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WHAT DO WE DO NOW?
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By Pam Droog Jones
In mid-April, the U.S. Centers for Disease Control and Prevention
suggested that health risks to average overweight Americans
might not be as bad as people believed. Seven weeks later, CDC Director Dr. Julie Gerberding said, “We want to be very clear. It is not okay to be overweight.”
So what are we supposed to believe? Is it okay to be a little overweight? Is a low-carb diet good for us? How many times a week should we exercise? And for how long? What do the experts say we should be doing to live healthy now?
 Dr. Susan Deusinger, P.T., Ph.D., director of Program in Physical Therapy, Washington University School of Medicine |
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Actually, knowledge regarding health and fitness hasn’t changed much recently. “There’s a lot of assumption about newness that doesn’t necessarily meet the test,” says Dr. Susan Deusinger, P.T., Ph.D., director of Program in Physical Therapy, Washington University School of Medicine. “For many years we’ve known a lot about the benefits of exercise. We already know how to control diabetes. Yet we haven’t paid attention to health advice or knowledge. We aren’t using what we know.”
The question is, ‘Why not?’ One answer, Deusinger suggests, is, “Perhaps it’s because we’ve put a lot of trust in medical science to help us out of hard spots after we get into them.” But more likely, we ignore advice about healthy living because, “We live in an environment in which the control mechanisms are really difficult,” she says. “It’s a super-sized environment and one that encourages sedentary behaviors.”
Dr. Michael Treisman of Florissant Oaks Internal Medicine, part of Mercy Medical Group, agrees. “We are much too sedentary. We spend way too much time driving around or sitting in front of the TV or computer,” he says. Treisman believes any kind of exercise a person can fit in is good. “I don’t think it’s been proven that mild or intense exercise is better for us, but any exercise is better than none,” he says. “It’s difficult to find the time for many of us, but it’s time well spent.”
What about recent reports urging people to exercise in 10-minute blocks? Deusinger says over the past decade research has shown definite health benefits from these short bouts of exercise. “The required duration of exercise sessions depends on one’s goal. For example, if you want to run a marathon, “10-minute bouts of exercise won’t do it,” she says. “If you want to live longer or reduce your blood pressure, then you design your lifestyle and exercise program around those goals, aiming for accrual of 60-90 minutes of exercise and physical activity over the course of each day.”
In addition, Deusinger notes, “We have to get over the notion that the only reason we exercise is to lose weight. We have to stress that exercise is about health, living longer, being functionally independent and not just about weight.”
Treisman suggests turning exercise into productive family time. “Kids today get way too little exercise,” Treisman says. “If parents could get kids into better habits we may save the next generation.”
That is, save them from Metabolic Syndrome, a combination of high blood sugar, high cholesterol levels, overweight, high blood pressure and high triglycerides that indicate a significantly increased risk of developing diabetes and cardiovascular problems. An estimated 20 percent of the U.S. population have the syndrome. The good news is it can be reduced or eliminated. “There are some genetic elements to it, but primarily lifestyle choices contribute to Metabolic Syndrome,” Treisman says. “Some people can overcome it, for example a 45-year-old man who never worried about diet or exercise can get active and lose 50 pounds and turn things around.”
Besides avoiding Metabolic Syndrome, getting and/or staying fit offers numerous other benefits. “Everyone wants to be healthy and independent in their old age and for that to occur you have to have several things in your fitness portfolio,” Deusinger says. “That includes cardiovascular endurance, good balance to avoid falling, flexibility and strength, which is very important to be able to lift
your granddaughter or get up off the floor if you fall. All your tissues are healthier when you’re strong.”
In addition proper nutrition is important for keeping our muscles strong, which brings us back to the CDC’s dual announcements on weight. In the last 20 years, rates of obesity and overweight in this country have skyrocketed: 65 percent of adults are overweight and 30 percent obese. The number of obese children has doubled to 16 percent of all American children. And the costs associated with excessive weight are staggering: about $52 billion was attributed to obesity in 1995, and $75 billion in 2003 (CDC figures).
“For practicing physicians, it makes our lives difficult, treating people with slightly elevated body mass,” Treisman says. “Obesity in no way can be said to be a positive thing, but maybe being a few pounds overweight is okay. But even in my small practice I diagnose two or three cases of diabetes a month, people in their 30s and 40s. They face significant complications but it can be avoided, overcome or controlled by watching the diet.”
That doesn’t mean watching a particular diet. Just as we need to exercise to be fit, we need to eat right to be fit—not to lose weight. “I think in a way we’ve lost sight of the real goal, healthy living,” Deusinger says. “Any diet needs to be sensible, something that seems reasonable to you. It’s a matter of sticking with it and making it part of your life rather than something you do in the next three weeks with the hope of losing 30 pounds. But we are human and there are so many temptations. We just need to make small changes at a time and to be consistent.”
| Natalie Allen, RD, BJC HealthCare school community outreach coordinator, displays a “milk mustache” for fifth grade students at Briar Crest Elementary School
in the Pattonville School District as part of a lesson on strong bones. |
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The new U.S. Department of Agriculture’s MyPyramid, which recently replaced the
Food Guide Pyramid, illustrates this sensible approach. Natalie Allen, R.D., School-Community Health Educator at BJC Healthcare, explains MyPyramid can be tailored to meet an individual’s specific calorie and weight goals. “The new pyramid incorporates exercise and it makes serving sizes a lot clearer,” she says. “Also the food groups are illustrated vertically, not horizontally, to represent that no one food group is more important than another.”
The MyPyramid.gov web site is interactive so you can create your own nutrition plan. “The original Food Pyramid was developed in 1992 so it was time for an update. We have learned more about nutrition and the science of weight management and this new information is incorporated into the 2005 dietary guidelines and the pyramid,” Allen says.
Another recent development in healthy eating, she adds, is the advice to “eat the rainbow”—to select more colorful items which generally are more nutritious. Allen especially urges parents to encourage children to eat fruit and vegetables. “Fruits and vegetables are typically lacking in American’s diets. Only nine percent of children and 25 percent of adults eat the recommended five servings of fruits and vegetables a day. If someone wants to lose weight, turning to these low-calorie, low-fat foods is a good option,” Allen says.
Regarding the current wave of low-carb diets, Allen says several long-term studies, including a major research project at Washington University, are going on now to measure the effects of these diets on people’s health. “Right now we don’t know the long term consequences of a low-carb diet,” she says. “The results are still a couple of years away. The studies usually take longer than the fads last.”
In the end, what’s really new is “the disturbing recognition that there is much to be done to get people to use what they know,” Deusinger says. She believes employers can help. “We spend a lot of time at work and the opportunity to intervene in people’s health on the job is really important,” she says, “not in an invasive way but in a helpful approach.”
A Worksite Wellness project at the Washington University School of Medicine, funded by a CDC
grant, may provide some insight. “We’re very excited about it because we’re basing the intervention that we’re providing on principles of people’s need for feedback, for proximity to exercise, for encouragement and for variety so they don’t get bored,” Deusinger says. “Some corporations have taken this challenge and there is evidence we can decrease the cost of health care as a result. It doesn’t have to be, ‘Oh no, another requirement,’” she says, “but instead, “‘What an opportunity to contribute to people’s health and save money.’”
WORK & WORKOUT |
It has the makings of a reality show, but there are no cameras and although there’s a prize, it’s not a recording contract. Instead the reality is healthier employees at Fred Weber Inc.
Employees have access to an in-house fitness center fully equipped with stationery bikes, treadmills, an elliptical machine and a variety of weight equipment. According to Executive Vice President Tom Barta, the use of the fitness center has grown tremendously this year. The fact that personal trainers are provided and paid for by the company (with the exception of a $5 fee for each session paid for by the employee) may have something to do with the popularity. Currently 34 employees work out with the trainers. And with flextime, they can workout during the day to fit their schedules.
And if that weren’t enough, the latest skinny is a ‘fitness challenge’ including 30 employees who are competing on teams of three for four months. The winning team must lose the most body fat and gain the most muscle mass—they also get points for turning in a food diary and cardio log each week (one point for food journal and one point for every hour of cardio). Teams receive 100 points for every percentage point of body fat lost. The prize is $1,000 to be split among the winning team. Thus far teams have collectively lost more than 135 pounds of body fat in the first month of competition. Losing is winning. |
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