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Dr. Joani Jack

Decades of chowing down on fried chicken and lounging on the couch with the remote control have caught up with us.

American waistlines are the widest ever. Our health is slipping, and billions of dollars are spent every year on medical treatments for Americans who weigh too much.

We're in the worst shape ever.

In fact, the number of overweight Americans is reaching proportions that health experts say would have been unimaginable just 40 years ago.

It's so bad that Americans' perception of a healthy body has become warped.

"Over the last 10 years, we are as a society looking at people who are normal weight and calling them skinny," said Donna Day, registered dietitian at Hutcheson Medical Center in Fort Oglethorpe. "People have lost the perspective of what normal is."

Overall, the percentage of overweight and obese Americans has reached a record high of 67 percent.

In the past 35 years the number of American adolescents who are obese has tripled, rising from 5 percent to almost 18 percent, according to the Institute of Medicine.

"Back in the '60s when they started compiling this (weight) data, obesity was just almost unheard of," said Dr. Joani Jack, a pediatrician at T.C. Thompson Children's Hospital.

Doctors in Chattanooga say they are diagnosing children under 10 with conditions previously rarely seen in youth, from Type 2 diabetes to hypertension.

It's not that we want to be fat and unhealthy.

Americans appear more obsessed than ever with health and self-improvement. Our society spends billions on fad diets and weight-loss products. Reality television show contestants are battling one another to drop hundreds of pounds.

"The weight-loss industry is not a multibillion-dollar industry for no reason," said John Bilderback, program manager for Step ONE, the anti-obesity program of the Chattanooga-Hamilton County Health Department. "People obviously want to lose weight."

Yet the most determined person can struggle to achieve the basic fitness levels that for previous generations were the norm. Even Oprah Winfrey, one of the richest women in America, who has employed a personal chef and trainer, is a yo-yo dieter and has spoken about her struggle with her weight.

One of the problems is our convenience-centered and electronics-driven culture. Instead of walking most places as our forefathers did, we drive. Then we sit at desks all day, drive home and watch television. In between, we snack on foods high in sugar, fat and calories.

Nutritionists also say many families demonstrate a shocking ignorance about basic nutrition.

Overweight Americans also face serious physical and emotional health consequences that diminish the quality of their lives, doctors say.

The list of obesity-related consequences is long and not pretty: hypertension, heart disease, asthma, sleep apnea, Type 2 diabetes, premature death. That's not to mention social and professional discrimination and ridicule.

Changing the shape of America will take far more than focusing solely on individuals' willpower, Mr. Bilderback said.

"Right now the environment makes it easy to be overweight or obese, and we're always going to choose easy. That's human nature," he said.

Counselors, health advocates, school officials and policymakers are grappling with how to stop the swelling ranks of unhealthy Americans while preserving consumers' freedom of choice and without adding to the number of children with unhealthy weight obsessions.

Deceptively Simple Formula

The mechanics of weight loss are deceptively simple: expend more calories than you take in.

"It's not rocket science, but it is the first law of thermodynamics -- energy is neither created or destroyed. It's gotta go somewhere," said Dr. Gregory Heath, head of the University of Tennessee at Chattanooga's Department of Health and Human Performance.

But the difficulty of changing deeply ingrained eating habits should not be underestimated, experts say. Americans will have to re-learn how to eat for nutrition rather than for convenience, comfort or to satisfy emotional needs.

"You have to put it in a context of how we live and why do we live the way we do," Dr. Heath said. "The issue then is how do you dig yourself out of this hole, as a culture?"

For millions of Americans, healthy living is a daily challenge. Busy, overworked or cash-strapped people often view taking care of their bodies as a luxury and don't put it high on their priority lists, dietitians said.

"When you can drive anywhere in this city and in five minutes get to an all-you-can-eat food bar, (it's clear) our society is not yet ready to embrace a healthy lifestyle," said Graham Brannan, clinical social worker at Memorial Hospital's Weight Loss Management Center.

Altering an unhealthy relationship to food is a huge challenge, often fraught with underlying emotional issues, counselors at eating disorder clinics say. Compulsive eating in many ways can resemble a clinical addiction, they say.

But compulsive eaters must face their temptations day in and day out, unlike alcoholics or drug addicts who often can cope by avoiding the sources of their addictions, said Noelle Schwantes, program director of the eating disorder unit of Focus Healthcare of Tennessee here.

"Picture an alcoholic trying to face alcohol and use alcohol moderately five times a day," she said.

"Engineering" Unhealthy Lives

The shape of today's Americans has been generations in the making, Dr. Heath said.

After World War II, America witnessed an unprecedented prosperity and a population move from city centers to outlying suburbs, he said. Commutes to work grew longer, and reliance on the automobile increased, he said.

The consequences of these changing habits began to emerge in health statistics in the 1980s, he said.

"We have systematically engineered things like activity and access to healthy food out of our lifestyle, and in place of it are issues of convenience and issues of comfort and of entertainment," Dr. Heath said.

Fewer families today work long hours on the farm or do manual labor, but we haven't changed our eating habits, Dr. Jack at T.C. Thompson Children's Hospital said.

"Our jobs are sedentary ... but our eating habits are still based on the old three square meals a day, like we were going out and working in the fields all day," she said.

Today's environment, in which sugar- and fat-laden foods are cheap and accessible, forces individuals to constantly fight against instincts that evolved over thousands of years, said Mr. Bilderback of Step ONE.

"Our bodies crave sugar and fat. It's built into our DNA," he said. "It doesn't matter what your internal strength is. Eventually if it's around you constantly, you're gonna cave in. ... I think there's a lot of people out there that work really hard to be healthy but they live in an environment that is just more than they can handle."

HEFTY COST

Less than 20 years ago, not a single state had an obesity rate above 20 percent. Today, almost two-thirds of states have obesity rates above 25 percent, according to data compiled by the nonprofit Trust for America's Health.

These rising obesity rates are weighing down the nation's health care system. The obesity epidemic accounts for nearly one-tenth of health care spending in the United States.

In Tennessee alone medical spending on obesity totaled $1.8 billion in 2004, the most recent data available, and in Georgia $2.1 billion was spent in 2004 for preventive, diagnostic and treatment services related to obesity, according to U.S. Centers for Disease Control and Prevention data.

"Obesity will bankrupt this country," said Dr. Billy Arant, a pediatrician and hypertension specialist in Chattanooga. "It's a war that's much more expensive than Iraq and Afghanistan."

Medical spending for treating obesity hit an estimated $147 billion in 2008, an increase of 87 percent from the $78.5 billion price tag of the disease 10 years ago, according to an analysis published in the July edition of Health Affairs.

The cost of treating individual obese patients has remained relatively stable. But the increase in spending has been fueled by the ballooning incidence of obesity, which grew 37 percent between 1998 and 2006, said researcher Justin Trogdon, part of a team of researchers at RTI International, a nonprofit research group in Research Triangle Park, N.C.

For the 6 percent of Americans who are extremely obese, with a body mass index, or BMI, over 40, the extra weight is a matter of life and death.

A recent study from RTI International found that those who are slightly or even moderately overweight live the same length of time as normal-weight individuals, on average. But the study concluded that people with weights at least 80 pounds more than normal live three to 12 years fewer than normal-weight people.

MOTIVATING CHANGE

Obesity takes a toll on quality of life, both physically and emotionally, counselors say.

Often a health crisis triggers a lifestyle change. Sometimes, though, obese people simply grow weary of not being able to enjoy life, said Mr. Brannan, the Memorial Hospital social worker.

"People are so tired of the emotional pain that they're ready to make a change," he said. "The looks from other people, the comments from other people, what they tell themselves in the privacy of their own thoughts."

That was the case for Chattanooga resident Josh Blair, a consultant at Unum who said he'd been conscious of his weight as early as age 11.

"I was already embarrassed to walk around without a shirt," he said.

After stopping the sports that had kept his weight relatively in check as a child, Mr. Blair's weight ballooned while he was in college. He continued to pack on the pounds after graduation in 2006 "when I got a job in the corporate world sitting at a desk all day," he said.

He started most mornings with a sausage biscuit and a Coke from McDonald's and drank at least six Dr Peppers a day, snacking on a candy bar when his job stressed him out.

At 315 pounds, 5 feet 11 inches tall, prediabetic and suffering from sleep apnea, Mr. Blair had gained almost 70 pounds in his first 18 months working at Unum, he said.

He decided to make a change in November, as he and his wife were trying to conceive a child.

"I was 24, 25 years old and I could barely walk up a flight of stairs without getting out of breath. I could barely tie my shoes," Mr. Blair said. "I knew if I wanted to be a dad and I wanted to be around to see my kids grow up and be able to play with them, I needed to do something."

Since November he has lost 80 pounds through regular exercise and replacing carbohydrates and high-calorie snacks with vegetables and fruits. He emphasized that he has a way to go before he'll be satisfied with his health.

"The people that are at a healthy weight are termed super-skinny in our culture," Mr. Blair said. "I'm still a good 30 to 50 pounds overweight, and people are telling me I'm just so skinny now, and I'm like, 'No, I'm not. I need to be healthy.'"

Insensitivity Hinders Improvement

Weight is one area in which it still is socially acceptable to ridicule and judge, said Ms. Schwantes of Focus Healthcare of Tennessee.

She recalled the experience of one of her obese patients who had more than one co-worker actually take away food from her "as if (that) was doing her a favor," she said.

"It perpetuates (the challenge) if somebody is struggling with shame, then constantly shamed (because of) their weight. It's just a chronic, horrible cycle," she said.

The stigma against obesity still is prevalent, Mr. Brannan at Memorial agreed.

"To admit that you have a problem that society says is your fault takes a lot of courage," he said. "To stand up and say, 'I've got this problem and to say that I have failed in the past and that I'm willing to make another effort,' takes a lot of courage."

Despite barriers to healthy living, individuals can make choices today that can begin turning around years of unhealthy habits.

"The good news is, there's a way out. You can be a healthy person again as long as you don't wait too long before you start," Dr. Arant said.

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