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Date Posted: 03:59:35 08/03/04 Tue
Author: J.R.Smith,c.f.t.,s.p.n.,s.s.c.
Subject: A Mega-Dose of Healthy Advice for a Fast Food World

This is taken from the FitLouisville web site. It is our desire to see all of Kentucky get in the absolute best possible shape and therefore we support the GetFit Kentucky initiative. Dr. Dave is a supporter of that program.

Dr. Dave's Page

A Mega-Dose of Healthy Advice for a Fast Food World

By David T. Allen, MD, MPH and Nancy Kuppersmith, RD, MS, LD

This article was originally published in Louisville Medicine, February, 2003.

Dr. Allen is President of Fit Louisville. He lives with his wife and pets in Anchorage.
He runs every day.

Send an email to Dr. Dave
with your comments...

In our very complex world most Americans want everything important boiled down to 30-second sound bites. Just tell me the bottom line! Well, here it is! As a nation, we are losing the battle of the bulge!

Up until recently, the major concern about weight was tied to appearance, or cosmetic issues. Now the connection has been made between weight and a multitude of specific health problems.
The Surgeon General was extremely persuasive in his Call to Action to Prevent and Decrease Overweight and Obesity1 concerning the importance of maintaining an optimal body weight as a step towards the prevention of several forms of chronic illness, with particular attention to type 2 diabetes and hypertension.
OBESITY MAPS HERE
As a result of the Surgeon General’s recognition of the magnitude of this problem, obesity as a health issue has made the cover of Time, U.S. News and World Report, and countless women’s magazines. The evidence suggests that physicians should devote as much energy today towards exercise and weight management as they devoted towards interrupting the ravages of smoking in the last decade. Meanwhile many physicians may have just given up addressing the obesity problem because it can be so labor-intensive to make a real difference. Some doctors may even believe that dealing with a patient’s diabetes is the practice of medicine, but dealing with a patient’s weight is meddling!

The obesity problem is so pervasive that we cannot leave this problem to others. Physicians must reevaluate their actions during regular office visits to reduce the chronic problems associated with an absence of adequate weight management. Some important quick and easy changes physicians can make to address this weighty issue:

1. Plot a weight chart in every patient’s medical record at every visit – a chart is much more instructive than a weight table. With a Body Mass Index conversion you can demonstrate to your patients where they are compared to an expected standard weight.

2. Demonstrate in black-and-white the symptom-free weight gain that can creep up on anyone. Remember, losing 12 pounds is easier than losing 50 pounds.

3. Bemoan the truth that physical activity has been engineered out of daily life.2

ALTERNATIVE WAYS OF ACCOMPLISHING EVERYDAY TASKS HERE
For the 20 activities on the chart above, if a person always chose the sedentary way to accomplish the tasks, he would expend 1700 kcal over the course of a month. If a person always chose the active way, he would expend 10,500 kcal over the course of a month, for a net difference of 8,800 kcal. This difference in energy expenditure is the equivalent of 2.5 pounds of fat a month, or 30 pounds of fat a year!2

For your 30- second sound bites for the New Age:
Pearl #1: Portion size is very important!! If we divide most restaurant servings in two and ask for a take-out box, or share one half with our spouse, the meal would be much closer to our true caloric needs.

Smaller portions mean fewer calories. Despite the diets touting high or low fats, high or low carbohydrates, or high or low proteins, it is still true that a calorie is a calorie is a calorie and if you consume more calories than you burn, the excess calories get stored – as fat!

Pearl #2: Thirty minutes of daily exercise is very important for everyone -- or at the very least everyone must add activity back into one’s life. The key is to find dedicated time and/or energy-consuming activities every day and just do it!

Exercise has disappeared from the daily routine of most Americans. There are two consequences: Weight gain is clearly related to the absence of any significant level of exercise. Furthermore, in America today more aches and pains are caused by too little exercise than by too much exercise.
Pearl #3: Limit sugared beverages to a maximum of one 12 oz can or bottle per day – or better yet, take a sweet drink only occasionally as a special treat – and limit highly refined carbohydrates to 1 serving per meal.

Sugar and highly refined carbohydrates (NOT WHOLE GRAIN CARBOHYDRATES) in large quantities are emerging as more detrimental to one’s health than some fats.3
A few interesting statistics for your discussions with patients:

In 1954, when McDonalds was launched, the average American ate 4 pounds of french fries/year. Today the average American eats 30 pounds of french fries each year.4

In 1942 the average number of soft drinks produced was sixty 12 oz. cans/person/year. In 1997 the production was 590 cans/person/year - a 9-fold increase.5

In 1978, the average teenager drank 6.5 oz of soft drinks per day, in 1996 the average was 15 oz. per day -- the intake has more than doubled in less than 20 years.5

Soft drinks are aggressively marketed. In 1997, the soft drink industry spent 631 million on advertising. The cost of soft drinks in 1997 was ~36 cents/quart and milk was 95 cents/quart. Coca-Cola’s goal is to make Coca-Cola the preferred drink for any occasion and to do that they have their product at the grocery, video store, sports field and gas station!5
Every year the fast food industry spends over $3 billion dollars in direct advertising on television alone. In addition to television and the internet, the fast food industry has major campaigns focused on children which use the attraction of give-away or discounted toys to bring in the children – and the children bring in their parents.6
Speaking of marketing, there are several advertising gimmicks that sound so good at the beginning - but they are traps for weight gain over the long haul. Two of the trickiest are:
1. "All You Can Eat for $6.99", and
2. "biggee-size" for an extra 27 cents!!
Beware - especially if you were raised as a member of the clean plate club!!
When one looks at weight issues holistically, there are many pieces to the puzzle and we cannot solve all of them at once. However, our patients’ eating/exercise environment has changed dramatically over the last 10-15 years. By alerting our patients to the negative health traps of the 21st century, we can begin to tackle these lifestyle issues.

THE BOTTOM LINE, TO BE PART OF THE SOLUTION, AT EVERY VISIT:

1. KEEP TRACK OF PATIENTS' WEIGHTS OVER TIME AND ALWAYS ASK FOR THEIR WEIGHT HISTORY.
2. REMIND YOUR PATIENT THAT WATCHING PORTION SIZE & FOOD QUALITY ARE BOTH CRITICALLY IMPORTANT.
3. A DAILY SCHEDULED EXERCISE PERIOD IS AN ESSENTIAL, FOR LONG-TERM, HEALTHY LIVING.

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