M.D. Deborah Cohen - A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic — and How We Can End It

A Big Fat Crisis

ALSO BY DEBORAH A. COHEN

Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World

(Co-authored with Tom Farley)

A BIG FAT CRISIS

The Hidden Forces Behind the Obesity Epidemic
and How We Can End It

Deborah A. Cohen, MD

Copyright 2014 by Deborah A. Cohen

Published by Nation Books, A Member of the Perseus Books Group

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Library of Congress Cataloging-in-Publication Data

Cohen, Deborah (Deborah Ann)

A big fat crisis : the hidden forces behind the obesity epidemic - and how we can end it / Deborah A. Cohen, MD, MPH.

pages cm

Includes bibliographical references and index.

ISBN 978-1-56858-965-7 (e-book) 1. ObesityUnited States. 2. ObesityGovernment policyUnited States. 3. ObesityUnited StatesPrevention. 4. Overweight personsUnited StatesSocial aspects. 5. Public healthUnited StatesPlanning. I. Title.

RA645.O23C64 2014

362.1963'98dc23

2013024389

Contents

To my mother, Sheila Fried Cohen

Obesity shows how abundance, through cheapness, variety, novelty, and choice, could make a mockery of the rational consumer, how it enticed only in order to humiliate.

Avner Offer

I am one of the 97 percent of Americans who find it difficult to routinely eat a healthy diet and get sufficient exercise. I have been fortunate not to have serious weight issues, but according to the US Departments of Agriculture and Health and Human Services Dietary Guidelines for Americans, I am still supposed to eat a wide variety of fruits, vegetables, and whole grains; limit my consumption of meat; and drink the equivalent of three cups of milk every day. And because my cholesterol is high, it has to be skim milk. Hypertension runs in my family, so I also need to limit my salt intake.

If you think that maintaining a healthy lifestyle would be easy for me because I am trained as a medical doctor and conduct research on diet and physical activity, you couldnt be more wrong. Adhering to this kind of healthy diet is neither easy nor fun. You pretty much have to cook everything from scratch, and whether you work outside of the home or are a stay-at-home parent, its no picnic finding the ingredients and the time to prepare tasty, balanced meals. In every supermarket I visit, the items are scattered everywhere in no logical pattern that I can understand. I often have to ask for help to locate what I need. Does the store have any low-salt canned beans? Or will I have to buy them dried, soak them overnight, and then boil them for hours?

When I do find the right aisle, I am never sure which item to choose from the dozens of available varieties. Which cereals really have less sugar and more fiber? Should I get the multigrain, whole wheat, or rice flour pasta? What about chips? Are the baked chips or the ones with the flax and sesame seeds really good for me? There are so many products, and I just dont have the patience to read every label.

It was especially difficult to be a wise consumer when I had to take my kids grocery shopping with me, whether they were four or fourteen. As a mom, I not only had to figure out what to buy for my family but also had to remove more than half of what my kids managed to sneak in the cart before I got to the checkoutchips, sodas, and sugar-frosted cereals. Now that my kids are older and I tend to shop alone, I have a hard time resisting the premium dark chocolate candy bars at the cash register. Yum! Should I get the large bar or the three-pack of small ones?

And my family hates to eat at home all the time. (Boring!) Once in a while I give in and take them out to a restaurant, even though it is next to impossible to find a meal away from home that is both healthy and delicious. Last week we went to a Mexican restaurant called El Torito, conveniently located a few blocks from our house. The menu listed the calorie count next to every entre, as mandated by a recent California law that requires all restaurants with twenty or more outlets to list calories prominently on menus and menu boards. Although this theoretically should have helped me choose something healthy, I could find hardly any meals under nine hundred calories. And thats not including the free chips and salsa, the margaritas, or dessert. Forget about trying to find skim milk, fruit, or a low-salt optionits just not on the menu.

(El Torito is not an exception, by the way. According to recent research, fewer than 4 percent of restaurant meals meet the latest USDA guidelines for sodium, fat, and saturated fat.)

What about exercise? That should be easier than finding a healthy meal, because it only involves carving out thirty minutes five days each week. But it somehow doesnt work out that way. Although I could take more breaks and be more active during the day, or even walk around the block a few times, other things always seem to take priority. Deadlines for completing projects, the needs of my family, and the lure of a good movie after a tiresome day at work keep me in a chair, in a car, and on a couch.

Should I blame myself for my failure to make healthy choices? Should I hold myself responsible for eating too much chocolate? For my untoned, sagging biceps and belly? Should you? When were on our own, who else is there to blame?