The extremes of energy intake: part 1.

it seems ours is a culture of extremes. On the one hand, the latest information on the growing national waistband indicates 30.4% of Americans 12 to 19 years old are overweight. In stark contrast, we have a body-image obsessed culture sculpting and suturing its way toward the unattainable. We seek perfection through surgery, steroid use and any other means short of diet and exercise. Indeed, if there is a link uniting these extremes, it's laziness.

Yet not all of the image-obsessed are lazy, just as not all of the physically active are healthy. An obsessive bodily dissatisfaction, manifest in a falsely perceived underdevelopment of one's muscle mass and tone, represents a growing concern in the young adult male demographic. In a later issue, we'll address this disorder, known as muscle dysmorphia. And then we have the runner for whom, for a host of reasons, the delicate balance between energy expenditure and intake remains elusive; see page one for details. In Part 2, we'll also look at strategies for guiding these undernourished athletes back to health. Part 1, however, addresses the opposite imbalance manifest in our culture: the ever-spreading incidence of obesity.

What happened? There is obviously no one answer. But at least partly what occurred was that, as the nation became more prosperous, the price of manufacturing food went down even as food supplies went up. Competition for dwindling demand became fierce, and consequently food manufacturing budgets moved from producing to marketing food. The question went from "How do we grow more food?" to "How do we sell more food?" As a result, you may now supersize for a quarter, and eat in every bookstore.

Cultural factors. Poverty and lower educational attainment are consistently associated with obesity, regardless of ethnicity. Poverty translates into an inability to afford health insurance and prescription medication. Poor education, for its part, often prohibits informed decisions about diet, exercise and tobacco use.

Among women, the highest prevalence of obesity is among those with less than a high school education earning less than $20,000 a year. Interestingly, among men, obesity is highest among those in the highest income category but still with less than a high school education. Obesity is lowest among those who have more than a high school education, regardless of income.

What are we learning in school? In an attempt to explain the high prevalence of obesity among minority groups (see above box), an article in the American Journal of Clinical Nutrition suggested that our culture has created many neighborhood environments in which highly palatable foods are accessible to all at low cost, and physical activity is not required. Subculture aside, this sounds a lot like today's American classroom.

There are some genuine nutritional reforms in place on school menus. The standard, USDA-funded lunch must contain less than 30% of its calories from fat. But 20.2% of public schools also sell high-fat, brand-name fast food. A chocking 58.1% of public elementary schools allow cola sales through vending machines. That number is 93.6% for high schools. Of school districts that allow brand-name soft drink sales at school, 35.3% allow companies to place their ads in school buildings, 43% on school grounds. Schools, then, are replete with both junk food and the messages that sell it. These disconcerting facts in combination with the loss of physical education programs in public schools make for devastating effects on our children's health.

Protect your kids. Until the nationwide restoration of physical education funding occurs, one of the most effective counterstrikes you can mount as a parent is to limit your child's television time to two hours a day or less.

The link between TV and adiposity (fatness) is well-documented, and trifold: If you're watching TV, you're inactive. If you're watching TV, you're being bombarded with food messages. And even without this bombardment, if you're watching TV, you're likely to snack. Today any parent will adamantly attest that the era of seeing and not hearing children is very much over. These days, children are viewed by food manufacturers as market controllers. They call it the "pester factor." Junk food companies target these young consumers as vigorously as car companies vie for the attention of the over-30 crowd. Add to this a baggy clothing fashion trend among kids and a culture of perceived effortlessness (see "Getting--and Keeping--Children Active," July/August 2003, page four) and you've got a true recipe for disaster. Limiting young people's exposure to unhealthy food messages is essential. Have your family join the 10th Annual TV-Turnoff Week, April 19 through 25 (www.tvturnoff.org).

Protect your health. If your BMI is 25 or above, What can you do about it?

Recognize starting on a weight loss program, while never easy, doesn't have to be joyless. In addition to consulting a registered dietitian for a comprehensive plan specific to your needs, keep the following points in mind:

Set specific--and realistic--goals. It does no good to dream loftily of a 20-pound weight loss six months from now. You need to micromanage, daily, a gradual lifestyle shift. Begin with changes you can make immediately. Starting Monday, promise yourself you'll walk up one flight of stairs each day on your way into work, then take the elevator the rest of the way. Dig out a set of smaller plates and bowls to serve meals, so portions seem larger.

Don't neglect success. Choose a (nonfood) reward for going above and beyond; tell yourself if you complete a week of stair-walking three extra flights each day, you can go out to a movie on Friday.

Verbalize your plans. Tell a friend about your goal and have them hold you to it. Who knows? You may end up with a diet/exercise partner. And if you make plans with someone to meet at the gym at 7 a.m., you won't be able to skip out so easily.

Change food choices. Buying low-fat, satisfying foods like fresh fruits and vegetables, whole grain pastas, nuts and skim cheeses can contribute greatly to a healthy weight-loss plan that includes regular exercise. If you have these foods readily available at home instead of potato chips, processed frozen foods and candy, these are what you'll be reaching for when hunger strikes.

Get relapse-ready. During your diet, if you should indulge, give yourself permission to make a new start at the very next meal. If you miss a workout, expect of yourself a fresh start the next day. Eventually your goals will feel a part of your regular lifestyle.

Enjoy the challenge. Treat your weight loss program a little like a game. An attitude of "Let's see if I can ..." will take you far. For example, you can purchase a step counter (see Jan/Feb 2004 for more information) and try to clock more steps this week than you did last week. Likewise, you might research new and tasty recipes for healthy eating and see if you can pull them off in the kitchen. This will keep things fun and far from feeling like work.

Add weight to subtract weight. Once your weight loss plan is up and running you might find you're becoming bored or less challenged by your original goals. If you haven't the time to walk or run longer, try adding weights to your existing regimen. One- to three-pound, vinyl-covered wrist weights are a comfortable and convenient way to burn 20% more calories power walking your regular route. These weights also build lean muscle mass and help you develop strong rotator cuff and shoulder muscles.

(Phys. & Sportsmed., 2003, Vol. 31, No. 11, pp. 23-28, 33-38, 41-44; No. 10, pp. 18; Food Politics: How the Food Industry Influences Nutrition and Health by Marion Nestle, PhD, University of California Press, Berkeley, CA, 2002, 469 pp. $15.95; Am. J. Clin. Nutr., 1991, Vol. 53, Supp. 6, pp. 1621S-1624S; Physical Activity and Health: a Report of the Surgeon General, Foods and Beverages Sold Outside School Meal Programs and Fact Sheet on Food Service, www.cdc.gov)

RELATED ARTICLE: Obesity Facts

Obesity is defined by a body mass index (BMI) of 30 kg/[m.sup.2] or higher

Overweight is defined by a BMI of 25 to 29.9 kg/[m.sup.2]

Normal is defined by a BMI of 18.5 to 24.9 kg/[m.sup.2]

Underweight is defined by a BMI of less than 18.5 kg/[m.sup.2]

BMI = [[weight in lbs.]/[(height in inches)[.sup.2]] X 703

* Calculate your BMI at www.cdc. gov/nccdphp/dnpa/bmi/bmiadult.htm

* For kids, be sure to refer to the growth charts at www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm

* The prevalence of obesity is highest among Mexican boys and African-American girls.

* Between 15 and 20% of 17-to 20-year-olds are not eligible for U.S. military service due to excess body weight. Nearly 45% of women would not qualify for Army service.

* Only 24% of the general population engages in moderate physical activity for 30 minutes a day, five days a week.