Living large 

Why are so many of us so fat?

Cover Illustration By Jill PearsonIllustration By Jill Pearson
In his recent documentary, Super Size Me, director Morgan Spurlock ate at McDonald's every day -- three meals a day -- for a month. Under the terms of his "experiment," he ate everything on the menu at least once and had to supersize his purchase if asked by employees to do so. At the end of the month, Spurlock had gained 25 pounds and developed liver problems.

Some dismiss Spurlock's experiment as unrealistic. The director himself acknowledges that most people don't eat fast food every day.

But what if they did? What if they do?

Mary Palmer is the director of child-care at Southwest Tennessee Community College. At the Campus Kids Corner, on STCC's Macon Cove campus, Palmer has an office of cozy disorganization. Brightly colored pictures adorn the hallways and three baby faces -- each a different race and button-cute -- hang on the door. Plastic grocery sacks of whole-wheat rolls, grated Parmesan cheese, pounds of flour, and spinach line the floor.

"One thing I noticed," says Palmer about her charges, "is that a lot of parents don't fix breakfast for their children. They pick something up on their way in. They'll go to McDonald's. I started talking to parents about it, and I learned that a lot of them don't cook dinner for their children either."

food pyramid

Food Guide Pyramid

In March, Palmer started the "Shape and Bake" program with a grant from the Assisi Foundation. During the five-month course, parents learn about nutrition while their pre-school-aged children do the equivalent of kiddie aerobics in a nearby playroom. Afterward, they eat a balanced dinner together. Tonight it's Parmesan garlic chicken, golden macaroni and cheese, and creamed spinach.

To make it easier for parents to feed their children heathily, Palmer sends them home with a recipe and all the ingredients they'll need to recreate the featured meal. "Children are not eating properly," she says. "Families are not eating properly. I'm guilty of it myself. I have a 16-year-old, and after I pick her up from school, we'll stop at Chik-Fil-A. Some days we'll go to Picadilly.

I try to make sure she has vegetables. It's so much easier as a working parent to just pick something up."

As Palmer talks, a little girl of maybe four walks into the center, munching on a bag of microwave popcorn.

Children are not supposed to have to worry about stretch marks, cellulite, bad knees, aching joints, high cholesterol, heart attacks, or high blood pressure.

But that is changing. In the United States, 15 percent of young people ages 6 to 19 are overweight, a percentage that has tripled since 1980. More than 10 percent of children 2 to 5 years old are already overweight. These youngsters are developing health problems such as arthritis and Type 2 diabetes, once only seen in adults. There's even evidence that children today won't have as long a lifespan as their parents.

And the problem is getting worse. From 1998 to 2003, obesity rates in adolescents increased by more than 40 percent among African Americans, more than 50 percent for European Americans, and almost 70 percent for Hispanics.

"When we go on field trips, the children who are over 40 pounds don't need a booster [seat]," says Palmer. [That law has] since changed, but we had quite a few children who were over 40 pounds." Then, last December, a child at the center who had problems with sleep apnea died.

Palmer didn't think the children looked too heavy, but all the signs were pointing toward the pediatric obesity epidemic she knew existed. The center used a formula to calculate the kids' body mass index (BMI), a number that evaluates weight in relation to height. "When we did that," she says, "we realized we had a lot of overweight children."

If young people can't win the battle of the bulge, how do aging boomers stand a chance? And what happens when these children grow up and, inevitably, as they age, get even fatter? The Centers for Disease Control in Atlanta has a sobering answer: It released a study earlier this year that said by 2005 obesity will overtake tobacco as the leading cause of preventable death in this country.

In Memphis, the proverbial Bible belt has been let out a couple of notches. Two national magazines -- Self (for women) and Men's Health (for men) -- have rated Memphis the unhealthiest city in the country in the past three years. Though magazine lists are hardly scientific, one has only to look around to see many overweight Memphians.

Is there any way that we can slim down? Healthy Memphis Common Table, a group of health providers, educators, and private businesses, has come together with what they call their "big audacious goal." They hope to not just stop or slow the growth of obesity in Shelby County but to reverse the trend by the year 2008. To do so, they are talking to everybody from legislators (who voted to remove vending machines in schools) to the Memphis Restaurant Association.

"I think people in Memphis have lost the concept of what's normal," says Dr. Jim Bailey, the outgoing chairman of the HMCT board and a physician with the internal medicine division at the University of Tennessee Health Science Center. "We've gotten so used to seeing one another as fairly broad that we don't see lean as normal. The truth is, we're designed to be lean and very active."

HMCT started in 2000 when members of various groups became worried about the general health of Memphians.

"We were concerned that there were several health problems that were being overlooked by the system," says Bailey. "To be frank, we were concerned that the health system was broken."

Even with all the other health concerns -- cancer, AIDS, hepatitis -- the group decided its first causes had to be obesity and diabetes.

"[Obesity] is such a major cause of so many other ills and not just the ones you usually think of," says Bailey. "Gout, hypertension, infertility -- it's all there. We've thought of these things as separate diseases, but in the past 10 years, the scientific community has begun to think that maybe they're not different diseases at all but part of one disease. The term we usually use is pre-diabetes."

He adds asthma and Alzheimer's to the list, as well, stressing that the public needs to understand that healthy living is the best preventative. Patients expect doctors to heal ailments with medication, but there is nothing a doctor can prescribe that works better than what patients can do for themselves.

"In our health-care system, we expect [doctors] to do everything for us," says Bailey. "If you go to a used-car lot, you know that you have to be informed."

The good news, if you want to call it that, is that Memphis is so unhealthy that the city has an opportunity to make dramatic improvements. And there are organizations working to curb the problem: Overweight children can get treated at Le Bonheur Children's Medical Center's Pediatric Lifestyle Clinic. Adults can have lap-band or gastric bypass surgery at a number of facilities. The Tennessee Healthy Weight Network started its multi-pronged "Eat More, Move More, Tune In" initiative in May to promote healthy weight in the state's youth. Because the reasons for obesity are so varied -- genetics, poor eating habits, sedentary lifestyles -- the cure has to be equally multifaceted.

DeeDee Lunsford is the physical education supervisor for Shelby County Schools. She says that if she had her way, every student in grades K-12 would have an hour of daily P.E. The reality is that most students get an hour of P.E. a week -- two, if they're lucky.

"All of our schools have a certified P.E. teacher. Our students do not have daily P.E. time with a certified teacher because of budgetary constraints," says Lunsford.

In Memphis City Schools, elementary students get 30 minutes of P.E. a week. In high school, students need to take only one physical education/health class to graduate. There are other physical education electives they can take if they so choose.

Lunsford says she can see the effect structured P.E. has on the students in her neighborhood. "When the kids are studying jump-roping," she explains, "I'll see jump ropes out. Whatever they're studying they seem to catch on to." The district's staff is mindful of the obesity issue. They've focused on a nutrition solution, since they can't do anything about the lack of funding for P.E.

Linda Wilson is Shelby County Schools' director of school nutrition. She says the district has always arranged the serving line with entrees first, then fruits and vegetables, before less healthy fare. This year they've tried to encourage fruit and veggie consumption by lowering prices and making the displays more eye-catching.

"We're feeding 700, 800, 1,500 students in a short time. They go through cafeteria-style," she says. "They're not going to peruse the menu and say, 'That sounds good.' They're going to pick up what's in front of them."

Ty Tims is a medical exercise specialist with Baptist Rehabilitation. He runs a program that was developed by a physical therapist in Michigan to get kids moving. The exercises, variations on old standards such as squats and push-ups, help improve coordination, strength, and endurance.

"For kids, the main thing is keeping them active," he says. "The more coordinated a child is, the more likely they are to be active and the more likely they are to keep up some sort of activity in later life. With the obesity issue, it's so important to get these kids doing something they like, rather than forcing them to exercise."

One issue that comes up again and again when you discuss adolescent or pediatric obesity is that kids do not play outside as much today as they once did. "Neighborhoods don't have sidewalks," says Tims. "Mothers are keeping children inside because they're not safe outside. Parents are busy."

The PlayStation generation is more occupied by television, computers, and video games than by riding their bicycles, playing tag, or joining a neighborhood pick-up football game.

"Kids have such great metabolisms," says Lisa Buckner, co-owner of InsideOut gym. "All they have to do is run and play games. [But] parents let them sit in front of the TV or at the computer for hours. The parents have to make them [do something active]."

Buckner knows about the psychological effects of being overweight first-hand: "Being overweight is like an affliction everyone can see. You're ignored. You're waited on last. People make fun of you and snicker as you walk past. I just want to help some kids not have to live this kind of life."

Buckner planned to hold a weight-loss camp for adolescents this summer but later scaled back plans to a day camp.

"Last summer I was just flipping channels and I stopped on MTV. It was this real-life special on weight-loss camps. I was mortified," she says. "There was a 386-pound boy who was running -- that's an accident waiting to happen. Then they were taking measurements and pictures in front of everybody. I was a fat kid. I didn't want my picture taken. I didn't even want to be in a bathing suit, much less in front of other kids in one."

Buckner's idea was to teach adolescents -- and their parents -- as much as possible about fitness and nutrition. "I'm continually surprised by how unhealthy people live on a general basis. My life is so different from most people's. Working out for me is like brushing my teeth."

In her role as a personal trainer, Buckner often goes to clients' houses. She says you can tell a lot about a person by looking in their refrigerator. "I go in and start tossing things out. I tell them to get a trash bag. We'll go to the grocery store, and I'll teach them how to shop," she says.

It wasn't always that way. Buckner was an active kid but started gaining weight when she was about 8, around the same time processed foods came out. Mothers bought kids potato chips because they were a novelty. By the time Buckner was in fifth grade, her family had to drive two and a half hours to Louisville to a Lane Bryant store to find clothes that fit her.

"On the way back, my father offered me $100 if I lost 30 pounds," she says. "At the time, I was excited, but it was probably the worst thing anybody could have done. It told me that I was not okay."

One study found that obese children had a poorer quality of life than kids who had gone through chemotherapy.

As part of the camp, Buckner set up a Web site for overweight kids and their parents and included a place where kids could share their stories.

"Parents have no idea what their overweight kids are going through," says Buckner. "They don't talk to their parents. I get letters from the Web site, and they're so sad. They're not going to tell their parents if someone was calling them names. They want their parents to think everything is great."

"It's critical for parents to be involved," says Teresa Cutts, director of program development at the Church Health Center's Hope and Healing facility. "The child can be as motivated as possible, but if Mom doesn't buy healthy foods, they can't do it."

Cutts says that many people in West Tennessee and Memphis are overweight because of poverty.

"Poverty and obesity go hand-in-hand. It's not just a matter of saying, 'Why don't you exercise five days a week? Why don't you eat right?' If the only grocery store in the neighborhood is a Mapco, they're not going to have access to healthy foods," she says. "If someone is on food stamps, they may buy the cheapest cuts of chicken and those are going to be the fattiest. In this population, survival takes precedence over prevention."

The latch-key kid from more affluent neighborhoods may not be allowed outside until a parent is home. The latch-key kid in rougher neighborhoods may not be allowed outside at all because of gangs or violence.

To encourage exercise in a safe place, the Hope and Healing Center lets anyone walk for free around its track, but Cutts acknowledges there aren't many people who want to drive -- or catch a bus -- to go exercise.

The center also holds monthly classes, such as "Healthier Desserts," which teach how to prepare low-fat, low-sugar treats, and "Healthy Bodies," for people to learn the scientific and healthy way to lose weight. Cutts says classes are informal, because it is difficult for many people -- especially low-income people -- to get to every class.

Children are also targeted. One worksheet has a list of activities for a healthy lifestyle. Kids fill out corresponding pledge sheets, promising to "get eight hours of sleep" or "do sit-ups/push-ups while watching TV." Other healthy activities on the sheet include reading for fun and talking with friends.

"It's not brain surgery. It's just to get them thinking about getting healthy. It's just simple stuff, like drinking more water," says Cutts. "We've got to prevent it before it becomes a problem. It's a hard trend to reverse."

Just a few years ago, the weight problem facing American teens was not that they were too big but that they -- specifically girls -- were too small. Cutts says obesity and anorexia and bulimia are similar in that they are diseases of control, wherein people have difficulties modulating how much food to eat.

"You can do [low-calorie diets] for a while [but] when you go back and eat normal food, it doesn't work," says Cutts. "It isn't a lifestyle change that you can keep."

"It should be a wake-up call for everyone. [Obesity] is increasing even among white, affluent people. It's everybody's problem. The money will be spent 10 years from now. It's going to use up all our health-care resources," she says. "We need to build it into everybody's mind: Nutrition is important. It's not just a luxury."

Donna Downen has been teaching nutrition for over 20 years as an agent with the University of Tennessee's Agricultural Extension Service. She goes to schools, businesses, and health fairs to teach adults about what cholesterol is (one of the major fat groups; it's only found in animal products) or why they shouldn't soak vegetables to clean them (it leeches out many nutrients). She has an easy way with a metaphor and believes in the USDA's food pyramid, which advocates people should have six to 11 servings of breads, three to five servings of vegetables, and two to four servings of fruit each day.

"We have quite a job to do convincing people what a serving size is," she says. "A [Burger King] Whopper is two servings of protein and three servings of bread. It easily adds up. You can make better choices, like fresh fruits, light foods, low sodium, low sugar."

For her, the biggest challenge to the obesity epidemic is changing people's eating habits and their perceptions about food. She thinks we need to confront our psychological and cultural ties to food.

"I hear, 'The only fun thing I get to do is have chocolate cake.' People are substituting food for things they don't have," she says. "Food is so much a part of our culture." Most celebrations come with cake; births and deaths always bring covered dishes; and movies are synonymous with popcorn.

"It's a mentality," says Downen. "Parents, school teachers, adults -- we've got to retrain ourselves. People who are in a position of leadership -- and parents -- need to lead by example. Instead of drinking soda, drink water or fruit juice."

Downen points out how commercials make fast food look like fun and how celebrities are signed on as pitchmen. Millington's own Justin Timberlake, for instance, is "lovin' it" for McDonald's.

"It's a status symbol to be able to go out to eat," says Downen. "For many people of limited means, it's fun to go out to a fast-food restaurant. It's simple and it's on every corner. No matter what you're doing, it fits into your lifestyle."

Downen knows how hard it is to change eating and exercise habits. In her talks, she shares the fact that she's lost 100 pounds since November 1999. "When I was that big, I would look at [normal] people and say, 'What does she know? That girl hasn't dieted a day in her life.' That's why I share."

Due to health problems that had plagued Downen since the 1970s, her doctor told her not to exercise. "In 1999, I was walking with a friend in Eads. I could barely carry on a conversation with her."

The next morning, Downen got up and walked on her treadmill. The next day she did it again. Now, she walks every day. She's cut out snacking and has most of her daily calories at lunch. For breakfast and dinner, she has an instant breakfast drink.

When giving a presentation, Downen often brings her "fat vest," which resembles a cheddar-cheese belt and weighs 20 pounds.

"I make them wear it. When they take it off, it's like, 'Ooh, that feels good,'" she says. "When you put the weight on, it's gradual. You don't realize what you're carrying around.

"When we were an agrarian society, we were healthier. We didn't eat so many processed foods, and we exercised more," she says. "Parents have got to get their children off computers and out from in front of the TV."

Bailey, HMCT's outgoing board chairman, says he used to feel guilty about exercising during his lunch hour. Now he feels as if he's doing his part to fight obesity.

HMCT, which plans to have a formal community launch in mid-September, has ideas about churches opening up their gyms to give neighborhoods safe places to exercise and making healthy foods available to everyone. Already, group members say, they're seeing a change in public awareness of the problem.

"The only chance we have is a community-wide effort," says Bailey. "We sent a man to the moon. My belief is that miracles happen all the time. We need to take a concentrated, long-term look and decide what we want for our community for the next 1,000 years."

Even McDonald's is getting in on the act. The company's restaurants now offer a Go Active! Happy Meal for adults -- a salad with water and a free pedometer. And the supersize option is gone. n

Cover illustrations by Jill Pearson

Ideas for a Healthier Life

™ For family gatherings and potluck dinners, ask everyone to bring a healthy dish.

™ Have dinner as a family. Studies have shown that families who eat dinner together eat healthier.

™ Eat at home more often.

™ Eat whole foods instead of refined foods.

™ Drain syrup and rinse canned fruits.

™ Allow yourself treats, especially for special occasions.

™ If you have home exercise equipment, don't put it where you can't see it.

™ Lose the remote.

™ Limit TV and computer time for kids.

™ Drink more water or 100 percent juice, instead of soda.

™ Take outdoor weekend excursions as a family.


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