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Super-Sized America

Kendracampbell472x721Kendra Campbell -- I’m currently sitting in a suburb outside of Washington, DC, the capital of the United States. I’m on vacation from everything that is med school. So far, I’ve had a wonderful time with my family, hanging out with my friends, and eating all the delicious foods that I can’t get in the country where I go to school, Dominica.

When I first stepped off of the plane a few days ago, I had a similar experience to the last time I was in the States, over eight months ago. As I wrote in a blog entry before, I was immediately shocked by the large size of many Americans, as well as the overabundance of incredibly unhealthy food options. Yesterday, my partner and I went to grab a bite to eat for lunch at a popular restaurant. I wasn’t that hungry, so I offered to eat half of whatever he ordered. He picked the steak special (I’m currently a meat eater but was a vegetarian for 13 years), and I agreed to eat some. When the server brought out the plate, my first reaction was that he was playing a practical joke on us. The plate was huge! On top of the plate was the largest steak I’ve ever seen, covered with huge pieces of greasy bacon, and topped with a one-inch pile of cheese! On the side were mashed potatoes (about 4 potatoes worth), and a small pile of greasy spinach. At that moment, I could barely contain myself. I looked outside into the parking lot filled with huge SUVs, and around the restaurant at the many large patrons, and realized that America had in fact become a super-sized country.

My experience at the restaurant really got me thinking about public health and responsibility. Why would a restaurant even offer a meal that provides 500% of the daily recommended allowance of fat? Shouldn’t restaurants be more responsible when it comes to the health of their patrons? I guess it all comes down to supply and demand. If people want it, restaurants will offer it. Then I started thinking about the public health department and their responsibility. When is it necessary for the government to step in and do something? New York City, for example, has passed a law banning trans fat in all restaurants. Should cities also ban dishes that contain over a certain amount of fat? Fried chicken? Doughnuts? Where should they draw the line?

I guess it all comes down to free will. We certainly all have the ability to make our own choices when it comes to eating (except of course that cost does play a major role… but that’s another rant). But what about our children? Many public school systems have been trying to provide children with healthier food options in their cafeterias. Should we be doing the same thing for adults? I know that many restaurants have been trying to provide healthier options for their patrons, but at the same time, it seems like they are providing even more unhealthy options. Some restaurants have even begun to list the nutrition information on the menus. I think this is definitely a step in the right direction.

It’s no secret that America’s expanding waistlines are directly correlated with our expanding health woes. I think one of the problems is a general lack of responsibility and action on everyone’s part. Hopefully, people will start stepping up and finding some solutions, because everyone’s health is at risk.

For the record, I actually did try a few bites of the steak we purchased (between the two of us, we couldn’t even eat one-fourth of the meal). It actually made me a bit nauseous, so I stuck with the greasy spinach instead.

December 28, 2007 in Kendra Campbell | Permalink

Comments

well then, maybe you should just stick to dominica and not come back.

Posted by: | Dec 28, 2007 3:28:37 PM

Kendra, the portion size is definitely one of the main problems causing the obesity epidemic in the U.S. I myself have found that if I eat a mix of whatever I want (both healthy & unhealthy foods), but the portions are a small to moderate size, I am slimmer than when I eat either ONLY healthy foods or ONLY unhealthy foods. When I eat only healthy foods, even if they have a lot of fiber, I find myself hungry & craving junk food and then I eat too much of the junk food. If I eat only unhealthy food, then obviously I gain weight from all the sugar and fat.

You're so right about America being a country of extremes -- from cars to meals to houses, the unwise belief in American culture is that bigger means better.

Posted by: space-time | Dec 28, 2007 6:31:44 PM

regarding the first (uncalled for) comment there - I think it precisely reflects what's wrong with the entire mindset - arrogance.
bigger = better? puhlease.

Posted by: | Dec 28, 2007 8:38:43 PM

Hey Kendra,

Not to be a huge downer, but the things we got taught in second semester about diet and fat are terribly wrong. Our bodies are really quite adept at making sure we're getting what we need, and using what we get--as long as we don't derail it by adding non-nutritive calories like purified sugars and fats.

*shrug* I've got a whole list of sources for this (all from real scientists, too!) But, it'll take a while for everything to percolate through society. Maybe another two generations.

Posted by: Jared | Dec 29, 2007 6:21:09 AM

1) The first comment on this article is such a fine example of Americentric arrogance! I mean really, wtf? I actually had some hope for the new generation of doctors...

2) I'm spending my vacation in in the Netherlands (am an M3 at Case Western) and I completely agree with your observations about serving size and people size outside the US. But I think American's are fat compared to people in other countries also because we drive more and walk less. The content of the foods here in the Netherlands doesn't seem to differ all that much, but it's amazing how few fat people there are still, despite the abundance of greasy fries and fried dough.

My opinion as to why American's are fatter:
bigger meals + less walking(more driving) --> fat Americans


Posted by: A | Jan 2, 2008 5:56:04 PM

Although others who have left comments are right in stating that eating the the right proportions of healthy/unhealthy foods may work for those of us who understand this concept, I feel that most Americans now have a distorted view of what a normal portion size looks like. For example the size of a hamburger in the 1950s was much smaller than the hamburgers you would get at the same restaurants today. Additionally, it is much more expensive to feed a family of 4 a healthy meal than it is to feed that same family less healthy options.
Whether you agree with Kendra or not, all you have to do is look around at our country to realize that something is wrong. Americans needs to be educated on how to live healthier lifestyles, but in addition companies and food producers may at some point start having to take some responsibility as well. Obesity is a multi-faceted issue that will likely have to be tackled from multiple angles. Fingers clearly cannot be pointed to a single source.

Posted by: Lorie | Jan 2, 2008 5:58:00 PM

I wonder how fat the person is who posted that first remark.
I have to disagree with Lori when she says that "fingers clearly cannot be pointed to a single source". Of course they can. Let's stop with the politically correct stuff. It hasn't worked, and it won't work. And yes, I know a doctor in New York was sued for telling his patient that she was obese...(sickeningly true)...but it is time to tell the truth to bloated Americans that the one and only reason they are bloated, diabetic, and/or suffering from metabolic syndrom is because of their own choices. They get what they asked for.

Posted by: Bob | Jan 2, 2008 7:42:37 PM

need to create a healthy culture by starting from the bottom up--schools, government and families need to make a coordinated effort to focus on the life long benefits of eating well, moderate exercise and avoiding smoking etc. If the message is drummed from every level it will get through eventually and save lives not to mention billions of dollars in health care.

Posted by: Joe | Jan 2, 2008 7:55:13 PM

Oh dear. I love it when scientists start prescribing full out government policy. Not that those in the know shouldn't have a (loud) voice in such things, but doctors and scientists also have an unfortunate tendency to look at gov't policy and large, societal action through their viewpoint- and their viewpoint alone.

First off, please, enough with the "American arrogance." Stop. You're doing your own arguments a disservice when you resort to such hyperbole and insinuation that the group character of 300 million people- if 300 million people spread out over a huge country can have a group character- is flawed, evil, and arrogant. (Perhaps one should look in the mirror and see if one has a superiority complex, hmmm?). While the following arguments are no excuse for obesity, and should be overcome, I'd like to at least point out that certain elements of American society/culture that cause obesity are not a result of "arrogance" but are a natural result of our geographical and economic environment.

Several of you bash on Americans driving constantly. Many Americans do not have a choice. Many European cities have been inhabited for centuries (if not millennia). Space conservation has been a much more prominent issue in their design, over a longer period of time, than in many American cities. I live in Houston- sprawl, sprawl, sprawl (and the public transport system is unreliable and spotty). All the major highways were laid down in the 1950’s, before the oil industry exploded. As anyone who lives there will tell you, it was not well planned- not for becoming the fourth largest city in America. And so many of us have to drive. If you’re a middle-income person who works with an averaged size firm in any of the several corporate centers, you probably can’t afford to live within walking distance. I know I would never move to the (affordable) areas close to where I work because of the ridiculous crime and gang violence in that area. So I drive half an hour to work. Many Americans have similar stories. Just because many of us are lucky enough to live within walking distance of our campus doesn’t mean the average 4.5-person American family is so lucky.

I also love the language many use to talk about the American food situation- describing the vast array of “bad for you” food establishments as if “the man” is deliberately, perniciously trying to make everyone huge. Free markets, people. These food companies and restaurants are run and staffed by everyday people, just like you and me, who want to do well in life. And in a crazily competitive market like food, you try to offer the best package – the most delicious (aka bad for you), biggest, cheapest- you can to a consumer, because you want business! There’s nothing sinful about that. Do I hope that more people try to create niches in the market- healthy food, smaller servings at smaller prices? You bet. But that doesn’t make those that are doing the 9-5 this way so they can put their kids through school the devil incarnate. As Kendra mentioned, market forces are slowly starting to create a few changes. But the battle against obesity is always going to be primarily personal, not institutional.

Are any of you wrong? No, largely not. Americans should walk more, drive less, eat better, eat less. We’d like restaurants to offer better foods, in smaller portions. True. But I think we should be more careful of what we say, people. The last few commentators have stripped an infinitely complex problem down to a few (some of them snide) comments about American psyches (apparently we’re all consumed, “bigger is better” zombies). Consider- there’s a good chance that we commentators and readers are decently well off enough at least (we know people who can pay for or cosign massive school loans, after all) that they have the means and knowledge to overcome a few of these obstacles. Others are not so fortunate. Yes, the average American lifestyle has a lot of problems- but does that give you an excuse to be a judgmental jerk, looking down on those around you?

The part I find most concerning about all of this is that this is a forum for medical professionals (or wannabe ones, anyways). We are supposed to be the pillars of compassion and understanding that these obese persons will turn to when their health fails. And no matter what specialty you go into, given the rising obesity rates, many of your, you, tu, your personal patients will be huge. Obese. Fat. And perhaps I’m being too harsh… but I sincerely hope they do not put too much trust in some of you, unless they want to be judged, condescended to, and considered “arrogant Americans” by the very people who are supposed to help them beat their obesity.

Posted by: Jessica | Jan 2, 2008 8:04:42 PM

As a therapist in a nursing home, I see everyday the dismal lack of nutritional education for Americans. Every day we have patients come in for various reasons, who weigh in excess of 300 lbs. These people are miserable because they are extremely difficult to move, keep clean, to get in and out of bed, etc. Most facilities are so short staffed, that if it takes 2-3 people to safely get one person out of bed, it stands to reason that they are not going to be up a lot unless they can tolerate staying up in the wheelchair for quite a while. And heaven forbid, they need to use the restroom in a hurry! Not going to happen! Better have on that bariatric diaper that has to be special ordered.

Then you throw into this mix the geriatric nutritionists whose only function seems to be to ensure that no one in the facility loses weight! No matter how much they come in weighing! Absolutely drives me nuts! But I’ll skip than rant.

If every overweight person in American could see how horrible it is to be old, obese, poor, and dependent on a nursing home that accepts Medicaid and has the equipment necessary to handle them, they would all be at the gym.

Posted by: Theresa | Jan 2, 2008 8:33:48 PM

The basic premise of this argument is incorrect. Obesity is a global epidemic. The introduction of processed foods and the ability of a population to afford more calories than they need results in obesity in many countries.

Furthermore, a simple condemnation of an obese individual ignores the complex physiology regulating the drive to eat. This drive is not well understood and dysregulation of this drive should not be considered a simple lack of willpower.

Finally, let's not forget that this country and our medical establishment does not exactly have a perfect record regarding nutritional advice (eg - the oh so successful "let's all eat margarine" advice) so we should all be careful to step gently off of our soap boxes when doling out the "obvious" solutions for obesity.

Posted by: Jill | Jan 2, 2008 8:38:32 PM

To quote Al Bundy from "Married With Children": "It's not the clothes that make you fat...it's the fat". Although Atkins adherents would beg to differ, the average "Great American" high fat diet is the unhealthiest on the planet.

Obesity however, is not an epidemic, global or local. Epidemic is a term specific to infectious diseases, the contracting of which are totally involuntary. Obesity is a condition caused solely by overeating, which is a voluntary action. People do not "catch" obesity, nor are they born with it. They can however, be born with a hereditary propensity to become obese, although this does not always occur. What does occur invariably, is the development of eating "habits" that reflect an individual's environment and culture. When I say habit, I'm referring to the fact that obese individuals do not overeat out of need, (Prader-Willi Syndrome being the exception here) but rather out of habit or convention. Clearly then, the source of the "convention", (i.e. the role of food in our culture, how it is presented to us, and its availability) is what needs to be examined.

Posted by: Paul | Jan 3, 2008 4:52:08 AM

I have always felt extremely fortunate in being poor as a young person. Couldn't afford alcohol, cigarettes, transportation or meals out. I remained trim well beyond the norm for an American.

Posted by: Linda | Jan 3, 2008 5:49:55 AM

I have had a thought in my mind for years that has never seemed to be addressed about overeating & obesity.

I was a Vet. Tech..I worked w/ many farms. History shows for almost 50+ years, even worse in the last 35 years,farmers use HORMONES in the feed or as injections to make an animal GROW FATTER & FASTER & MATURE AT RECORD SPEEDS! FERTILITY MEDS ARE PUSHED!
The mother is injected w/ hormones to increase chance of reproduction. She is also given hormones to increase her weight increasing chances of implantation & the calf has a better chance of high birth weight. They continue injecting/feeding the mother hormones to produce the milk w/ super high fat content. The calf gets high fat milk as well as growth hormone injections to make them mature faster & gain weight faster.This continues up to the time of sale for slaughter. The farmers OVERDOSE the animals w/ more growth hormones & hormones to gain the largest amount of weight in the shortest time.The animal get very ill. THE SAME IS DONE W/ CHICKENS,TURKEYS AND MOST EVERY FARM ANIMAL W/ MEAT ON THE MARKET! {this is done in the name of FAST-MONEY-GREED!}

With all this I would think anyone could see the meats/milk & eggs) are FILLED LARGE AMOUNTS OF HORMONES/CHEMICALS that make the body produce EXTREME WEIGHT GAIN AT EXTREMELY FAST PACES! We know many of these chemicals are IN THE MEAT WE EAT & when ingested is ABSORBED INTO OUR BODY. This TRIGGERS the brain & body to react the same as the animal did. HUNGER RAGES W/ OVEREATING RAGING, the body OVER ABSORBS FAT & CALORIES **OBESITY is a result. But the body is told to GATHER & BIND ALL CALORIES AND FATS NOT LETTING ANYTHING FLOW OUTWARD. This then is the DOOR to our MORBID OBESITY problems!

The same w/ humans OUT OF CONTROL URGES FOR SEX to the point of RAPE & SEXUAL CRIMES & CHILD SEX MOLESTERS going over the walls in numbers! They seem OVERLY ATTRACTED to something our great grand parents & before did not seem to have a problem with. Why?

With our meat & other farm products,(including some veggies w/ cow/chicken manure w/ these OVERLOADED HORMONES/CHEMICALS being absorbed & come to our plate) OVERLOADED W/ HORMONES to INCREASE SEXUAL EXCITEMENT (*MALES become VERY HORNY & AGGRESSIVE to mate. * Many animals will FIGHT TO KILL just for the SEX! Some animals get HURT from the AGGRESSIVE SEX!)
YOU SHOULD SEE A PATTERN HAPPENING!
Also, they cause a great increase in fertility (eggs & sperm)(mothers ability to ovulate & implant more times that normal & give birth to more than the normal numbers of babies each litter or in a single year!) .
{In some cases this causes infertility due to the body being put on OVERLOAD and the quality of eggs/sperm becoming poor or overworking the sex organs resulting in infertility & even sexual organ problems.}

Also are given hormones that make the animal HIT PUBERTY at a VERY YOUNG AGE!
NO LIFE TIME FOR THE ANIMAL TO GROW NATURALLY AND LIVE A NORMAL TIME IN LIFE.
*THIS IS EXACTLY WHAT OUR CHILDREN ARE EXPERIENCING! Kids today are becoming "physically mature adults" at 9-12 years of age! With the hormones letting out the scents that attract mates -like a dog in heat the power to find sex becomes an OBSESSION w/ ADDICTION & AGGRESSION & VIOLENCE beginning to play a huge roll. Even though they are 9-16 YEAR OLDS Sex & pregnancy starts at these ages now!

Like a narcotic, we can not pull away from these chemicals OVERRULING OUR THOUGHTS & ACTIONS! Our life begins to circle around it.The brain & body CRAVES MORE & HIGHER DOSES. CONTROL IS HARD!

Just from the GREED that makes the farmers DRUG UP THEIR ANIMALS to get BIGGER,FATTER-MORE HUNGER,HORNY,HIGH IN FERTILITY ANIMALS FOR SLAUGHTER IN THE FASTEST TIME

We have began drugging up ourselves. Like a type of ILLEGAL DRUG being sold on the market but the FDA says it is "OK TO DO".

{**BUT THEY TOO MORE MONEY OFF THE LARGER NUMBERS OF BIGGER,FATTER ANIMALS/PRODUCTS ON DEMAND so they are KEEPING THIS UNDER THEIR HATS!}

Why is it taking so long for anyone to see this pattern. We are meat eaters. The meats are tampered with & poisoned. Americans (growing in other countries also) are becoming one of the most MORBID OBESE PEOPLE IN ALL OF HISTORY in just the last 40-50 years, getting worse each year.
People at 300 + pounds are totally accepted by most all society's.People of 800->2,000 # is not a "one time circus freak". People trying to help are being charged w/ insulting a person while wanting to help them.
Children as young a 3 yrs old living at almost 70+ #. Kids 5-10 weight over 100+ # and teens over 200+ # is becoming OK & NORMAL & ACCEPTABLE.
{I was placed on a NO RED MEAT DIET and have found my weight the lowest I have ever had! My appetite is very small. I do not feel hungry. I can attest to this being a HUGE KEY to the "WHY"!}

Will anyone take this as a HINT to the "WHY" and start research to validate this?

{{{Corn syrup would be #2 on our CAUSE for morbid obesity & obesity. It is another food product made by man that has no nutritional value...BUT LEGAL!}}}

Posted by: Kay | Jan 3, 2008 7:38:48 AM

So So true! and So So scary! Increased portions with increased suburban sprawl and soon we will all be morbidly obese!

Posted by: Andrea | Jan 3, 2008 3:08:40 PM

Wow, you've had some heated responses to this!
I totally agree with you that Americans (and many in the first world) are getting fatter, eating more poorly, and increasingly dependent on the medical system to "fix" them when they refuse to make the behavioral changes they could make on their own if they had the motivation.

The problem with our culture is that we look for instant gratification. Why work out for months in a gym and make long term lifestyle changes when a few trips to the plastic surgeon and some new drugs can do the work for you?

People need to start taking responsibility for themselves. It is bothersome to me that instead of focusing our attention on preventing many of the chronic diseases facing our population today which are linked to obesity (hypertension, diabetes, etc), we focus on treating the problems after they occur and become chronic. Our money would be better spent preventing these issues through education. But in the market economy we live in, it will be hard to educate people against their own culture.

Posted by: Julia | Jan 3, 2008 7:43:26 PM

Obesity is public health problem in industrialized nations in contrast as malnutrition, parasite infections, HIV, tuberculosis and many other infectious diseases in developing countries.
I think we do our nice share of telling people the risks. But rarely do they listen..

Alberto R. Zambrano U.
MS3 @ José María Vargas School of Medicine. Central University of Venezuela, Caracas, Venezuela

Posted by: Alberto R Zambrano U | Jan 3, 2008 11:17:38 PM

It is amazing how scientists (or scientists to be) can fall in the temptation of finding easy solutions to complex problems. Nutrition is of concern of every single person on the planet, and the problems related to over or under nutrition are multi-causal.
There is genetic predisposition, environmental influences, diet, behavior, attitudes, perceptions and so forth. We should be therefore careful when addressing complex situations trying to give simple and unrealistic explanations.
A. Perez Cueto, PhD

Posted by: Armando | Jan 4, 2008 1:52:21 AM

why dont fat ppl just metabolise faster?

Posted by: rofl | Jan 4, 2008 7:01:36 AM

yup, you are right. i was thinking why people keep taking those high fat food even though they know the risk of being obese and getting other disease.

one of my lectures had said that, in war countries, people died of not enough food. but in developed countries, people died of excessive food intake...

Posted by: salsabila | Jan 4, 2008 11:13:40 AM

Causes of obesity are multifactorial putting in mind genetic predisposition and the different psychs of every obese person, but one can see patterns growing out of the blue, that weren't there in the 50's, that are gaining popularity, that are all linked to one or two simple causes as general causes of obesity.

Posted by: | Jan 5, 2008 2:48:20 PM

It's the American culture- the super sized america. That's why in my country when you say american size it connotes one thing- BIG!
Everything and anything in America is possible. Any unimaginable thing happens. It's both the upside and downside of living in America. It all depends on how one perceives life-good food or bad food would mean healthy or unhealthy life.
Its our choice to eat healthy or not. It's the motivation the comes within. The restaurants may serve anything a customer wants. For me, that BIG SERVING of food always makes me want to share it with a friend. Otherwise, I will not eat at all in that restaurant. Will cook for myself or eat half of that full serving and take it home, good for my next meal.

Posted by: dulce | Jan 5, 2008 8:02:54 PM

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