It's a story that has become nearly universal in America today, where so many of us are overbooked and overweight—or in imminent danger of becoming so. Researchers say roughly 65 percent of Americans are overweight or obese, and a new study suggests that seven out of 10 women and nine out of 10 men in this country will eventually become overweight, even if they have made it to middle age with a sleek physique.
To James O. Hill '78G, '81G, an internationally recognized expert on obesity, these statistics are not surprising. His own research reveals that the average American adult is gaining one to two pounds a year. "In the current environment," he writes in the journal Science, "people who are not devoting substantial conscious effort to managing body weight are probably gaining weight." The problem, he believes, has a biological basis: There is a mismatch between our ancient genes and our modern lifestyle. Eat, drink and be lazy, our genes tell us, for tomorrow we face famine—or at least a grueling trek in search of food. Alas, food is all too easy to find these days, and technology has eliminated even those tiny energy-burning treks we used to take to the TV to change the channel.
"If maintaining weight is something you now have to think about," says Hill, who directs the Center for Human Nutrition at the University of Colorado, "then we have to start equipping people to do a better job."
ALTHOUGH CALS WAS far from obese when she decided to lose weight, new research on fat reveals the wisdom of exerting mind over matter—before the matter takes control. "Once you get to a certain weight, the whole endocrine system is off," says UNH cellular biologist Deena Small, who studies how undifferentiated cells become fat cells, which can happen at any stage of our lives. "Fat is now considered a dynamic endocrine organ that responds to signals in the body, but also makes its own signals." These signals affect immunity, reproduction and brain chemistry. Unfortunately one of their favorite messages is: Make more fat. For some of us that message comes through extra loud and clear. Hill has found that, in contrast to lean people, both the obese and formerly obese respond to a meal with heightened activity in the areas of the brain that control anticipation and reward.
It was when he studied the interplay of brain chemistry and food intake as a graduate student in physiological psychology at UNH that Hill first became interested in obesity. Since then, he has looked at the problem from virtually every angle. He is the author of more than 250 scholarly journal articles and book chapters, and it's difficult to find an organization in the field that he hasn't led. Some of his studies are highly technical; others address commonly asked questions. Are people who follow a consistent diet more successful at maintaining weight loss than those who loosen up on weekends and holidays? (Yes.) Does a structured commercial weight-loss program work better than self-help? (A little.) Does excess dietary fat lead to more body-fat accumulation than excess carbohydrates, with calories kept the same? (Yes.) Does weight-loss maintenance get easier over time? (Yes.)
At first, Hill didn't worry about the practical application of his findings. "Much of the time we do research and stop there and just assume somebody is going to do something with it," he explains. "But that wasn't being done." In 1999, he co-founded the National Weight Control Registry to study the characteristics of people who have lost at least 30 pounds of weight and kept it off for at least a year. Hill and his colleagues have learned much from its 6,000 members.
Unless you have five or six hours a day to devote to exercise, you're going to have to restrict calories to lose weight," says Hill, "but it almost doesn't matter what diet you choose. There are a lot of ways to lose weight, but not a lot of ways to keep it off." Those who succeed generally monitor their weight carefully, choose a low-fat diet and rarely, if ever, skip breakfast. They also get plenty of exercise, which can largely free them from the necessity of having to restrict calories. In fact, it may take 60 minutes a day of activity or more, though not necessarily all at once, to maintain a large weight loss.
One of the registry's "successful losers"—we'll call her "Adele"—lost 160 pounds by limiting portions, cutting fat intake and walking. She has since maintained her weight for more than four years by biking, lifting weights and doing yoga. She's shown friends and relatives that DNA does not equal destiny: "People told me fat was in my genes and there was nothing that could be done about it," Adele reported on the registry Web site. "I say, my 'jeans' are now size 11/12!"
IN ONE OF HIS STUDIES, Hill found that successful weight loss is often triggered by a medical event. For Adele, the trigger was more geophysical than medical. When an earthquake knocked out the elevator in her building, she acknowledged that at age 36—and 325 pounds—she couldn't make it up the stairs to her own apartment.
Kimberly Cals' motivation to lose weight did come from a medical event, but not her own. When her mother was diagnosed with terminal cancer at age 63 in 2003, Cals decided to change her own lifestyle, and signed up for the 10-week UNH weight management program. "I knew nutrition could affect certain cancers," she explains, "and here I was eating all this junk food. Plus I worried that my daughter, Sammie, would develop some of the same bad habits."
Experts confirm her concerns on both counts. Excess weight has been linked to a number of health problems—diabetes, heart disease, stroke, arthritis and some types of cancer—racking up an estimated $117 billion a year in obesity-related medical costs, according to the Centers for Disease Control and Prevention. At UNH, Tony Tagliaferro, professor of animal and nutritional sciences, has found a link in women between weight gain in adulthood and the development of asthma.
Fortunately, Sammie, then 14, didn't have bad habits—she was already active and healthy, and Cals simply wanted to help her stay that way. In today's environment, it may take considerable parental effort to help children resist environmental pressures to eat too much and move too little. The percentage of American children qualifying as overweight has tripled over the past two decades; many have begun to suffer from conditions previously seen only in older adults, like Type 2 diabetes and elevated levels of cholesterol and blood pressure. Obese children, studies show, score as low as young cancer patients when asked to assess their quality of life. In comparison with their normal-weight peers, they are also more likely to bully, or be bullied.
WHILE AN INSURMOUNTABLE FLIGHT of stairs or the loss of a loved one can motivate an individual to change, it takes another type of force entirely to move an entire system. Tammi Martin '78, UNH research assistant professor of health management and policy, is interested in the well-being of all 200,000 of New Hampshire's schoolchildren. It is every child's right, she believes, to be fit and healthy. To that end, she helped found the New Hampshire Healthy Schools Coalition as part of a national initiative started by the U.S. surgeon general.
Since New Hampshire has long been touted as one of the healthiest places to live, Martin suspected she would need hard facts to convince school districts to reverse some of the trends that have thrown off the delicate balance between calories in and calories out. These include a reduction in recess and physical-education time and an increase in fast-food style lunch fare coupled with the proliferation of foods like Pop-Tarts, soda and cookies in school vending machines and snack carts. In many classrooms, sweets are dispensed daily as rewards and brought in often for birthdays, "breakfasts," and other occasions.
In 2003, Martin conducted an assessment of the height, weight and fitness levels of 20,000 children around the state. She found a weight problem in every county, and all told, two-fifths of the state's children, from kindergartners to high school seniors, qualified as either at risk or obese. An assessment called Physical Best, developed by the Cooper Institute, revealed a parallel problem: declining levels of fitness. Compared to a similar assessment in 1990, roughly one-third fewer students were able to pass the aerobic-capacity test in 2003. Furthermore, the older they got, the poorer their performance. While 88 percent of preschoolers passed tests of strength and flexibility, by the end of first grade, only 47 percent passed. For older students, fewer than 18 percent of 10-year-olds and 4 percent of 15-year-olds passed.
The frosting on the Hostess HoHo was a study that showed a strong correlation between excess weight and low scores on the third-grade statewide assessment in math and reading. The same factors that lead to weight gain—poor nutrition and lack of physical activity—have already been shown to contribute to difficulty in concentration in school and lower academic achievement.
Martin now had a statistical stick, as well as some carrots in the form of federal and charitable grants, to take to the school districts. Still, it wasn't an easy sell. Educators resisted the idea of blaming the schools for a societal problem. If she had a magic wand, says Katherine Moore '84, '94G, the school nurse at Mast Way Elementary School in Lee, N.H., she might do away with junk food. Since it's here to stay, however, she believes parents must take responsibility for their children's health. As a working mother, she understands the pressures of a hectic lifestyle and parental guilt. But she urges parents to prepare healthy food, "have the guts to say no" and "stop expressing love with sugar."
Although Martin agrees that parents and other segments of society share the responsibility for our growing weight problem, she believes that the school is the easiest place to reach all children.
WHEN "KEVIN" WAS 8 YEARS OLD, he was not a joiner. He was one of those students who would stand on the sidelines in gym class, needing to be coaxed to try an activity. Children like Kevin are too heavy or weak to do a trunk lift, a test in which a child lies prone and uses back muscles to lift up the front of the body. Unable to keep up with others, they may avoid games of soccer and tag at recess. In fact, today many children stand around playing hand-held computer games, Martin says, where in the past there would have been "packs of running, jumping and screaming children."
In January 2004, Kevin's school was one of 20 in New Hampshire to apply for a grant, and, with Martin's training and supervision, start a three-pronged program to increase students' daily activity levels, teach them about nutrition and improve the nutritional quality of foods served in school. Kevin's gym teacher used the Physical Best program as a basis for her classes, rotating groups of students through activities designed to keep them moving while developing strength, flexibility and aerobic capacity. Once a month, Kevin's class received a nutrition lesson tied into another academic subject, such as math. At the same time, the school lunch team made gradual changes, eliminating whole milk and sweetened ice tea and adding whole-grain bread to the sandwich offerings.
During that first year, schools across the state used relatively small grants to make some big changes. Andover instituted a salad bar. North Hampton School planned a landscaped walking path around the playground where classes can take daily walking breaks and teachers can exercise during playground duty.
Meanwhile, Kimberly Cals had begun the UNH weight management program, run by Tagliaferro. Once a week, the class met at lunchtime to try out new recipes and listen to presentations by graduate students. After one session, Cals bought a star fruit. She and Sammie were stymied by the exotic fruit, however. "We kind of looked at it every day in the bowl on the table wondering what the heck to do with it," she recalls with a laugh.
Still, they kept trying new foods. In their new routine, Sammie made a fruit smoothie every morning. Lunch might be a whole-wheat wrap filled with tuna or veggies. Even dinners were usually homemade, with fish or chicken and plenty of vegetables. They avoided a sense of deprivation by indulging in the occasional Big Mac or a slice of pizza, minus the pepperoni.
Monitoring her daily steps with a pedometer, Cals started arriving at work half an hour early and going for a walk. Early on, she found herself huffing and puffing up the stairs to her office after her walk. But before long she could manage both walk and stairs with ease. By the end of the class, she had lost 12 pounds.
As for Kevin, the new emphasis on fitness and health at school had inspired him to join a karate class, and he was actually nudging his mother toward healthier choices when they went shopping together. Over the summer, Martin crunched the numbers from the "before" and "after" Physical Best tests at the 20 schools that had received grants. She was amazed by the progress that had been made in just six months: 27 percent more of the boys and 35 percent more of the girls had passed the test. Teachers reported lots of beaming faces when the students recognized their own progress—described not as passing or failing, but as getting into the "healthy zone." Says Martin, "You've got to focus on the positive with kids." That means talking about feeling better and being healthy, instead of losing weight.
The year had been a great success for Martin, but at a personal cost. After countless 60- to 70-hour workweeks spent at the computer, analyzing research and writing grants, she had—ironically—gained 30 pounds. Over the next year, even as she ramped up her program, ultimately training more than 300 teachers and school nurses, she made a point of going to the gym several days a week. She lost 50 pounds and now at the age of 50 can easily pass the Physical Best aerobic pacer test.
IN SPITE OF THE EVIDENCE before our eyes, the concept of an "obesity epidemic" has been questioned by the food industry as well as some sociologists and political scientists. They question the definition of obesity and complain that the focus on fat may be partly aimed at drumming up business for diet docs and stomach-stapling surgeons while exacerbating the stigma associated with being heavy. Others see the epidemic as the product of much larger forces outside the individual's control. A glut of government-subsidized corn, for example, has been turned into inexpensive corn-based snack foods and sweeteners—including the high-fructose variety, which some researchers believe may alter sugar metabolism and promote the growth of fat.
Gale Carey, UNH professor of animal science and nutrition, says flame-retardants can be added to the list of things that might be messing with our metabolism. Used in furniture and electronic equipment, these chemicals have been building up in our homes, our food and our bodies over the past 30 years. Carey is working with rats to investigate whether flame-retardants can interfere with the normal mechanisms of fat storage and use.
Understanding the complex causes of obesity, whether microscopic or macroeconomic, will be useful in the long run, no doubt. But Hill noticed several years ago that many in the healthcare profession were feeling overwhelmed to the point of paralysis. So he and his colleagues started a program called Colorado on the Move to help people learn how to consciously manage their own weight, and in 2004 the group founded America on the Move.
The principles of America on the Move are simple, even mathematical. An individual who cuts daily intake by 100 calories and increases daily activity by 2,000 steps (slightly less than half a mile) can halt the annual, insidious gain of one to two pounds a year. The deficit of 100 calories—equivalent to a pat of butter or a can of soda or a cookie—Hill believes, is small enough to stay "under the radar of the body's regulatory system." In other words, it won't trigger the slowing of metabolism and pangs of hunger dieters often experience.
The idea of a national movement to simply stop gaining weight has struck some observers as overly modest. To these critics, Hill says, "We don't have definite evidence yet that the small-change approach works, but we have plenty of evidence that big change doesn't work. So if small change doesn't work, we're in trouble." Once they get a grip on weight gain, he adds, many members go on to lose weight.
Perhaps as important as pounds lost are some of the other benefits of moving more, eating less and simply taking charge of one's own body. For one thing, exercise makes people feel good. Even pigs may get a runner's high, reports Carey, who has used miniature Yucatan swine to study the biochemistry of exercise. Pigs that become fit not only develop stronger hearts and more efficient circulatory systems, they also run eagerly to the treadmill room when it is time to exercise.
Kimberly Cals was thrilled to lose weight, but in the end, she says, the changes she's made have affected every aspect of her life. Even though she's busier than ever, having added a second job after receiving her associate's degree in 2004, she now has the energy to socialize in the evenings, to go running with her boyfriend, to try new things and have more fun. She and Sammie have even taken up juggling, an apt symbol perhaps for the struggle to manage one's weight. It will always takes some effort to defy the gravitational pull of earth—or couch. But once you get the hang of it, says Cals, it's easier than it looks, and very gratifying.