A Big Fat Crisis (26 page)

Everyone from the chefs to the busboys should have some basic knowledge and certification to be able to inform customers about the health consequences of the foods they order, and make recommendations that are appropriate.

My husband is not the only person who finds it difficult to choose what to eat for dinner in a restaurant. Often customers ask their wait-staff,
“What do you recommend?” and many maître d’s make suggestions for their specials. Their recommendations should not be for items that have too much salt, too many calories, or too much sugar. Just as it would be unethical for a doctor to recommend a treatment that carries a worse prognosis over a more favorable one, or for a lawyer to advise a client to make a plea bargain for the harshest sentence, the recommended meal of the day should always be balanced and healthy.

Reframing the way we think about the food industry and the way we promote careers in the food business, from a field that requires no skills and no training to a highly respected profession that has as much responsibility for the health of our nation as the health industry itself, is a critical paradigm shift that I believe is necessary to control obesity.

We won’t know the impact of any of these proposed new regulations until they are enacted. Offering healthy meals could backfire if people become more likely to overcompensate by eating poorly afterward, rewarding themselves with foods they should avoid. All innovations should be accompanied by rigorous evaluations to see whether unintended consequences negate any short-term benefits. We may have many false starts and bumps in the road ahead, but the more we keep at it, the more likely we are to succeed.

*
LEED stands for Leadership in Energy and Environmental Design, and was developed by the US Green Building Council to set a benchmark for design, construction, and operation of high-performance green buildings.

11

Fit and Fat: What About Physical Activity?

Although I spend the majority of my professional life studying physical activity, exercise is my Achilles’ heel. I know how important it is to my health, yet I find it personally challenging and rarely get the 150 minutes of moderate-to-vigorous activity that is recommended as a weekly minimum. Moderate-to-vigorous physical activity—the intensity of a brisk walk or higher—is necessary to avoid health problems like heart disease, diabetes, colon and breast cancer, osteoporosis, and hypertension.

I am in good company: 95 percent of American adults do not meet the national physical activity guidelines. Although only two out of three are overweight or obese, nearly everyone fails to move enough to get the full health benefits that physical activity confers.

Children and teens are doing only slightly better than adults, in part because of scheduled physical activity at school. Children and teens require more than twice the amount of moderate-to-vigorous physical activity that adults need—sixty minutes a day. But in 2006, just 42 percent of children ages twelve and under met the guidelines of sixty minutes of moderate-to-vigorous physical activity every day. Among teens, fewer than 9 percent did.
¹
Moderate-to-vigorous activity
is crucial for bone growth and muscular development. Vigorous exercise, like running and playing energetically so that the heart beats faster and breathing is more rapid, may determine whether the calories children consume are used to multiply lean muscle cells and build strong bones.
²
Sedentary behavior, in contrast, will convert excess energy into fat cells.
³

Currently, the United States has no physical-activity-related entitlements or safety net support systems that children or adults can count on to help them get moving. Instead, it is up to individuals to figure out for themselves how to get enough exercise. Many special tools are available, like smartphone apps, pedometers, accelerometers, and GPS trackers that provide advice and feedback about the duration and intensity of a person’s physical activity. Anyone with money can hire a personal trainer, join a gym, or purchase home exercise equipment. And even if money is a barrier, everyone can walk the streets, do jumping jacks in their home, or jog through a public park. Nevertheless, you are on your own when it comes to figuring out an approach to physical activity that fits best with your abilities, budget, and lifestyle.

In my view, that’s why so few of us maintain regular physical activity.

Adults need about thirty minutes a day, five days a week. That doesn’t seem like much, but somehow I seldom find the time, even though I actually enjoy being active. My family and my job usually get priority over my exercise. When my kids were younger, after being away at work all day I felt I had to spend all the rest of my time caring for them, from getting dinner on the table, to helping with homework, to making sure they bathed and brushed their teeth. And of course, chauffeuring them to their sports activities and making sure that
they
got regular exercise kept
me
pretty sedentary. You would think that now that three of my four sons are adults and don’t need me to ferry them around, I would finally have more time for myself. But I still have a teenager at home, and if he needs a ride to school, I find myself driving rather than biking to work, which I keep telling myself I have to do more regularly.

With so many demands between work and family life, I feel guilty about taking time out for myself, even though I should be able to and
still have enough time to accomplish most everything else I have to do. I know several people who find a way to do it. In fact, if they don’t get their daily exercise they feel cranky and depressed. Fortunately (or unfortunately), up until recently I never got any recognizable signals from my body demanding that I get up and run a few miles. And when I did make the effort to be active, I also didn’t notice much improvement in my mood or feeling of well-being.

But now, I feel twinges and mild aching in my hips, legs, and lower back when I sit for too long. After decades at a sedentary job, I expect it is finally catching up with me. Even though I am of normal weight, if I don’t get my act together soon it is likely that an overweight person who exercises regularly will be healthier and live longer than I will. Surprisingly, it’s very possible to be “fit” and fat at the same time.

Staying Active Can Protect Against the Harms of Obesity

In fact, exercising and staying fit can mitigate most (but not all) of the harms associated with excessive weight and obesity. The World Health Organization ranks physical inactivity a greater risk to health than excessive weight and obesity.
⁴
But lack of exercise has less to do with the obesity epidemic than we might think.

In the United States, levels of physical activity appear to have stayed relatively stable since the early 1980s, when rates of obesity accelerated. Although leisure-time physical activity has been increasing slightly, this has been largely balanced by the decline of physical activity at work, as jobs have shifted from manufacturing to the service sector.
⁵
Overall, we expend on average sixty to one hundred fewer calories per day at work today than we did in 1980.
⁶
It’s not much, at least compared to the 571 extra calories we’ve been consuming on average every day since then, but it’s a gap that is important and should be relatively easy to close.

There is no doubt that increasing physical activity can help people prevent weight gain. And it can also help people lose weight, if they also diet. But it is very hard to lose weight merely by becoming more active. That’s because exercise burns a relatively small number of calories. To
burn off an extra 500–550 calories, the amount in one typical bakery cupcake or a single Dunkin’ Donuts chocolate muffin, the average person would need to walk for an hour and a half (about 5.2 miles) or do an hour of high-impact aerobics.

Yet even among people who do not lose weight, physical activity can stave off diabetes and other chronic diseases.
⁷
This has led many physicians and health providers to discuss physical activity with patients at every clinic visit.

This is the source of my next confession about my relative inactivity. When I went to the doctor for a checkup a few months ago, a new protocol for preparing patients for a doctor visit led the nursing assistant who took my blood pressure to ask if I exercised thirty minutes a day, five days a week. When I said no, she gave me a lecture about the importance of exercise. The next time I came in, and she asked me again, I just said yes. After all, I really, really do intend to exercise.

Cajoling or haranguing people to exercise no doubt falls on many deaf ears. The reasons are multiple: besides not liking being told what to do, we don’t really appreciate the consequences of inactivity because they are so long-term, and we don’t see our health and functional capacity slowly slipping away. We are often stuck in a routine: commuting, working, and taking care of family, over and over again. Habits are hard to interrupt.

As far as why we exercise so little, it’s important to remember that the history of civilization is the story of the search for labor-saving devices and luxury. The ultimate purpose of most of our endeavors is to make our lives a little easier and more pleasurable. The hierarchies of civilizations have developed so that the people at the top do not labor. Because labor and physical activity are so unappealing, civilizations have developed positions for a wide variety of workers and servants. In the past, slaves were forced to do the most backbreaking and unpleasant of duties.

Most important, we have to recognize that over the past century physical activity has been engineered out of our lives by cars, machines, and technology, and that it is only getting worse with more desk jobs, electronic media, the Internet, and online shopping. Yet if we want optimal health and lower rates of heart disease, diabetes, hypertension,
depression, and cancer—diseases from which exercise can protect us—we need to make physical activity part of our daily lives. Because it is so difficult for individuals to exercise on their own initiative, a variety of policy changes could make routine physical activity automatic, and in ways that will either find the time we cannot find ourselves or in other ways we may hardly notice.

Physical Activity for Children

Many of us will agree that children need to be given the opportunity to exercise at school. Although most school districts no longer offer daily PE classes for all students, it makes sense to build PE into the school day so all school-aged youth can get their exercise. I expect that most parents would be grateful if their children came home with sixty minutes of exercise under their belts and just enough energy left to finish their homework and chores before bed. If the school day were lengthened so our kids got the full hour of activity every day, working parents wouldn’t have to spend so much on child-care services and would probably worry less about what their kids were doing in the late afternoons.

But even when youth have PE scheduled at school, children seldom spend more than 50 percent of gym class, if that much, getting moderate-to-vigorous physical activity. Instead much of class time is spent getting instructions from the teacher or waiting turns to play or perform. Although the goal of school PE is to be engaged in such activity at least 50 percent of scheduled class time, studies examining the quality of PE class instruction indicate this is rarely achieved.
⁸
In one study, children actually got more physical activity during lunch than they did during PE class.
⁹

Curricula and teacher training programs have been developed to help PE classes provide more moderate-to-vigorous physical activity, but to be successful schools usually have to invest in more equipment. For example, instead of having children in a class of thirty play basketball with five on a team (the majority would have to wait for their turn), providing the class with fifteen balls would allow everyone to practice drills with a partner.

In too many PE classes students have to sit on the bench and
watch a few select others be active. The worst are elimination games like dodgeball, where a student who is hit has to stop playing. Those who are the least athletic or fit, and would benefit more from physical activity, are often eliminated first.

Unfortunately, when it comes to children’s extracurricular sports in large communities, where the demand for participation exceeds the supply of opportunities, elimination is the standard. Children’s sports, like soccer, baseball, basketball, track, and football, can be quite competitive, and winning trophies can be seen as the most important goal. Children who develop better skills become more highly sought after for team sports. At the same time, those who do not excel may be discouraged from continuing to play.