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Physicians Speak Out on Obesity

obese man Obesity is one of today's leading public health issues, with more than half of all Americans considered overweight or obese.

In a recent study by Epocrates, over 500 physicians shared their opinions on the severity of the crisis, contributing factors, proposed solutions and health risks caused by the “most severe public health issue” facing America.

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168 Responses

  1. Carol Taylor

    There is no high-fructose corn syrup or trans fats in fresh fruits and vegetables, raw seeds, nuts, most beans and legumes, most wholegrain breads, cereals and pastas.

    Who is being ‘forced’ to buy garbage food that leads to obesity and ill health?

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  2. Dr. Lee Johnson

    Obesity is obtained through more than numerous ways- genes, lifestyle, eating habits, and chemical hormones throughout the body- however I find in patients, they expect a pill or program to fix it all. Really its much harder than re-shaping your body, a person must re-shape their life.

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  3. Lisa Brown

    I think obesity has to do with what is either layed in front of people or the choices that they make pending the thought of money wise as well.

    FROM LISA 23

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  4. Kristal L. Rosebrook

    Interesting thoughts on this topic. I appreciate everyones feedback.

    Kristal L. Rosebrook

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  5. ofexcbq ikoyx

    narfzlgxh wvszhrxui hrbjfdgq ljnokw imsfvzkx zulsfbnac lqncsefj

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  6. Marci, ARNP, FNP

    Obesity, as some in the above commentary have noted, is a problem that has many factors involved in it’s development and continuation. There has been a lot of research in the last 5 to 10 years which points to the fact that for many, obesity is a phenotype which gets switched on to a functioning genotype by lifestyle factors. Once that genotype is operating, losing weight and maintaining weight loss is extremely difficult because of abnormal hormonal signals from fat cells, the stomach and other areas along with a down regulation of response to these hormones in the hypothalamus. Obesity is a disease. Yes, those of us who are obese need to decrease our intake and increase our exercise, but the response to these actions is never going to be as great as it is for those who do not have the obesity genotype switched on.
    In addition, there are some people who do not have the phenotype in their genetic material and will never have to worry about having an activated obesity phenotype.

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  7. Folee

    Obesity is a big problem in the USA. The main problem is the lack of want to cook inside the house. There are McDonalds commercial on television every other commercial break, coaxing people to leave their homes and get food instantly at a fast food resturaunt. McDonalds Served extremely fatty foods, even though they claim to be getting better. The reason they are claiming to be getting better is because they added salads and “healthy” foods to their menu. This is true. They have in fact added a few healthy items to the menu. There is only one problem… Nearly every obese person will CHOOSE the fatty foods over the healthy foods. And even if they DO choose the healthy food, they will have a different food with it that is extremely fatty. Or, they will have so much of the food that it will cause extra fat. Americans need to stop, and actually pay attention to what they’re doing. Go outside, run. Then all the overweight kids say, “I can’t run! It hurts! I’m too fat to run, the fat makes me heavier, which makes it harder for me to run!”… Here’s the catch… I am a runner… IT HURTS FOR EVERYONE!! Running causes physical pain. A fact. GET OVER IT. If you run MORE, it won’t hurt as much, and some of that fat will go away! I don’t understand all these people who say they “barely have anything” and they gain lots of weight. This is simply implausible. I am in fact underweight, and have been for most of my life. I don’t understand HOW you gain so much weight.. I actually wish I could, I weigh very, very little. I actually diet to GAIN weight, and I can’t. America needs to get their act together. Soon. Obesity causes more than 300,000 deaths every year. This is a huge problem. Get on the ball, USA.

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  8. Myron Drazen

    Does anyone know if laproscopic lap band surgery can be performed if I continue to take Plavix and 325mg aspirin as my cardioogist instructed? I had a stent successfully put in my right corronary artery in April of 2006. I have no other risk factors as my BP is typically around 120/70 and I have no indications of diabetes.

    Thanks for any insights.

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  9. Robert C. Grupe, Ph.D.

    My wife Dorothy Cleveland Grupe submitted her comments earlier in this forum. My youth was similar to my wife’s in dealing with weight issues. At age 11 I weighed 190 pounds. I have yo-yo’d for years. Until my doctor gave me the bad news in 2005 that I had become diabetic (7.5) and my BP was 165/105. At that time I weighted 307 pounds. Since 2005 I have changed my eating habits, taking out “empty” carbs, increasing protein and taking up a consistent exercise program including resistance training. I was ADDICTED to food. It was my emotional friend and release valve. I am now 223. I have slowly lost over 80 pounds and am maintaining the new weight. Many have ask me how. So many in fact that I have published a book: BUILDING SAND CASTLES - a Baby Boomer’s Journey Through Addictions outlining my weight loss experience. Personally, I believe permanent weight loss and maintenance is a matter of deep psychological change as with true release from any addiction. I’ll be 60 next year. My A1C is now in normal range (5.3) and with Lotrel, my BP is in healthy range (118/65). My website provides more background information about my challenge with food addiction.

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  10. Michael Joynes

    The obese child is unfortunately becoming the norm rather than the exception.I recall from my childhood that seeing an extremely overweight child was unusual.This is not to “glorify” the good old days as we certainly don’t want to go back to diseases like polio,measles,rheumatic fever,etc.When i was a youngster the fast food chain industry was just getting started.If you lived in certain parts of the country and in less urban areas this stuff was just not available.Now it’s practically inescapable.The co-marketing between Hollywood and the fast food chains attracts the kids and probably has had far more impact than “Joe Camel”.And while the kids are wolfing down the trinket laden meals the parents are gorging themselves on the the fries and burgers.The unashamed and blatant appeal to come in and get a burger with 3 slabs of meat,with extra slices of cheese,bacon and “special sauce” is downright disgusting.No one needs that much food and especially that type of food.And the drinks-loaded with corn syrup-32 or 64 onces worth!-doesn’t any one drink water anymore?This is a phenomonon i’ve seen in my practice over the years that seems more and more prevalent and usually accompanied by loads of excuses-e.g-”i don’t like the taste of water” or “the water has so many impurities” or the best one-”i’m allergic to water”-As a family physician i try to cover some of these areas in a “compressed” fashion but lately i’ve gotten into advising more of the ‘do’s” rather than the “don’ts”-trying to emphasize the importance of regular exercise,consumption of anti-oxidant foods and beverages and stress management.Hopefully these few words of advice will have a positive impact.

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  11. Allan Hernandez MD

    I am a board certified Family Medicine specialist extremely concerned with the obesity problem in the United States. I have dedicated the past 5 years to researching and developing a program to get people started on a healthier weight loss and anti aging lifestyle without using surgery or drugs. I have created a free diet website based on real science as well as my clinical experience and overwhelmingly I am hearing that it really works. Please visit my site and if you like it, feel free to send all of your overweight and obese patients as well as your staff and family members there. The name of the diet is commical to make it sound less severe, but check it and you’ll see it is all well founded and beneficial to the patient.

    Please go to for the unique program full of free information on weight loss and lifestyle modification. The book called the 5 finger diet and anti-aging lifestyle will be coming out later this year and I am sure you will all be asked about it by your patients very, very soon. I have written it in a selfhelp and highly motavational format that gives the patient the tools they need to take responsibility for their weight loss and actually accomplish their weight loss goals. Please let me know what you think of it. My email can be found at the free website,

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  12. Brenda Holiday, NP-c

    There are a lot of complex psychobiosocial issues surrounding obesity; however, the individual is ultimately responsible for their own health.
    I think more attention should be on alcohol and give the smokers a break for awhile. (No I don’t smoke). This almost obession with smoking, while ignoring alcohol and recreational drug use by comparison is a serious error in my opinion. I have alot more patients that are seriously impacted by either their or a family member’s use of drugs and alcohol than smoking.
    National health care will not become a viable reality until the for profit insurance companies are taken out of the loop. I mean, really, how many physicians or hospital administrators do you see with the income of insurance administrators? That comes from unpaid claims for work done and patient paid premiums.

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  13. Carol Tremain

    Our Dr. son sent the me the link to this site. I have read page one with interest. I shall continue, after I tell our story.

    The BMI chart would have called me obese. Back in a snowstorm Nov 30th I fell, tucking my knee under me in an unusual manner. I felt a pull. Since I could walk, and didn’t fancy trying to make it to emergency to sit there all day amid other snow related accidents, it wasn’t until after Christmas (still hurting) that I told our family Dr about it. EX-rays proved there is no bone damage.

    Meanwhile tidying up the living room one Monday morning, I picked up a copy of Reader’s Digest. It opened at a page showing Tylenol for Arthritus. Because I do take these as required (we live on the WET end of Canada) I glanced at the article, and out popped ONE sentence. “Losing only 10 lbs takes 40 lbs pressure off the knees.
    Wow! Really!?! I think I will test this!
    That afternoon my husband came home from a Dr’s visit to say the Dr had told him to lose his front porch (he has a stent in his heart).
    At this I told him what I had read and said, I think it is time for me to go to WW. Since I do the buying and preparing, he would be on a WW diet, like it or not.

    ONE month later… Ten pounds of pressure didn’t cut it. Better, yes, but still pain, so I asked Dr. son if losing 20 lbs would take 80 lbs pressure off. He gave a too quick yes (the kind where you knew he was grinning inside) so I knew what his game was. Our Mathmaticion son spoke up and said.. Mom, I am the one to ask that question, not the Dr…. and at that he went into a detailed explanation about since we carry most of our weight above our knees it is funneled through, and yes, if I lost 20 lbs I would take 80 lbs pressure off.

    TWO months later..and 80 lbs pressure off that knee I went on a day trip with our camera club that consisted of uphill, down dale, over and under trees. Nary a twinge from my knee. I was delighted.

    And while I was working on this, my husband lost his front porch.

    No, this is not a success story.

    I am telling you this simple tale because I don’t think the “obesity” problem is as complex as some highly educated “thinkers” see it.

    If my great grandparents both weighed 400 lbs as did my grand parents and parents…that says a gene problem? Well maybe… But I tend to think that “bad habit” inheritance factors in there as well. Or we can HOPE so, for the other thing they all had in common was they all died before age 50.

    Children who live with, learn to.

    The bricklayer, he takes two sandwhiches and 3 cookies in his lunch box, then comes home to heap a plate for his evening meal. He has three well rounded children. Why? Because the children are learning to eat what Dad does, but aren’t moving bricks all day.
    Perhaps Mom is obese too. And this is where it becomes sad. She is cooking for a “high energy consumption guy”… serves big portions and all become obese, and not necessarily for the love of food. Lack of education or AWARENESS. Habits after all are something we do because it is done, not because we gave it any real serious thought.

    Habitual=you car is on auto pilot to the nearest drive through where they have fancy coffee and muffins to shoot your eyes open with.
    I don’t have to carry on to say that there is a habit worth finding a subsititue for.

    Habit… getting up from the table to turn on the telly for the evening.. commercials being food breaks…. Definitely one we could come up with a number of healthier substitutes for..

    It really doesn’t matter how many great ideas we come up with…. action hinges on the person in question becoming AWARE and WILLING to kick the less healthy habit.

    And maybe it takes medics asking blunt questions. For leg problems for example….. dare one ask the patient.. “Do you want the MASK, or the CURE?

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  14. Aviva Rahmani

    Several things jumped out at me from reading the posts here: the constellation of factors for which obesity is a red flag or symptom; the complexity of addressing that constellation of factors; the seduction & comfort of simplisitc solutions (fat people are morally deficient).

    I am an ecological artist, who studies how sites become degraded and what can be done to restore systemmic change. It strikes me that obesity is the mirror of what and how we degrade our large landscapes. Questions about hormones in food, safety concerns for young children outdoors, being unable to set boundaries in an abundant society: these factors refelect a culture that prioritizes consumption and isolationism. But numerous studies in many fields clarify the depth of our limitations and interdependence. Could it be that “fat” people are the embodiment (literally) of what RD Laing once described as the designated “patient” simply being the reflection of the dynamic system’s dysfunction? The other half of “nomral people’s “Divided Self”?

    I was fascinated by this site. I came across it by accident because I’m on a blog list serve for tech problems. I was curious about a post and that person’s blog led me here. I read the posts after attending a 12-step meeting (overeaters anonymous). That system proposes that internal serenity is the answer to compulsive relationships to food and body image. It is, as they say, a simple program that works if you’re honest.

    This other stuff, is pretty damn complex and certainly needs to be addressed. Strikes me, reading the posts, that a way into some of that complexity is more ethical than the self-righteous condemnation of lazy fat people: like humility, self-honesty and social responsibility.

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  15. Michael Jones MD

    I agree the obesity seems multifactorial. Our children no longer play outside, as a kid I spent from sun up to sun down running around outside playing with my friends, now it is video games, TV, and stacks of homework. Most also have no idea what a proper portion size is or should be. I am still always suprised when I counsel a patient that a majority of their health problems could be averted by 1.getting up and moving and 2.pushing away from the table, the response I get is “just give me the pill doc”, to fix their hyperlipidemia, blood sugar or hypertension.

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  16. Jon EMT-Paramedic

    We have become lazy. We don’t have to leave our chairs to shop, go to movies, or even get help for yard work. The more we cut back on making people go out and do something, the less people will move to do anything. People on welfare are overweight due to not having to work to get their food. Make them work to get their cards. Monitor their weight and health. If they don’t take care of themselves, then why should we? Everyone needs to get out and do more, less video games and television, more outdoor games or walks outside. Yes, we make it easy for people to be lazy, but it’s up to you to take pride in the way you look. Eating well costs more, you need to change that.

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  17. Jaime Santos

    The statement “obesity is due to ingest more calories than we consume” is a platitud. It is certainly a multifactorial condition, the lack of will is not enough to explain it, there are slim people who smoke and do other silly mistakes against their health, or at least never care about how they eat.
    It is necessary to look in two areas: 1) Metabolic factors and 2) the use of hormones and some nutrients in feeding animals who are our protein sources.
    Of course diet discipline and phisical exercising are necessary but the results show that they alone are insufficient.

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  18. S. Green GNP

    The notion that solving obesity is as simple as counting calories and exercising is absurd. Like many growing problems in prosperous nations, obsesity is a bio-psycho-social issue. Aside from the genetic component, there are societal factors. Living with abundance, access to transportation, a blending of the line between gender roles, and the opportunity for families to have two sources of income has its benefits but also its risks.

    There are more two income families, latch-key kids and a lack of supervision over what our children are eating. There is a great deal of anxiety about the safety of children in any neighborhood, so kids don’t go out and play like they used to; especially when there are so many indoor sources of entertainment like video games, television and the internet. Its also much easier to drive the kids to school than to worry about if they’re going to get there. Kids who don’t exercise and have no one to tell them “no more cookies” get fat. Unfortunately, fat kids, tend to become fat adults.

    Anxiety is also fuel for the fire. Why is it that after 911 obesity skyrocketed? When people feel afraid they try to nurture themselves any way they know how. Food is a source of comfort. With so much of it available and so much anxiety people feel over crime, the “war on terror” and the day to day stressors of work and family, its no wonder obesity is becoming more of an issue.

    Commutes have also gotten longer. The more time spent on the freeway (another source of stress and anxiety) is less time spent taking care of ourselves and our families. With two parents working who is cooking dinner? Especially when its so much easier to pick up a bucket of chicken or a few happy meals…or better yet, go to a restaurant. Any of these options are usually not great if we are looking for low fat, well balanced or portion control. People tend to eat what’s presented to them. We’ve been conditioned to clean our plates.

    These are just some possible reasons. The bottom line is this: People don’t want to be fat. It just sort of happens and it isn’t immediate, it’s gradual. A pound here, a pound there, before they know it, the BMI is over 30. Those of us who are of normal weight can not possibly understand what goes through the mind of someone who is obese. Chastising a patient who is obese isn’t only insensitive, and unprofessional, its harmful. What patient is going to seek the care of a health care provider who sees only the obesity at an office visit when the patient has come in complaining of a sore throat?

    Our job, our obligation is to help, to offer a solution, to encourage and follow up. If our own personal biases do not allow for this, then we must refer appropriately, keeping in mind that nutritional counseling, psychotherapy, exercise, and regular follow up visits in a nonjudgemental atmosphere are all key components to trying to solve this issue. Sound expensive? It is. But, as we’re all aware, the cost of treating hypertension, coronary artery disease, type 2 diabetes, cancer, and depression, (all more common in those who are obese) is breaking the health care bank.

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  19. Thomas

    Nice site!

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  20. Jon Leigh DO

    I read with interest the comments. Living and working in the UK we now have the honour of being the fattest and nmost obese nation in Europe.
    Like many of the previous contributors I am of the opinion that obesity is a reflection of the wealth of our society and the easy, cheap availability of food. When I was a child, just after the last war, we ate what we were given and as we say in the UK, ’seconds’ or extra portions were almost unheard of. Since then we have seen the rise of supermarkets, imported food, which we did not have until the late 1950’s. There has been a rise in the average size of women in the UK it has increased from a size 12 to size size 16. This represents a 4 inch increase in bust size from 34 to 38 inches. Waist and hip sizes have increase too.
    In men, the average waist size for the median has increased from 34 inches to 38 inches.
    As a practitoner dealing primarily with musculo-skeletal problems obesity has lead to an increased occourance of hip, knee, anlle and low back arthrotic changes with an ever increasing incidence of knee and hip replacement.
    Obesity is not purely an American problem but wherever there is abundant food, there will be obesity.
    As I tell my patients, and I may say this as it affected my family, there were no obese inhabitants in Belsen or Aushwitz, except the guards.
    In order to treat the majority of obese patients we need to re-educate them simply to eat less, leave the table hungry or to put it more simply, KEEP THEIR MOUTHS shut.

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  21. Nerrante

    We are a prosperous nation(which is a good thing) and there are side effects to this. But, there are a couple main issues to weight.

    1) We need to get aesthetics out of the issue. Many people these days get labeled as “obese” when they are very healthy. It doesn’t take much weight on an adult to be labeled as obese. And I have read a lot of responses here that are more about aesthetics than health. Not everyone is going to have that perfect, idealized body of our cultural times. And that perfect body isn’t necessarily healthy. I’ve treated many perfect body weight Bulimics that demonstrate this. If our culture were not so prosperous we would all want to be over weight and obese since it would then be the symbol of wealth. However, we are in a very prosperous culture so it is not difficult to have a little weight on a person. Due to our prosperity it is then the symbol of wealth when a person is thin, meaning they have the wealth to attend a gym and have a personal trainer and cook, etc.

    2) We really just don’t have much information as to when an individual’s health is actually at risk. Most of the tools are not very accurate.

    I have seen the BMI used often to label patients as obese when they are perfectly within a healthy weight range. I have also seen patients who aesthetically appeared over weight (and even obese) but were in far better health than many patients in a low weight range. I have also read many studies pointing out that it has less to do with weight and more to do with activity. As long as the person is getting certain amounts of activity they are healthy. And I have seen this evidence in practice. When a health care provider chastises a patient about their weight rather than discussing with them their health the person who is obese (though usually just over weight) will stop returning and attempt to avoid the health care system. There are several studies pointing to this as well. Even here I use the terms over weight and mean what the BMI or our aesthetic scales determine them to be. More likely than not, with research, we will find out scales are too small. And that it is more than just weight that determines health.

    As far as what we eat, well, the comments about people not eating the same thing in the past is not accurate. Many of the foods consumed in history are far worse than what is being consumed now. It is that food is in abundance and cheap. Again, we are prosperous.

    Bottom line, we will have no answers until aesthetics are removed from the issue and science and health only take its place.

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  22. Serena, MSN, FNP

    Our culture and the “just out to make a buck” American business model coincide to make this a bigger and bigger problem. While our jobs are becoming more sedentary and time is more crunched, the American food industry produces enough calories for each and every person (including babies!) to have 6000 calories a day. Nobody needs that amount! We really do need to “grow our own!”

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  23. Richard A. Uhlig, D.O.

    Obesity in America is a cultural phenomenon. A corporate culture where a large segment of the food industry is run by Tobacco CEO’s (Phillip Morris, Oscar Meyer meats, Ritz, Philadelphia Cream Cheese), where corn syrup, aspartame, processed carbs, hydorgenated oils are universal ingredients for everything. Where drug and food lobbyists have co-op the FDA, and the Fast Food Industry keeps promising “healthier choices” reminiscent of the auto industry’s 40 year-old promise of an electric car. The new food pyramid is actually 6 pyramids, and as unreadable as a Richard Powers novel.

    Obesity in its weightier part is a political problem.

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  24. PGA MD

    I believe the overall problem of the obesity epidemic is multifactorial, but that’s not to say that all or most of the factors are at work in any one individual (ie. different factors may predominate for different people). Here are some I think are the main culprits (some of these have been widely mentioned by others):

    - the modern American lifestyle for many people demands greater productivity & allows less time outside of the workplace and other (family) obligations. Despite working more, the type of work done by most people, most of the time (& these other obligations) involves less physical activity than ever before. Lack of appropriate amt. of sleep is also linked with obesity (although correlation is not causation; and even if there is cause & effect, which is causing which).

    - another effect of the modern culture is media streaming a constant litany of messages that intentionally (marketing) or not (news) feed us an up to the miniute & never ending list of things to be uneasy about - crime, natural disaster, identity theft, financial market fluctuations, do we need to buy those replacement windows, or that long term care insurance, etc, etc.
    I believe the average man, woman & child has a greater level of baseline anxiety and pessimism than in past generations.
    Food is a very powerful source of instant gratification and pleasure, appealing to the rewards mechanism in the brain (ie. the behavior of eating is instantly rewarding) and in infancy & childhood was, for most people, also associated with the feeling of being cared for, protected and nurtured by our parents - ie. anxiety reducing associations.

    - perhaps due, in part, to the higher productivity demanded of Americans, there is a steady shift in the Amer. diet from basic whole foods cooked at home, to greater use of meals ready made at the grocery store or major components of meals made in factories. This doesn’t even count the greater consumption of fast food takeout.
    Factory modified and factory formulated foods have a severe detrimental effect with addition of ingredients to modify taste and texture. This helps the foods (that companies are fiercely competing to market to you) appeal more to the pleasure centers in the brain - esp. sugar, salt and fat). Some snack and convenience foods and canned foods have come to have a greater content of chemical soup than wholesome food ingredients.
    We’re starting to understand the detrimental effect of some things that end up in our food - like trans fats and the high fructose corn syrup and of hydrogenation of veg. oils. We’re still being desceived or distracted with marketers’ and manufacturers’ misleading claims (like “low Fat” claim on a food very high in carbohydrate and nutrition labels showing unrealistic serving sizes).
    What I say in regard to foods also includes beverages (soda pop is a bad choice, but fruit juices are being doctored so many are just as bad as non-diet soda).

    - finally, I believe there may be additional significant problems, even with whole foods, that have justifiably led to the growing organic food demand. Meat from poltry and livestock may possibly contain hormones, antibiotics, drugs and other chemicals included in animal feed.
    I urge everyone to read (internet) some of the information being discovered about our municipal water supplies. Be aware that a medication’s effect wears off because it is eliminated from the body, sometimes unmodified or little modified. Chemicals in the wastes eliminated from the body can eventually enter the ground water and reenter the water supply. Soluable chemicals are not normally eliminated by filtration and water treatment. Municipal water supplies have been shown to have significant concentrations of, for eg. oral contraceptives. This one class of medications alone could be the cause of many metabolic derangements & health problems in developing children and in adults. It is unknown whether and how much, food and water contaminants could help trigger the metabolic derangements that are part of obesity development.
    When overweight, obesity and abdominal adiposity develop, it is likely that the excess body fat exudes factors into one’s system that promotes additional wt. and fat gain and the tendency toward greater obesity becomes self promoting. It is possible that some contaminants initiate or help drive this cycle, (esp. hormones).
    Advice: simple lifestyle. Grow your own - organic. Buy organic foods. Read food labels. Avoid manufactured & modified foods. Increase activity and don’t think of it as an exercise program, but a new lifestyle. Get enough sleep. Portion control and sensible food choices (when you go to a restaurant, consider only ordering an appetizer or only a salad, no dessert, water to drink). A diet should not be designed to be a temporary thing to achieve some target, but a sensible lifestyle change to be maintained ever-after. Turn off TV & go for a walk.
    The only factor ever discovered to have a definite correlation with increased longevity, in an individual, is caloric deprivation.

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  25. Diane MSN, ARNP

    Many of the previous opinions imply a character disorder as the reason for obesity. This is an environmental and multifactorial problem. (see many of the previous opinions) Our environment is toxic and until our environment changes, I see little hope for this obesity epidemic to change any time soon. Even those that would like to “move more and eat less” find it almost impossible to do given their particular lot in life. I live in a safe neighborhood, can afford a gym membership, home exercise equipment and can even have a personal trainer. (Now if I could only afford a cook!) I’m not sure that medicine will be able to come up with a realist answer. (I would welcome someone proving me wrong) I have no doubt if these same obese persons lived 100 years ago the majority would not be obese. Same character - different environment. For the most part, individuals cannot control their enviroment, and our “lot” in life could change on a dime. We must always remember the expression; There go I but for the grace of God.

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  26. Thomas Kus

    Calories in > calories out = Weight gain

    That’s it - the job is to find out what’s happening on each side, take account of individual habits and basic metabolism and get people who want to lose weight to make long term changes and then weigh themselves regularly to see if they have the desired effect. If yes, stick with it - if no, make further changes. Professionals can help as can software programmes like DietPower ( which I have used myself 4 years ago with great (and sustained) success.

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  27. Kristyn

    When did we start to think that in order to be satisfied after a meal, we had to be STUFFED? Portions are so large and most Americans want MORE. And fast food is the worst. BIGGIE SIZE, should refer to the size you’ll be if you continue to eat that stuff in those quantities! It may only be a fraction of change we’d have to make but it is surely relevant. As a cardiac nurse, I at least have job security because of people’s reluctance to change old habits. Here’s to that!

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  28. C. Rees, M.D.

    These are the culprits as I see them:
    1)automobiles. The year I lived without a car, I had to eat all the time to maintain my weight. In communities where people don’t have cars, sidewalks are full of people, walking is safe, stores are close, and life is more pleasant. The after dinner stroll is a great way to wind down, get out of the house, and mingle with neighbors. (Some urban ghettoes are an exception.) These days anyone on foot is suspect, or prey for hoodlums.
    2)television. Getting together with other people for games, dances, bowling is fun and builds friendships. Instead we sit alone on the sofa and snack for pleasure and escape. I would like to see food advertising on TV go the way of cigarette advertising.
    3)as a result of the above, neighborhoods and parks are deserted, streets are unsafe for bicycles, children do not walk to school.
    4)women no longer control what is eaten by their families and people have gotten used to eating bad food. Time is lacking for food preparation. Marketing for junk food to children has penetrated schools with reading programs and prizes as well as vending machines which, in addition to selling junk, promote constant snacking.
    5)we haven’t found a way to compensate for activity lost when jobs became sedentary.

    A feed lot puts young cattle in confined spaces and feeds them corn and other starchy foods, often sweetened, so they will eat more. The purpose of this is to produce well marbled steaks. Does this you remind you of school? Do we really want well marbled children? At least the cattle are outdoors exposed to sunlight. Cattle, by the way, have a much lower requirement for exercise than human beings do.

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  29. Lesa Bethea

    Obesity is the result of eating more calories than your body needs for daily activity. Period. Fat and food are both sources of stored energy. There is not a human on this planet who will not lose weight on a 500 calorie per day diet. There was not one person in the German concentration camps of WWII who did not lose weight. Weight loss is not a mystery. Weight loss is difficult because it takes discipline. The problem is not how to lose weight. We all know that if you eat few enough calories a day you will lose weight. The true problem is that our American culture that has taken the pursuit of happiness and individual liberties to an extreme and has thrown personal responsibility out the windown. Medicine and especially psychiatry is especially to blame by allowing people to escape personal responsibiltiy by mislabeling all bad behavior as mental illness and therefore taking the responsibility for the behavior away from the individual. I believe we need to start talking in terms of gluttony and morality when it comes to food. In our pleasure-driven and selfish society food has become just one more addiction, no different from drugs or alcohol. People need a moral philosophy about eating and the role it plays in their lives. Read Solomon Schimmel’s The Seven Deadly Sins chapter on Gluttony if you are interested in this idea.

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  30. Wendy Sapolsky M.D.

    I am a practicing pediatrician and in January 2005, I opened That-a-Weigh Kids which is a weight management program for overweight children and teens. I created and developed the program because of the increasing number of overweight children I was seeing every day in my practice, and I, like so many practicing physicians had no ongoing programs designed exclusively for children. I also have struggled with my weight since I was a child and I do believe that genetics is a strong predictor of obesity. However, if there is recognition by parents and physicians at an early age and appropriate intervention, I believe many families are willing to make lifestyle choices and changes to benefit their child(ren).

    I think we all know that many factors play a part in the sad statistic that childhood obesity has tripled in the past thirty years - fast food, computers, decreased physical activity and the overall busy lifestyle of so many of today’s parents. Tackling obesity at any age, from five to seventy-five, is never easy but it can be done! At That-a-Weigh Kids, we have had wonderful success with children at all ages especially when there is committment on the part of all the family members. I still believe in the old fashioned method of losing weight which is eating less and getting more physical activity.

    For all the parents who are reading this, I ask you to take an honest look at your child(ren) and seek help if you are noticing extra pounds creeping up on your child(ren) especially if they are between the ages of 5-9 years of age. Feel free to browse our website at for more info.

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  31. james kluzinski md

    I treat obesity as a chronic unrelenting medical problem. I believe it is 60% genetic and 40% enviornmental. I beleive obesity managment is at the same point that depression teatment was at in the 1950’s or so. I mean “still in the dark ages”. Both conditions have genetic and envirnmental components. Both can be managed medically in motivated patients. In my opinion, neither are character flaws. We now know both conditions are influenced by diferent neruotransmitters, hormones etc. Human obesity is not a homogenous disease. One persons obesity is different from another persons obesity. That is very frustrating. I am a family practice md who is not opposed to using anorectic agents in motivated well worked up patients in a multidiciplinary approach. Some success lots of failures. I have never seen anyone die or be hospitalized because of anorectic medicaions, but God knows I have seen people die of the consequences of obesity. If I can help one out one hundred get better control of this disease process, I believe it is worth it.

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  32. Kevin RN, MEd

    Well Patrick, I doubt riding bikes and skooters will eliminate our dependence on foreign oil. Even so, industry alone requires the use of fossil fuels and natural gas that easily offsets the ‘green benefits’ of walking to work. But your point is well taken, if people could propel themselves to work rather than sit in a car or mass transit, the benefits to their body, mind and spirit would be uplifting.

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  33. patrick CRNA

    Simple answer to fat.

    Human power transportation. No dependence on foreign energy source, health, happy people.

    Provide safe routes and human powered transportation with an economic incentive, we’ll burn our calories and feel better about it.

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  34. Kevin RN, MEd

    Re: Sbeard comment; very interesing argument, one that certainly fits into the obesity puzzle and one I never considered. Indeed, although it would seem that our young peoples increasing interest in being sedantary and eating junk food, I feel that obesity more likely stems from psychological issues, most importantly depression and, like Sbeard says, some sort of sexual trauma. I remember as a kid growing up practically outside my house ( its easy when you grow up in Hawaii), always playing with my friends. I remember the largest size soda I could have was the 12 oz size. Nowadays I see kids routinely drinking the 20 oz size, thats nearly twice the calories, and these kids are obese.

    You can imagine the cylce beginning at this point; a child becomes overweight and is teased or feels left out by other kids because of his or her appearance. The child feels bad about themself, causing them to reach out to the things that make them feel better, like soda, potato chips, candy and icecream. If these things are available in the home, they will be eaten, especially in times of stress or unhappiness. After all, who wants to remain unhappy? This cycle continues, unbeknownst to the child, with ever-increasing cravings for more junk food. The teasing and self-loathing continue into adult hood, when behavior patterns and responses to stress continue to trigger the unhealthy response of poor food selection and eating habits and the resultant depression.

    So which came first, the poor food selection, poor self esteem, or poor personal health practices (e.g. lack of exercise)? Throw into the mix any emotional trauma and the issue becomes more complicated. I vacillate between being angry at people who are obese and then feeling sorry for them. How much of it is there fault? How can you fault someone for being in pain, physically or mentally? How can you feel sorry for someone who clearly is making poor choices for themselves and their children?

    Clearly this is an issue that needs to be handled on an individual basis, like all health issues. Take into account the individuals personal and health history, understand the dynamics behind their weight issue and then proceed with a plan tailored towards addressing their individual issues. Additionally, institutions can and should help. Schools and employers should provide only healthy foods in vending machines, the government should fund research and public campaigns aimed at educating the American people about proper nutrition and to seek help for depression, all health professionals and their related professional organizations and institutions should promote within, the idea that they should model good health choices (stop smoking, fat loss etc.). Lastly, we all can be more understanding about our own faults, then perhaps we will be more compassionate with others and be better able to help those who have experienced a lifetime of abuse, neglect, or maltreatment to help themselves.

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  35. Sheila Parker

    I am overweight, obese. I have played the diet games for years. I lose some and then I gain it back. I lose it again, and then gain it back. I’ve tried them all. Pain is part of my problem. I have bad hips and legs. Yes, you say it’s because I’m overweight and you may be right, but how is a person supposed to function when they are in pain. I even had a mental illness that didn’t allow me to eat. I couldn’t swallow food, especially that food that was high in fat, because I thought it would kill me. I lost 115 lbs, but once I got better, I gained it all back and more. I slowly introduced very low fat foods into my diet and the weight started to come back. I can just look at food and the pounds come on. I believe alot of our weight problems are hereditary. Every person in my immediate family and also many in my extended family on both parents sides, are obese. I also beleive I have no metabolism. I have two sedentary jobs plus I go to night school full time. I rarely have time to cook a meal at home anymore and often end up grabbing a quick bite or my husband brings me food at work. My second job is at a hospital and even the foods that they cook there are high in fat and calories. No matter where you look, these things are starring back at you. I say hurray for those people who have the time, the energy, and the healthy bones and muscles to keep up with exercise, but please don’t look down on those of us who don’t have those things. People who are obese don’t like being that way, but often times there are reasons that others don’t know about. I often find myself eating when I’m not hungry, but when I’m stressed, which is a big part of my life right now.

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  36. Tom Bunnow

    I am frankly disgusted with the obesity problem in this country. Of my 8 collegues, 1 is obese, and two are overweight. My experiences have shown that most do not want to hear they are obese, overweight, fat (use whatever term you choose). They are offended when told, and are less likely to return for a follow-up. I’ve been chastized by parents for pointing out the obesity in their kids (parents also obese) and told, “That’s NOT what we’re here for!” What is the solution? I feel it is to strike at the cause. What is the cause? Not sure I can put a finger on that one… too many factors and variables.

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  37. Heather King

    I think there are a few reasons for obesity. One, there is a sever lack of personal responsibility in this country, not just with food. Two, people in this country are more lazy than ever, with the computer and everything being so fast paced who has time to take an evening walk with the kids when it is 8 pm and everyone needs to get showered and in bed. Three, People in this country are nlooking for a quick fix with pills and a docotr to fix them. Gastric bypass has become a huge success, but how many of those people reagin their weight because they have not changed their eating habbits. Four; people have very bad eating habbits.

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  38. paul

    From a clinical standpoint people are far to caught in the “rush” society of today. Everything must be done quickly,leading to a proliferation of fast-food. Time constrants along with need for more income has forced more and more people to work longer to pay for less. Having a meal at the dinner table is a thing of the past. Just taking the time to sit and talk around the table allows for the body to relax, to calm down, to talk more and eat less. Exercise in the 50-60s was incorporated into the currriculim in the pre-school and throughout high school. Now computers and palms take the place of a walk or playing a game of catch. As a society we must take responsibility for our actions and incorporate our lives into our children, taking the time to go for a walk instead of watching television. Our childcare is technology. We need to take our children back. Become involved in their lives not just there financially. Watching nutrition not just ordering pizza as this is quick, and we are tired from our job.

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  39. Kim, CRNA

    I am reading many comments here from overweight people who say they eat much less than their “normal” weight friends, but still gain weight. There are many components to a healthy lifestyle. Portion control is only one of them. What you eat can be much more important than how much you eat. Healthy weight people, especially physically active healthy weight people, such as athletes, eat 4-6 meals a day. They eat the right amount of the right kind of food. AND they engage in physical exertion. Walk to work, ride a bike, jog, lift weights, swim, whatever, just find an activity you like, and do it! I know this from personal experience. If morbid obesity were caused by a fat gene, or a virus, then this would not be a relatively new phenomenon. If anyone thinks the sedentary life style and fast food habits of the 20th and 21st century don’t play the biggest part in this epidemic, they are ignoring the facts. Type II diabetes is at an all-time high.
    The tried and true facts are: eat right (amount and type of food), exercise, drink plenty of water (good ole’ plain water), and get enough sleep. Guaranteed. There’s no magic to it. I’ve been on both sides of the fence, so I can speak from experience.

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  40. Misty-Oklahoma

    Here is my experience and opinion.

    I have experienced losing 35 lbs on altering portions to what they are suppose to be. I did not change what I ate per I generally eat healthy. I maintained this for 2 years and stuck. I also was not consitent with my portion control. Now I have added exercise and portion control and the results are to be continued. So far 6 pound in 4 weeks.

    My opinion is that there is no 1 answer for weight loss and reasons for obesity. Everyone is different. I have yet to meet that textbook patient in the past 10 years. I do agree that we put the blame on others a lot in America. We tend not to take responsibility for our own actions. I agree with adding nutrition for school, but this also needs to be consistent and reinforced by parents in children.

    For the woman who tried many diets. Followig is what I would ask you from what your opinion says. How long were you consitent?. Also were you just not given the right answer for your body? Were other medical causes researched for you?

    I agree with behavior modification and psychological counseling are needed in all weight loss programs, just like what occurs in gastric bypass surgery, smoking cessation, Diabetes education, and the list could go on and on.

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  41. Dr. Drill Instructor

    I appreciate and honor the input of every writer before me.

    I do agree that psychology, addiction, genetics, lifestyle, and our consumer culture ABSOLUTELY have much to do with the obesity epidemic…it’s obviously a multifactorial issue.

    The tools that I primarily use to combat excess weight are lifestyle accountability, group exercise, enforced self discipline, and motivation. I run a boot camp course termed the Dr. Drill Instructor program, and let me tell you…it actively engages folks in the process of health and they lose weight and feel better about themselves simply becuase they want to.

    Passive care such as a pill, procedure or office visit is a bunch of shit…the treatments don’t work and patients mostly don’t comply. Health must be taken, it can’t be merely given. The best kind of help is self-help. We must lead by example in health care…we can’t afford to be smoking nurses and fat doctors. We MUST hold the line for a patient-centered model of healthcare and chronic disease CAN go away. Being politically and medically correct isn’t cutting it…we’re soft…losing the war and your average American is a poor slob as a result.

    You heard this from a Doctor of Chiropractic!

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  42. Sbeard

    What is not for the most part being addressed here is that obesity has increased dramatically in the last 20 years. Nearly all the issues mentioned- abundance of food, negative feedback towards obese patients, no good answers to help lose weight, psychosocial issues have been around for 50 years or more. The children of the 70’s had video games, plenty of TV - Iwatched my mandated 5 hours aday- and no pressure to be active, yet there was barely an uptick in obesity vs the historical norms. In med school the first thing the bariatric surgeons tell you is that 80% of their patients have deep rooted psychological issues stemming from abuse- usually sexual. What has been the one thing that has changed dramatically over the last 25 years - PORN! Freely and readily available in the convenience of your home or cubicle via the internet, or local video store- you no longer have to go to some seedy store on the out skirts of town or in the redlight district. Porn was the first and still is the major player on the internet. Each generation has more accsess to the internet.
    In the last 5 years as a GYN I have seen Pubic shaving - not bikini shave- go from about 10% of my patients under 30yo to nearly 100%. Its not a “social norm” like shaving arm pits(if it were a societal norm issue then it would not be as equally common in my young amish patients- they are all about defying norms)- its an effect of the popularization and commonization of PORN. Our young people are not trying to be skinny like Paris or Brittany- they are just trying to have their genitals!
    I’m not calling the obese pornographers, just saying that we are seeing the effects of this abuse (children viewing porn, or molested by pornos - they are both abuse) on our society, just like the increase in child molesters.

    That said - there will likely never be one answer to the obesity epidemic. Ihave seen patients eat their way through their “stomach stapling” (less common technique now) only to be rushed back to surgery to save them. Many have some degree of metabolic sydrome, but as weight goes up so does insulin resistance till nearly 100% have this situation. Not all HTN meds or cholesterol meds work for all patients either- why does everyone think obesity is different? Many abused people don’t have an obesity issue. In the end its a multifaceted epidemic that does come down to an issue of calories in and out, but getting past that and on to something productive is the hard part.

    I apologize for the explicit nature of this discussion, but lack of activity and easy access to food do not explain the differences b/w todays kids and tose of 25 years ago.

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  43. fred RPh.

    I believe inactivity, portion control and the ease of availability are all major players in this issue. I also believe people need to dink more water to cleanse their bodies and help boost metabolism. I believe there is another factor not investigated thouroughly and that is genetic precursers and biochem. factors. ( i.e. can a person make a true effort and not lose weight or fat)
    also we need to study more about metabolism and boosting metabolism.Maybe insurance companies need to offer more incentatives to people to exercise more and dixcount gym memberships

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  44. bradley md

    I think the evidence favors a cause for obesity that is multidimensional. There seems to be a CNS factor where by the control of appetite and food intake is disturbed, a metabolic factor associated with insulin resistance, a hereditary factor which may be related to the above causes and some kind of hormonal regulation possibly mediated through teh hypothalamus. Whatever the cause it seems that no one knows enough about terh problem to be able to give advise beyond eat less and exercise more.

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  45. Mike RN BSN

    I have through the opinions posted and it seems that everyone is trying to find an excuse or reason why there is obesity today. My question to all of you is were our parents grandparent, grandparents etc. all old beasts as we are today? Of course not they did not indulge in the poor choices of the type of food that we do today. Ryan and Dr. Connor hit the nail on the head by stating we have to take responsibility and to quit making excuses for the obesity/laziness. Everyone is trying to find an excuse of why we have the obesity but no one is looking at the attitude of the patients when they are informed that they must lose weight or their health will deteriorate. Today patients ignore that advice and continue doing what they want to do and be damned with the future outcomes of their choices. I have seen patients come through the critical care units like a revolving door with the same problem over and over and failed to follow through with their instructions upon discharge.

    It is my opinion that with obesity left unchecked we are draining our resources that could be used elsewhere. I am a firm believer in establishing a set baseline weight and if patients refused to change their eating habits and with a way of life than their insurance deductibles/premiums should increase. The average American is too lazy to do anything about it unless it is coming out of his own pocket book. Until then we’ll have diseases such as diabetes, CHF, bilateral knee replacements, bilateral hip replacements, etc. not to mention the potential injuries to all medical personnel handling these obese patients. On the average the patient in today’s hospital ways between 200-300 pounds.

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  46. Judy Anderson, MD

    I suspect that partially hydrogenated vegetable oils and high fructose corn oil are bigger culprits than previously suspected. I believe they are toxic, and should be banned from food. I counsel all of my patients to avoid them. I do everything I can do to avoid them myself. We should not be blaming the victims here, we should be doing something to prevent the food industry from putting this stuff in our food.

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  47. adoh

    I have 4 words for why most americans are obese, HIGH FRUCTOSE CORN SYRUP. Read the literature, and face the facts. it is in every item that an average american consumes, starting in the morning with jelly, and ending in the evening with soda. i have lost over 10 pounds in 2 months just by cutting out this needless chemical.

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  48. tania mendoza herrera

    Yo pienso que gran parte de la responsabilidad deriva de la poblacion consumista en la que vivimos, sino veamos que marcas patrocinan los principales eventos deportivos, la vida sedentaria que no nos obliga a sacar tiempo, el stress, la falta de motivacion personal ya que cada dia hacemos las cosas en forma mas automata, y nosotros, el no imaginar que una vida al lado de nuestra familia es mas gratificante que un turno de 12 horas en un hospital…

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  49. Victoria Sucher, NMD

    I work with many patients who are overweight for multiple reasons. The problem that we as providers sometimes forget is that many times it is not just a simple answer of eating less and exercise more. Sometimes there are other reasons behind the weight gain just like there are reasons behind a sore throat (not to be too over simplifying).
    Many times a good intake with a diet and exercise history can help give a better idea of where to look with a patient. Sometimes it is simply just education that the patient is lacking and referring them to resources to help them further with diet and exercise. However, many times I am finding that with some patients it is not an easy answer. Some have hormonal issues that no matter what they do with their diet or how much they exercise, they have a near impossible time losing weight if not putting on more weight before losing weight (PCOS, some adrenal hyperplasia’s, etc). Then there are those that have severe mental and behavioral issues around food. They require a lot of time, energy and support if they are to reach their goals.
    The problem then becomes one of reimbursement on the provider’s part and prejudice. We do not have a system in place to pay doctors to spend time educating the patient on diet and lifestyle issues. Time spent in prevention is many times unpaid time. Also many patients who are overweight feel hopeless and many doctors attribute other health problems to weight issues. I have one patient who is obese who was told that her back pain was because she was overweight. On further exam it was found that she had severe (-4 SD) osteoporosis on a DEXA scan with scoliosis. Prejudice on the practitioner’s part can also led to a misdiagnosis and furthering the patient into the disease process.
    I do agree that our culture causes and reinforces the obesity epidemic, but we also do not have the way as providers to effectively address this issue as the health care system is currently set up unless we really take the time that our patients need or we can give them good resources to go to.

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  50. Cofield Green

    Most people eat not because they are hungry but because they see food. I believe a lot of obesity could be eliminated if people only eat when they are hungry and stop when they are full.

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  51. Martha

    I think people are socialized from a young age to consume more calories than they need. “Clean your plate.” I think technology, TVs and computers are two of the biggest factors contributing to sedentary lifestyles. Cafeteria food in highschools has few healthy options. Fast food may be cheap to make but the real cost comes many years later to society who in a sense pays the high cost of care for the multitide of obesity-related moribitidies through increased insurance premiums.

    Medical providers whould educate the public that once he/she gains 5 pounds, they should heighten their efforts to eat healthier and increase their activity till their weight returns to their baseline. However, many people are totally unaware and 5 pounds becomes 10 and 15 or 20 before they realize they are “gaining weight.” In addition, kids who are raised on fast food especially those of low SES are at the mercy of their parents. Unfortunately, the damage is already done and the patterns for a unhealthy eating patterns are firmly established by the time they graduate from high school. Maybe the schools shouldn’t just teach nutrition, but teach kids how to make a vinagrette, toss a salad and poach some fish. By the time low SES kids are 18, their food likes and dislikes have probably been established and they may be obese or have diabetes. At this point, they might as well roll out the door. (just kidding).

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  52. Teri H RN

    I have found the comments interesting. I am overweight and havehad this problem since I was a child. I have lost weight before but have regained it and more. I have just completed a 12 week program at my community hospital. My weight was 250 lbs when I started. I was eating 1000 calories a day but was told to increase this to 1200 by the nutritionist. I worked out with a personal trainer 2 days a week with weigh bearing exercises and cardio 4 days a week. I feel stronger and have more energy but I have not lost any weight! I am tired of naturally this people beratting me for being lazy. I exercise more and eat less than most people I know and I still weigh more. You know what the experts are telling me. They don’t know what the answer is. I think they think I am lying about what I eat. I write it all down and measure carefully. Someone please give me the answer, I will follow it.

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  53. Erin King, MS-III

    I have read many of the comments and concerns listed and am struck by both the concordance of medical opinion as well as what appears to be a downfall of American culture. Problem and blame aside, I feel what Americans should embrace is PERSONAL RESPONSIBILITY. Those are your children, your Big Macs, your calories, and it will be YOUR health on the line with 100+ pounds of excess at your side. Certain ills are incapable of being managed by “big brother”. What is so wrong with being hungry?

    Without caring for ourselves we leave little ability to assist others whose lives are much emptier than our own.

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  54. Rosemary RN CARN

    At a lecture in the early 1970’s a surgeon was asked if death was his enemy, he replied way back than “No, fat and blood are”
    Look at the increase in surgeries and life span in 2007.
    Anyone who is taking care of an elderly parent knows this!
    I work in the field of addiction and realize there is no “one size fits all” answer, however this is a quailty of life issue for all of us.
    I believe nursing is in an excellent position to spearhead this issue.

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  55. Christine A. Horn RNC, MS, ANP

    When looking at obesity I believe one has to look at the rise of insulin resistance in the overall population and how it leads to central adipocity and elevation of free fatty acids.

    The American diet right now is overloaded with high fructose corn syrups, over processed CHO’s which have a high glycemic index, and hydrogenated and partially hydrogenated oils which are the true “bad” fats. All of this in combination with the decrease in exercise makes for a cardiac time bomb.

    Hyperinsulinemia is deadly and causes the all too familiar “metabolic syndrome”. The fact that excess insulin production causes increased sodium retention by the kidneys, decreased elasticity of vessel walls, and release of norepinephrine speaks to this. Also the release of plasminogen activator 1 by the omentum in obese patients is very disturbing, leading to quicker clotting.

    I believe looking at a complete change in diet beginning with eliminating all refined CHO’s, wheat (as it is very high glycemic index), eliminating all trans fats and eating as clean as possible (organic) without sodium benzoate and hormones is a very effective start in correcting this condition.

    I actually have a patient who was pre-diabetic and lost 60 lbs just by doing this. She is now feeling “well enough” to incorporate exercise into her daily routine. One problem with intiating this very healthy diet is that it is expensive as these foods are not subsidized by the government. My patient is low income and feels so strongly about eating this way, as she has not lost weight on any other diet, she financially makes it work for her. There are co-ops and “deals and steals” kinds of stores that help people with the expense.

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  56. Cynthia Lassiter, RN

    I agree with Mike Harper and Amy, more physical activity is necessary to keep the pounds off. As Amy pointed out the Amish are busy with physical labor all day and remember they eat a heavy German diet, sausages, whole milk products, pastries….all the “good” food. They simply burn it off. However, we all will not have a 24 inch waist no matter how much we exercise. I think people also focus on having a “hot body” and not so much a healthy body. Genetics determine body shape to a certain extent and the media is constantly bombarding us with the message that “hot” is “healthy” and that is not necessarily so. Every body needs exercise every day, enough to get one out of breath for about 20-30 minutes and some strength training for healthy toned muscles and strong bones and not stuffing yourself at every meal but very few of us will look like models. Me? I’m 5′7″ and 150 lbs at 44 yrs old. Yeah, I’m over weight but if I continue with regular exercise (and stick with it) I think I will lose those extra 10 to 15 lbs.

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  57. Sharon Dullen RN COSC

    I have had both personal and professional experience in this area. I know the statistics, was obese according to BMI, and am an expert at losing weight! Keeping it off has always been the difficult part and remains so for many people. The basic education is simple. Keep moving and lower you calorie level. But on a broader scale their are a few things I want to point out.
    First of all I here many doctors commenting on this forum how they help their patients fight obesity. Of course I don’t know these particular doctors, but would like to say that all too often, doctors behind the examining room door will tell patients that they “need to lose weight.” But not point them in a direction to get appropriate help.
    I have on my own done the research and finally found a program that is working very well for me. I am down 55 pounds and just 20 from my goal. My BMI is now 25 and I am still considered overweight, by about 7 pounds. The program is not Weight Watchers or South Beach, but a hospital run program. It has made a huge difference. The other programs work but don’t teach or provide pyschological counseling and behavioral modification. This is key. Maintaining weight loss is where most programs lose their punch, or when someone is approximately 4 months inito a program and begin to lose momentum. This is where the focus needs change in weight loss programs.

    In the hospital run program I am in, I attended 12 weeks of group therapy, followed by 8 weeks of nutrition classes, and now am in a continuation group until I reach my goal which is head again by a psychologist and discussing a specific topic of behavior at each one hour session. These can be private or group, but studies have shown greater success with the group sessions.

    It is simple to blame others for our problems, but the United States has a 65% overwight issue. That is 127 million people and climbing fast. Of that 30% or 60 million are considered obese and 9 million or 5% are morbidly obese. These statistics are staggering. We need to change our culture here. We are slowly killing ourselves with conveniences. And yes the media, and marketing plays a huge role. Just yesterday I went to a sporting goods store to buy a pair of new running shoes and every worker I had contact with in the store were overwight or obese. I was the healthiest person in the store. It was sad.
    This is critical and it is going to be up to us in the medical field to make it our priority to change. These are big shoes to fill.
    Sharon Cullen RN COSC

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  58. Ian Churchill, B.Sc.Pharm

    On the simplest level, weight gain/loss is a basic calculation of energy in and energy out. Of course, as we all know, nothing is ever quite that simple. I do however, believe that we frequently complicate things far too much with all our theories, formulae, and pontification on why there is a problem and how it should be fixed. I think it is important to remember this most simple and basic truth that if you consume more calories than you burn off then you will obviously gain weight, and that the reverse is equally obvious. Beyond that, all that is required is patience, perseverence, and common sense. That, apparently, is the hard part for most people.

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  59. PhatSoWhat

    What about those studies showing gastric virus, GI hormonal disorders, etc.? Why isn’t there more into that and seeing if there is a physiologic connection, the treatment of which might assist?
    And how do you have obesity as a global epidemic in 3rd world countries where people scrounge for one decent meal a day? How do they eat too much and cause their own obesity? To me, that supports the above.
    How about the new studies that treat drug addicts with more drugs? Everyone accepts that these days but when I worked with addicts, it was blame the addict and nothing stronger than an ibuprofen even for postoperative pain for spinal fusions. Why can’t we do this for fat people, and I don’t mean those nasty diet drugs but the stuff in the first paragraph.
    We treat alcoholism and alcohol withdrawal with more drugs. Again, why can’t we pursue something besides a drug that makes people leak fatty stool constantly or destroys their hearts before the fat would, to treat obesity?
    We treat nicotine addiction with nicotine and antidepressants. We treat fat people with antidepressants that make you gain weight then destroy their self esteem by blaming them and telling them they are not cooperating with no evidence that they are “cheating” or not adhering to the program.
    Sexuality and infidelity and hypersexual behavior including deviations from the “norm” are ignored despite the spread of genital herpes, AIDs, Hepatitis B and C, and drug resistant forms of STDs like syphilis and gonorrhea, which are practically an epidemic, that have to be severely increasing the healthcare costs in the US. But no one says that’s wrong despite the spread of disease and the destruction of families that often accompanies it. Spreading Hep C alone can lead to a huge cost in the form of a liver transplant, and for women bearing children, the effect on the baby.
    Add to that porno addiction that, like drugs or alcohol, leads into a spiral of needing more and more porno, more and more deviant sexually explicit porno, and finally child porno and possibly child molestation. But no one talks about porno addiction as a problem for society despite the immense costs of treating the porno addict’s victims or the cost to society of abused children and destroyed families. But we call that “free speech” and “personal preference” instead of a disease that costs healthcare dollars.
    We treat obesity by blaming the victim. We do not recognize their contributions because they don’t look like someone we’d like to have an affair with. We don’t like to look at them or talk to them even if we ourselves are overweight or obese (obese people are our own worst enemies). We hide them in the background and skinny people take credit for their work, deflating their value to the organization, keeping promotions and raises at bay, and increasing self loathing and depression which keeps them fat.
    We treat them by making them pay from their own pockets to have surgically induced malabsorption syndromes - let me ask you, is the cost of the treatment for surgically induced osteoporosis, malnutrition, treatment of massive fungal and yeast infections from hanging skinfolks and eventual removal of the excess skin, leaving something ugly that can be hidden, is cheaper than treating diabetes and hypertension? And how about those 6 months postop when they’re in and out of hospitals throwing up, with diarrhea, requiring treatment for protein and electrolyte deficiencies, is all that really cheaper or are we pushing the expense elsewhere and saying, OK, if you keep your clothes on, you look attractive, so now we will admit you to society. And I have heard of so many people who have this surgery who actually move to other states and take jobs where no one ever knows they were fat or had the surgery. They get sick more quickly than I do and I am pretty fat.
    Medications for obesity, along with diets like Slim Fast and South Beach, focus on high fiber or getting rid of fat, which means constant diarrhea - in other words, they are making you defecate your fat out. So in order to get through your day at work without getting your boss angry for too many bathroom breaks and a smelly restroom occupied to the inconvenience of other workers, you take stuff to stop the diarrhea which of course means that you stop losing weight since the diet depends on getting rid of it by having more bowel movements, and weight loss surgery seems to do about the same thing - cut to the chase and just become a bulimic, the healthcare costs are about the same for what you do to your body and you don’t have the expense of surgery or special diets.
    Another thing: Certain chronic illnesses are NOT fat related - lupus, fibromyalgia, traumatic arthritis, chronic fatigue, hypothyroidism, psoriasis or eczema, etc., but if you are fat, the cure for all this ia a 1200 calorie or lower diet and an exercise program, plus some doctor telling you how ugly you are and to look in a mirror so you won’t “cheat.” No allowance for plateaus, nor the fact that if you hurt all the time you can’t exercise, and if you have a skin condition, you aren’t allowed into a public pool even if what you have is not contagious, so you’re out exercising that way.
    Find a cure and QUIT BLAMING THE VICTIM.

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  60. Piotr Karauda

    Obesity is, in my opinion, very strong connected with depression . In treatment obesity in all cases I remember always about antydepresant drug or psychoterapy.
    Piotr Karauda
    Family practitioner

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  61. Dr. Tiffany W.

    As an obese healthcare provider, I can offer some unique insight:

    Obesity means trying to love yourself with food - eating until you’re full, eating when you’re hungry, soothing yourself, reducing your stress by buying prepared meals, streamlining your life by not preparing food at home, celebrating with friends. Eating to obesity does not feel like punishment or hatred, it feels like love.
    These are not excuses, just reasons. Switching your mindset from the “I’ll love myself with food” to “I’ll love myself in spite of the food” is incredibly SCARY! Life changes at all levels when you take control of eating - and in unpredictable, uncomfortable, unpleasant ways. I am discovering this first-hand as I immerse myself in Weight Watchers. No wonder weight control is so difficult and transient, and why I never did it before despite being a pharmacist!

    That’s the take-away message. Acknowledge how scary this change will be, and how the person was just trying to love themselves (albeit misguided). Let them know that they can’t do it alone, they won’t be able to see the short-circuited coping mechanisms that lead to emotional overeating. Encourage them to make whatever changes they can and not try to be heroic all at once, that you’d rather see small permanent steps in the right direction rather than an exercise program that fails after a month.
    But most importantly, remember that overeating served as emotional support for the patient, and if you don’t first help them replace that support, all diet reform will fail.

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  62. ryan

    Obesity is the plague of today, however it does not absolutely beat out chronic disease/smoking. Any physician knows that these 3 topics are all closely linked by a main theme “depression”. It is a viscious cycle that only the person involved can overcome. Some obesity cases can be attributed to genetic predisposition, ie increased fat storage, or even undiagnosed disease such as hypothyroidism. The main cause of obesity today isnt all necessarily diet. What we put in must get close to what we burn off. The latter is the main issue with obesity today. Laziness/excuses is our biggest issue


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  63. Anita, Surg Tech (almost)

    I have read most of the comments posted on this subject - good and bad and there are some things missing from some of the comments posted.

    First of all, some of the comments seem to be doing the same thing EVERY overweight person does to themselves every minute of every day - berrating. There are several things that overweight/obese people have in common other than the medical issues at hand. Overweight people are looked at as dumb, lazy, ignorant, and unworthy by 90% of the American public. I find this uterly unacceptable. When I weighed 288 pounds, I was unable to exercise because of the water retention (80mg of Lasix a day - did no good). I was 32yo and at risk for CHF - no medical reason why, it just started one day and never stopped. I was passed up for promotions at work, I was denied request for educational assistance from my employer - obese people are not treated as equals to those who do not have a weight problem. How can I prove this? Lose 145 pounds and see how society treats you now. Oh yes, it’s true. I am now treated as I saw everyone my whole life except me being treated. And you wonder why those with weight issues eat because they are depressed? HELLO - you are perpetuating the cycle! I had Rouen-Y gastric bypass nearly four years ago and it was the third best day of my life (marriage and child come in 1st and 2nd) and I would do it again tomorrow if I had to. Is it a cure-all? No. It’s a tool and if it’s not used as such it will not work.

    Others keep saying to push away from the table. Well, a lot of overweight individuals are very conscious of their dietary habits - almost to the point of obsession - again, experience talking. I was eating less than my normal-weight coworkers and still packing on the pounds. Most conventional diets tell you to eat less but what they don’t tell you is if you don’t eat enough your body goes into starvation mode and in this mode you will gain weight too. How sick is that? It turned out when I was gaining weight I was eating less than 1000 calories a day - the average adult female needs 1200 calories a day just to function.

    I have lost 145 pounds since my surgery and I would encourage anyone who has the need (not want) to lose weight to look into the procedure. It is not a cure all but it is a great tool and with the right education with it, you get a new life. Yes, it’s expensive (around 45K) but a heart attack is over 75K and most people don’t get off that table.

    What am I trying to say? Stop berrating those you know that are overweight. Instead of giving them rotten looks when they reach for that slice of cake that YOU are serving, dish up some fruit and yogurt instead - you are helping to perpetuate the cycle. We all need to take responsibility for each other and quit passing the damned buck!!

    Thanks for letting me rant. This is a passionate subject for me.

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  64. Angela Williams

    I so agree with Dr. O’Cannon. I have been overweight for most of my life, and have, after many a diet, failed to maintain a lifestyle that will keep me at a healthy weight and state. Even when I was exercising and eating healthy, it often did not produce desired results s.a. curbing cravings.
    Many a time have I heard from one or the other Primary Care Physician: “Well, we have to try and do something about your weight”, but then never received any concrete advice, or plan, or even pressure. Most certainly there was no follow up that would hold me accountable; at least more so than I was doing, obviously. These are the people in he know!!
    I was recently diagnosed being pre-diabetic, and only received a phone call from my PCP’s office to go to a Diabetes Clinic. No discussion…nothing!
    A few days after that I visited my Chiropractor, who is also an Acupuncturist and Nutrition expert, to have him treat some knee issues I’ve had, but he immediately, and unsolicited, began talking to me about my weight and eating habits ( I had started eating brown rice, whole grain bread and pasta, fruits and vegetables and non-processed foods, and thought I was doing fine, albeit not feeling better and not loosing weight. He told me he suspected I have Insulin Resistance and Metabolic Syndrome, explained at length what that means and what causes it, and made a very strong point that if I ever wanted to be healthy, I needed to change what I do. This was not only reinerated several times, but accompanied by concrete suggestions on what to eat, and what not to eat, and why. He was so passionate and persuasive that I felt that for the first time a had someone in my corner that is truly interested in my getting healthy and spends the time and effort to make me “get it”. His support is ongoing and, since I’ve begun eating differently, I have lost 15 pounds, feel a lot better, and have less knee issues. I say: Hurray for holistic/alternative medicine.
    Thanks Dr. Vaitsas,
    Angela Williams

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  65. Roger B PA

    For those of us who are baby boomers. Since childhood we have heard our parents tell us to eat and be healthy. We have associated eating with health. Skinny was sick; strong was healthy. As we got older it was harder to eat to be strong and not become fat because our metabolism decreased and we exercised less. Now we are learning that eating less prolongs life and low calorei diets have increase life span in lab rats. We need to change our thinking and associate eating healthy with lean bodies.

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  66. Jill Norton RDLD

    This survey is interesting in that obesity and Malnutrition are at opposite ends of the spectrum, when in reality they are very much the same. In consideration of the numerous diet recalls I do, many people are eating empty calorie foods, rendering them “malnourished” in terms of acquiring the nutrients their bodies need. This starts a cycle of eating more to satisfy the body and psychological hunger, leading to obesity.

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  67. Joe, RN, BSN

    All the opinions are valid and we share them. I have a question on my mind, though. What happen to the hormones that are injected to the cows and poultry? Are they in the meat and milk that we consume? Is there research on this? Could this be another important factor to consider and if it is so, then how do we regulate this issue ? FDA?

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  68. Robert 0 Cannon, MD, MPH

    We are the problem. Dysfunctional eating and lack of exercise,as other risk behaviors for adverse health outcomes, are a sign of a lack of confidence in the medical profession with its conflicting and never ending admonitions, its failure to take the time to engage people on a personal level and to work with them over time, (behavior change is an iterative process), frustration with the health care system that is too: expensive, complex, time consuming, lacking ancillary programs, inaccessible, and lacking focus on prevention. The result: a sense of futility and a lack of empowerment. If we don’t change the system through increased and persistent advocacy (and constructive confrontation) within our clinics, hospitals, communities, political system, insurance structure, and the media - its only going to get worse. Effective medical care will only come about when we change the profession’s priorities and become activists for social change. The system is broken, we are the problem.

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  69. Stephanie Bellomo, MD

    American cultural values have been driven by consumerism, with marketing and competitiveness making people believe they need MORE OF EVERYTHING, including food, leisure time, bigger automobiles, and “safer” environments for kids. The high cost of consuming all this food, reducing physical activity, and of adults working more hours in two-income families to pay for all this STUFF,is that nobody focusses on just how excessive this really is and thus that has resulted in soft, flabby children and adults who have no concept of fitness.

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  70. Hasnain Patel

    Obesity is most likely a sign of HYPOMETABOLISM, due to the inability of the body to excrete products of metabolism, due to several factors viz. lack of sleep, heavy metal toxicity from our environment and food chain. It is highly likely to be determined that it is an inflammatory response of the body in the near future.

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  71. Denise Singleton, RN, BSN

    Not in the too distant past, childern had PE and more sports to choose from. It was safe to ride your bike and you had to walk several blocks to the bus stop. What happened was in an effort to “catch” American childern up with other children around the world, PE went by the wayside. Children now have to carry rolling bookbags to school for the amount of books they have to carry. In addition, many parents do not feel safe letting their children “play” outside in the parks anymore. Plus, with the “sue-happy” state of the US, many sports have been axed. Add all this to still eating the same amount of food or more and you get over-weight children who turn into over-weight adults. You are so right to say we have to get off our rearends and do something. One of those somethings is to set a good example for our children by eating right and exercising. Another one of those somethings is to bring PE back into the school systems. Finally, we have to learn to take responsiblilty for ourselves. It is not the fast-food industies fault if you pick up a triple hamburger and extra large fries with a super soda, then you get fat because you did. Get real!!

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  72. Suraj Achar MD

    I am a family physician and sports medicine doctor. Of course Obesity is a huge problem for america. However, for the doctors the problem cuts both ways. We want our patients to get well, but obesity proves that it is a myth that there is a “pill for all ills.” As for our jobs, obesity and its medical complications reshapes the health care landscape. Not too long ago papers were written that we had too many doctors. Now I ask patients try to book an appointment with their local family physician or internist. Unfortunately for America obesity and its complications has created a growing shortage of primary care physicians and huge increases in the cost of healthcare.

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  73. Chief Mike Harper

    I am a paramedic and overweght myself(not Obese) but never the less overweight. We as americans need to accept responcibility for our own actions. Of the 10 leading causes of cardiac arrest we can controll 7 of the leading causes. The three we cant controll are race, gender and age. By the way obesity is the fourth leading cause of cardiac arrest in the U.S. We need to get off our butts and lead a healthier lives and educate the younger generations on how to lead healthier longer life.Not to mention educating them to be productive honest hardworking adults!!!!

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  74. Amy

    Since most of the world is now blacktopped and business like, farming and general outdoors stuff is on the wayside. Does anyone remember the days where you had to work all day in the fields, hammering, fencing, walking, working, baling, repairing, building stuff? The Amish community has almost NO morbidly obese people. Can you think of anyone in the Amish community that required a gastric bypass? I can’t. We’re fat and lazy, and we need to get off our big butts and work harder, but we always find stupid excuses not to. We eat too much, drink too much, and do too little, all for the sake of increased industrialism and increased efficiency. Bring lunch to work, go to the park and walk, find another excuse for laziness, because this one ain’t working!

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  75. Lynn

    I’m 55 and fat. I’ve tried lots of diets; if they worked, I wouldn’t still be fat. One of the worst was a “doctor supervised fast” I did in the 80’s - I lasted 4 or 5 weeks, ate 500 calories a day, reported for a vitamin shot and weigh in once a day. I lost 35 pounds and developed CRAVINGS for junk food I hadn’t eaten or wanted in years.

    Last summer I was lucky enough to be able to start working from home. You’d think w/ a full fridge I’d be worse off, right? NOPE. Access to decent food along with the fact that being away from the office and out of the commute traffic cut my stress. After several months of tinkering with my diet and trying to improve it, a bit at a time, I settled on a food schedule that works and is much healthier for me. Within three months I’d lost 15 pounds - without dieting.

    But I still say it’s about the stress most of us are under. My corp. layed off 1/3 of our division two months ago - my anxiety went off the charts and food selection turned into a mess. I couldn’t focus on eating well, and the stress drove me to want to eat more. (I did control it enough so that I didn’t gain) I confided in a couple of work friends that I was so stressed that I was throwing up 2-3 times a day - only to find out that they were too! Comparing notes we agreed that we ate more, we ate more junk, and we threw up regularly. this is ugly! Corp. America doesn’t usually go around comparing notes on this stuff - we keep our “weaknesses” very private. I wonder how widespread the problem is?

    The topper came yesterday, when a young collegue recently promoted to her position stopped by my office to brag about a difficult appointment she’d just managed with a client. She topped the story by saying proudly “he didn’t make me throw up!”

    I believe for many of us obesity is the symptom and stress is the problem. We grab crap food because we aren’t thinking straight.

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  76. Alwin C. Lewis, MD

    I am delighted that so much focus has been placed on obesity–at rightly so! Obesity has become a global epidemic with unspeakable health consequences. It is not a problem with our genes, and the lack of activity that we fit into our daily schedules, usually, is already maxed out. The problem then lies in the AMOUNT of food that is placed before us and which we proceed to eat.

    I practice internal medicine, and obesity has become the main focus of my practice. I have written a book entitled “Why Weight Around? Changing the Weight Loss Strategy”. Of just the last 100 people that I have coached for weight, I have a total of 0 pounds gained and about 2900 lost. Not bad, eh? And most of these patients have been seeing me for less that 1 month. The secret is outlined in my book. “Why Weight Around?”, for those who are interrested, will be available on in about 1 month.

    If you have questions in the meantime, you can e-mail me at:

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  77. Chris

    Increased caloric intake and more sedentary life-style have been the major cause of the obesity/overweight pandemic. You don’t have to be a rocket scientist to understand the simple math: 3500 cal = 1 lb of fat. Decreased caloric intake improves quantity and quality of life. Eat to live, not live to eat.

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  78. Alex Catalan

    I agree with many of the comments already posted. Obesity is a big issue in many ways. Except for genetic or medical reasons obesity becomes a medical issue once the person is obese. The biggest reason for obesity which has been stated a few times is personal responsibility and accountability. I am 42 years old and still maintain a lower than 10% body fat, why? I eat right and exercise regularly. Additionally I don’t drink and don’t smoke. My family including my youngest daughter of 5 years share in this healthy lifestyle. Not only is a healthy lifestyle important to me but as a firefightr/paramedic and as well as a Marine Corps reservist it’s vital to my survival.So who can we blame? Ourselves and parents who don’t instill a healthy lifestyle in our children. It’s easy to blame the government, society, the media, etc. But at some point we must except responsibility for our own actions instead of trying to find excuses. Also does anyone see a corollation between removing mandatory physical education from our school system and the rise of childhood obesity in the U.S.? Maybe if we spent less time watching t.v. or letting our children play X-box all day we could instead spend that time walking in the park as a family this would not only keep us in shape but at the very least let our family get to know each other.

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  79. Edwin L. McCampbell, M.D.

    I think the sudden surge in obesity is directly related to the high sugar content of the American diet, especially since the introduction of high fructose corn syrup. As the studies have shown, we have placed too much emphasis on the low fat diet, and not enough on a low sugar diet. This is in keeping with my 39 years of experience as a PCP with a huge number of obese patients. My patients lose weight dramatically on low carb diets, they have more energy, their lipids and blood pressure improve, and they become much more motivated to continue their lifestyle changes than they do with a low fat diet. I had a patient who weighed 286, had been a diabetic for fifteen years, and was on 3 oral hypoglycemic meds. After 6 months on a low carb diet he had lost 80 lbs, was off all of his diabetic meds, and had an FBS of 76 and a Hgb A1C of 5.7.

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  80. Ellen Schaeffer, M.D.

    The variety of comments is interesting. It also highlights what I think is a problem in our efforts to help obese individuls. Patients hear so many differing ideas and opinions that they feel overwhelmed. They then turn to eating more to deal with the discomfort and anxiety that being overwhelmed can cause. One thing I have found to be well received is to make one or at the most two very concrete and doable suggestions. The most attention getting and listened to of these is the suggestion that obese patients not think about what they need to cut out from their diets (as this inevitably leads to an increased desire for the “forbidden” foods), but to make themselves add in foods that are nutritious. I give them the example of apples vs. Snickers bars - we talk about how many apples they think they could eat at one time. Most people think 2, maybe 3. And then they would feel full. We compare the caloric and fat intake of 3 apples to one Snickers bar. 70 or 80 calories an apple,210 to 240 calories total and zero fat compared to over 300 calories with lots of fat, no fiber, and still likely a fair bit of hunger..and I suggest they try ADDING in some fresh fruits and vegetables to begin change. I challenge them to reach for the healthy foods before they reach for the Snickers or the chips and dip or what ever their food weakness. I tell them that if they are still craving that food AFTER filling up on the healthy foods, just eat it. I mostly want them to get in to the habit of buying and reaching for good stuff. Most obese people, I have found, skip breakfast. I encourage them to eat a healthy breakfast. Anyway…I don’t know that all of the folks I have talked to are now on their way to being slim and fit. But, the suggestion to think about adding in (healthy)foods is refreshing for most and at least, I hope, a start.

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  81. Dr.A K

    when I see people who are trying to go on a diet, they make a plan to eat well!!
    My recommendation - Instead of making a plan to eat, make a plan not to eat.

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  82. John MD

    Anybody watch “Biggest Loser” on TV? A bunch of morbidly obese individuals, many lifelong, subjected to healthy eating and vigorous exercise–with a good dose of spandex humiliation.

    What happens where there is incentive (in this case, big money)? Weight loss and improved health! Diabetes goes away, walking turns into marathons, and it’s simply remarkable to see the transformation in overall attitude.

    Genetic? Nope. There are a few homogeneous populations who metabolically are better able to store fat (certain Native American tribes, Inuits etc) but for 99.9% of us it’s a simple caloric balance out of whack.

    I’m not surprised that comments from some of the overweight respondents are rife with excuses, excuses and more excuses. I’m not skinny, but to maintain a healthy weight at age 50 I need to eat very modestly and exercise for an hour 5 times a week. I’ve heard every excuse in the book, as I’ve come up with most of them myself.

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  83. Iam Fat Ryou, CRNA

    Obesity, The last socially acceptable prejudice.
    Many people stand outside and look in thinking they have the answers. Willpower,…yeah, that’s the ticket. Push away from the table, yessir,…disregard that nonsense about genetic predisposition. Just tell the fat guy not to eat. Oh yeah,…addiction ? What’s that all about? Nonsense you say. Well folks put 50 (pick a number) morbidly obese people in a room. Guess what? They all demonstrate very similar if not identical behavior, and thought process regarding their weight, body size,… you get the idea. My point? It’s easy to look in from the outside and have all the answers. Try it from inside the box folks.
    Certainly society is and will be burdened by the secondary health issues associated with obesity. After all we will be obligated to provide bigger seating in theaters, on public transportation, etc.,…heck we might even have to blame the failure of our health care and insurance sysem on all those fat diabetics with joint failure, and blindness.
    Never mind tobacco, or alcohol,…
    My thought is that indeed, obesity is and should be a point of focus,…and should be a pinnacle issue in our overall health care planning. But ladies and gentlemen, give fat people a break. Lobby your politicians to put pressure on insurance providers to provide treatment for obesity other than telling obese people to push away from the table.
    It has been suggested in this forum to up-charge obese individuals insurance premiums. Hey folks, …do you realize what a challenge it is to get insurance as a morbidly obese person? I would gladly pay a reasonable premium for a reasonable insurance policy…Excuse me,…could you pass me a piece of that humble pie?!

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  84. Jonathan Long

    Everything I will say has been mentioned in the previous responses: The market drive to automate everything further removing humans from needing to actually move to get through the day. Fast food preying on the large percentage of the population that mistakes fast food as a source of nutrition. 95% of the cold drinks in the store are sweetened with HF corn syrup, portion size, television, video games, Bush’s ‘Culture of Fear’ contributing to parents needing to monitor their kids 24/7 and their increasing fear of the outdoors. This is a culture thing. Food is assumed here. You can always get it. It is a comfort thing not a nutrition thing. The increasing numbers of obese Americans is just the physical evidence that we have a big problem as a culture. Don’t blame the people who are obese, they just didn’t know enough to resist the barrage of messages that suffuse the culture in ALL media. They need help not derision.

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  85. Jay

    Great comments and suggestions so far. I don’t know if i can say the governament is responsible for all the obesity, but it can certainly remove the subsidies it is providing for corn farmers to produce more high fructose corn syrup. And it can definitely tax the hell out of fast foods, fattening, diabetogenic foods in any place such as grocery store, restaurants etc. Just as they do for the cigarettes.

    On an individual level don’t order a two entrees when you and your spouse go to a restaurant, (just cause the server may suggest with his/her body language) order one and finish it.

    Agree that you are an addict to food, face it, it is not another nonobese individual’s responsibility to fight your problem. Take responsibility my dear! You are most likely depressed, if you eat more to feel better, it is only going to add to your depression and dependency on food. Don’t take shelter in genetic predisposition of obesity or good fat theory or improved outcomes in obese people etc. That is a losing battle. Yes, BMI is a number. But there is quite a bit of range for “normal”.
    Our modern automobile dependant, computer mediated life and never ending hunger to automate and simplify everything is the reason for our obesity. Let us not blame ourselves and feel stigmatized, instead let’s fight it. If we start doing all these things then we will begin to understand why it is important to have better mass transport systems (buses, trains, car pooling EtC) or other modifications in our daily life that will make it easy to stay in our nonobese state. It is a long road to get there, but you will not get there if you dont start in the right direction.

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  86. Steve Wilson, PA-C

    33 years ago my senior paper for PA school was on obesity. Not much has changed except there seems to be more obese people. The health problems it produces are enormous. Despite normal vital signs and lab test, it evetually gets you. Loss of core strength and poor posture results in back problems. The knees and hips give way to the weight. Feet develop their own issues. Joint issues result in inactivity. Inactivity encourages weight. Weight encourages inactivity. Inactivity… Eventually, the cholesterol will become a factor. Diabetes will surely catch up and have its own effect on the heart, kidneys and eyes. Yet, it seems like such a simple formula for success: calories in vs calories out. The best exercise is the effort utilized to push away from the table - especially before dessert. The evening snack is not a fourth meal. If only our mother’s had taught us better eating habits. (It is always our parent’s fault - isn’t it?) Just remember, obese practitioners talking about weight reduction with patients is just as effective as smoking practitioners talking about stoping smoking. Americans always want the pill or surgery to correct years of abuse to themselves. The road back to health is a long one. Is there enough education to help the generation avoid this discussion 33 years from now? Will the medical system/insurance system collapse from the weight of problems faced from obese people?

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  87. Calvin Kidwell, LPN, CDT

    I too am a nurse (as JD Jolly) and am overweight (5′8″ 225#) and could not help but notice that the picture you used was of a baseball umpire. I, too, am a baseball umpire (American Legion, High School, Babe Ruth, Little League) and am in pretty good shape (round is a shape). For what its worth my cholestrol is 135, BP 122/78, HR 78 on EKG and I’m not diabetic. I routinely work games in 105 degree heat. So to say that everyone that is over weight is a health risk is grossly inacurate. And FWIW the umpire that you have pictured (and most of the umpires working in minor and major league baseball) even though they may be overweight are probably in pretty good health. Most people that are in “good health and good weight” probably could not do what these men do to begin with.
    BMI is, at best, a tool and at worst can be used to force a preception of “what we should look like and weigh” in order to be publically and socially acceptable. Also recent studies have shown that “heavier” people tend to have better bone density (osteoporosis) than do persons who are average or under-weight. Just my 2cents worth.

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  88. Keith D Rouleau PA-C

    All of us are to blame with the current epidemic if obesity. We banned TV advertisement of cigarettes, yet we allow television advertisements of fast food restaurants, soft-drinks and snack foods. There should at least be warning labels.
    From a healthcare standpoint, we tell our patients to walk 30 minutes a day, 3 times a week for exercise. That happens to be an ADA guideline. That is a horrible approach to stemming the tide of obesity! Hit the gym!
    Insurance companies should use a two pronged approach to helping the healthcare providers: Demand higher premiums from obese, and/or smoking clients and pay for interventional programs and medications.
    Providers should also be role models. It is very difficult for a patient to regard any advice on fitness and obesity provided by a practioner that is overweight and smokes.

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  89. Dorothy Cleveland Grupe RN, SFNP

    As one who weighed 105 at 5 yo and 145 at 8 yo and still struggling to keep my weight (many, many years later) under control, the problem is certainly multifactoral.

    On the portion size issue — yes, things have changed dramatically. ONe’s morning OJ used to be served in a 4oz glass. That size class is no longer commercially available. “juice” classes range from 6-8oz, up to double the size. And that’s one of many examples.

    Commercially, we are bombarded with “beautiful” people, whom my son calls “genetically gifted.” (OF course what we don’t understand is that keeping that appearance is part of their career.) Most of us will NEVER look like that. But yet, we try and become discouraged.

    I agree that education is a big key. Let’s start with the kids! There are web sites that offer teaching plans for teachers to incorporate healthy eating, eating motivation, etc. Not bad for working with adult groups either.

    When working with people, I try to work with “baby steps” — start out with keeping a food diary(know what you’re dealing with). Work for measurable goals. A pedometer, for example, is a way that a person can add exercise to their day. Maybe it’s not the 30 minutes a day suggested, but it IS an accomplishment to add even 1000 extra steps to their daily activities. I also try to incorporate a give and take attitude — stressing the benefits– something they get, vs. something that’s taken away or some sort of trade off.

    It is easy to say “Go forth and live a healthy lifestyle,” but unless we understand where that particular client is coming from and how to reach him/her at a level where they can, not only understand, but see some tangible benefit, it is often too overwhelming, especially if their circle of support is not on the same page.

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  90. rosalinda walbrun

    I am not obese, but I tried to share my habit of eating to my friends and co-workers. Obese people are insecured people and makes them more insecure and do lower their self-esteem. I wish there is a better way or program that will help them curtail their love of food.I do feel sorry for these kind of people, but it will take self discipline and will power to change their attitude towards being overweight.

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  91. Dr Paul Baumgarten

    Proper diet and excercise are what are important here. Hi protein low carb and good fats are essential , but most of us dont even know that it is also the QUALITY of the fats and proteins that matter! Studies have proven that non-natural sources of diet for the fish and animals we eat change the quality of the meat. Farm raised Salmon are fed grains and so do NOT produce OMEGA-3 fatty acids but omega 6 which are not healthy. The same goes for grain and corn fed beef. Hormones and pesticides are mostly fat soluble so they are deposited in the fat of the animls we eat. Our soil is nutrient depleted so we need to eat much more of the vegetables to get the proper amounts of nutrients.

    Exercise problems are even worse! We really only need to excercise 15-20 minutes a day, but the exercise needs to be of high intensity to get out hearts and lungs working to capacity NOT the so-called “aerobic” zone. Aerobics is the worst type of exercise you can do! The only way to build heart and lung capacity is to work it!

    The reason that people dont lose weight when they are on the “proper diet” is because they are taught to excerciser and or walk for an hour etc. This just teaches your metabolism to store fat instead of burn it!! Short 10-20 minutes of intense exercise teaches your metabolism to BURN fat instead of storing it.

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  92. Hugh P. Babineau, MD

    The is obesity problem is in fact multifactorial: Food is cheap and plentiful. Most work activities do not require physicial exertion, and most leisure activities do not either. Our ancestors, whose metabolism we inherited, evolved to survive an unpredictable food supply and they needed to be active to survive. Not the case for modern humans, so we tend to get obese.

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  93. Monica McMain

    I wonder if the obesity epidemic can be linked to the hormones and antibiotics animals that we are eating are given to promote growth. Has any studies been done on this subject?

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  94. Curt Kaufman

    The real problem is that there is a heavy reward and availability system in place for being obese, and it operates much the same way as does addiction. Until are addressed all other efforts will probably fail in anything but an individual basis.

    Curt Kaufman
    212 lbs 1 1/2 years ago
    155 lbs now.
    This was done without diets, excercise programs, operations, etc. The one “secret” was motivation.

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  95. Catherine

    I agree that patient education by health-care professionals is key to making a positive impact on the obesity epidemic. From what I have observed, patients are aware that obesity is bad for them in general, but they do not have a true appreciation for specific long-term consequences. At our hospital, we see young patients in their 20’s with CHF, sleep apnea, and obesity. My colleagues routinely see pediatric patients with Type 2 diabetes. The list goes on. I also agree with comments above that the media can play a key role here. Often, patients do not fully comprehend (or accept) until they themselves suffer the serious consequences of their obesity - maybe more attention to the truly disabling consequences would be beneficial. It’s probably less difficult to make lifestyle changes when you are obese and relatively healthy, rather than obese with severely reduced exercise tolerance secondary to comorbid conditions.

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  96. Paul E. Smith, MD

    Obesity is such a problem because it is so visible. Smokers have been relegated to the back alleys (like other drug users) and so have become much less visible. In addition, the propaganda machine of the mainstream media pushes this problem continuously.
    This latter is probably a good thing, as it was the propaganda efforts during the ’70’s and ’80’s that had the most significant effect on smoking and seatbelt use in this country: the laws came later.
    Historically, obesity was always a sign of wealth (”I am rich enough to feed myself without working hard.”) It is only in the last generation that it has become a sign of poverty.

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  97. Daphne Chakurian RN

    I’ve enjoyed reading the comments, heated and otherwise, made by my medical and nursing colleagues.
    My friends, obesity which leads to chronic illness in children and adults, will cripple our nation’ insurance system. Without massive cuts, there is no way that medicare and medicaid can cover the costs of tertiary care for these individuals over the next 50 years - hospitals will close down first when they lose money hand over fist. We must develop a publicly funded, primary care system to educate and treat this issue upstream where we will get the biggest bang for our bucks.
    Our health care system must move quickly to a competitive HMO type system paid for by public monies and employers.
    Let’s not wait for disaster.

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  98. Dr. Francine Katz

    In response to who is responsible, I agree that this is a social issue that must be addressed using a well-rounded approach. First, schools need to increase the education of children and parents to emphasize increased physical activity, and eating in moderation with an understanding of what a well-balanced diet entails. Next, physicians and Health professionals need to take a stronger interest, using a strong and caring approach to empowering patients to change their lifestyles. Third, the media is an extremely powerful aid that has great influences on the masses, thus it is a necessary component to creating an approach to weight control that will work.
    It is true that an unhappy person may choose to eat in order to fill the bottomless pit, but we need to stress that physical exercise will actually create solid lasting patch for the hole. We need to definitely lead by example. If we ourselves are preaching to become fit and eat well, while we are also overweight and out-of-shape, then we must have the decency to admit our weakness and share how we are trying to ameliorate the issue.
    As physicians we are not always educated very well in what a good diet is. We should make the effort to learn and medical schools need to create a strong curriculum to address this.
    My standard suggestion to patients is to look into a program such as Weight Watchers. This is one of the only plans that truly addresses lifestyle adjustment for weight loss and more importantly maintenance.
    The issue of obesity is only getting more severe. The most important way to tackle the issue is education and changing our menus in schools. Education needs to be an effort taken on by everyone, especially through mass media.
    In closing this long-winded opinion, I will end with a story. Several months ago, while listening to NPR, I heard a news piece on obesity and The Countries “fattest cities.” It featured one city’s approach to change its profile. This city was implementing a grant initiative partnered with Weight Watchers to enroll its residents, for free (subsidized by Medicare), in a weight loss program. We need to find an approach that will, like this city, empower people to take the issue seriously and give them a viable option to change.
    Thank you for allowing me to share.

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  99. P. Hazel

    My opinion is…and this is not meant to be offensive, is that we live in a society that is VERY LAZY. The truth is I have zero sympathy for almost all overweight or obese people. I do have sympathy for people that have a medical condition that causes their obesity but zero sympathy for the opposite (people that have medical conditions because of their obesity!) How hard is it to walk around the block, park farther from the store or take the stairs instead of the elevator? As a society we will continue to get fatter because people are too busy looking for the next pill, gimick or quick fix. The reality is if people got thier lazy behinds off the couch for a half hour a day we would be much healthier as a whole. One more point since I am on a roll, (I realize I am preaching to the chior) going to McDonald’s ordering three cheesburgers, two fries and a diet Coke does not mean you are on a diet!!!

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  100. Jody Nash RN

    I recently found new understanding of how my fat was hurting my life in a book called,”You On A Diet, the Owner’s Manual to Waist Management” by Dr. Oz( CV surgeon,New York Presbyterian-Columbia Univ) and Dr. Roizen(chair of Anes and Critical Care-Cleveland Clinic). The style is easy to read,but a little cutesy for medical professionals. It may be the tool you are looking for to “wake up” your obese patient.

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  101. Michele Payton, BSN

    Yes, the problem is complex and multifactoral. The reasons for obesity lie in every one of the factors already mentioned here. Genes, environment, portion sizes, fast food, industries who make a profit from promoting unhealful lifestyles, and even our government all have a hand in the problem. I also agree that the long-term solution must be in the education and training of our children. But what solution do we give to the grown man or woman who sits in front of us weighing 50, 100, 200 pounds more than he or she should? Do we tell them that genes, fast food restaurants, and advertising are to blame and there’s nothing he or she can do? He or she will be dead before we ever change society enough to make a difference to the individual. That’s why the ultimate responsibility MUST be with that of the obese person! Before anyone jumps all over me for “blaming” the individual, you should know that I weigh just over 300 lbs as I sit here writing this. As a kid, my mother soothed, rewarded, bribed, and loved me with food. My dad forced me to eat every bite of food that I put on my plate so I would learn not to wast food. I was destined to be obese from a very early age. I HATE that my parents taught me horrible eating habits that I struggle with every single day of my life. That wasn’t their intention but it was the result. HOWEVER, I don’t blame anyone else for the fact that I am FAT in my 40’s, because the choice of what to eat, how much to eat, and when to eat became MY RESPONSIBILITY as soon as I was out of their household and away from their parental control. We have to stop patting our patients on the hand and telling them it’s not their fault because it does them no good! That attitude removes any hope that they have in solving their problem. We owe it to them to empower them by helping them to accept responsibility for their condition in a caring way. They need that from you. I need that from you. I/we don’t need any more excuses. Please hold us accountable for our choices while supporting our struggle, and we just might surprise you with the results. Thanks for listening.

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  103. Carolyn Hartman, MD

    The recent increase in the extremely obese is dramatic and startling. It appears that, once a certain extreme weight threshold is reached, new dangers emerge. The overweight are at high risk of musculoskeletal problems that make exercise even more necessary, but more painful and difficult. Inactivity then contributes to deconditioning and demoralization. At what point do they give up?

    I also note that many of my obese diabetic patients blame their diabetes medications for making them extremely hungry - almost insatiable. If there’s any truth to that, perhaps Symlin will help, but it’s not for everyone, and many of these patients were insatiable before they developed diabetes. Some meds do indeed lead to extreme weight gain; some psychiatric meds commonly add 30, 40, 50 or more pounds in a very short period of time. That is iatrogenic weight gain, and it demonstrates how little we know about the physiologic mechanisms of obesity.

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  104. Jan RN,BC (gerontology)

    I think that obesity, like most conditions, is multifactorial and needs to be addressed that way. It involves body, mind, spirit, and social factors. We might be able to give a pill, diet, and exercise, for the “body” part. But, the pill, diet, and exercise, do not address the mind, spirit, and social parts (which may be the factors that KEEP a person obese). Anorexia treatment address these factors better (probably because anorexia kills sooner, obesity takes longer to kill). Maybe a multidisciplinary approach to obesity would be more effective in the long run.

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  105. E. Gonzalez

    It is the US culture, beginning with our restaurants and other eateries where oversized plates and dishes are typically served, in addition to supermarkets, TV ads, etc, targeting children, especially. Contrast that to how people eat in Europe, and you will see the big difference.

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  106. Craig Pope, MD

    I appreciate Dr. Cushings comment and agree that there are a myriad of contributors to the current crisis, making one intervention impossible. This is not a one-size-fits-all situation. It will take time and education on one hand while promoting healthy public policy on the other. As a family doc, I approach my patients with a “moderate lifestyle change” philosophy; encouraging moderate, permanent lifestyle changes that increase physical activity and move diet choices toward a healthier norm. I stress that it takes time and cannot be about “losing weight” but becoming healthier and feeling better. I’ve had good results with this and my patients like the pace and focus.

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  107. Laura Langmack

    As a RN completing adult nurse practitioner training, it is a weekly phenomenon to discuss obesity in class, because it relates to practically every disease process. HTN, DM, metabolic syndrome, chronic kidney disease, depression…the list goes on. It is staggering to witness the growth of obesity in the USA in graphic form (for animated version of spread of obesity in US, see website ).

    Let’s consider changes in the socio-cultural fabric of the USA in the last 40 years. There is increased technology (TV, film, computer, DVD, VCR, palm devices, handheld gaming devices, cell phones.) There are increased number of restaurants (fast food, fast sit down, moderate sit down, fine dining, and all echelons in between) and ready-to-eat, calorie-dense snacks and beverages (remember when the only beverages in the house were water, milk, and tea?) Our consumption is not linked with effort required to produce our own food (hunt it, grow it, harvest it, or cook it), or need to conserve food for the long winter. We have abundant resources to purchase it–and oddly, calorie dense foods tend to be less expensive that an equal amount of fresh foods.

    So in the past 50 years, our ability to access calories has increased astronomically, but our physiologies have not adapted to the increased intake. Our bodies have been accustomed to a feast/fast cycle, eating when food was plentiful, and well, not eating when it wasn’t. Our incredible bodies figured out how to store calories for the lean times. Is it possible that our problem is that we don’t experience enough lean times?? That may be one way of looking at the issue. Another is that our bodies cannot adapt to such rapid caloric increases overnight. And when increased caloric intake is combined with decreased caloric expenditure–well, you get a positive balance in overall weight (if only that happened so regularly to my bank account!)

    Further, with increased intake of high calorie, high glycemic foods (particularly those with low nutritional value–think chips, soft drinks, beer, candy) there is an almost immediate blood sugar spike, which leads to an insulin spike, which drives the energy into the cells, and then blood sugar plummets, which leads to a sensation of–hunger, lack of attention, depression–whereupon one reaches for more food to quickly drive the blood sugar up and alleviate the nasty feeling of hypoglycemia–and the cycle continues.

    So food choices are important–a calorie is not a calorie is not a calorie. Exercise is important as well–in terms of curbing appetite, using calories, increasing basal metabolic rate, promoting feelings of well-being, and regulating insulin production and sensitizing insulin receptors to work more effectively, instead of becoming resistant when exposed to increased amounts of insulin in the body.

    The issue calls for a paradigm shift in our cultural thought process. We need to examine the wisdom of removing all necessary physical activity from our day. We need to examine our use of technology and our growing need for electronic entertainment during all segments of our day. We need to examine our use and our investment in foods that do us harm (consider the number of foods that are articificially colored, artificially flavored, sugared, or hydrolyzed to make them more appealing—hmmm). The move by New York and now the nation to remove hydrogenated fats from restaurants is a perfect example, and an excellent start.

    We need to examine the reduced efficiency and mood of our nation, and the absolutely skyrocketing health care costs related to these issues. If the projections are correct, it is unlikely that we will be able to cover our health care costs in the next 20 years due to tripling numbers of diabetes, hypertension, heart disease, congestive heart failure, kidney disease, etc., etc. We need to emulate dietary habits of nations without an epidemic of obesity. (It is possible not to have a population of obese individuals in this day and age–we have to realize that before we can make the changes necessary.) We need to lose our mentality that bigger (huger!) portions are always better. We need to focus a bit less on quantity, and more on quality. There is an issue of self-respect here as well.

    Some quick fixes–

    1. Drink water–only. No soft drinks, no coffees, no triple fruit smoothies. Try is for a week, and see if it makes a difference. It saves money too!
    2. Eat protein, fruits, vegetables. Think natural. Avoid processed foods–anything that comes sealed in an airtight bag.
    3. Limit breads, pastas, potatoes, sugar (the white stuff) to no more than 2 servings a day.
    4. Walk in the morning; or in the evening; or when your child is at soccer practice; or music lessons… sometimes adults spend inordinate amounts of time watching their children be active while they themselves sit (or sit and eat/drink!)
    5. Choose the hamburger OR the french fries if you must have one or the other–but not both. Each has approx. the same number of calories (400-700 and beyond)–and the french fries have less nutrition, higher glycemic index, and more fat

    Education and understanding is key in this issue of obesity. It behooves us to get a handle on obesity now, rather than waiting until it spirals yet further out of control. If we do, we will have a nation of healthy and vital individuals who spend the lion’s share of their energy, their time, and their money on worthwhile pursuits rather than on treatment of disease and the breakdown of their health related to obesity.

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  108. D.Duval NP-C

    You look the way you eat…No secret there.
    No time to exercise, but it seems that we always have time to eat.
    I am using the glycemic index to help my patients to understand that it is a matter of “choice” and “size”.
    Our “pets” are also overweight! No secret there!

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  109. Dr PV ERWIN

    In addition to exercise and diet considerations there needs to be A Shared responsibility placed on the food industry.
    High Fructose corn sugar ia a big player in unwanted calories, and artificial sweeteners have only made a negative impact on the health of the nation.
    Whole foods are less and less a part of the american diet.
    What has changed?

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  110. Jennifer Rogers

    Interesting comments on a complex issue. I believe obesity in our country is multifactoral. My greatest concern is how we are teaching the children. Food has become the center of all activities, including rewards in the classroom, treats after any activities or if you are feeling emotionally high or low. The student council in my son’s elementary was selling candy bars (no limit) to students after lunch. The scenario looks like this… Johnny doesn’t eat his lunch so he can buy candy and eat it during recess instead of playing. It took several phone calls and a meeting to get a limit put on things.
    Access to overindulge has never been at a higher level. It needs to be addressed by society with guidance from the medical profession. I agree with the pediatrician that it will make “a million mad moms” to make a difference. Unfortunately, the moms will be battling the bulge right with their kids. We all need to learn and teach our kids that food does not solve the problems of the world.

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  111. David N. Ford EMT-P

    It’s not just obesity; it’s morbid obesity that has become an epidemic. As an obese Paramedic I have fought this fight since I got out of the military. What I see as the main problem as Medical Knowledge (the stigma with being fat). Medical practicioners still advocate that eating right and exercise will take care of the problem and that people got this way because they are lazy. It has been proven time and time again that there are genetic factors to consider and real medical issues at play. Doctors need to start thinking out of the box and stop spewing the company line.

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  112. Jasmina Petrovich

    I think the resolution of this problem is to allow shorter days in classes and more physical activities, which would count in the end for marks. This, started at a very young age, would give the incentive to learn and learn well for the years to come. This does not necessarily mean to run … but just occupy your mind with something else than food!

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  113. Michael Schechter, M.D.

    As a prevention consultant to companies nationwide, I find the number of individuals who suffer from what I call the “big six” (overweight/obesity; high blood pressure, lack of exercise, high cholesterol and smoking) astounding. What is even more amazing is that people generally believe with proper medication they can continue their ill-advised lifestyles with little change. I believe that the public needs to be motivated by an incentivized health program that rewards behavioral change and healthy lifestyles.

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  114. Darrell King SN, EMT-B

    I agree with an earlier comment that focused on portions in the sense that we are taught by media and peer pressure to value size and quantity without thinking. Of course, such topics as proper eating, good habits vs bad and sexual conduct used to be the province of the family. Without beating a dead horse, I believe it’s safe to say that the primary information source for these subjects has at least partly passed from the hands of protective parents into those of profiteering advertisers and media professionals.

    In my experience, younger folks are not all that concerned with consequences that won’t appear until years down the road unless that concern is instilled from an early age. Educators, physicians, nurses and similar professionals may be the people best suited to picking up the flag dropped by the family, whether for today’s adults or for tomorrow’s.

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  115. Matt Cushing MD

    All the answers were interesting and topical but suffer from the ‘blind men and elephant’ problem. That is especially true of those who state that ‘the real cause is…..’ There are many interlocking causes: low cost of food, portion sizes in restaurants, reduction in caloric expenditure, social conventions of serving food at meetings and gatherings, the good taste of fat and its ready availability, rebellion against conformity, and several others. No single remedy will control the problem. The abject failure of dieting and pharmacotherapy needs to be stressed. At the moment there is only one immediately successful therapy for a few massively obese persons, and that is bariatric surgery. But, as the Charlie Weis story reveals, that is far from an ideal answer. Joining Weight Watchers and staying in it for life can work, but compliance is low. Sure, self-control is an answer but the percentage of people with that much discipline is low. As with cancer, AIDS and tuberculosis, cure awaits future developments. Meanwhile, we stumble along, using the few tools we have, and often fail to address the paucity of treatments, leading to frustration and guilt, which only compound the problem.

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  116. Brenda Christian, PA-C

    As an overweight individual and as a clinican I recognize the magnitude of this problem. Recently I lost 52 pounds by adopting healthy eating habits and regular exercise. It is not easy. Every day I have to focus on myself. I pack my lunch, plan what I will eat should I go to a restaurant, and prioritize exercise no matter what my daily schedule entails. But my kids are grown, I work a regular 9 to 5 and I don’t have to deal with all of the responsiblities of raising a family today. If one has never had a weight problem, it appears simple; eat less and exercise more. Clearly if it were that simple, the obesity rate would not be so staggering. This problem is multifactoral. In an effort to simplify our lives, we have endorsed fast food restaurants, embraced the computer, and basically become more and more sedentary. No it’s not impossible, but the overweight need a lot of help.

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  117. J.D. Jolley

    I am a Registered nurse that has practiced for approx. 40 years. I am overweight. I do not have DM and I do not smoke and never have. The first thing we in the health care industry must face is that we know NOTHING about weight control. Saddly we (including the participants above) find it easier to blame the obese person. Very few in America seems to want to do research on this issue and find out the truth. In other countries they are coming to the conclusion that at least the real morbidly obese (we over use that phrase) appears to have all the symptoms of the addicted personality. All of the stated factors do play a role in weight managment but we have so much more to learn. If we could approach it as a disease instead of being superior and accusatory in the treatment of our patients. Reminds me of the attitudes toward alcholism before it was accepted as a disease.

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  118. Ross Berlin

    Obesity is, of course, a major health problem, clearly epidemic in proportions. However, it is also a mirror, representing a multitude of cultural and social issues contributing to it. This survey is most valuable is directing our common attention to it. We, as health professionals, must approach obesity as a disease, devoting significant time with our patients and their family and friends, as we have with smoking, etc., helping them understand that factors contributing to obesity must be modified. Not doing so places them in a disease state which, like hypertension and DM will otherwise only get worse, depriving them of what they want, independence and quality of life.

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  119. Philip Dutton

    I accept many of the aspects discussed but if we are looking for cause and not just reasons then I have suggest ‘unhappiness’ as the major cause of obesity. The body will self-regulate for a time when we don’t look after ourselves, but once we become chronically unhappy we lose motivation to look after ourselves and set limits. If we feel worthless or unloved or unable to achieve goals, then we are unable to regulate our eating and exercise. The ability to make our own happiness stems from being loved and cared for but with appropriate limits in childhood. Any person who I have assisted to ’self-regulate’ back to a ‘normal’ body weight has first achieved a measure of happiness and self-belief and cleared ‘blocking beliefs’ about their core selves. As a clinical psychologist, this is the focus of any treatment I would use to assist people.

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  120. G. Rafool

    The fast food chains are definely a problem, but the real cause of obesity lies with the individual. No one forces a person to stop at a fast food place nor to gulp down double portions. The other simple fact is that there are less minutes a day devoted to excercise. It is a simple equation the more calories taken in and the less expendated the greater the weight gain. As physicians, we must keep drumming this fact in and stop blaming the restaurants.

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  121. Glenn R. Rutland

    The root cause of obesity is a lack of vision. People who become obese lack a vision regarding their own future, purpose, and destiny. If they had a proper perspective of reality, of responsibility to themselves and to the people of the world, they would behave differently towards food. They would be aware of what they eat, how they eat, when to eat, etc. Proper boundaries would be set in their lives. Even those with a genetic predisposition to obesity would rarely become obese if they were aware, focused, and living by an accurate vision of their own humanity, authentic sense of personal value, and the reason they exist. This problem is a reflection of a lack of spiritual understanding on the part of individuals and our society as much as it is also a problem of circumstance: dietary lifestyle, economics, socialization, etc.

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  122. CSH, DNP, FNP-C

    I find the responses very interesting in that they are so focused on individuals when it is clearly a social issue. 30 years ago, there were fewer fast food resturants, not one on every corner, portion sizes were “normal” not supersized; most people drank 1 or 2 sodas a day rather than a liter or more; children played outside and not in front of the computer or television with a joy stick; meals were shared and prepared at home, not picked up……Today it is much cheaper to eat highly processed foods rather than fresh meats, fruits and vegetables. The answer is complex and I do not believe that it can be solved by the medical community but requires that the public demands that there are changes in society as a whole. We need to have safe communities where children can play outside and parents can afford to buy food that is nutritious.

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  123. Howard Huber PA-C

    There are probably as many opinions about obesity as there are obese people in the world. All have their merits, but few address one significant issue related to American dietary habits. And that issue is portion control. The “get the most for your money” mentality imbedded into the consumer psyche filtered into our dietary habits many, many years ago. Today, almost every restaurant serves portions much larger than any human should ever eat at one sitting. No human should ever consume 14-16 ounces of red meat at one sitting. Still, this is the size of most steaks served at popular restaurants and most people eat the whole steak. Add that to the “eat everything on your plate” attitude pounded into ours heads by our parents as we were growing up and you have a sure fire recipe for obesity. In the store just today I saw a candy bar being sold as a “energy booster.” There were 240 calories in each serving and there were three servings in the candy bar. Who purchases such an item and eats only one serving? And don’t even get me started on the ultra jumbo mega popcorn bucket sold in most movie theatres now days.

    Without a doubt, genetics, hormones, and other factors contribute to the problem of obesity today. However, I believe those factors to affect only a small percentage of our obese population. The larger percentage, especially those who fall into the boderline metabolic syndrome category, based on BMI, could successfully lose weight and keep it off by making lifestyle modifcations and monitoring the portion sizes they consume.

    As a society, we have fallen too far into a pattern wanting it all, wanting it all right now, and not worrying about the consequences until it is too late. Obesity research and proper dietary education are paramount today, but we must certainly teach our children moderation through appropriate example. If, as a society, we insist on an “eat everything on your plate” attitude, let’s at least serve appropriate portions.

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  124. Emmanuel Yirenkyi MD

    As a primary care physician, this is one of the areas that I have targetted to attack.It is easy for someone who is not obese to say a lot about obesity and make it seem like its solution is easy but given its multifactorial origin in nature, I think it is a problem which has to be attacked from various angles, but the key to success in the fight against it is in trying to get rid of it in the child or adolescent. Atttacking it from its early roots is the way to eliminate it in at least the future generation, if nothing can be done now for the adults,as it appears.Children should be encouraged to exerciseand partiularly, obese children should be obliged to exercise together with strict dietary regimen made for them.I personally think, attacking it from its early beginnings, is the way to go. In adults, it becomes a little-bit-too-late-issue and as we all know,it becomes more expensive and difficult to treat.

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  125. Farouk M Zeaiter M.D.

    Obesity per say is a genetic factor. But if we ask ourselves: What is the percentage of Obesity related immediatly to genetic diseases ? we see that not much of Obese people are that obese to be concerned to related diseases overall, while on the other hand we see Other factors like ” nutrition, Poverty, life styles, and Educations, are the most contributor to related diseases concerning Obesity”.
    Here I could say that it’s a sharing responsibility among us ( Obese Individual themselves, the Government(Rules of public safety concerning Fast Foods, Etc ), Family Education, and Physicians). We have to solve thes issues before jumping to a conclusion that affecting our study.

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  126. Bill DeFazio, PA-S

    The other contributors have made some excellent points regarding obesity. True there are different metabolisms for different individuals. I have always been thin and have never had to attempt to lose weight. However I do have a strong family history of heart disease and am currently being treated for hypertension and hyperlipidemia though I exercise 3-4 times weekly and eat a healthy diet. I make no excuses and do not feel sorry for myself regarding these inherited traits. Therefore it frustrates me to here people who are overweight complain and make excuses because of their metabolism. Being obese can, and in most cases does affect one’s self esteem, but it should be treated as a health issue primarily with behavioral therapy thrown into the mix. I’m not saying that every patient can and should be their ideal weight, but just because a person has “always been heavy” doesn’t mean they should give up and become morbidly obese. In many cases we are not just talking about Americans being 10-20 lbs. overweight. We all see people so large now that they have trouble walking down the street, using public transit, walking through the grocery store, etc.
    I don’t believe this epidemic is the fault of just one culprit. There are many factors including larger portions, sugary beverages (yes including Starbucks which if you think about it sells a series of large calorie laden caffeinated milkshakes), and lack of “built in exercise” due to poor urban planning and advances in technology eliminating labor. The other huge issue is the lack of personal accountability in America in general. Everyone wants to be a victim of something. I do not blame the fast food industry for super sizing everything. People need to eat less an burn more calories then they take in. As far as I know it is impossible to gain weight with a negative caloric intake.

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  127. Cheryl Norris RN, MSN, CRNP

    I am currently pursuring a PhD in Health Education and Promotion. My area of interest is obesity in children. 25 to 30% of children in the US are obese and it will not be getting better. This is the first generation that will demonstrate a decrease in years of life expectancy. Schools in the US have taken away recess and many don’t even require PE anymore. Children go home, lock themselves in the house and turn on the TV or the video games and snack on junk food. We all live fast paced lives, running here and there, grabbing a burger or other fried food. All of these situations have helped to promote obesity in our youth. We must start with our children and then the parents will fall in. As a health care provider, I am also concerned that many children are not appropriately diagnosised as obese or potential for obese. If children are under 6 and overweight, no counseling is done or follow-up. I have seen a 4 year old that weighs 80 lbs, the parents believe the child to be healthy. I have also had a 15 yo die due to complications, breathing, because he weighed over 400lbs. I don’t want to see our children become diabetic at 10-12 years of age and have a heart attach when they are 30 years and die young.

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  128. Mark Harris

    How about we take a look at the chemical companies and their food additives along with possible collusion with the drug companies? I am sure we will find a link.

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  129. Shan Crockett, MD

    I share the opinion of several contributors to this discussion, but I may express it more starkly. People are lazy and want something done for them or to them. When asked to actively participate in their own care, they really cannot be bothered. Even if they say they will exercise, they don’t often actually do it. How very sad this is. Exercise and being acutely aware of what one puts in one’s mouth are the keys. Enough said.

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  130. Parag Kumar, MD

    I am a pediatrician with special interest in treating childhood obesity. I am also the medical director and an advocate for healthy eating and an active lifestyle. With each passing year, I am realizing that this condition is difficult if not impossible to treat. Our enviornment is very “obesogenic”. There are too many incentives to make unhealthy choices(fast food is cheap, tasty and convenient). I think we will loose a whole generation of children(dying before their parents) before the nation gets serious. This problem cannot be managed in physician’s ofice. More and more pediatricians feel that we should abandon attempts to treat obesity and concenterate on preventing it. This we can do in our office by anticipatory guidance. Outside the office parents have to be motivated to demand change in our enviornment. Only a “million mad moms” will bring change. Parag Kumar, MD, FAAP. Bismarck, ND.

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  131. Mary Barr, RN, NP-C

    I think more clinical/basic science research is needed to look for a metabolic connection between obesity and sleep. We are a society of sleep deprived individuals and many struggle with weight issues. There has to be some connection here that is bigger than we know. We see it in our clinic in some sleep apnea patients who are treated. They begin to lose weight, but not all do. Worth looking into further, NIH is doing it!

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  132. Tom Taylor

    Obesity gets going in grammar school, yet only Illinois has required gym classes. Kids are sedentary, riding the school bus, or mom driving them, an important daily physical activity, walking to school is gone. Letting kids play in parks without supervision is scarey today. We need a lot of societal changes and change in priorities for both activity and healthy diet. Wont happen overnight but taking first steps is essential.

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  133. Georgia

    I think Mark Grohman has the right idea. There is high fructose corn syrup in just about everything. Avoiding it is a full time job. The weight of Americans is a political issue. We won’t get any straight answers about this nightmare until researchers stop taking money from the corn growers. In the meantime, we can refuse to purchase anything that contains high fructose corn syrup, eat only whole grain products, even if it means carrying our lunch to work, stop eating anything with sugar or hydrogenated oils in it and eat all the fresh fruits and veggies we can find. Weight loss guaranteed!

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  134. David T. Allen, M.D.

    When Surgeon General Terry released the report on the risks of cancer due to smoking (in 1964 or shortly thereafter) 55% of all physicians were smokers, and it took 20+ years for the majority of physicians to stop smoking and to add the risks of smoking into their regular practice health education messages. Surgeon General Satcher released his report on overweight and obesity in 2001, and 50% of physicians are overweight or obese today. What will it take for a majority of physicians to walk the talk and model physical fitness — not just a BMI of 20-25, but also a cardio-pulmonary fitness so that they would be in the top half of the nation by age for the one mile run, push-ups, sit-ups, etc. I think we have to lead by modeling, and be prepared to “wear our numbers on our sleeve”, e.g., age, weight, height, BP, BMI and BMT (best mile time), and then expain to patients why they all are important. How many folks reading this would be willing to “wear their numbers”? Let me know at:

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  135. FNP in Family Medicine

    Obesity IS the number one health problem in America. It is directly related to changes in dietary habits and activity in the last 50-60 years. The rise of obesity closely follows the rise in TV viewing (passive entertainment) and the amount of sugar and high-fructose corn syrup in the average diet. Through in “fast food”, not sitting down to regular meals in a family setting (and I define family very loosely), and you have a recipe for obesity.

    The cure is SIMPLE, but NOT EASY: calories in less than calories out = weight loss. It is remarkable that many patients can do this as the prequisite to bariatric surgery when the absolutely couldn’t (wouldn’t?) earlier. Frustrating? Yes! Should we punish patients with higher insurance fees, etc? NO! Motivational interviewing is the key to behavior change, and the key to addressing almost all chronic illness, including obesity.

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  136. J. Reekie

    I have been obese most of my life. My 10 year old son is built exactly like I am. No I don’t eat right, but that hasn’t seemed to have a great bearing on my weight in the past. I was a life guard from 18 to 21. Ate only twice a day and exercised several hours a day. I was never less than 10 to 20 pounds overweight. When I was in my thirties I went on the atkins diet. I was about 50lbs overweight. I lost about ten pounds and leveled off. With portion control and exercise I lost another 15lbs. Four years ago I recieved a promotion which increased my commute. I now spend over 4hrs a day commuting and have a sedementary job. My weight is spiralling out of control. This was made worse when I tore my shoulder and stopped going to the gymn.
    I understand that food choices and excersize are major factors in weight control. However, no two people are alike and different programs will have different effects on individuals. All avenues need to be explored. I feel insurance companies have a vested interest in research and development of curative programs.

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  137. John T. MD

    Obesity is a huge public health problem, and one of the reasons I left primary care to pursue a second career in palliative care. Excuses, consumerism, sloth and the hope for a “quick fix” are all contributing. Patients want pills, not advice.

    Just 50 years ago the US had problems finding military recruits who were not UNDERWEIGHT. It’s not genes, nor a disease, but is becoming our number one health problem. Health insurers and employers need to start charging a prorated premium for overweight patients, as there is no doubt they use a disproportionate chunk of the health care pie.

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  138. D. Renee RN

    I work primarily in an out patient setting in a hospital and am not surprised by the survey at all. Three quarters of the patients I see are obese or morbidly obese, smoke and or have diabetes. Some shockingly enough blame their bad knees on arthritis and do not seem to have a clue that their weight is the cause of their pain. Many obese patients who are diabetic would not be if they would just loose 50 to 100 pounds. That may sound hard but it is better for them, however most think taking a pill to control their diabetes is easier. How very sad. Many many people want a quick fix like a magic diet pill. And that is why the bogus diet pill business is in business. I do not know one person who takes those pills forever or even stays on fad diets. Losing weight is a life style and people have to be commited to weight control for the rest of their life not for two weeks. Education is THE most important factor in helping the public understand how important it is to eat healthy, eat the correct portions and do some form of exercise 3 or 4 times a week. I have been a nurse for 12 years now and am still amazed at the number of people who just do not get it. I will never forget what a doctor told me a few years back about a morbidly obese patient that he was managing and I had taken care of many times for heart failure, “The patient is killing him/her self one fork full at a time”. When the patient died he/she weighed more than 575 pounds and was less than 60 years old.

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  139. Michael I Omori MD

    I think there are factors out there that are yet to be discovered. Insulin resistance for one. This is the epidemic underlying the obesity problem. Exercise is only one way to decrease the resistance problem. As am EM physician, whenever I see a patient with shortness of breath with a BMI of 35 or greater, I assume they have DM, HTN and and ischemic cardiomyopathy regardless of age– and that they are at a 3 to 5 times greater chance of death than if they weren’t obese. Remember that this class of patients rapidly desaturate, even with preoxygenation prior to intubation.

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  140. Med Student

    I am surprised by the statement: “The message should be made clear that obesity is an organic disease and that the eating habits and sedentary lifestyle of the obese is an effect of the disease rather than the cause of the disease.” If you look at the recent splurge in obesity, it is obviously a cultural health issue as a result of poor nutrition and exercise. If it was organic, then there would not be the recent crisis we are now facing in America. Children are now morbidly obese! And the health effects stemming from obesity are numerous! I’m not obese, yet I find it difficult myself to maintain portion control and find time for exercise. Schools spend little time teaching proper nutrition and portion control. As doctors, we need to do more!

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  141. Penny Peterson, LCSW

    I am impressed that the things doctors see as most likely to help solve the weight problem are not going to help me, ie, no soda machines or fast food in schools, nutrition education for low income families. Their next best solution, higher insurance rates is absolutely punitive. I’d have to say there is an unhelpful attitude problem here. Solutions did not seem to correspond to their ideas about cause, ie, lack of exercise and portion control. On the whole I do not think primary care doctors are being effective in their care of obese patients. I know mine finds me a challenge and hasn’t offered anything but eat less and exercise more or have bypass surgery. Good luck to us all!

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  142. RN Bariatric Clinic

    I agree with Schmidthuber PA-C and Shick. I work in a baratric service for surgical prep and hear all the excuses of those that can’t lose weight and see results of those that can. There are many, including me, (yes I am obese) that truly have difficulty getting the weight off. No matter what they do or try. Too many physicians have preconceived notions that it is a matter of what the individual does or doesn’t do to lose weight. I agree that “The undertone remains that the obese are lazy gluttons suffering from a lack of self control and motivation” Even my own PCP is negative and offers no help in this battle. Although our program does not prescribe “diet” pills, there are those medications that are fairly new to the market that can be safe for the patient when monitored closely and correctly. I am very dissapointed in medical practitioners that can’t (or won’t) give some support. There are poor excuses, I have seen and heard them all. They are as pitiful as a opioid abuser claiming he/she “accidently dumped the pills in the sink”. But there are those that are honest and pathetically affected by obesity. My truth is I eat 800-1000 calories per day - high protein, low fat and carbs, exercise 1 hr per day, and work (yes work, not sitting) 10-12 hours per day full time. My weight hasn’t changed from 204 lbs for 2 years or more. I despise being obese, but I am frustrated with medicine, even more.

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  143. S. Bromley, PA-C

    There have been many occassions that I have counseled my patients on diet and exercise. Several patients have told me that they don’t want to diet or excercise and have asked me for a “miracle” pill to loose weight effortlessly. As an overweight person myself, I would reply that if there was such I would be out on the street selling it in my size 6 jeans instead of counseling them. I finally took some of my own advise and started following a balanced diet consuming less calories than I burn/metabolize. Amazingly this simple math has netted me a 40 pound weight loss to date. Loosing weight and maintaing the loss is hard work, but for most people it is a matter of making the right choices. The cause of obesity for the majority of our population is directly related to the individual’s unwillingness to put forth the effort and make sacrifices. I would venture to say that out enlarged waist lines speak volumes about our society, and the problems goes much deeper than what we weigh!

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  144. Daniel Gouws

    I enjoyed your survey and comments, which I found balanced and informative. Over the last year I have embarked on a fairly intensive exercise program, doing “bootcamp” every week day morning for an hour. My weight has dropped a bit (10 pounds), but my waist is two belt notches tighter, and my energy levels are much beter. I have not consiously changed my diet but I find that I eat less when I exercise.
    I agree that the BMI score can be way out for some people, but still find the mirror the best scale to use to “check for” obesity. As for portion sizes-these match North American automobiles where size is everything and bigger is better while quality remains sadly lacking. We seem to have an enormous divide between the “health fanatics’ who suggest bland tasteless protein shakes, and the junk food crowd on the other side. The fact is that strict dietry prescriptions do not work for the majority of people, and many of us, including myself, enjoy eating, and enjoy good food and wine. I’m all for replacing quantity for quality, and for practicing moderation. Why is it that everything in America is low-fat these days, except the Americans? We have to find out why this is not working, and stop this epidemic.
    Daniel R Gouws, MD, Vancouver.

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  145. Stephen Hanneken, PA-C

    I often feel like a fool when I’n counseling a patient to lose weight. I’ve been trying myself for 35 years, with limited success. I’m always wondering if they’re thinking I’m a hypocrite.

    On the other hand, as has been pointed out, as health care providers our lifestyles do not always lend themselves to healthy eating. When the only source of food is the McDonald’s in the hospital lobby, much as you hate it, you take the path of least resistance in the 20 minutes you have to eat.

    Making better choices when not working, i.e. when you have the luxury of time, will help, but I believe it is only part of the picture. The abundance of high-fructose corn syrup- it seems to be in everything except gasoline; maybe they put it in there, too- has been identified as a prime contributor. As with many health concerns in this country this represents is an economical/industrial angle that will not easily go away.

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  146. srp82

    Obesity is something that starts in the home, when children are exposed to poor diet and pick up bad habits from their role models, parents. I know a morbidly obese person who had just this experience. Then, as a result of different diets would lose weight, then gain it back, with 50% more, each and every time. Finally decided that metabolism had been afffected, and just stopped dieting. This person has been a constant 630 for many years now. The only way to lose weight for this situation is gastric surgery, which has its risks, as well.

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  147. Rich Schick PA-C

    While I am encouraged by the growing attention that obesity is receiving as a significant health issue I am somewhat discouraged by how the obese patient is being characterized. The undertone remains that the obese are lazy gluttons suffering from a lack of self control and motivation. The message should be made clear that obesity is an organic disease and that the eating habits and sedentary lifestyle of the obese is an effect of the disease rather than the cause of the disease. This is not to say that the obese should not try to improve their diet and lifestyle but only to acknowledge what a monumental task this will be for the obese patient until we discover effective treatments for the underlying metabolic disorder. (I do not suffer from obesity 5′8″ 140lbs)

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  148. Dr. Sharon Rogers

    I am a clinical psychologist in Texas and I believe obesity is a very important issue in my community and perhaps everywhere. I know that it contributes to the incidence of diabetes in the population and has a strong influence on both an individual’s willingness to exercise and ability to sustain movement. A major concern is obesity among children, creating what I believe to be a sluggish, unenthusiastic involvement in both group and individual activities. Education is important but so is modeling behavior by adults, who probably don’t eat very well and certainly are less active than we need to be. Discussing these issues with parents, families, educators and other professionals has led me to believe that the more we talk and model, the greater our effect. Talk alone won’t do it and modeling along is sometimes ignored, we need both.

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  149. Cathy VandenHeuvel

    I think the public needs to take more responsibility for acting on the volumes of messages given to them about healthy lifestyle, dangers of fastfood, especially keeping our children more active and less plugged into TV/computer screens for long periods of time. Doctors and other health care workers need to continue to set the tone, provide role modeling but also sympathetic support for those who are trying and not successfully losing weight. But individuals in our society need to take more personal responsibility — we’re all too eager to blame someone else for offering us tempting things, being too busy, being in self-denial about our weight issues and their risks.

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  150. Don Hodson

    Obesity is rampant in my part of the midwest. There is a wall of resistance to any suggestion to patients that they are overweight, they seem to take it as personal criticism rather than medical advice. I am a believer that losing weight is not about dieting, it is about eating right and exercising every day whether you feel like it or not. Can ANYONE get their patients to do that? And if so tell me the secret, life is too busy for the average American to do that.

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  151. Mark Grohman OMS II

    The curve for the obesity epidemic and that for the consumption of high-fructose corn syrup are a close match. Drinking soda floods the bloodstream with fructose, which does not provoke a significant insulin response. Fructose enters cells, is broken down, and its components are shunted into lipid synthesis. It is of little other use to the body. Thus obesity is promoted, and through unclear mechanisms, diabetes is also promoted. Fructose is the classic empty calorie of obesity.

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  152. L. Regier

    Very interesting and timely. Our academic detailing program has just finished physician discussions regarding our newsletter and drug comparison chart on weight loss drugs as well as herbal/natural options ( After discussing with several hundred physicians, I am convinced that we need to identify early and prescribe lifestyle interventions before obesity begins to set in. In some cases, patients may benefit from being asked to report back in 2 months as to their progress with diet and activity changes. The issue is a difficult one and interventions need to be made at various government, education and workplace levels as well. (Perhaps some technology like the new Wii will help the gaming segment of the population.)

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  153. John Hammond

    Obesity is a problem of individuals. It’s tempting to try to blame someone or something else (like the food industry), but it’s simply a current cultural “thing” which can be completely controlled by individual behaviour. For example, from a country perspective, consider that farm diets are rich in fats and carbohydrates simply because those that worked (please underscore worked) on the farms expended huge amounts of energy in the course of a days work. And, in years past, obesity “on the farm” was simply not a problem. Today, farm communities cling to the good food that grandma made, yet there is no comparison to the amount of energy expended by the farm community today compared to years ago. Those that still work hard on the farm, don’t seem to have a weight problem. Those that are from the farm “working” in sedentary jobs and continue to eat like their grandfather find themselves becoming grossly obese because they only expend a fraction of the energy he did. There are many observations and opinions as to how quantity first, quality second came to be sought by our society. It’s simply a problem of individuals.

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  154. Teresa Connor

    I think a very hectic busy lifestyle…fast food readily available, and convience meals that are high in fat, sugar and calories, are some contributing factors for the reasons that individuals make poor food choices on what to eat. Once the bad habits are established, then it is hard to change. Stress that goes along with hectic living, often makes individuals want to reach for comfort food. Foods high in carbohydates or sugar can help you raise serontin levels in your brain..A blood sugar level that goes up fast, usually drops as fast from the splurge of insulin that your body gets from the pancreas..the ups and downs of your blood sugar can make you want to eat more shortly and then want to sleep… without exercies, a sure way to gain those extra calories..somehow the lean fish and vegetables doesn’t seem as appealing as that juicy hamburg to most… Once you are over 50, you start to get the idea of what is good for you and why it is important…then you are still fighting a lifetime of poor eating habits. We need to remember, that we eat to live not live to eat! ..Teresa Connor Licensed practical Nurse

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  155. Dr. S. R. Skaggs, PhD

    I agree with the PA, Schmidthuber. My body mass index says that I am obese, BUT, I swim a mile every day. At the finish I take my pulse and find that immediately afterward it is running at 100-110 or about 65-70% of maximum for a 70 year old. I continue to take my pulse at one minute intervals and find that it drops by about 10 beats a minute until at around 5 minutes it is down to the 60-70 range.

    Am I at risk? I dont think so. I think the BMI is not a good indicator of physical condition, especially for those of us who exercise vigorously at least three times a week. I try to swim five days a week and take weekends off by just walking or bike riding.

    Somewhere along the way we need some better measures of physical conditioning.

    BobSkaggs, PhD

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  156. Jade Teta ND CSCS

    I found this survey very interesting. I was surprised to learn so many physicians view exercise and nutrition as the key elements to address this issue. However, I find it sad that our medical schools do not teach nutrition or exercise prescription leaving doctors clueless as to what to recommend. I also find it telling that Weight Watchers is viewed as the best nutritional approach to the issue. Until we move beyond the narrow one dimensional approach of “calories in must be less than calories out” I am afraid we have no hope to combat obesity. The body is not a simple furnace but a complex metabolic machine that is directly impacted by its environment. Food, sleep, stress, exercise, light, temperature all have a role to play and have direct impacts on hormones in the body that determine metabolic function. We need new approaches to weight loss that are not so one dimensional and move beyond the narrow drug, surgery, and calorie models.

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  157. RN from WA

    I am not suprised that obesity was a major concern. I feel that insurance companies are behind the curve in realtion to treatments regarding obesity. An insured patient who is interested in a weight loss surgery, is not covered. They will cover the cholesterol medication, diabetes medication, anti hypertensive medication and surgeries to repair joints. While the clock ticks and the side effects of obesity ravage the body, hardening the veins, destroying tissues leading to more need for more invasive procedures, more medications, and increased medical care as well as decreased quality of life. I think many health care workers are judgemental regarding acceptable ways to lose weight - and hope that in the future that healthcare can embrace and support this surgery, as well as staff for the increased needs when dealing with high weight demands on health care professionals.

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  158. Lori

    I think we need to start addressing this issue when our children (not when we have become obese adults) are in elementary school and pre-school. We are so caught up on having an “active” lifestyle, but don’t even offer our kids a true recess. This is an issue that is not only one for the parents but for society. Children spend more time in school than they do at home. They should be allowed to have more recess time an “active time”. Through the no child left behind act, we are required to have a certain amount of time in all acedemic areas, but we forget that we also need to have outlets for children to have physical fitness mixed into acedemic life. Cutting sports programs, or making them available to a certain economic class is also an issue. Start small…with the children.

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  159. Jason Schmidthuber PA-C, NSCA-CPT, CSCS

    I am all for health care providers having a duty to address the obesity problem as well as increased insurance premiums for obese patients. There are a few problems I see though. #1 using BMI for figuring obesity vs actual body fat%. I am 5′8 205lbs with about 15% body fat and I am considered serverely obese with BMI calculations. BMI works well for the un-fit/non-athletic only. #2 can you deny medicaid to an obese mother with obese kids? Can you deny or make an obese eldery man pay for his medicare coverage? I would like to see numbers of how many medicaid covered adults and children are obese. My guess is these numbers are rather high as is the smoking rate amongst medicaid covered.

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  160. Dr. Maxwell Capistrano

    I think the survey results are quite fascinating. I would be interested to see further exploration into the questions of whether and how health plans can provide more incentives for healthier lifestyles and disincentives for the opposite. It would seem to be in their interest and in that of the general public for them to invest more in these efforts.

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  161. Liviu Klein, MD, MS

    These responses are very relevant, as during the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30% of US adults 20 years of age and older (over 60 million people) are obese and another 35% are overweight. In addition, the proportion of young people who are overweight has more than tripled since 1980, with 16% of children and adolescents aged 6-19 years (over 9 million young people) being considered overweight today.

    According to the current study, most physicians believe that individuals are directly responsible for the increase in the obesity epidemic, and addressing the obesity problem should be an individual mandate. Only a minority of those surveyed thought that the government, physicians or other parties should get involved in addressing the obesity epidemic. Interestingly, although 30% of physicians surveyed thought that the food industry played an important role in the obesity increase, only 6% agreed that it should do something about addressing this epidemic.

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  162. Dr. Ann M. Alberts

    I think that there’s a bias among physicians; many see obesity as limited to personal lifestyle issues. The Ornish data suggest that lifestyle changes can reverse CAD - would we withhold statins and aspirin and just tell patients to change their lifestyles instead for CAD risk modification? I think many of us do the equivalent when it comes to obesity - leaving the patient without on-going support, just because there are no prescriptions involved.

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  163. Sharon Jundis, MD

    Sometimes, a small percentage in body weight - even 10% - can mean the difference between needing insulin or not, or needed CPAP for OSA or not. Yet, since lifestyle changes are so hard (and I don’t always follow them for myself), it’s challenging to be optimistic enough to embark on a sincere effort to support the patient through them. I think we underestimate the role of support - if not from an MD, then from a nutritionist or counselor, or someone who cares and has regular follow-up time with the patient.

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  164. Dan Jamison, MD

    I try to remember to calculate a BMI as one of my patient’s “vital signs” and encourage patients to know what theirs is just the same as many (not all!) keep track of their BP.

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  165. Dr. Dean Kaplan

    Since the lack of physical activity (83% of us say it is the factor that most contributes to obesity) is one of the key problems, maybe we should not only be “talking” about obesity with our patients, but be better about “exercise prescriptions?” I agree with the 19% who say we can be doing more as physicians to address this problem - but it starts with actively making recommendations for lifestyle changes for our patients. The cure for epidemic will be found one patient at a time - not through legislation.

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  166. Dr. Michelle Stephens

    I don’t want to minimize the negative health implications of obesity (it is clearly a very important public health issue) but I’m surprised that it beat out chronic disease and smoking. I wonder if some of this perception is still being influenced by the flawed CDC study from a few years back that initially suggested 400,000 deaths attributable to obesity in the US annually - but which was later readjusted markedly downward.

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  167. Amy Millhouse

    My lifelong personal struggle with obesity has led me to a career in nutrition. I now help people make more informed choices. I am not a doctor, but many of my clients are physicians. I would be very interested to hear what physicians think about meditation as a way of controlling eating habits.

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  168. Dr. Jared Wilson

    This was a very interesting survey. I hope more physicians take a more proactive stance on preventing obesity in their patients. As a family practitioner, I constantly make recommendations to my patients that help them lead a more healthy lifestyle which includes eating properly and exercise. This really is the most effective prescription to America’s weight problem.

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