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Women & obesity.

Ask Meredith Meyers if she was overweight as a child and she honestly doesn't know. Her mother certainly thought she was. She put Meredith on one diet after another, beginning at age eight.

"Every summer her goal was to see how much thinner I could be to go back to school in the fall," Meredith recalls. Yet Meredith never shopped in the "big" girls' clothing sections, never got teased about being overweight, and doesn't appear as anything other than a normal, healthy little girl in pictures from that time. Nonetheless, her mother, who had her own weight issues, insisted that Meredith was too heavy.

While much of Meredith's early life focused on dieting, now she has shifted her focus to healthy eating and exercise and thinks she finally is on the right path. Today, at barely 5 feet and 44 years old, she weighs 165 pounds--27 pounds less than she weighed three months ago thanks to major lifestyle changes she's making. Her weight and height combine to give her a body mass index (BMI) that classifies her as obese. (1)

"I have no doubt that my current issues with weight were heavily influenced by my mother's unending desire for me to be thin and all that goes with that, i.e. happy and popular and successful," she says. "In fact, when my husband and I bought the house we now live in, my mother's response to the news was, 'You'll have to go on a diet. You wouldn't want to be the fattest one in the neighborhood.'"

She's definitely not the fattest girl in the neighborhood any longer. Throughout the country, an estimated one out of three women are considered obese, while two out of three are either overweight (a BMI of 25 or higher) or obese (a BMI of 30 and higher). (2) Although there are more overweight men than women (57 percent vs. 43 percent) there are significantly more obese women than men (54 percent vs. 46 percent men).

What's more concerning, however, is that overweight women have more than six times the amount of disease as men, and obese women nearly twice as much as obese men. Obese women are also more likely to die early than overweight or obese men. The numbers are so significant that in the not-too-distant-future they may wipe out the longevity advantage women have over men, says Peter Muennig, MD, MPH, a professor at Columbia University in New York, who published a study on this topic. (3)

Why does being overweight seem to hit women so much harder than men? Part of the reason may be related to the stigma of being overweight, says Dr. Muennig, since there's more pressure on women to be thin. Other research shows that stigma--whether related to weight, race, sexual preference or mental illness--can be deadly. That's because such stigma--regardless of what it's directed against--unleashes a cascade of inflammatory chemicals implicated in everything from heart disease and high blood pressure to possibly even cancer. Ironically, those same chemicals increase your risk of obesity--creating a vicious circle. (4,5)

There is some good news amidst all this: The numbers of overweight and obese women have remained steady between 1999 and 2004, even as the numbers increased for men and children. (2)

And that's enough to give hope to nutrition and weight experts like George L. Blackburn, MD, PhD, associate professor of nutrition at Harvard Medical School. "It gives you optimism, because women are always the leader in this area," says Dr. Blackburn. Women are often the ones who shop and cook for their families, he says, and they keep their fingers on the pulse of their families' health. "If they've 'got it' and are not increasing their weight, that's big news."

What women are apparently "getting" is the seriousness of what many health experts call an epidemic of overweight in this country. A 2006 national survey conducted by the National Women's Health Resource Center, in which nearly two-thirds of the respondents were clinically obese, revealed that women overwhelmingly understand the health risks associated with being overweight.

Still, today, an estimated 66.3 percent of adult Americans weigh too much, compared to just 33 percent who were overweight between 1988 and 1991. (6) The reasons for the rise are numerous: bigger portions, less physical activity, more processed foods, greater stress. "We live in a perfect storm of obesity-causing factors," says David Katz, MD, associate professor of public health at Yale University School of Medicine and the author of several books on nutrition and weight loss. "You can either let the floodwaters overtake you or learn how to swim."

Global Epidemic with No Easy Answers

If there's any comfort, America isn't the only fat country in the world. The World Health Organization (WHO) notes that obesity has reached epidemic proportions globally, with more than one billion adults overweight and at least a third obese. Ironically, countries with high levels of malnutrition, such as India, also have co-existing levels of overweight and obesity. The epidemic is also not restricted to Western countries with fast food restaurants on every street corner; in fact, the increase in overweight population is often rising faster in developing countries. Wherever the problem occurs, the WHO says it is attributable to increased consumption of foods high in sugar and saturated fats and low in nutrients, combined with reduced physical activity. (7)

The answer to the epidemic isn't as simple as putting the world on a diet. There's little evidence that restrictive-calorie diets work in the long-term, primarily because by their very nature they're designed to be short-term, unnatural ways of eating. Think about it. Would you only eat protein and fat if you had a choice? Would you spend the rest of your life counting "points" if you didn't have to? Would you deliberately set out to get less than 20 percent of your calories from fat? Yet that's just what three of the most popular diet plans--Atkins, Weight Watchers and Ornish--call for. By the way, in case you were wondering, a major study found none any better than the others when it came to long-term weight loss. (8)

Meredith Meyers knows that well. She figures she's lost and regained more than 100 pounds over the years on at least six diets. "My opinion of 'diets' is that they are, by name alone, too overbearing," she says. "There has to be a fresh approach to the whole concept and elimination of the particular four-letter word 'diet.'"

In fact, "yo-yo" dieting like Meredith practiced for years--in which you lose weight on a diet then gain it back in a process known as "weight cycling"--is associated in some studies with a greater risk for obesity and a reduction of "good" HDL cholesterol. (9,10)

Instead of trying to stick to the latest restrictive "fad" diet, focus on eating a diet high in fruits and vegetables, complex carbohydrates and lean protein, and low in saturated fat and added sugars. And downsize your serving portions.

One study compared this way of eating combined with moderate physical activity and training to recognize signs of hunger and fullness and eliminate eating in response to "emotional cues" to a more traditional diet that restricted calories in obese women. After two years, both groups maintained the same weight (yes, even the dieters, who initially lost weight but then regained it). Unlike the dieters, the intervention group experienced significant declines in "bad" LDL cholesterol and blood pressure levels and quadrupled their physical activity levels. Just as important were the improvements in self-esteem and depression that the women in the intervention group experienced, improvements none of the dieters showed. In fact, the study found that the dieters' self-esteem plummeted. (11)

Measuring Weight-Related Health Risk

Just because you're overweight doesn't mean you're unhealthy. It can take some time for weight-related health issues to surface. "We know that obesity significantly raises your risk for developing high blood pressure, unhealthy cholesterol levels, diabetes, sleep apnea, heart disease and certain cancers," says Dr. Katz, so it pays to act preventively.

"The best way to gauge your risk for health problems is with a tape measure," says Dr. Katz. That's because the fat that collects around your middle is the same fat that puts you at risk for many of these weight-related diseases, including diabetes and cardiovascular disease. Women should be concerned if they have a waist size over 34 inches.

"What you see is that people's weight may be a marker for other things that are going on their lives," says Dr. Muennig. So, for instance, someone who is very overweight is probably not eating many fruits, vegetables, whole grains and healthy fats, all of which can help prevent disease. They're probably also not getting the 30 minutes a day or more of physical activity that studies find can reduce the risk of many diseases. These healthful lifestyle habits, when pursued consistently for the long term, can help to reduce weight gain.

It wasn't her own health that finally led Meredith Meyers to get serious about losing weight. Her blood pressure is fine, and she doesn't have diabetes or heart disease. But her mother has had bypass surgery. "So given my size, my doctor and I wanted to attack my weight before it got worse and before any health issues did start," says Meredith.

Her doctor prescribed phentermine (Fastin), the "Phen" in the combination "Phen-Fen" medication. The second part of the combo--fenfluramine (Pondimin)--was withdrawn from the market in the late 1990s after it was linked to serious heart problems. Like all weight-loss drugs, a pill wasn't enough to lead to significant weight loss. (See Ask the Expert on page 7 for more on weight-loss medication.) Meredith also had to change her lifestyle.

She started by ridding her diet of all coffee, tea, soda, caffeine and processed sugary sweets as a way to clean out her system. "This has cleansed my palate," she says, "and the natural sweetness of fruit is now satisfying for a dessert or evening snack."

Then her seven-year-old daughter joined a gymnastics team that practiced for two hours, three times a week. The gym was right around the corner from a local fitness center where Meredith began working out three hours a week.

She also starts her meals with just two things on her plate--lean protein and vegetables. "If I focus on the protein and the vegetable, my hunger is satisfied enough that the lure of yummy, quickly satisfying carbs is eliminated or at least diminished enough that I have more control over portion or food choice," she says.

She doesn't focus on individual foods or meals, but, rather, her entire pattern of eating. "Whereas in the past I would have been critical of each and every meal or snack, my concentration is now focused on a whole day's worth of calories and food choices and the ability to enjoy some previously forbidden foods without ruining the whole diet," she says. "By managing the negative feelings, it is much easier to stay the course for the long haul as opposed to micromanaging each misstep."

Finally, and just as important, she redefined her goal for weight loss. "A few years ago, my goal would have been to be a particular number on the scale," she says. "But this time it's to be healthier and stronger."

She defines that not by the size of the clothes she wears, but by whether she has more energy to play with her daughter. "I don't care what the scale says," she says. "I feel better, and I'm stronger. Today, I view weight as a byproduct of all the other parts of your life."

She has two messages for other women who are overweight: First, "When the time is right for you to make that lifestyle change, you'll know it." And second, "Just because you're overweight doesn't mean you're unhealthy."

Most important, she adds, "Being overweight doesn't mean you're a bad person."

Resources

The American Obesity Association (AOA)

202-776-7711

www.obesity.org

A nonprofit organization dedicated to promoting education, research and community action that can improve the quality of life for people with obesity.

Shape Up America!

www.shapeup.org

A nonprofit national initiative to raise awareness of the importance of healthy eating and increased physical activity for weight management and disease prevention.

TOPS (Take Pounds Off Sensibly) Club, Inc.

800-932-8677

www.tops.org

A nonprofit, non-commercial, weight control support group with approximately 10,370 chapters that focuses on weight reduction through sensible dieting, regular exercise and group support.

Weight Control Information Network (WIN)

877-946-4627

win.niddk.nih.gov/index.htm

Established by the National Institutes of Health as a national source of information on weight control, obesity and weight-related nutritional disorders for health professionals and the public.

Definitions

Body mass index (BMI): A number calculated from weight and height that provides a reliable indicator of body fat for most people.

You can learn how to calculate your BMI at www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/ab out_adult_BMI.htm.

Overweight: In adults, a BMI greater than 25; in children, a BMI between the 85th and 95th percentile for their age.

Obese: In adults, a BMI greater than 30; in children, a BMI in the 95th or higher percentile for their age.

Visceral fat: Metabolically active fat that accumulates in and around abdominal organs, including the liver.

RELATED ARTICLE: The Second Annual WomenTalk National Survey

In the summer of 2006, the National Women's Health Resource Center hired Harris Interactive to survey 1,087 women ages 18 and older about various health-related issues, including their weight. Although the majority of women in the survey were found to be clinically overweight or obese most were taking steps to help themselves or family members lose or maintain a healthy weight, primarily by making better selections at the grocery store (79 percent), starting an exercise program (49 percent) and reading books about healthy cooking (42 percent). In addition, 80 percent of women think it's extremely or very important that they maintain a healthy weight, yet 70 percent report that they are worried about themselves or a family member being overweight. (12) Visit www.healthwomen.org for more survey findings.
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Publication:National Women's Health Report
Date:Oct 1, 2006
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