Authors: Jörg Blech
We as physicians, have come to accept as normal what even a century ago might well have been looked upon as below normal, abnormal, or even sick. We blandly accept the fact that men and women in their late thirties cannot run, that they are overweight, that they might have to “watch their hearts,” that they need diets, and that they have an assortment of minor or major orthopedic aches and pains. . . .
On the other hand, we consider as supernormal or as freakishly exceptional people whose physical activities approximate those of past generations of less mechanized countries. We consider the low pulse rate of an athlete as something unusual. . . . We are surprised at the relatively low muscular tension, the spontaneous weight control, the better muscle strength and flexibility, the greater breathing capacity and the high fatigue level of the well-trained, not over-trained, athlete, and we settle back comfortably to our daily sedentary routines after having declared such people unusual, as indeed they are.
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Kraus and Raab described an emerging ailment produced by lack of exercise—the hypokinetic disease—at the same time such revealing terms as “disuse atrophy” and “untrained heart” entered medical dictionaries. Doctors initiated studies asking whether there might be a correlation between physical inactivity and the rate of heart disease. Their conclusions: people with physically demanding jobs were three to four times
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likely to die from a heart attack. Forty years ago, this outcome caused a sensation: “It is not labor that damages the coronary arteries and the heart—but the lack of labor.”
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Lack of exercise was found to upset crucial bodily functions and to turn “sleep disorders and impairments of digestion into the most frequent ailments of our time,” said Harald Mellerowicz, a sports physician in Berlin. In a blend of cynicism and wrath, he cautioned: “The muscles of the torso are no longer able to give it natural support. Weak and bad postures, degenerations of the spine and of the ribcage develop, with impact on the bloodstream and the respiratory system. This bad posture is not only unattractive but also triggers a whole chain of additional impairments affecting development, health and performance.”
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STUCK IN OUR CHAIRS
These harsh words, published in 1967, had little effect. No generation has ever moved as little as today’s inhabitants of the United States and other Western nations. Experts at the World Health Organization have classified 60 percent of the world’s population as sedentary; 41 percent do not even have two hours of moderate exercise per week; 17 percent are completely inactive. It is estimated that 2 million people die from illnesses caused by lack of exercise, among them cardiovascular disease, breast cancer, and type 2 diabetes. In the United States, treatment for sedentary citizens costs 75 billion dollars every year.
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However, most people do not consciously decide to be lazy. In general terms, they are yielding to the manifold temptations of the modern world. Though we do not act to avoid them, the hazards are well known. In the 1950s, television sets conquered American households, and gasoline was so cheap then that families, instead of walking, took to road trips on the weekends. Today, there is less need for physical exercise at work, at home, or during recreation, to the point where, as William Haskell at the Stanford University School of Medicine puts it, we can speak of its “non-existence in industrialized and urbanized societies.”
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Haskell himself is deeply worried.
In the United States, children grow up in a world that leaves no time and no room for physical activities. For most of the baby boomers, it was common either to walk or to ride a bicycle to school. In these days, kids are moved around in mini-vans, and teachers have a hard time advocating walking days. Once in school, students will rarely be challenged physically because many school systems struggle to finance a physical education program worthy of the name. At recess, video games and other gadgets have taken the role balls and skipping ropes used to occupy. The idle members of generation XXL spend their youths indoors, and they would rather travel online than by foot. Granted that some ten-year-olds design impressive Web pages, but many have difficulties climbing, jumping, or pitching a ball. According to Nielsen Media Research data, the average child or adolescent watches an average of nearly three hours of television per day. This figure does not include time spent watching videotapes or playing video games; one 1999 study actually found that children spend an average of six hours and 32 minutes per day with various media combined.
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No wonder there is literally no time left for playing outdoors.
The abandonment of exercise is a global trend affecting not only kids growing up in American suburbia but also youngsters living in walkable areas of Europe. Wilhelm Niebling has a doctor’s office in the idyllic Black Forest. As he puts it: “Many children in our town are not able to balance backwards.”
We hardly realize the subtle ways in which digital technologies reduce the amount of exercise we get at work. To start with, often workers no longer have a real need to leave their houses in the first place. Thanks to cell phones, Internet access, faxes, and e-mail, more people can work from their home. And even if an employee finds her way to the office, there she need not leave her cubicle. She can communicate by phone and e-mail with every colleague. Writing, copying, and sending a document can be done without leaving her chair. The automatic redial function on phones reduces even the amount of energy needed to hit the numbers. Over the course of days or weeks, these effects seem to be negligible for our well-being.
In the course of months and years, these small effects make a big difference. To illustrate this point, William Haskell offers the example of an initially slim white-collar worker weighing 60 to 70 kilograms (130 to 150 pounds).
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Imagine, says Haskell, that the worker had the following choices: He could print all his documents; pick them up at the printer; and personally bring them, like an office boy, to the relevant colleagues. In this case he would rise from his chair once per hour and walk slowly for two minutes. Alternatively, he could send all his documents by e-mail, and he would thus sit all the time. In the latter case, the energy consumption would be decreased by an amount equaling 500 grams of fat per year. That is to say sending e-mails gives rise to an insidious obesity—after ten years the worker will be five kilograms fatter. If the same man walks one kilometer every morning, he may make up for this. However, if he keeps his food intake, but stops his morning strolls, he will gain two kilograms within one year.
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OFF THE CHARTS
Not only do people get bigger in wealthy countries like the United States, Kuwait, or Australia, but the wealthy classes in poorer states like Thailand do as well. By now, there are more overweight people living on this planet than there are individuals who have a weight once thought to be normal. However, there is no clear boundary defining the line at which excess weight should be considered a pathology. The Body Mass Index as used in most official guidelines serves only as an approximate guide.
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If a person arrives at a number between 25 and 30, he or she is overweight, according to the World Health Organization. If the BMI is 30 or higher, the person is obese.
Even though experts disagree whether or not these definitions are too strict, there is no doubt that humans are getting bigger. In 1970, male Americans were on average 8.7 kilograms heavier than men of the same age and height who were examined in 1863. The British army increasingly has had problems finding slim recruits. Earlier this decade, only one-third of 16-year-olds met their requirements, whereas two-thirds were too heavy. In 2006, the army relaxed the rule. Since then, men with a BMI of up to 32 may be recruited; the old cutoff was a BMI of 28.
Our modern habits produce human bodies that were unknown in the Stone Age. In a special clinic for obese adolescents in 2000, I met a boy named Paul. During the first 15 years of his life he put on an average of 820 grams every month. When I interviewed him, he stood five feet and ten inches high and weighed 347.5 pounds—more than half of his body consisted of fat.
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In the natural world a physiology like this is rare, apart from humans. In summer, the bar-tailed godwit gorges on clams in the estuaries of the Alaskan coast, until fat makes up 55 percent of its body weight. Then, however, the brave bird sets forth on a journey that will take it across the Pacific Ocean to New Zealand. Its fat serves as a fuel tank on an exciting journey that lasts four or five days.
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Humans with such enormous padding, by contrast, develop debilitating symptoms and can even become unable to move without assistance. Paul, the student, was suffering from ailments for which he should have been too young. The boy, at age 15, had a fatty liver, and his blood pressure was so high that he was frequently bleeding from his nose. In his body the level of uric acid molecules was dramatically elevated—a sure harbinger of gout. Fat masses constricted Paul’s neck so that he couldn’t breathe properly while asleep, and his nighttime respiration occasionally went into hiatus. Meanwhile Paul’s feet were under immense pressure so that he was walking like a duck on his flatfeet. His shoes were two sizes bigger than they would have been at a normal weight.
In the United States, there is no shortage of freakish stories about people grown so big they can’t move. Now in Europe similar tales are making the rounds. In the city of Hamburg, firefighters had to respond to a call from a woman in diabetic shock. She weighed 250 kilograms and wouldn’t fit through her door. The firefighters lifted her with a crane from her balcony on the fourth floor. In the city of Düsseldorf authorities have purchased special ambulance cars for such heavy cases: They have heavy duty stretchers and hydraulic ramps.
In American amusement parks, such as Sea World in San Diego, it has become part of the daily routine for some visitors to be too big and heavy to walk through the park. They leave their cars at the spots reserved for disabled persons close to the entrance. Having covered the short distance from their car to the ticket booth, they sit down on electric scooters that take them around. The Israeli company Afikim Electric Mobilizers is one of the suppliers in this market. Originally, its model was designed to carry two or three elderly people with mobility problems. Due to heavy demand from overweight Americans, however, the company has supersized the scooter by upgrading the motor and replacing a two-person bench with a single bucket seat. It can now carry a driver weighing up to 500 pounds.
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Airlines, on the other hand, consume more jet fuel due to the increased weight of their customers, and they even must deal with passengers who need two seats but just want to pay for one. On a flight from England to California a young woman suffered from internal bleeding because an obese passenger next to her squeezed her. It wasn’t until the victim threatened to sue the airline that she received a compensation of 13,000 British pounds.
Many scientists trace the global spreading of obesity to overeating. However, in the United States the average intake of calories remained roughly the same between 1909 and 1970, and even appears to have slightly shrunk since then. Nonetheless, U.S. citizens have put on a lot of weight because they burn fewer calories through physical exercise.
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Nobody knows exactly how the human energy balance looked a few centuries ago. It is estimated that hunter-gatherers burned an average of 1000 kilocalories per day to move their bodies. At the same time, they ate food containing 3000 kilocalories—this is a ratio of 3 to 1. In our time, a sedentary American actually eats less food; his intake amounts to 2400 kilocalories. But he burns only 300 kilocalories per day—this is a ratio of 8 to 1. This mismatch leads to an excess of 100 kilocalories per day—a principal reason for the obesity seen in today’s societies.
Walking Off Diabetes
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N 2006, A GROUP OF RESEARCHERS GATHERED IN MELBOURNE, Australia, and made a grim prediction: The earth’s remaining indigenous societies, the experts warned, would see a dramatic decline in the course of this century. Whole bands and tribes could become wiped out, in some cases.
In the past, infectious diseases as well as the destruction and confiscation of the natural habitat led to the collapse of indigenous societies and cultures. Now, something new threatens the last remaining aborigines and islanders. The meeting in Melbourne was called Diabetes in Indigenous People Forum,
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the first of its kind addressing the danger diabetes poses to these communities around the world.
Australia’s aborigines and Torres Strait Islanders are just as much at risk as New Zealand’s Maori and Native Americans in the United States and Canada. Small children in these communities, as young as six years old, have already fallen sick with type 2 diabetes. They are in danger of having heart attacks and failing kidneys later in life and are also at high risk of losing their eyesight.
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If you feel sorry for these indigenous peoples, however, you should not forget to feel sorry for your neighbors, acquaintances, friends, peers, relatives, and colleagues as well—and possibly for yourself. The fate of the Aborigines, Islanders, and Native Americans is our own fate, too. In terms of their genetic makeup, the members of all human ethnic groups are substantially identical. A sedentary New Yorker faces the same risks as a sedentary Navajo. And indeed, Western societies are in the middle of this crisis: Every ten seconds, a person somewhere in the industrialized world gets a limb amputated because of type 2 diabetes.