Weighing in on obesity:

Do we practice what we preach?

By Samuel T. Coleridge, D.O., TAFP President

It seems that I have always been interested in weight control. Why, I do not know. Perhaps it is because my parents believed in healthy living and instilled this belief in all four of their children, none of whom has a weight problem. We lived by simple rules. Eat three times each day; no snacks except fruit, which was always on the table. My parents never bought soda except on rare occasions when we might have a ginger ale and ice cream float. They never had candy or potato chips or any of that kind of stuff in the house. We were not allowed to be in the house after breakfast, lunch or dinner except to wash the dishes or do other chores, after which we were “kicked” outside to play. We weren’t allowed to watch TV except for a few hours on Friday nights before going to bed.

We played sports — baseball, basketball, football. We played in the woods, the streets, a vacant field. We rode our bicycles and we walked and ran everywhere. We walked to school and played games in gym class — yes, the schools actually had PE! And we brought our lunches to school. There were no vending machines to make additional money for the school districts because the school districts actually spent money for teacher pay and supplies for the classrooms. We did not have multiple assistant principals; in fact, we had no assistant principals until Junior and Senior High where we had one assistant principal and one principal. There was an administrative staff but it was not huge. Teachers were dedicated to teaching and we loved them as our mentors for life.

Today in Texas we have special session No. 4 to deal with the school finance problem. We had to pass additional or enabling legislation to require elementary schools to provide PE classes where the students actually do some exercise. Additional legislation was required to eliminate soda machines from the schools, but the schools are challenged to identify replacement “food” items that students will want to purchase since they appear to be brain-washed into eating a myriad of junk food that is advertised vociferously on TV and readily available in most homes in huge quantities. Children ask for a ride to the corner drug store and ask for a ride to the local school to play sports instead of walking. I grant you that we live in a more dangerous society where we are hesitant to let our children walk the streets but is it that scary to walk to the local drug store?

When I was in medical school, each student had an assignment in Bio­chemistry to keep a log of all the food and physical activity that we did for a week. We were expected to be honest and quantify the portions for each meal and snack. Likewise, we listed all of our physical activities and were expected to estimate time performing each and then compute the calories expended, sort of like the input and output charts we do for fluid management for our inpatients. Well, I did this and learned to my disbelief that I was not expending a lot of energy. Back then my excuse was that I was studying so very hard and had no time to exercise, sort of like our excuse now that we work so very hard and we have no time.

I learned to read food labels and recognize that “one portion” was about half of what I would consider a serving. I also learned the simple truth that losing weight is really not that hard! If one burns up more calories that one takes in, one should expect to lose weight. Why is it so hard to make our patients understand this? And what about ourselves?

One problem is that there are no advertisements or signs showing the number of calories that we expend in our daily activities: walking for 30 minutes, running for 30 minutes, exercising in the gym for 30 minutes. The number of calories varies on the degree of energy expended and we feel uneasy attempting to quantify this, so it’s hard to find charts that are helpful.

Another problem is that most people including we physicians do not know the size of a serving and do not read labels. Hence we underestimate the number of calories consumed. I note again that patients do not read labels and labels are misleading (intentionally). The label on a common sports drink states 160 calories per serving but if one reads further, it also notes that the bottle has two and a half servings. That’s 400 calories or one-third of a 1,200-calorie diet! Isn’t that amazing? I wouldn’t think twice about drinking the whole bottle during a round of golf or while walking. Is it any doubt that patients find it difficult to lose weight even when they meagerly attempt to do so?

I bother to share these not-so-surprising revelations with you to remind us all that we live in an information age and our patients appear to thrive on learning new information. Perhaps we can use this new culture to change the current bad culture of over-indulgence and under-activity.

Money makes the world go round and businesses exist on our patients purchasing more food, drink, snacks and unnecessary calories. They also thrive when we sit in front of the TV, the computer, a movie theatre screen or in the grand stands of a sports event watching other people expend calories. We should be playing some sport or enjoying (yes, really having fun) a workout at the local fitness center, YMCA, or just outside or in our garages pumping some iron.

As role models and mentors for our patients and medical students/residents/junior partners, what are we doing to keep healthy? It is not too late to start and it is fun. AAFP has emphasized the Americans in Motion program. See the sidebar for this program and other Web sites with additional information to help yourself and your community. It can be fun becoming a more vigorous advocate for weight loss for our patients and demonstrating it to them. It never ceases to amaze me how an obese physician can convince a mildly overweight patient to lose weight. How does one really expect the patient to believe someone who does not “practice what one preaches?”

 

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Americans in Motion Goals

1. Encourage family physicians to be fitness role models.
2. Improve family physicians’ ability to positively affect the fitness of their patients.
3. Enhance the awareness of family physicians’ unique ability to promote fitness within their communities.

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Web Resources:

Healthy School Meals Resource System: schoolmeals.nal.usda.gov

Dietary Guidelines for Americans: www.nal.usda.gov/fnic/dga/index.html

Centers for Disease Control and Prevention: www.cdc.gov

Healthy Schools Healthy Kids: www.healthykidsproject.org

Healthy U.S. Initiative: www.healthierus.gov

Healthy People 2010: www.healthypeople.gov

National Dairy Council: www.nationaldairycouncil.org

Texas Dietetic Association: www.nutrition4texas.org

Texas Department of Agriculture Food and Nutrition: www.agr.state.tx.us

Texas Department of Health Public Health Nutrition Program: www.dshs.state.tx.us/phn/default.shtm

Texas Department of Human Services/Texas Nutrition Library: snplibrary.dhs.state.tx.us/snp

USDA Child Nutrition: www.fns.usda.gov/cnd

USDA Team Nutrition: teamnutrition.usda.gov/library.html

USDA Food and Nutrition Information Center: www.nal.usda.gov/fnic