Fat Times What health craze?

By Philip Elmer-DeWitt

While they were happening, the '80s seemed so darned healthy. Joggers and bicyclists clogged the pathways. Exercise spas threw open their glass doors and mirrored chambers. Folks didn't just watch their weight, they also enrolled in diet movements, diet 12-step programs and diet franchises complete with celebrity TV endorsements and calorically correct prepackaged snacks, meals and desserts. Even the Christmas turkey seemed somehow leaner.

But when scientists finally put a representative sampling of Americans on the scale, the decade's secret scandal was uncovered: rather than getting healthy in the health-conscious '80s, Americans actually plumped out. It's not just that individuals got heavier as they got older, although they did: the average weight gain between ages 30 and 39 is 4 lbs. for men and 9 lbs. for women. It's that fortysomethings are now heavier than fortysomethings were 10 years ago, thirtysomethings now are heavier than thirtysomethings then, and so on down the demographic ladder.

In fact, the latest results from a long-term study conducted by the federal Centers for Disease Control and Prevention show that the number of Americans who are seriously overweight, after holding steady for 20 years at about a quarter of the population, jumped to one-third in the 1980s, an increase of more than 30%. According to a report in the Journal of the American Medical Association, some 58 million people in the U.S. weigh at least 20% more than their ideal body weight -- making them, in the unforgiving terminology of dietary science, obese.

"All of us were stunned," says Dr. Albert Stunkard, a psychiatrist at the University of Pennsylvania and a leading expert on what makes people put on pounds. "It runs counter to what we as a nation seem to be doing." In a sharply worded JAMA editorial, Dr. F. Xavier Pi-Sunyer of New York City's St. Luke's-Roosevelt Hospital sounded the medical alarm, pointing out that the extra baggage is not just unsightly but unhealthy as well. Pi-Sunyer says the plumping of America will put millions of people at an increased risk for diabetes, hypertension, heart disease, stroke, gout, arthritis and some forms of cancer. "If this were about tuberculosis," he observes, "it would be called an epidemic."

Moreover, there are alarming signs that the next generation may be in even worse shape by the time it comes of age. The percentage of teens who are overweight, which held steady at about 15% through the 1970s, rose to 21% by 1991. "The kids eat nothing but junk food," says Liam Hennessey, a special- ed teacher from San Francisco who watches students on school trips open the lunches their parents pack for them, gobble up the Oreos and Pop-Tarts and toss out the sandwiches.

These issues always seem particularly sobering in the wake of the holidays -- after those Thanksgiving dinners, Christmas parties and New Year's revelries have conspired to undermine whatever remained of the previous year's resolutions. But this year the situation may be worse than ever. According to a CNN Prevention magazine poll of 771 Americans taken just before the holidays, nearly 70% said they planned to go ahead and eat whatever they wanted. Most took it for granted that they would put on weight -- nearly 5 lbs. on average. Fully 40% also said they expected to take it off in the New Year, but that may not be as easy as they think. As many a thickening boomer can attest, those pounds just get harder and harder to lose.

In 1990 the U.S. Department of Health unveiled the Healthy People 2000 Goals, an ambitious framework of 22 programs aimed at disease prevention. One goal was to reduce the percentage of overweight Americans from 25% to 20% by the turn of the century. It was, for the Bush Administration, an unusually activist experiment in preventive medicine, with the added purpose of helping curb health costs. Now the U.S. is not only unlikely to meet that target, says Robert Kuczmarski, lead author of the big CDC study, "but it's going in the opposite direction." Just when the country needs to reduce its health-care bills, its eating habits may be pushing costs higher.

How could this happen? How could the health movement, which seemed to be chugging along so energetically, have backfired? There is no shortage of theories. Weight-loss tycoon Jenny Craig blames the news media. "They pushed one diet, then the other," she says. "Now they broadcast that diets don't work." Exercise guru Richard Simmons fingers TV advertising. "It's crazy," he says. "The ads say 'eat, eat, eat!' but show a girl who's so thin she clearly never eats." Julia Child, TV's French chef (no caloric slouch herself), cites sedentary life-styles. "Maybe they're not doing enough in the way of activity," she speculates. "Maybe they don't have jobs. Maybe they're not doing anything but sitting around eating."

And maybe it has something to do with what they're eating: those orders of fettuccine Alfredo that the Center for Science in the Public Interest calls "a heart attack on a plate," or those tubs of greasy movie-theater popcorn, which pack four days' worth of fat into a container nearly as big as a fire bucket, or those servings of extra-rich Haagen-Dazs Triple Brownie Overload, each of which contains 44 grams of fat -- the artery clogging equivalent of half a stick of butter.

Nutritionists say it really boils down to this: despite all the fuss about diet and fitness, Americans in the '80s ate too much and exercised too little. In thermodynamic terms, they took in more calories than they burned, and they stored the excess as fat.

But why that is so, and why it finally hit home in the middle of what everybody thought was a fitness craze, is harder to explain. It's a complex story, experts say, one that pits a lucrative diet industry against an even bigger and more aggressive packaged-food industry. It pits a handful of exercise machines against a century of labor-saving devices. It pits a frenetic workaday pace against the understandable temptation to put one's feet up at the end of the day, turn on the tube and just veg out. It may even turn out that the best-intentioned resolutions made in the '80s -- to lose weight, to eat "lite," to plunge headlong into heart-pounding aerobics -- ended up doing more harm than good.

Saturday night at the Cheesecake Factory in Atlanta: the restaurant is packed with customers waiting up to an hour and a half to stuff themselves with slices of fat-laden cheesecake so thick that most will be forced to take home a doggy bag. A half-pound slice of cheesecake may contain 700 calories -- roughly a third of an adult's recommended daily allowance.Manager Michael Moore notes that the Factory's reduced-calorie cheesecakes languished on the shelves when they were introduced last year. "If people want cheesecake, they don't want 'lite,"' he says. "They come to our restaurant to mow."

Americans, it seems, have been mowing with abandon lately. A thesis about why so many have gained so much weight puts the blame squarely on America's huge, well-oiled, heavily advertised food industry. There may be salad bars at the local fast-food joints, but to find them customers have to run a gauntlet of starchy, beefy delights and breathe air perfumed with the scent of rendered lard. According to the Agriculture Department, the food and restaurant industries spend $36 billion a year on advertisements designed to entice hungry people to forgo fresh fruit and sliced vegetables for Ring Dings and Happy Meals. The average child, says psychologist Kelly Brownell, head of the Yale University Center for Eating and Weight Disorders, watches 10,000 food ads a year on TV. "And they're not seeing commercials for brussels sprouts," Brownell complains. "They're seeing soft drinks, candy bars, sugar-coated cereals and fast food."

Drive-through windows and 7-Elevens just make things worse. Takeout-food consumption climbed sharply in the 1980s -- up about 13%, according to a Roper poll -- as Americans found themselves with less and less time to prepare meals. That represents a triple whammy on the waistline: 1) takeout food tends to be high in fat, carbohydrates, sodium and calories; 2) it tends to be eaten quickly, which means more of it is consumed; and 3) it tends to get eaten, all of it, no matter how much of it there is. "I've found that people have no idea what they're eating," says Claudia Plaisted, a dietitian at Duke University's Center for Living, a health camp for adults. "They just eat until they clean their plates."

Given the size of the servings these days, that is an increasingly dangerous practice. Food that used to be delivered in modest quantities is now dished out in humongous portions that would satisfy Godzilla. Graphing the size of McDonald's largest burgers, from the Big Mac to the Double Quarter Pounder and the Triple Cheeseburger, is like watching America's appetite grow before your eyes. And yet that seems downright modest compared with the bloat at movie- theater concession stands, where candy bars have tripled in size since the '70s. "It's a food and utensil explosion," says Gail Frank, a professor of nutrition at California State University at Long Beach. "For a thousand years we had one glass size -- 8 oz. Then in a decade it's quadrupled in size!"

How can the school nutritionist compete against BigFoot pizzas and Super- Size fries? The $50,000 the U.S. government allots each state annually to teach kids to eat right is lost next to the billions spent designing food and packaging that will ring the kids' Pavlovian bells. A telling statistic: Kellogg's in 1993 spent $32 million advertising a single product: Frosted Flakes. By comparison, last year the produce industry spent $55 million on an educational program to promote its entire product line, from asparagus to zucchini.

This kind of comparison, however, is too simplistic. The reasons people eat what they eat, and as much as they eat, go deeper than government programs, nutrition classes or even the ads on TV.

Look at it from a psychological point of view. According to Dr. Lawrence Cheskin, director of the Johns Hopkins Weight Management Center, "We eat out of emotional needs. We eat when we're happy, we eat when we're sad. We've grown up in a way that food is a substitute for many other things." Or as an eating-disorder sufferer put it, "When I get depressed, I eat fat. It coats my nerves and numbs the pain."

The truth is that for many Americans, the '80s and '90s have been tough. Malaise. Recession. Unemployment. Double employment. The decline of the family. The rise of aids. The real epidemic, says Dr. Dean Ornish, author of the best-selling Eat More, Weigh Less, is not obesity but what he calls "emotional and spiritual heart disease." "There's been such a radical shift in our culture," he says. "People feel lonely, isolated and alienated."

But like the last recession (and, for that matter, the economic recovery), America's new heft is not evenly distributed. The bone-thin models in the fashion ads seem to live only in slivers of the U.S. along the two coasts -- primarily in New York City and Los Angeles. The people in the country's midsection, points out Dr. Michael Jensen, who treats obese people at Minnesota's Mayo Clinic, tend to be beefier. "There's a lot less social pressure to maintain a lean weight in the Midwest," he says.

As anybody who travels widely in America will attest, there are deep pockets of obesity, especially in rural areas and among certain racial and ethnic groups. The CDC study found that the prevalence of obesity was nearly 50% for black and Mexican-American women -- compared with 33.5% for white women. In some Native American communities, up to 70% of adults are dangerously overweight.

In all groups, genetic factors play a role. Scientists have known for years that twins separated at birth are far more likely to grow into the body types of their genetic kin than to resemble their adoptive parents. And last November researchers at Rockefeller University reported that they had discovered a defective gene that disrupts the body's "I've had enough to eat" signaling system and may be responsible for at least some types of obesity. But genetic traits alone cannot explain the American weight trend. As Dr. George Bray, editor of the journal Obesity Research, points out, "Our genes haven't changed in the past 10 years."

One thing that has changed is the cost of eating right. "Junk food is pretty cheap," notes San Francisco lawyer Peter Haley. A Burger King meal may be more expensive than one that is home cooked, but calorie for calorie, burgers are cheaper than the salad bar or the fare at fancier restaurants that serve vegetables. And eating out is a lot easier than chopping broccoli and cauliflower in your own kitchen.

"No woman can be too rich or too thin," goes the old saying. Pity, then, America's underclasses, who are not only poor but heavy -- or at least they have been since 1965, when a landmark study showed that the rate of obesity among the lowest economic brackets was five times as great as among the highest.

In many other cultures it's just the reverse: the rich are fat and the poor are emaciated. Anthropologist George Armelagos of Emory University calls it the Henry the Eighth syndrome, referring to the corpulent King of England who lived so well off the labor of his peasantry. "Think about how many people had to work to make the King the size that he was," says Armelagos. Being rotund is still a sign of prosperity and prestige in Polynesia and parts of Africa.

Food was money for mankind's first million years or so. When it is plentiful, the body -- for sound physiological reasons -- stores the excess away as fat, biology's own energy reserve. It's no accident that fat adds taste to food; evolution reinforces the body's urge to eat the things it needs to survive. In peasant villages, people instinctively gain weight in the summer and burn it off in the winter. Laboratory animals will eat Crisco right out of the can.

The advent of agriculture upset the balance of nature, creating food & surpluses. And the practice of fattening animals for slaughter consolidated those surpluses into the dietary equivalent of a gold brick: the thick juicy steak, marbled with fat.

Nowhere else are those steaks (served rare, chicken-fried, chopped or charbroiled) so affordable for so many as in the U.S., whose farms and slaughterhouses produce an average of 3,700 calories a day for every man, woman and child -- a third more than the recommended daily allowance for men and twice that for women. With the price of beef falling, Americans last year ate nearly 64 lbs. per person -- the highest consumption level in five years -- and that number is expected to increase again this year. No wonder America has become the fat Polynesian prince of the world, the 20th century's answer to Henry the Eighth.

But all this talk of food ignores the other side of the weight-gain equation. Most Americans are bulging not just because they consume too many calories but also because they burn off too few. In fact, people are eating less now than their ancestors did at the turn of the century, when the rate of obesity was much lower than it is today. What has occurred, says Mayo's Jensen, is a century of invention and industrial development. Technology has taken the majority of people out of fields and factories and plopped them behind desks -- and in front of computers. "With more and more conveniences," says Jensen, "we're doing less and less manual work."

The automobile, of course, is a culprit, along with an astonishing array of other inventions: elevators, escalators, garage-door openers, food processors, push-button telephones, drive-in windows and a drawerful of remote controls. "It used to be that when you'd watch TV, you'd at least have to use some energy to get up and change the channel," complains pediatrician Dr. William Dietz of the New England Medical Center in Boston.

If the so-called information highway ever gets built, the situation could get worse. "My husband has gained 10 lbs. since he got his laptop," says Maria McIntosh, a dietitian at the Pritikin Longevity Center in Santa Monica, California, who feels the highway has already arrived at her home. "We're all glued to machines. We're on information overload."

Americans who hold desk jobs and want to burn off extra calories have to do it the hard way: by willing themselves to play organized sports, to go to aerobics classes, to climb onto the StairMaster. But that willpower seems to be flagging. Despite the continued presence of joggers and Rollerbladers on the sidewalks and streets, trend watchers say the exercise movement peaked in the '80s and then headed south. "It's now a 'screw-it' attitude," says pop prognosticator Faith Popcorn. "Consumers are having a secret bacchanal. 'I'll eat,' they say. 'I'll have a drink. I won't exercise."'

Indeed, the CDC reported that in 1991 58% of U.S. adults said they exercised sporadically or not at all. The inactivity was especially marked among blacks, Hispanics, low-income people and the unemployed, according to another CDC study. Even school gym classes, which for generations forced even the laziest students to huff and puff at least once or twice a week, are becoming a thing of the past. Only 36% of U.S. schools still offer daily phys-ed classes.

Meanwhile, many of the steps Americans have been taking to get in shape and lose weight seem to have backfired. Take dieting, for example. Each year an estimated 80 million Americans go on a diet, but no matter how much weight they lose, 95% gain it back within five years. A major problem, say nutrition experts, is that most people perceive their diets as temporary restrictions imposed from outside. As soon as the diet is over, they slip back into their old habits -- putting on the weight they lost and more. "We've got to stop the dieting mentality," says Carolyn Bernardi, program director for the Outpatient Nutrition Center at the Georgetown University Medical Center. "The long-term track record of success for these weight-loss programs is abysmal."

The explosion of "lite" and "reduced-calorie" foods may also have raised the needle on the scale. People often forget that reduced-calorie foods are not calorie-free. Cathy DeThorne, a research director at the Leo Burnett advertising agency, ran a series of focus-group studies for the Beef Industry Council that suggest that when it comes to food, people show an almost infinite capacity for self-delusion. A woman believed she was eating a low-fat diet because she was pouring the fat off her pork chops. Others forsook meat for healthy salads, and then drowned those salads in dressings that contained more fat than the meat they gave up.

Exercise itself has come under attack. Penn's Stunkard suspects that the fitness movement was too narrowly focused, hitting mostly the upper and upper- middle classes and missing the rest of the population. Kathy Smith, a Hollywood fitness expert, thinks aerobics and weight lifting scared a lot of people away. "The exercise message of the 1980s was too strong, too high impact," says Smith. "We ended up with a select group of elite exercisers with hard bodies." The proper message, most health experts now agree, is to set aside time for regular, moderate exercise -- bicycling, climbing steps, walking briskly to work.

The Surgeon General's campaign against cigarettes also seems to have contributed to the bulging of America. Millions of people have given up smoking, driving annual per capita cigarette consumption by adults from its peak of 4,345 in 1963 to 2,493 last year, according to the American Health Foundation. And when people quit smoking, they usually gain weight -- 4 to 6 lbs. on average. But health officials are quick to point out that while those extra pounds may harm your health, cigarettes are even more damaging. Most doctors advise patients that a bit of additional weight is a small price to pay for kicking the smoking habit.

"You're not fat," says Natalie Tolbert, 26, to a friend who has just ordered chicken nuggets, waffle fries, a soft drink and a brownie from an Atlanta fast-food joint. "You're pleasantly plump." More and more Americans are couching their excess in euphemism these days, and they're not necessarily ashamed of it. "Obviously I don't care," says Tolbert, gesturing to her ample figure and equally ample lunch. "I don't care because I find most men I go out with like a woman with some meat on her body."

So does Laura Eljaiek, program director for the National Association to Advance Fat Acceptance, a lobby group that fights weight discrimination. "Fat is a natural state for most women," says Eljaiek. "We feel people should accept their weight without shame or denial."

There is some truth to what NAAFA teaches. And it is certainly unfortunate that some teenage girls have taken to binging and purging and starving themselves to keep their weight in check. But health officials warn that drifting into obesity may be just as dangerous in the long run. The growing prevalence of both extremes suggests America is struggling with something akin to a national eating disorder. "The society is dysfunctional," says Robin Wes, founder of the Little Gym fitness centers for children. "We are eating out of whack."

The situation is not beyond hope. Americans have been persuaded to change * their eating and drinking habits in the past, when the message was clear and the alternatives palatable and affordable. There is 4% less cholesterol in the U.S. diet today than there was 15 years ago. Illegal drug use by adults is down. People are even drinking less hard liquor than they used to, although alcohol still accounts for 5% to 7% of the daily caloric intake of American men.

But it's one thing to switch from martinis to white wine or from saturated fat to unsaturated fat, and quite another to adopt moderation as a permanent life-style. The hardest challenge, perhaps, is to eat and drink just what your body needs, and not one ounce more.

Restraint and self-awareness have never been America's strong suits. How can one teach people to listen to their body? To eat when they're hungry, to taste what they're eating, to eat appropriate portions, to leave food on the plate? Deep, lasting behavioral changes cannot be imposed from the outside. They are internal battles. Before they can be won externally, they will have to be fought internally -- one unsightly, unhealthy bulge at a time.

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With reporting by Janice M. Horowitz and Lawrence Mondi/New York, Ken Myers/Cleveland, Bonnie I. Rochman/Atlanta, Martha Smilgis/Los Angeles and Richard Woodbury/ Houston