Growing up fatCarol Taylor is down to a healthy weight now, but it's been a long, long struggle. Taylor had been heavy all her life -- it ran in the family. Her mom and niece both weighed over 300 pounds, and her six older brothers were all big, hulking men. Part of Taylor's weight problem came from her upbringing on a farm in a small town in Ohio. Around the Taylor household, eating was a favorite pastime, and the idea of exercise a foreign concept.
"My parents came up during the Depression, so food was very important to them," Taylor said. "Every meal was a big family event, there were always huge portions, and we were expected to clean our plates. Exercise was doing your chores. The idea of physical activity for fun or benefit was beyond anyone's comprehension."
School for Taylor was filled with all the stereotypical worst case scenarios -- sitting down for lunch only to have the rest of the table get up and leave en masse, always being the last one picked during gym class, and being teased relentlessly as the "fat kid."
"It was horrible," Taylor said. "I was a very lonely, unhappy and withdrawn child. I just wanted to disappear into the woodwork. And of course that only reinforced my bad eating habits because food was a comfort for me. It became a vicious cycle."
After high school she went to the University of Akron, landed her first job, and rented her own apartment. It should have been a great time in her life -- she was miserable.
In February 1983, she looked in the mirror and saw a depressed 265-pound, 23-year-old woman who was suffering from a number of health problems. She decided it was time for a change. "I said enough is enough. I felt bad all the time. I was unhappy. And I knew I could be a damn attractive woman if I just lost some weight."
With the help and support from her friends and co-workers, she started making lifestyle changes. Instead of pigging out on fast food for lunch, she ate sensibly and walked two miles. If she really wanted a candy bar, she had one, but then she balanced it out later with exercise or cutting calories elsewhere.
One of her biggest challenges was, of all things, her mother.
"When I would visit my mother she would make all these fatty foods that she knew I was trying to avoid," explains Taylor. "And if I didn't eat it, she would say, "I spent all day cooking this and you won't even try it. You don't love me anymore.' It wasn't that she didn't want me to lose weight. It's that she didn't know what was going to happen to me. Fat me she knew. The person she saw emerging had far different goals and values, and she didn't know what to make of it. It's not uncommon for people trying to lose weight to be sabotaged by the people they count on the most."
Despite the ups and downs, Taylor stuck to her guns, and over the next year lost 100 pounds. Taylor's life took off on a new direction. She began teaching part-time at college, got involved with community theater, joined the bowling team at work, and started dating.
"It was an entirely new me," she said. "For the first time in my life I shopped for clothes to look good in, not to hide my body. I had to learn to put on makeup and style my hair. I had never done it before; I never cared. Suddenly I was having fun and enjoying life."
At 25 Taylor decided to head south and moved to Charlotte. Today, she works at The Center for Nutrition and Preventive Medicine, which specializes in treating obesity. Forty-two years old and married, Taylor has successfully maintained her weight since losing 100 pounds some 19 years ago. Unfortunately, obesity has had a devastating impact on her family, where heart disease runs rampant. Her mother and two of her brothers -- one was 56, the other 52 -- have died of heart attacks. Taylor said she's the only one in her family with a healthy heart and normal blood pressure.
"Living healthy became a habit for me," she said. "But no amount of encouragement will make you lose you weight. You have to decide for yourself that you want to do it. And for me, it truly is about eating to live, not living to eat."
A ton of reasonsSo why are we getting fatter? For the same reason we've always gotten fat: by consuming more calories than we burn. But never has the problem been so bad. Is it because of our lifestyle? Our genes? The ubiquitous Golden Arches? The answer: Yes, yes and yes.
"It's becoming fairly obvious that obesity is a multi-factorial disease," said Dr. Donald Schumacher of The Center for Nutrition and Preventive Medicine. Schumacher has developed the "What I Need" (WIN) program, a weight management strategy that focuses on nutrition, physical activity, personal awareness, thought and behavior strategies. "It's becoming the number one killer in this country, and it's the biggest health care cost because of all its associated complications. The real problem is that we're more educated now than we've ever been about low-fat, low-calorie, portion size and exercise, but we're not doing anything about it. We lack the discipline and the structure."
Just look at typical week in your life. How many times do you eat out? More specifically, what are you eating, and how much? Do the words "fries with that" and "super-size it" sound familiar? How often do you exercise? Is the most strenuous part of your day walking from the parking lot to your desk? Or is it lifting the couch cushions to look for the TV remote? If you have kids, are they eating a nutritious lunch at school? Once they get home, are they active, or do they become zombie-like slaves to their PlayStation? If you're able to brush off all these questions confident in the knowledge that you're consistently eating a balanced diet and exercising regularly, then you're lucky -- and growing increasingly rare.
First, let's take a look at what we eat. According to Eric Schlosser's book Fast Food Nation, one in four adults eat fast food at least once a day. It is estimated that kids get up to 40 percent of their meals from fast-food chains, convenience stores and restaurants. Moreover, there are fast-food franchise outlets in 13 percent of the nation's schools. Americans shelled out more than $110 billion on fast food in 2000, compared with $6 billion in 1970. That's more than what we spent on movies, books, magazines, newspapers, videos, and records combined. But it's not just what we eat, it's also how much.
Consider this: Diet and nutrition experts indicate that one serving of meat is supposed to be the about size of a deck of cards. A serving of cheese should be no bigger than a golfball. And a single serving of pasta should be no bigger than a tennis ball. Now compare that to what you're typically served at a restaurant. Or more to the point -- compare it to what you expect to be served.
"America's serving size is appalling," said Schumacher. "A big mistake all of us make is that when we're hungry, we pick a restaurant where we know they serve a lot of food. And if we pay for it, we're going to eat it. This makes you lose perspective of what a portion size is."
Schumacher and other experts say that given typical restaurant serving sizes, when dining out you should either share one meal with a friend, or take half of it home in a doggie bag.
"Typically, when you order just the main course in a restaurant, if it doesn't have a bunch of sauces and gravies and it's not fried, you've still got at least 1000 calories sitting in front of you," Schumacher said. "And that's only one meal out of the day. That's simply too much food."
Ironically, in looking at the general population, it's the poor and minorities who tend to be the heaviest, with the Southeast leading the way in the country's growing weight problem. Many experts blame the fast food industry for this development, particularly how their aggressive marketing techniques crowd out access to healthier foods in inner cities. Some even compare it to how tobacco companies targeted inner-city minority communities in the 1990s.
"Income level has a lot to do with one's awareness of obesity and what you do about it," said Schumacher. "The more education and money you have, the easier it is for you to join a health club or purchase exercise equipment for your home. It's also easier to afford the lower-calorie foods."
"Have you ever really looked at the price of fruits and vegetables?" asked Dr. John Cleek, of the Carolina Weight Management and Wellness Center. "They're relatively expensive compared to macaroni and cheese, hot dogs and beans. A lot of it is just pure and simple economics."
Another big culprit contributing to our expanding waistlines is our sedentary lifestyle. According to TV Free America, the average American watches at least four hours of TV a day -- of course, for many folks that's after sitting at the computer for eight hours during work. Making matters worse is that only one in five Americans exercise on a regular basis, according to NPD Research.
There is also the little matter of our growing reliance on the automobile. Remember walking? Most folks don't. Even if it's just down the block for a loaf of bread, we're going to drive. And we're going to park as close to the front door as possible. And can you imagine having to actually move your arm to raise or lower the car windows? Of course not. Just flip the switch.
Then there's genetics, perhaps the most debated part of the obesity equation. Are some folks genetically doomed to be obese? Or is it an excuse to cover up for laziness and lack of control? The consensus seems to be that while genetics certainly play a role, it's not the determining factor in one's weight. At least it doesn't have to be.
"The best estimations from scientific literature say that only about 30 percent of obesity cases are accounted for by genetics," said Cleek. "Our gene pools haven't changed over the last 10 to 20 years, during which time we've seen this dramatic surge in obesity. Gene pools take thousands of years to make big changes. The only thing that's changed is our lifestyle."
"There is no doubt genetics play a role," added Schumacher. "If it didn't, then why is it that most people have the same body type as their family and relatives? So while there is a genetic component to obesity, it still needs to be looked at as how many calories is someone consuming, and how many are they burning."
Lifestyles and choices
It's 6am on Monday. While most of us are still some time away from hitting the snooze button, George Holt and Kris Eldred are both working up a sweat on the treadmill. They're at the Carolina Weight Management and Wellness Center in Pineville, which is managed by Dr. Cleek. Holt and Eldred are with about a half-dozen other folks who have ventured out to exercise during the pre-dawn hours. All of them have been diagnosed as obese. When Holt, 43, first started coming to the Center last November, he weighed over 500 pounds, was essentially immobile, had severe sleep apnea, and was a social recluse.
"I was about as bad as you could get," Holt said. "My joints hurt all the time. I was always tired. I couldn't even get a haircut or go to the movies because I was too big for the seats. Just going to the grocery store was a major ordeal. I could only buy enough food for one meal because I couldn't stand to be on my feet. By the time I got to the register my back would be killing me and I'd be out of breath."
Like most folks doing battle with the bulge, it's been an ongoing struggle, and Holt's weight has fluctuated greatly. In 1990 he weighed 300 pounds. He went on a crash diet, started exercising obsessively, and eventually got down to an unhealthy 150 pounds, going from a size 46 to a 29-inch waist in less than a year. "I was skin and bones," he said. "I looked like I just came out of a death camp."
Then, as is often the case with folks who use extreme measures to lose weight, he started packing the fat back on. By November of last year, he surpassed 500 pounds. Holt's regular physician referred him to Cleek. An initial assessment was done, and in addition to various health problems caused by his weight, Holt was also diagnosed with a thyroid disorder, which, at least in part, was contributing to his weight gain. Cleek put Holt on the Center's multi-disciplinary weight management program, which consists of nutrition, lifestyle counseling and access to an exercise facility. Holt jumped in with both feet.
"I come here at 6am and exercise for about two hours," Holt says during a break from his workout. "As soon as I get off work I come back and exercise again -- six days a week. Right now this is my life." Holt has gotten down to 343 pounds, having shed some 140 pounds since last November.
"George has pretty much gone through a complete mind and body transformation," said Todd Dewey, who manages the Center's exercise facility. "When he first started coming here he would go off in the corner and not talk to anyone. But once the weight started coming off his personality changed. Now he comes in here and helps get everyone else fired up."
Kris Eldred, 35, was much like Holt when she first came to the Center last summer. She had ballooned to over 325 pounds, and was miserable. "I was sick all the time, I was developing lots of medical problems, and I just decided it was time to make a change," she says.
Although Eldred has been relatively active growing up in Michigan, everyone in her family loved to eat, and dinner was always a big deal.
"We didn't care about diet and nutrition, we just ate," she said. As a result, she was heavy all through high school. "It was tough," she said. "I missed out on stuff like dating and going to the prom." When Eldred graduated, she weighed 275 pounds.
Once she started working and wasn't as active, things only got worse, and she topped out at 350 pounds. Finally, last summer, Eldred had had enough. Her doctor referred her to Cleek, who put her on the same weight management program as Holt.
"It wasn't easy," Eldred admits. "In the beginning I didn't think I could do it. I'm a big chocoholic. I used to sit down at night with Ben and Jerry and have a good old time. So giving up all that sweet stuff was hard. But once living healthy became part of my routine, it became so much easier."
To help keep her willpower intact, Eldred carries a picture around with her that was taken last Easter when she was at her heaviest (one in which she's barely recognizable compared to how she looks now). "If I go to the grocery store and I'm feeling tempted, I just take out this picture. That way I can walk right by the ice cream aisle and instead get some yogurt."
Eldred now weighs 222 pounds, having lost some 100 pounds since last summer. "My personality has completely changed. I'm more outgoing. I've had people at work tell me I seem so much happier now. I'm going out and doing things now instead of sitting home."
Unfortunately, the Center where Eldred, Holt and about 50 other members gather regularly to exercise and give each other support will be shut down at the end of June. Moreover, it's the only weight-management obesity program in Charlotte to offer lifestyle and nutrition counseling, as well as an exercise facility.
Because most insurance companies don't cover obesity as a health benefit, members had to pay for the weight program out of their own pocket, which didn't make for a very promising long-term financial picture. And Carolina HealthCare System, the hospital group that owns the practice, declined to make any further investments in the Center.
"We lost money the first year of operation," says Cleek. "The only way to turn a profit at a facility like this is to put people in a 13-week program then shuffle them out the door and bring in new members. But obesity is a chronic disease; treatment needs to be long-term. So looking at a quick revolving door is not my idea of quality care.
"With obesity being the number one chronic disease in this county, I don't see how you can ignore it," Cleek continued. "Multiple studies have shown that by treating obesity you reduce doctor visits, medication costs and hospitalization, so you get improvement all the way around."
"We need facilities like this," said Eldred. "I could never go to a regular gym and feel comfortable. There's just more of a support system here. Everyone here knows what I'm going through."
"This place really is like a family," Holt added. "You can come here and not feel judged. It's pretty much saved my life."
Contact Sam Boykin at (704) 944-3623 or sam.boykin@cln.com