice a variety of other types of physical activity. At its peak, the movement reached far beyond its German immigrant origins to embrace a wide spectrum of the community. Before its demise in the 1920s and 1930s, due to assimilation, the turnverein had come to articulate a distinctly American view of fitness and citizenship. As one of its founders, Dr. Charles Beck, would write, there were great advantages to be derived by a republic from gymnastic exercises, "uniting in one occupation all the different classes of people and thus forming a new tie for those who, for the most part, are widely separated by their different education and pursuits of life."

There are already small — very small — signs that the na-

FAT LAND

tion's informal, experimental impulse is creating a new version of the public turnverein. By that I refer to the changing mode of the American Youth Soccer Organization. Until the last decade, the AYSO was largely a white, suburban phenomenon. But beginning in the early 1990s, the organization turned its efforts to cities, home to the country's burgeoning immigrant populations. The result has been an explosion of new members, and, as a result, a deeper penetration of the sport into the community. I need only spend a Friday evening on the practice field of my local middle school to witness this new phenomenon. All around the field, while boys and girls are running drills under the supervision of coaches, their waiting families are also at play. Papa teaches tiny Miguel how to skip rope. Mama jogs on the adjacent track. Brother Jose shoots hoops with a school friend over on the basketball court. The scene is re-created daily at hundreds of locations around the country. Instructively, all of this ancillary physical culture comes spontaneously. It is not the work of policy makers or recreation specialists but rather an expression of what happens when Americans take the time to move. My hope is that a variety of such responses might eventually become anchors for small but strategic new municipal investments in public fitness.

Until then, it pays to remember, perhaps while ordering that next supersized meal, that Dante put the gluttonous in the third circle of hell, where they were to endure "eternal, cold and cursed heavy rain." The slothful, one might consider as one cues up one's satellite dish, fared even worse; in the fifth circle they would "languish in the black slime" of the river Styx.

In the twenty-first century, we have put ourselves in the first circle of fat hell.

How we get out of that hell depends not upon prayer, but rather upon a new sense of collective will — and individual willpower.

Appendix: Fat Land Facts

Notes

With more food choices than ever ...

DIETARY DIVERSITY

The number of food products introduced into the U.S. food market classified as condiments, candy, snacks, and bakery foods parallels the increasing prevalence of obesity — expressed here as body mass index (BMI) — and has increased strikingly out of proportion to new vegetable and fruit products. BMI is a health-based measure of weight for height.

2500

t! 2000

D T3

o

"§ 1500

CD

C

-Q

E

1000

500

Condiments

Candy, gum, and snacks

BMI

Bakery foods

Entrees

Fruit and egetables

60

55

50

- 45

1973 1978 1983 1988 1993

40

Adapted with permission from the American Journal of Clinical Nutrition. © American Journal of Clinical Nutrition. American Society for Clinical Nutrition.

Americans are eating out more often ...

PROPORTION OF TOTAL CALORIES OBTAINED AWAY FROM HOME ON THE RISE, 1977-1995

40

30

20

10

Courtesy of United States Department of Agriculture.

eating higher-calorie meals in the process

HOME FOODS HAVE LOWER SATURATED-FAT DENSITY THAN AWAY-FROM-HOME FOODS, 1987-1995

15

14

13

g 1 12

■M

c

K 11

10

1987

1989

1991

1993

1995

Courtesy of United States Department of Agriculture.

and getting fatter by the year.

PREVALENCE OF OBESITY AMONG U.S. ADULTS, BY REGION AND STATE (Adults whose BMI [body mass index] is over 30)

PERCENT OBESE

REGION/STATE

1991

1995

1998

1999

2000

South Atlantic (cont.)

South Carolina 13.8 16.1 20.2 20.2 21.5

Georgia 9.2 12.6 18.7 20.7 20.9

Florida 10.1 16.5 17.4 17.9 18.1

East South Central 13.1 17.8 20.0 21.2 23.05

Kentucky 12.7 16.6 19.9 21.1 22.3

Tennessee 12.1 18.0 18.5 20.1 22.7

Alabama 13.2 18.3 20.7 21.8 23.5

Mississippi 15.7 18.6 22.0 22.8 24.3

West South Central 13.1 15.2 19.9 21.0 22.2

Arkansas 12.7 17.3 19.2 21.9 22.6

Louisiana 15.7 17.4 21.3 21.5 22.8

Oklahoma 11.9 13.0 18.7 20.2 19.0

Texas 12.7 15.0 19.9 21.1 22.7

Mountain 9.6 12.0 14.1 14.5 17.1

Montana 9.5 12.6 14.7 14.7 15.2

Idaho 11.7 13.8 16.0 19.5 18.4

Colorado 8.4 10.0 14.0 14.3 13.8

New Mexico 7.8 12.7 14.7 17.3 18.8

Arizona 11.0 12.8 12.7 11.6 18.8

Wyoming n/a 13.9 14.5 16.4 17.6

Utah 9.7 12.6 15.3 16.3 18.5

Pacific 10.2 14.2 17.0 18.1 19.1

Washington 9.9 13.5 17.6 17.7 18.5

Nevada n/a 13.3 13.4 15.3 17.2

Oregon 11.2 14.7 17.8 19.6 21.0

California 10.0 14.4 16.8 19.6 19.2

Alaska 13.1 19.2 20.7 19.2 20.5

Hawaii 10.4 10.4 15.3 15.3 15.1

U.S. Total 12.0 15.3 17.9 18.9 19.8

Courtesy of National Center for Chronic Disease Prevention and Health Promotion.

WHAT IS YOUR BODY MASS INDEX (BMI)?

4'6" 4'8"

4'10" 5'0" 5'2" 5'4" 5'6" 5'8"

5'10" 6'0" 6'2" 6'4" 6'6" 6'8"

Weight (pounds)

BMI = -— x 703

Height (inches) 2

Weight in pounds 120 130 140 150 160 170 180 190 200 210 220 230 240 250

□ Healthy Weight Note: This chart is for

□ Overweight §} Obese adults aged 20 years and older.

Courtesy of The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity.

NOTES

As obesity has become linked to a growing number of chronic diseases, the number of organizations tracking it has exploded. I will note the most pertinent ones in introductory summations to chapter notes, including respective Web sites if and only if those sites provide access to primary reports and studies. The two principal journals of the field, Obesity Research and the International Journal of Obesity, both provide access to abstracts of current month contents. These are published, respectively, by the North American Association for the Study of Obesity, at www.naaso.org, and by the International Association for the Study of Obesity, at www.iaso.org. Members of both organizations have been of tremendous assistance to this work, in particular James O. Hill, of the University of Colorado Health Sciences Center.