Obesity & SeDS

by Jeff Novick, M.S., R.D., L.D./N.

Being overweight may pose an even greater risk to your health than smoking, heavy drinking, or being poor, according to research that compares obesity to other well-known health risks. The study, which appears in an issue of the British journal Public Health, estimates that there are more Americans who are either overweight or obese than there are smokers, problem drinkers or those living below the poverty line.

“The overall health effect of obesity is much worse because the prevalence is much higher than other health problems, and the effects for people in that category are also stronger,” says study author Roland Sturm, an economist at RAND, a non-profit research institution. “It really points to this being an overwhelming public health problem, and I don't think it has had quite this profile yet.”

For the study, researchers surveyed a nationwide sample of 9,585 adults and questioned them about their height, weight, income, smoking and drinking habits and health status. They used the body mass index or BMI, a ratio of height to weight to define overweight and obesity. A BMI of 18-25 was considered normal, more than 25 was overweight and more than 30 was clinically obese.

Researchers found obesity was more closely associated with 17 major chronic conditions and 12 common quality-of-life issues than smoking, problem drinking or poverty — factors that have been widely acknowledged as health risk factors by both the public and health officials. For example, researchers found half of the people who are obese have an additional chronic condition. For smokers, that number is closer to one in four who have an additional chronic condition such as heart disease, cancer or diabetes.

Although researchers separated the risk factors in their study, Sturm notes that, “Bad health habits don't come in isolation.” Many people fall into more than one of the categories, such as being overweight and a smoker, which can make the ill effects even more severe.

Charles Billington, M.D., president of the North American Association for the Study of Obesity, says this study reinforces the fact that, “obesity is at least as much, if not possibly more, of a public health problem than some of the better recognized problems like smoking, problem drinking, poverty and the like.”

“Physicians, I think, would clearly side with public health officials that this is a medical problem that has medical consequences that we need to think about in those terms as a public health issue for the public and a disease that deserves attention and potentially treatment for individuals,” says Billington.

Dr. Frank W. Booth, a professor at the University of Missouri-Columbia, says there are approximately 250,000 people in the United States who die of diseases due to inactivity. The figure is an estimate, based on estimates that 750,000 Americans a year die of heart disease, diabetes and colon cancer, and on research which concluded that one third of those deaths could be prevented by physical activity, Booth said.

In order to emphasize his point and have more attention paid to the problem, Dr. Booth has invented a new name for being fat and out of shape — sedentary death syndrome.

SeDS, short for sedentary death syndrome, replaces “inactivity-related diseases,” a phrase that Booth says lacked pizzazz. His hope is that with the new catchy name, the condition will get more attention from the public and federal government and that more money will be spent on getting the public to be active again.

Booth, along with 40 of his backers, officially unveiled SeDS to the public at a briefing for reporters in Washington. Researchers Against SeDS, the organization that Booth founded, and which he funds out of his own pocket, called for an increase in federal support for research. Booth wants to retain or increase current funding for the Centers for Disease Control and Prevention's physical activity and nutrition program. The new federal budget would cut funding, he said. And he said the government in general should double the current two percent of annual health care expenditures that is spent on prevention.

Booth also called for the National Institutes of Health to create more programs that would focus on SeDS research. Although the scientific consensus is strong that a lack of physical activity raises the risk of several fatal diseases, Booth conceded that his estimate of a quarter of a million fatalities is not as firm as it could be. “It’s such a big number and it’s so new,” so it will take some effort to make America give SeDS the respect it deserves, Booth said.

To help SeDS get that respect, Booth’s fledgling organization recruited Margo G. Wootan, director of nutrition policy at the Center for Science in the Public Interest, one of Washington’s larger advocacy groups, to speak at the briefing. “With all the environmental factors that reduce physical activity, it takes more than willpower to be physically active,” Wootan said. Government agencies should take some of the ease out of modern living, so physical activity improves as an option, she said.

“Our bodies were designed to be physically active,” said Scott Gordon of East Carolina University. The trouble is that hard work, from farming to simply doing household chores without appliances, is no longer part of ordinary life for most people, he said. Gordon called for activity to be put back in. “In adults, this may mean planning exercise into your daily routine,” he said. “However, it may be as simple as taking the stairs instead of the elevator a couple of times a day.”

“Perhaps the greatest tragedy is that ailments previously associated with the middle-aged and older population now affect our children, and will serve to drastically decrease their quality of life,” said researcher Ron Gomes of the University of Delaware. Booth and his supporters said a special effort must be made to reach children, so they won’t turn fat and weak like their parents and, also like their parents, get sick and die early. Type 2 diabetes, also known as adult-onset diabetes, has increased tenfold from 1982 to 1994 among the young, and one third of all new cases are among people ages 10-19, Gomes said.

In spite of the knowledge of the relationship between exercise and health, a new survey found that most Americans think they’re fine just as they are and can live with being fat and getting too little exercise.

A poll for the health club industry found 74 percent of respondents saying they were generally satisfied with their health. But separate federal figures say 55 percent of Americans are too fat, and that more than 60 percent do not get enough physical activity regularly to benefit their health.

“It appears as though the accepted norm has shifted to an overweight person who does not exercise,” said the International Health, Racquet and Sportsclub Association, which commissioned the survey. “Most Americans are satisfied with their health, yet are most likely overweight.”

The Roper Starch Worldwide survey attempted to understand America’s thinking on exercise — why some people work out and others don’t. It found a range of attitudes, from exercise believers who get big mental and physical benefits from their workouts to couch potatoes who think exercise is just a passing fad. The report groups attitudes into six profiles, with the opinions of the rest — about one in five — being too diverse to categorize.

Three of the groups tended to be non-exercisers.

About 14 percent were termed Abracadabras because they wish there were a magic pill that could give them the benefit of exercise without having to do the work. “They don’t think it’s a waste of time, but they don’t seem to feel a whole lot of guilt about not exercising,” said Roper Starch research director Geoffrey Feinberg. Many are middle-aged moms who say they don’t have the time, he said.

The Woulda-Shouldas, 12 percent, can’t commit to a fitness routine, the study said. “They know they should exercise, but they have trouble getting motivated,” Feinberg said. “They feel kind of bad about it.”

Another 13 percent were termed Sitcom Skeptics. The survey found this group viewed exercise as unnecessary, and therefore was unlikely to do it regularly.

Sitcom Skeptics will be hard to reach with the exercise message, but Woulda-Shouldas could be tempted, Feinberg said. “If they can somehow become aware that they would feel so much better in so many respects if they would exercise, I think that would appeal to them,” he said.

IHRSA’s research director William C. Howland, Jr. is interested in targeting the Abracadabras. He thinks these time-pressured people might respond better if they looked at exercise’s more immediate benefits, such as stress reduction, increased energy and better sleep.

Other segments realize the benefits of exercise — and do it. About 13 percent, termed Balanced Holistics, believe fitness not only helps their bodies, it gives them a more positive attitude toward life. Eight percent who are Conscientious Preventors focus on the health and medical benefits. These include a reduced risk of chronic conditions such as heart disease and diabetes, as well as improvements in weight control. And Social Competitors, who are 20 percent, are young risk-takers who say their activities bring them friends and fun.

However, even though the fitness community has work ahead of it in getting more people to exercise, IHRSA President Joe Cirulli thinks it has some successes to look back upon. “I started lifting weights when I was 9 and when I was in high school, I was known as ‘the weight lifter’,” said Cirulli, who owns two clubs in Gainesville, Florida. “Now, when I walk in, I see thousands of people lifting weights and exercising. You go back 30 years, the people who worked out regularly were ‘the health nuts’.”

I agree that obesity is one of the major public health challenges of the coming century. But I disagree when they say that to really do something about it, we need a public health approach. If we really believe that we have to wait for a public health approach to solve this problem, then we are missing the point. A public health approach would be beneficial in providing public support and a framework to transform our society into a healthier one. But the real transformation and change must come from within — from within each and everyone of us. No public health initiative, program or directive can do that. No social/public program can force you to eat right and/or exercise every day.

We have everything we need right now to achieve “Optimum” health. We don’t have to wait for the food industry and all their scientists to invent or discover some miracle food. It exists already. The miracle food is fresh fruits and vegetables.

And we don’t have to join some sparkling, new gym, or buy some fancy elaborate gym equipment or hire a personal trainer to start exercising and get into shape. All we need is to get off our butts and start moving and walking. Add in a few simple calisthenics and we can be on our way to fitness.

But, this motivation/desire/effort has to come from within. There is no external solution to this problem. The problem isn’t “out there” and neither is the solution. No one can do it for us. And remember, this isn’t just about physical health. Eating right and exercise is essential for optimal health which includes physical, mental and spiritual well-being. We deserve nothing less than the best.