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Experts explore why obesity in American women is an alarming epidemic

| Monday, July 4, 2016, 9:00 p.m.
Patrick Kastner | Tribune-Review
Allegheny County Health Department Director Dr. Karen Hacker
Jasmine Goldband | Trib Total Media
Allegheny County Health Department Director Dr. Karen Hacker
Dr. Indu Poornima, cardiologist and Director of Allegheny Health Network’s Women’s Heart Center
Dr. Indu Poornima, cardiologist and Director of Allegheny Health Network’s Women’s Heart Center
Dr. James Longhi, General and Bariatric Surgeon, Excela Health
Dr. James Longhi, General and Bariatric Surgeon, Excela Health
Dr. Vicki March, Medical Director of the Comprehensive Weight Loss Program and co-director of BodyChangers at Magee-Womens Hospital of UPMC
Dr. Vicki March, Medical Director of the Comprehensive Weight Loss Program and co-director of BodyChangers at Magee-Womens Hospital of UPMC
Anne Berzinsky, RD, LDN, Lead Dietitian, St. Clair Hospital
Anne Berzinsky, RD, LDN, Lead Dietitian, St. Clair Hospital

The nation's obesity problem is getting worse, with new government statistics showing an alarming increase in obesity rates among women.

More than four in 10 American women are obese, the Centers for Disease Control and Prevention reported in two articles published by The Journal of the American Medical Association in June. While obesity rates for men and women have been comparable in recent years, the new findings show over 40 percent of women are obese, compared to 35 percent of men.

Why is the epidemic surging among women? We asked experts to provide possible explanations — as well as solutions.

Yo-yo diets must be stopped

Year after year, we helplessly watch obesity rates rise with no end in sight. Despite media saturation of advice and testimonials about the best route to quick weight loss, the disturbing trend is not reversing. Why?

The reasons for the persistent climb vary. For decades, obesity has been blamed on lack of willpower, but evidence from research indicates that the causes of obesity are far more complex. Some people seem doomed even before birth. Babies born to mothers who were obese during pregnancy are more likely to become obese adults; paternal obesity at the time of conception may also carry effect.

Factors that increase the risk of obesity include genetics, poor social support, financial constraints, African-American or Hispanic heritage, female gender, pregnancy, limited access to healthy foods and an environment that discourages physical activity.

To make matters worse, an individual with obesity who decides to lose weight can become overwhelmed by conflicting information about how best to do that. Fortunes are spent on unregulated, expensive supplements and diet plans that promise fast and easy weight loss but typically end up failing.

How do we overcome these barriers to ensure that the life spans of future generations are not cut short?

Medical providers across the country are waking up to the fact that obesity is a disease and are starting to treat it like one — comprehensively and with lifelong follow-up. In Pittsburgh and elsewhere, physicians are trained and certified in obesity medicine. These physicians learn that obesity can be successfully treated with a variety of methods, including lifestyle counseling, medication and sometimes surgery. UPMC and the University of Pittsburgh offer many services with teams that address obesity management.

Social support networks also are critical to sustaining weight loss. UPMC's BodyChangers program provides opportunities for weight-loss support by bringing together people with an interest in maintaining a healthy lifestyle. The free membership includes a monthly e-newsletter with tips for healthy living, recipes and a full calendar: cooking classes, hikes, bike rides, stair climbs, exercise classes, nutrition counseling, grocery store tours and other group activities. Best of all, BodyChangers helps dispel one of the worst weight-loss myths: that the process is boring and torturesome, with constant hunger, bland foods, deprivation, self-pity and self-blame along with hours of excruciating exercise.

If obesity is to be stopped, the pattern of yo-yo dieting also must be stopped. “Diets” only work in the short term. For permanent weight loss, a transition from eating processed fast food and being sedentary to enjoying natural food and moving more makes a quest a reality.

And it need not be drudgery, but an adventure in healthy living.

— Dr. Vicki March, medical director of the Comprehensive Weight Loss Program and co-director of BodyChangers at Magee-Womens Hospital of UPMC

it starts at a young age

Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years, according to the Centers for Disease Control and Prevention.

Overweight and obesity in children have immediate and long-term effects on health and well-being. They are more likely to have risk factors for heart disease and diabetes as well as poor self-esteem. Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases. To create healthful eating habits in your home, start with small changes and encourage the whole family to get involved. Avoiding sugar-sweetened beverages, making breakfast a priority, eating more meals at home — including fruits and vegetables with meals and snacks — all are great goals to help your child maintain a healthy weight.

Children perform their best when they start their day with breakfast. It also helps prevent hunger and may curb overeating later in the day. Stock healthful breakfast foods and include some choices that can be eaten on the run:

• Whole grain, low-sugar cereal with milk and berries

• Low-fat yogurt and fruit to make parfaits or smoothies

• Whole grain toast with peanut butter and sliced banana

• Fresh fruit and string cheese

Eating more homemade meals can ensure that kids get the fruits, vegetables, lean proteins, whole grains and low-fat dairy their growing bodies need.

Sitting down to a healthy meal can be a challenge for busy families but is well worth the effort. Kids who eat frequent family dinners have higher intakes of calcium, iron, fiber and vitamins and are less likely to be overweight or obese. For busy nights, try these easy entrees utilizing convenience foods:

• Turkey and bean tacos (lean ground turkey, taco seasoning, black beans, tortillas, shredded lettuce, salsa)

• Chicken salad (rotisserie chicken, salad greens, shredded carrots, light salad dressing)

• Vegetable stir-fry (frozen veggie mix, canned low-sodium chickpeas, low-sodium soy sauce, instant brown rice)

• Cheesy quesadillas (whole-wheat tortilla, reduced-fat cheese, salsa)

• Pizza (whole-wheat pizza crust or pita, low fat cheese, fresh veggies for toppings

Offering healthful snacks can keep hunger at bay, fuel active children and increase nutrient intake. Be sure to keep the the portions small.

• Fresh fruits

• Veggies with hummus

• Whole-wheat crackers, peanut butter, low-fat milk

• Low-fat string cheese

• Low-fat yogurt with berries

• Trail mix made with whole-grain cereal, dried fruit and nuts

­— Anne Berzinsky, RD, LDN, lead dietitian, St. Clair Hospital

beware of metabolic syndrome

Life is short enough as it is. Obesity leads to an even shorter life span because of the various medical problems that result from being overweight.

The many health problems related to being obese or overweight fit into a cluster of health issues including central obesity, hypertension, elevated cholesterol and impaired glucose tolerance or type 2 diabetes. The term used to describe this cluster is called metabolic syndrome. Another way to say this is that people with higher degrees of obesity have an increased incidence of developing type 2 diabetes and the many associated complications. These include but are not limited to eye disease and blindness, vascular disease and amputation, kidney disease and dialysis and, most important, death related to coronary artery disease. Women with diabetes are twice as likely as men with diabetes to die from a heart attack.

To further understand the complexity of the matter, the basic problem of too much central body fat must be considered. Excess body fat leads to excess inflammation of the blood vessels that, when present for long periods of time, has detrimental effects on the body. People with metabolic syndrome have a high degree of fat surrounding internal organs. This fatty tissue that is located inside the belly area is more problematic than excess fat in the subcutaneous area or just below the skin. The end effect of this excess inflammation over time can lead to insulin resistance and ultimately type 2 diabetes.

Hypertension or high blood pressure and obesity are another detrimental combination for the human body. The metabolic or chemical changes that occur in an obese patient can lead to the development of hypertension. A rather complex interaction between excess stress hormones with a cascade of interactions leads to a chronically increased blood pressure. As the obese body accumulates and stores fat and becomes larger, the heart needs to work harder to keep up with this increased demand. Also, the volume of blood a body needs is higher, which contributes to the heart's needing to pump more blood or increase the workload of the heart. To compensate for this increased workload, the heart increases in size or hypertrophies. Over time, this stress on the heart can lead to heart failure. Symptoms of heart failure, when severe, can include breathing difficulty as fluid accumulates from poor pump or heart function.

— Dr. James Longhi, general and bariatric surgeon, Excela Health

obesity trends can be reversed

What is it about women in America that makes them so susceptible to obesity? Is it the fact that we are less inclined to exercise than men? Is it our stress levels as we navigate work and home? Is it the fact that we gain weight in pregnancy and keep it on? Or is it our emotional relationship to food as cook, purchaser and consumer? Does our desire to nourish ourselves and others contribute to these trends?

My guess is all of the above.

We do know that certain factors increase the risk for obesity, including age, education, economics and race, which all play a role in rates of obesity. Women between 40 and 50, those with lower education, those living in poverty and minority women are all more likely to be obese. As recently reported, 57 percent of African-American women and 47 percent of Hispanic women are obese compared to 38 percent of white women.

We need to ensure that everyone has the same opportunities to live a healthy life. The county's Live Well Allegheny (livewellallegheny.com) initiative aims to surround Allegheny County residents with healthier options so that making the healthy choice becomes the easy (or easier) choice. As women, we owe it to ourselves and our families to manage our health.

Try these simple things to get motivated:

• Check out Choose MyPlate website for tips on picking healthier options (choosemyplate.gov).

• Consider active strategies for socializing; try out a yoga studio or take a walk with a friend.

• Encourage your children to get off the couch and do an activity outside together.

• Leave the frying pan behind and try different recipes that are fresh and nutritious.

• Pack a lunch for work; plan your meals for the week.

• Understand your relationship to food. If you eat when you are blue, consider other strategies — music, exercise, calling a friend.

• Follow the Centers for Disease Control and Prevention strategies for healthy eating habits (cdc.gov/healthyweight/children/).

— Dr. Karen Hacker, director of the Allegheny County Department of Health

OBESITY A STRONG PREDICTOR OF HEART DISEASE

One in three. Thirty-three percent.

That is the number of women who are estimated to die eventually of heart disease or stroke in the United States. Long considered an older man's disease, we now know that heart disease is a very real threat to millions of women every year, with a woman dying from it every 80 seconds. Heart disease and strokes are the leading causes of death in American women, and cardiovascular disease — particularly coronary heart disease — kills almost twice as many women per year than all forms of cancer combined.

These are sobering numbers, to be sure. But, unfortunately, many women do not recognize their risk of heart disease as well as they should. One of the primary risk factors for cardiovascular disease is obesity. So when the Centers for Disease Control and Prevention releases new figures that show, for the first time, more than 40 percent of U.S. women are obese, as a cardiologist it gives me great pause.

Obesity is one of the strongest predictors of heart disease, especially among women. In fact, the rising trend of heart attacks among young women is at least partially attributed to the growing rate of obesity in women under the age of 50. Being overweight can lead to a variety of risk factors for heart disease — among them diabetes, high blood pressure and high cholesterol. In addition, obesity predisposes women to conditions that include heart failure and irregular heart rhythms, such as atrial fibrillation. Even where a woman carries the fat on her body is important. Women with fat around the waist are at a greater risk for heart disease than women with fat around the hips.

At Allegheny Health Network's Women's Heart Center, we focus on helping women become more aware of cardiovascular disease and teaching them proper, gender-specific preventive measures. When it comes to being overweight or obese, our team provides our female patients with a variety of resources, from nutrition and exercise counseling to stress and other mental health programs, giving our patients the tools and confidence needed to make meaningful lifestyle changes that reduce their risk of cardiovascular disease and improve the quality of their lives.

— Dr. Indu Poornima, cardiologist and director of Allegheny Health Network's Women's Heart Center

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