The Little Known Truth About Being BIG

By Alex Lubischer

America’s obesity epidemic boils down to this: We do not move our bodies enough, and we eat too much food.

Genetics can play a key factor, but at the macro level, the exponential spike in obesity over the past 100 years is far too rapid to blame on a genetic shift in the human populace. Obesity is a very recent problem (when you factor in millennia of human existence); it’s a very American problem (we’re the second most obese nation on earth) and is more environmental than evolutionary; more behavioral than innate.

According to the Centers for Disease Control and Prevention, 35.9 percent of American adults were obese in 2009 and 2010, while 69.2 percent of adults were overweight, including obesity. In the Chicago metropolitan area 61.2 percent of adults are overweight or obese.

Our choices created this problem.

Admittedly, this sounds a bit tyrannical, a bit unsympathetic and maybe a bit dumb. “Our choices created this problem.” Nobody would choose to be fat. But, as some of the most renowned bariatric surgeons, nurses and health gurus in Chicago elucidate, the choices we make daily about what we eat, how much we eat and how much (or how little) we move add up, bit by bit, calorie by calorie, over days, months, years and decades.

Chances are, you think you already know most of what there is to know about obesity. Chances are, you think obesity is about how much a person weighs. Chances are, if you’re not horizontally large, you think this article is about other people’s problems. And that’s where you would be mistaken.

At the end of the day, an obese person is an individual with an excessive amount of body fat or an unhealthily distributed body mass index (BMI), not only somebody who weighs too much. While there is often an overlap between weight and high concentrations of body fat, it’s what’s inside that is literally killing us.

This means that thin people and not-thin people with a high body fat percentage will likely develop one or more of the following serious, and sometimes potentially deadly, conditions:[list]

[item icon="9881" ]Coronary heart disease[/item][item icon="9881" ]Type 2 diabetes[/item][item icon="9881" ]High Cholesterol[/item][item icon="9881" ]Stroke[/item][item icon="9881" ]Liver and gallbladder disease[/item][item icon="9881" ]Sleep apnea and breathing problems[/item][item icon="9881" ]Osteoarthritis (a breakdown of cartilage and bone within a joint)[/item][item icon="9881" ]Reproductive problems[/item]

Consider the recently discovered, yet largely unpublicized, phenomenon of normal weight obesity (NWO). People with NWO have a normal weight, but a high percentage of body fat (more than 30 percent for women or 20 percent for men); they have many of the same serious health risks as does someone who is obese.

And the amount of Americans with NWO is staggering.

When Mayo Clinic researchers presented their findings on NWO in 2008 at the American College of Cardiology’s Annual Scientific Session in Chicago, they had studied 2,127 normal-weight adults, equally divided between men and women. They discovered that more than one-half of the subjects had NWO. It is so prevalent that an estimated 30 million Americans likely have this condition.

Although the risk of killing ourselves by way of obesity increases with the numbers on the scale, we all need to be on guard.

Philip Barnett, 27, could be on a reality TV show. He is the kind of person whom journalists most often interview when they write about weight loss, perhaps because his story follows the script of an American pulling himself up by his bootstraps and winning—the kind of story we’re willing to listen to when we talk about weight.

He is a nice man who lived in Oak Park but recently moved to Columbus, Ohio, with his wife and their two dogs. He lost 105 pounds over the course of seven months following a sleeve gastrectomy (now a total of 112 pounds shed), and who, in September, ran a half-marathon. He has overcome a lot, works hard at maintaining his health and weight and now enjoys the benefits of that hard work.

Barnett had been a self-described “bigger guy” since childhood but became more svelte and remained healthy throughout high school. A big part of this was sports; he grew up playing tennis, baseball and golf, and played varsity hockey in high school.

In college, though, his weight began to escalate.

“As I got older, [I never thought I would weigh] 200, 220, 240,” says Barnett, “but it kept going up and up and up. Diets had limited success. They would work for a while, and then things would fall apart. My weight just slowly crept up on me.”

Four years out of college, he weighed 295 pounds. Barnett attributed most of his weight gain to overeating.

“It was a quantity thing. I knew how to eat healthy. I’d be eating good foods, but I would be eating a really large quantity,” he says. “It slowly spiraled out of control.”

At age 24, weighing nearly 300 pounds, Barnett suffered from shortness of breath and had trouble walking up stairs; even carrying one of his golden doodles from one room to the other became a near-impossible task. Concerns over his own mortality eventually prompted him to take action.

“When I got married, I looked at my wife and thought, ‘I have this beautiful wife; I have a great life; I have a great job; I love what I do; and I’m going to lose this all in 20 years if I don’t get my act together.’”

In December 2012, three months after his wedding day, Barnett went to the Loyola Center for Metabolic Surgery & Bariatric Care for his first appointment. He enjoyed the full-team approach, meeting with the program’s director, Bipan Chand, MD, and the primary surgeon, P. Marco Fisichella, MD, as well as a psychologist and nutritionist.

Given Barnett’s problem with food quantity, gastric sleeve surgery—in which a portion of the stomach is surgically removed, reducing its size to about that of a banana—seemed to be the best option for him.

Before he was approved for surgery, though, Barnett had to complete an intake questionnaire to paint an accurate picture of how and why he struggled with weight. The questionnaire gauged how he related to food, analyzed his eating habits and scanned for possible eating disorders.

Two weeks before surgery, he began a strict diet of protein shakes, chicken broth and water to start the weight-loss process and prepare his organs for the surgery.

“Even in those first two weeks, I lost almost 20 pounds,” Barnett says. “It was a total battle for two weeks because your stomach is still this large size. You think, ‘Just get through the day; just get through the day.’”

To this day, he won’t go near chicken broth.

Postsurgery, Barnett’s weight loss was so dramatic that it garnered concerned inquiries from co-workers in his office. They asked whether he was OK; whether he was on drugs or whether he was having marital issues. Clients whom he had met only a handful of times failed to recognize him.

The speed of Barnett’s weight loss was quickened by daily exercise. “Right off the bat, I was walking five or six miles a day. On a Saturday, I’d walk eight miles with my dogs. Now, if I don’t run in the morning, I feel awful. Exercise has become like a new drug—a good drug.”

In June 2013, the American Medical Association officially recognized obesity as a disease.

Chand, the doctor who worked with Barnett, thinks this is a step in the right direction. “A lot of the [metabolic disorders] that Loyola treats—cardiovascular disease, diabetes, lipid disorders—are very commonly linked to obesity,” he says, “Obesity is a central theme; if you treat it, many of those other conditions will improve.”

Patients don’t often come to see him only because of their weight problems, he says. Many come because they are concerned with their medical illness.

In addition to looking at the percentage of body fat, doctors use BMI to measure obesity levels. BMI is a measure of body fat based on height and weight. It is determined by dividing your weight in kilograms by your height in meters2. A body mass index of over 30 kilograms of fat per meter2 is considered obese, while a BMI between 25 and 29.9 is considered overweight.

“It’s not just that we’re seeing more obese people, but we’re seeing even greater degrees of obesity,” Chand says. He explains that class 1 obesity is a BMI of 30–34.9, class 2 is 35–39.9 and class 3 is over 40. Superobesity is anything over 50.

The percent increase in all of those categories is going up significantly.

This isn’t just an adult problem; the same thing is happening to our youths. In 2009 and 2010, 18 percent of adolescents, as well as children ages 6 through 11, were obese. The percent increase of obesity in adolescents is even higher than it is in adults.

“It’s taken two or three decades to see this rise in adults, and it’s happening even faster in adolescents,” says Chand.

What should be kept in mind is that not every person with a high BMI is at risk. Take body builders, for example. They may weigh a lot and be short, but most of that weight is healthy muscle. So, again, the danger comes into play when the BMI is high for a person with a large body fat percentage.

“We need to do something [about obesity] earlier on,” Chand says. “I think a lot of what needs to be done is in the realm of education.”

That’s where Stacey Cook comes in.

Cook founded Project Fit America (PFA) when she was 28 on a budget of $62,000 per year that she received through a private seed grant.

“That first year, I lived on hope and tuna fish sandwiches,” says Cook, her characteristic pep as evident as ever.

Before PFA, Cook made a name for herself selling playground equipment to grade schools.

“I saw that only the wealthiest schools were my clients,” she says. “It was a disturbing trend that schools that could not afford products were not getting access to the kinds of things that were needed to help kids be active.”

Then, Cook had what she calls her epiphany moment: “I thought, ‘What if instead of selling to superintendents, I were to sell to corporate America and give everything away to the schools that can’t afford it?”

Today, PFA is a national nonprofit public charity that donates fully funded cardiovascular health and lifetime fitness education programs to K–12 schools. The two-year program’s driving purpose is to create new and sustainable opportunities for kids to be active, fit and healthy as part of the everyday school experience.

At 52, Cook serves as PFA’s executive director.

“As of this year, I’ve raised in the neighborhood of 13 million dollars,” she says. “Seventy-five cents of each dollar goes to the frontline educators, whom the kids report to, because they are the change agents. They are the ones who are going to make a difference.”

Project Fit often targets local hospitals, like Gottlieb Hospital near Elmwood Park to be its partners in bringing effective fitness and lifestyle changes to schools.

“Hospitals are awesome partners because they become our eyes and ears in the community,” Cook says. In addition to having data about the health and demographics within their community, many hospitals have corporate partnerships for other capital campaigns, making them ideal partners for PFA.

According to Cook, the academic side of the organization is where the magic really happens. “The truth is that the equipment we donate will get kids fit—but only through the games and activities teachers are teaching.”

Cook refers to PFA’s exercise programs as camouflage fitness because they succeed by making exercise fun and giving the kids goals. Additionally, students will learn various health tidbits, like the fact that the heart is a muscle, or the four bad S’s (sugar, salt, soda, sedentary).

“There is so much stuff [kids] can do now that they actually like that involves zero movement,” says Cook. “So when we look at getting a kid active, it has to be cool.”

In one workout, kids play different games that earn them Fitness Cups, trying to accumulate the most cups so that they can stack the biggest tower. At the grand opening of Elmwood’s Project Fit program, Chicago Bulls’ mascot Benny the Bull made a celebrity appearance.

The schools almost always see results.

In John Mills Elementary School of Elmwood, for instance, 6th graders pre-PFA were able to do an average of 13.89 flexed- arm hangs at the start of the program; after two years, the average 6th grader was able to do 20.94. It took the average 6th grader 10 minutes, 59 seconds to run a mile two years ago; now, they can run a mile in 9 minutes, 56 seconds.

Cook stresses that the key to the program lies in self-empowerment.

“There’s a trend in America’s approach to childhood obesity,” says Cook. “People say, ‘Get ’em moving; get ’em moving; get ’em moving.’ That’s a missed opportunity. We have to get them moving, but we also have to get them physically educated. If [kids] can be physically educated, then they’ll know how to take care of themselves.”

This doesn’t just work for kids. It works for adults, too.

After six years as the vice president of David Barton Gym, Freddie Wolner became frustrated by the gym’s inability to help most of its clients lose weight. Even adding a nutritional counseling component failed to make a dent in the numbers.

Now as executive vice president at Revolution Physical Therapy Weight Loss, he says, “I realized that these patients were dealing with stress, anxiety, fear of failure and sometimes even emotional eating,” says Wolner. “No dietician or personal trainer is trained to deal with that. I knew, when I moved to Revolution, that I needed to add a behavioral component to the weight-loss program. We call it Motivation Management.”

Wolner learned that unless patients’ behaviors changed, they weren’t going to see a positive outcome. Today, Revolution’s clients meet weekly with motivational management counselors; all counselors have either a PhD or master’s degree in their field.

His clear-eyed, though blunt, analysis of modern-day Chicagoans painted a telling picture of why two-thirds of us are overweight. If not an accurate description of every Chicagoan, it at least conveys behavioral traps that most of us have fallen into at one time or another.

“Look at [average Chicagoans]. They get up. They get in an elevator. They go downstairs. They get in their car. They sit in their car. They drive to their office. They park. They get into another elevator. They go up to their office. They sit there. They work. They order lunch. They’re sitting all day. Then they go back into their car, back into their elevator, back into their apartment, and at 7:30, they watch TV, and then they go to bed.

“There are very limited opportunities for movement,” he says. “The gym is simulation—it’s an opportunity to simulate movement—but you don’t have to go the gym. You can do anything, but Chicagoans have to move more.”

Overweight Chicagoans aren’t the only citizens whose behavior follows this pattern, though. A plentitude of thin Chicagoans live this very lifestyle described by Wolner. However, their genetic predisposition for a fast metabolism shelters them from the symptoms of weight gain, despite their inactive lifestyle.

The solution, it seems, lies in focusing on health and wellness, and not on fat.

Candis Saunders and Andrew Miller have never met. The two Cook County residents lead very different lives.

Saunders works as a medical assistant for D. Duane Brann, DPM, in medicine and surgery of the foot and ankle in Orland Park near her home, while Andrew lives in the northern suburbs and commutes to his advertising firm in downtown Chicago. Both of them are parents, though, and both are winning their personal battles with obesity, albeit in very different ways.

At his heaviest, Miller weighed 350 pounds. He weighs 268 today. A client of Revolution, he takes a militant approach to keeping the weight off by going to the gym at least five days a week, meeting with his motivational management counselor on Thursdays and intermittently with his nutritionist. He’s made exercise a near-daily and regimented staple in his life.

Saunders, who maxed out at 283 pounds and currently weighs 172, is a proud mother of four who struggled with weight gain after each of her pregnancies. She turned to Enrique Elli, MD, a bariatric surgeon at University of Illinois Hospital & Health Sciences System (UI Health) for a weight-loss solution.

While at her biggest, Saunders had a healthy body fat percentage but her BMI was in the red zone. This is rare for caucasians like Saunders and more common with African American women. African American women are more likely to have more weight in the upper and lower extremities while keeping a slim waistline, one of the measurements taken when obtaining a body fat percentage. In situations such as these, Chand says it’s best to measure the waist and hips and compare the results—the waist to hip ratio is a good way to predict metabolic syndrome.

Like Barnett, Saunders opted for a sleeve gastrectomy. After making a healthy diet and regular fitness a staple of her life, she had the surgery and never looked back. Today, she says that she works out whenever she can—usually she goes walking with a neighbor about twice a week—and makes sure to eat healthy.

She considers scheduling her first appointment with Elli to be one of the best decisions she ever made.

“Somebody just approached me the other day asking for advice about [her] weight,” says Saunders. “I told [the person] that she should make an appointment with her doctor right away. And if they discuss it, and they feel that weight-loss surgery is an option for her, then she should go for it. It’s one of the best decisions I ever made.”

And the demand for surgeries like this is rising.

Elli estimates that bariatric surgeries at UI Health, has climbed over 25 percent in just the past few years. He attributes the rise not only to an increasingly obese population but also to the lowered risk of surgery. A leak in the stomach following surgery is the most common complication. According to the University of Rochester Medical Center, it occurs in 1–3 percent of surgeries. Elli stressed, however, that at UI Health, the rate has gone down to .2 percent.

“We have better technology now,” says Elli. “Most surgeries are minimally invasive, as opposed to open surgeries, with surgeons making tiny incisions in the abdomen.”

Some, like Wolner, have mixed feelings about the meteoric rise of bariatric surgery.

“If people need help, and surgery is their only option, then I’m thrilled that they can get that help,” Wolner says. “On the flip side, some surgeries can be very dangerous. There should be, for most people, a more reasonable solution than altering their internal organs.”

For the average Chicagoan, though, the burgeoning range of ways to get fit and stay healthy is solidly a good thing. Miller and Saunders both found strikingly different weight-loss solutions that worked for each of them.

Today, Saunders helps her eldest son Nathan, whom she described as being a bit on the heavy side, eat healthy and cut back on fatty foods. She’s also had a positive effect on her own mother’s recent weight loss.

Miller no longer dreads shopping for clothes or looking in the mirror, and he looks forward to a healthy future with his two boys.

“The first day that I got out of the bed and got diagnostically tested at Revolution was harder than every subsequent day,” says Miller. “I’ve been there 200 times since then. It’s facing the facts—acknowledging that your weight is out of control, and that you’re in danger—that’s the hardest part. It’s all downhill from there.”

Published in Chicago Health Winter/Spring 2014