Winnipeg Free Press - PRINT EDITION
In the shadow of the bulge
The solution seems simple -- eat less, exercise more -- so why has obesity become a runaway train?
Two decades ago, funeral director Kevin Sweryd would need just one or two extra-large caskets on hand, just in case.
Now, due to increasing demand, and girth, that number has jumped to more than 20.
"Funeral homes have to deal with the reality of having larger clients on a regular basis," says Sweryd, the president of Winnipeg's Bardal Funeral Homes. "That becomes a logistical problem. You have to ask some hard questions. Can you fit them (the caskets) through a door? Do you have the facilities to handle it? Do you have enough pallbearers?"
Could there be a more stark observation of North America's growing obesity issue: Do you have enough friends to carry you to your grave? And those in Sweryd's occupation have a unique perspective, given that finding caskets for 350-pound-plus clients has become much more commonplace.
A standard casket measures about 60 to 68.5 centimetres wide. Now coffin-makers receive requests for caskets up to 132 cm, capable of fitting a 1,000-lb (450-kg) corpse. They must be reinforced and cost up to $4,000 more.
These days, Sweryd notes, many casket lines have up to three larger dimensions. Call them supersized -- just like that last fast-food order at the drive-thru window.
"It's not a surprise that obesity is a problem," the undertaker says. "Because it's an issue in life, it's also an issue in death."
The moral con man
From his cramped office in Health Sciences Centre, where the walls are lined with a checkerboard of diplomas, Dean Kriellaars points out a window at the Children's Hospital and makes an argument for the erection of a building dedicated to public health, "only three times as large" as that building.
The University of Manitoba professor is on a mission. An exercise physiologist with a PhD in neuroscience, he has become a self-described fitness crusader. He still remembers, as a boy, watching TV evangelists in the 1970s and '80s.
"I remember thinking, 'I want to be a moral con man,'" he says.
Instead, Kriellaars crusades against obesity and fights for fitness. Since last November, he has made 87 presentations and counting. He's been to every major Canadian city. Kriellaars estimates he speaks in front of about 20,000 people a year, but says it isn't enough. In one week alone, Kriellaars attended a conference on obesity in Victoria then travelled cross-country to speak to participants in the Canada Games in New Brunswick.
"I'm literally away every single week in every single province fighting this battle," Kriellaars says. "For the next three years, I'm booked trying to help communities and cities and provinces fix this. I live that virtually 24 hours a day."
His message: "It's really quite simple. In every single developed country, we focus on literacy and numeracy. And that's been a pretty effective campaign. Most of the population can read and write and really add up numbers. But we've never focused on physical literacy. So that got downgraded. Our values are out of place. Our values should be promoting physical activity at the highest level. We don't do that. We should have workplaces that are active. We should have schools that are active. Sadly, none of those things are true. And we pay the price for that years into the future.
"Obesity and inactivity is an insidious thing," Kriellaars adds. "It slowly creeps up on you. The next thing you know you go, 'Wow, I'm 20 pounds overweight.' That still carries a health risk. And health-care dollars are just going to go through the roof. We're in the shadow of the bulge.
"Obesity is universal right now. It doesn't spare anyone."
Fat is the new black
An Obesity in Canada report, compiled in a joint partnership between the Public Health Agency of Canada and the Canadian Institute for Health Information, concluded 59 per cent of adult Canadians are either overweight or obese. (A body mass index, or BMI, of more than 25 is considered overweight and more than 30 is considered obese).
Approximately one in four Canadians is obese, and between 1981 and 2009, obesity rates doubled among both males and females in most age groups. The study determined economic costs of obesity were $4.6 billion in 2008, up about 19 per cent from $3.9 billion in 2000, based on costs associated with eight chronic diseases most consistently linked to obesity, including heart disease, stroke, Type 2 diabetes and cancer.
"The Americans are on a big freight train going south," Kriellaars says. "We're a couple years behind them. They're probably accelerating faster now. But if you want to stop that train, it's going to take a huge amount of effort."
But should we really be surprised waistlines are spreading? Modern society has become a slave to screens, after all, both big (home TV) and small (iPod). Work computers, Facebook, Twitter, YouTube. When aren't we staring at screens? Just go to a public event, such as a Goldeyes game, and observe the number of people sitting in the stands and staring at an electronic device. During the game. Outdoors.
It always boils down to math: calories consumed versus calories burned. And North Americans as a whole are consuming more than burning. But while the solution may appear obvious (eat less, exercise more), it turns out society's current battle of the bulge has complicated, prehistoric roots.
"You have to think of it in terms of evolution," notes Mark Fry, an assistant professor in the University of Manitoba's department of biological science. "It's probably evolutionarily more favourable to be able to gain weight. Think about our ancestors, and if there's a limited food supply you're better able to survive if you can convert those calories into fat. That was a strategy that might have worked thousands and thousands of generations ago, but it's not appropriate for the society we live in today. Our bodies are inherently programmed to store weight.
"The problem is evolutionary strategy is backfiring on us now."
Neither were cavemen and cavewomen bombarded by commercials with multimillion-dollar marketing campaigns hawking (what appears to be) the mouth-watering, soul-satisfying, gotta-have-it delights that invariably take the form of double-bacon cheese burgers, chocolate-covered/stuffed/flavoured anything and potato chips in bags the size of most human mid-sections. And rarely are these consumers, at least on TV, members of the "59 per cent club."
Bombarded with images of food
Does this scenario sound familiar? You've just returned from a one-hour walk or 30-minute jog and plop down on the couch still panting... and watch for the gazillionth time that commercial for a Wendy's Pretzel Bacon Cheeseburger. Spoiler Alert: The burger contains 680 calories and 1,110 milligrams of sodium. (By comparison, a Big Mac at McDonald's has 550 calories and 970 milligrams of sodium.) Not hungry yet? Don't worry, the drive-thru is open until 3 a.m.
Or how about snaking through Sobey's trying to navigate past the mountain of potato chips at the entrance, past the row of cookies, ignoring the bakery entirely, to instead buy yogurt and maybe a little fruit -- only to arrive at the checkout stand (where calculated impulse purchases are displayed) to find Kit Kat bars on sale -- 5 for $5. That's almost like saving money, right?
"In the media, at the grocery store, we're constantly bombarded with images of food and availability of food that's really dense in calories," Fry says. "You go to the corner store now and there's an astronomical amount of foods that are really dense in calories and inexpensive.
"I'll be the first to say I'd rather have a double burger at Wendy's than a salad," he adds. "That's one of the issues, right? The calorically dense food. It's not healthy for you, but it's so tasty. And the economics behind those things are really powerful. The fast-food industry -- the food industry in general -- they're not making as much money if you're eating everything from scratch."
Sure, there are plenty of TV ads for yogurt, too. And almost every major fast-food chain has over the last decade developed a health-smart menu. But McDonalds doesn't have a sign on the golden arches saying, "billions served" by selling salads.
Factor in the proliferation of processed foods loaded with calories and chemicals and the vast improvement in agricultural production since the 1970s (keeping costs for grains and cereals lower), and the recipe for obesity takes its pear shape.
Genetics, environment and capitalism all have their collective fingers on the scale.
"That's why it's so hard not to overeat," says Dr. Tom Warshawski, director of the Childhood Obesity Foundation. "We've got two million years of breeding in us to overeat whenever we get a chance to and store it as fat."
Combined with marketing, Warshawski adds, "we've got the double whammy of it's cheap and it's tasty and we are designed to like this stuff."
"People are lazy"
Of course, weight gain doesn't happen overnight. The net result is, for many people, a gain of one or two pounds a year. The change is gradual. You add a pant or dress size every few years. The fat around the abdomen accumulates. The kids and the job (where you mostly sit in front of a computer now) leave you little time or inclination to run home and, well, run.
"You might not notice it happening one year to the next," says Fry. "Ultimately, when you do get older is the time you're going to pay for it. It's become what I call the new normal now, so when we look at someone -- because all youth and adults are more, say, fleshy than they were 40 or 50 years ago -- we don't even recognize someone is overweight until we measure their height and weight and plop them on an appropriate (BMI) curve."
When Samantha Sinclair turned 30, she no longer liked what she saw in the mirror.
"Honestly," she says. "I let myself get so fat. I disgusted myself."
Sinclair was 5-3 and weighed 273 pounds. (BMI rate of 48.4).
She had been working two jobs, one of them at a fast-food joint. "I got a discount there and I was always working, so..."
In high school, Sinclair was on the cross-country ski team. But in her late 20s, she was not crossing anything. Finally, she reached her breaking point.
"I got tired of looking at myself that way," she says. "I've never been that big. I'm not a lazy person, so I'm trying to do something about it."
Sinclair now works out at Snap Fitness up to three times a week. She takes Zumba (dance) and kick classes. She's lost almost 50 pounds and fallen two dress sizes.
"I feel so much better," she says. "I'm happier. You know what I mean? When you're really, really heavy you're depressed. And that doesn't help your eating, either. I like what I'm doing. I enjoy it. I actually look forward to coming to the gym.
"I'm not going to stop there (at 225)," Sinclair adds. "I've never let myself get that big and I never want to see it again."
Sinclair did come to two uncompromising conclusions in her weight-loss journey.
Conclusion No. 1: "There's no miracle drug. There's no miracle pills. You've just got to get out there and do it."
Conclusion No. 2: "People are lazy. That's what it is, straight and simple. They all want to see changes, but no one wants to actually do anything about it."
Doing things backwards
Of course, Sinclair is far from alone. Her personal trainer, Jordan Cieciwa, has been in the business for more than a decade and sees Samanthas and Sams every day.
"I find the more that I meet people, the more times I'm shocked by the number of guys who come in here and say they used to be a high-performance athlete," says Cieciwa. "Or how many women will come in and tell me about how they used to be size whatever when they were back in high school. But that was 20 years ago. I don't think they have a concept of time going by. A lot of people just leave behind their fitness."
Cieciwa is the brainchild of the website onefitcity.com, which he says is designed as a "road map" for fitness, attempting simultaneously to lure potential clients not just into the gym, but also to the great outdoors.
Cieciwa uses the analogy -- and irony -- of The Amazing Race Canada, a television show where contestants race across the country while participating in often athletic endeavours in mostly natural habitats.
The analogy? We live in a country where countless people sit on a couch and say to themselves, "Hey, wouldn't that be awesome to compete in The Amazing Race?" yet most of us would never bother to go to the Travel Manitoba website and, according to Cieciwa, create their own memories. "It's right out the back door," he says.
The irony? "There's a lot of people that couldn't do that (compete in The Amazing Race) right now."
Cieciwa, who has an applied health degree from the U of M, points out another contradiction: Why isn't the same technology that's helping create sedentary habits not being used for fitness good instead of evil?
"It's strange that we have this problem, since we have so much science that can help us eat as healthy as possible," he says. "And with the Internet and blogs and all the social media out there... we should be the healthiest we've ever been. But it's a scientific fact, 60 per cent of our population is overweight or obese. We're doing things completely backwards. Instead of using technology to free up more time, we're sitting in front of it more and watching other people enjoy life and make memories."
Cieciwa blogs for Huffington Post and set up his onefitcity website to share first-person stories from people like Sinclair.
But trainers like Cieciwa are also using technology, such as text messages, to give them a more omnipresent voice in the lives of their clients.
"Complete lifestyle modification"
Personal trainer Blake Wood, the owner of Pure Lifestyle fitness centre in Winnipeg, will text clients he knows will be going out for dinner with a gentle reminder about making wise choices at the table. It's part of a plan that begins with Wood going through your fridge. Yes, your fridge.
"It's a complete lifestyle modification," says Wood, a certified exercise physiologist. "If they (clients) don't feel the support, then diet and exercise is a slippery slope. That's the biggest, the failing of it. If you're not put in the right direction from the start, the failure rate is through the roof. Then it's just a roller-coaster ride. Weight loss is always going to be a journey."
Wood's questions include: "What does your wife eat? What does your fridge look like? What do you feed your kids?"
Yet it's an uphill battle for many in a society often stuck on fast-forward. No one need wait for anything; food, information or even your favourite TV show. The decision-making consistent is, "what option is the quickest and easiest?"
"Society has made things so instant," Wood notes. "People have a hard time coming in here without having a BlackBerry strapped to their hip the whole time."
Someone suggests to Wood that when it comes to fitness and weight maintenance, there seems to be a never-ending internal conflict between healthy and easy choices. A good angel telling you to get off the couch and go biking. Or a bad angel telling you there's more chocolate cookie dough ice cream left in the fridge.
"The good guy is still there," Wood replies. "But he's really fat."
In fact, the field is so tilted toward the food industry, abetted by societal trends in both production and technology, that experts in fitness and health fields believe it will fall to governments, provincial and federal, to devise policy that goes beyond age-old public relations campaigns such as Participaction.
"Obesity is a massive health-care problem and we've known that for a long time," Wood says. "What is government doing to deal with that? Where is the money being spent to help the health care end of it?
"If the government doesn't step in... it will never change. Society is so driven by money. We're driving society into the ground. The hospital lists will become so enormous you'll die before you see a surgeon. It's inevitable.
"What's the tipping point? What's the number? People are going to be sacrificial lambs until the government steps in. And when we reach that tipping point, is it too late?"
Tax on junk food?
Kriellaars says taking money out of health care and putting it into health prevention isn't the answer.
"We can't take the money away from health care, we have to add it in. And if society's going to change, it's the level of stopping we need. People of Participaction have been promoting it for the last 40 years. Promotion means nothing.
"You have to give it teeth," he says. "You need to make it real."
Kriellaars isn't short of suggestions, either. How about a surcharge of 50 cents on every drive-thru order, with money targeted on prevention? Or a 10-cent tax on food deemed by nutritionists to be unhealthy?
Why not? If governments can tax cigarettes and alcohol, why not a KFC sandwich where the "bun" is actually two pieces of fried chicken?
"We have a two-cent environmental levee on plastic bottles, don't we?" Kriellaars says. "Nobody revolted against that. I'll tell you what: If we put 50 cents on every drive-thru, it would generate a lot of money. It would also stop people from driving through.
"We need creative ways. This is not going to be a comfortable solution. We're going to have to do unpleasant things to get this society changed around."
Or what about a government tax rebate on gym registrations or personal trainers? And since poverty is a key factor in obesity rates -- cheaper food is typically the least healthy and most calorie-dense -- how are programs delivered to those who worry about having enough money to put food on the table, much less consider a personal trainer?
If only every employer were like Darren Murphy, the owner of Broadway Pharmacy. Since 2011, Murphy has picked up the tab for his managers who attend Wood's gym. It costs Murphy a few grand a year, but he believes the return pays off.
"It's just been great results in the work environment," Murphy notes. "More energetic, more motivated. Just overall healthier. No one's dragging their butts. They come in and they're ready to go. The return on my investment is pretty good."
For example, one of Murphy's pharmacists, Oumad Khalek, has lost 40 pounds while attending three sessions per week after his shift. "To me, it's almost like an addiction," Khalek said. "It's part of the routine. I'm amped for the day. I have so much energy."
Although the 30-year-old has already tossed out one wardrobe, he plans to lose another 20 pounds. "It took me a while before I started liking it," Khalek says. "But you don't regret it."
Overweight and obese: different effects
That Canadians are becoming more plump, and obesity levels more extreme, is not in dispute. Neither are the predictions concerning increased costs on the country's health-care system stemming from obesity issues.
But just how much those costs might increase may be overstated, according to an extensive study by the Manitoba Centre for Health Policy. The MCHP crunched data from 35,000 Manitobans over a period of 20 years -- matching BMI rates with hospital records -- and came to a conclusion that runs contrary to most every working assumption related to weight versus health.
In a nutshell: Being overweight and being obese, at least when it comes to the health-care system, are two different animals.
"There are lots of reports that say, 'two-thirds of Canadians are either overweight or obese,'" says Dr. Randy Fransoo, senior research scientist for the MCHP and assistant professor of Community Health Services with the U of M's Faculty of Medicine. "That's not really an important statistic to cite, because there's lots of evidence to suggest that people in the overweight group are at no higher risk of bad health outcomes than people in the normal weight group. So it's really critical to distinguish obesity from overweight. Our data suggests that the sky is not falling there. You're not going to the doctor 20 times a year and being hospitalized more often."
The MCHP research concluded Manitobans deemed overweight (a BMI of 25 to 30) recorded about 15 per cent more hospital visits -- or on average one more visit a year -- than those with a BMI rating of under 25. The most significant jump in care came with BMI rates over 33.
However, Fransoo contends, "obesity is not going to crush the health-care system. While they do use more health services than others, it's not 10 times or even twice as much. It's a bit more, but even that is not a massive amount to deal with."
Fransoo admits the data run contrary to words like "catastrophic" and "epidemic" when it comes to obesity rates.
"I actually worry when you come up with such overwhelming numbers if you tune people out. 'Oh, my gawd, it's a foregone conclusion. What's the hope?'" he says. "I don't know if they're doing their cause a favour by saying we're all going to be obese someday. I don't like fear-mongering type of stuff.
"I'm not trying to be a contrarian," Fransoo adds. "We're just showing the results that we've got. And we think we've done a competent study. It's a good, large representative sample. It's not like we went and talked to 17 people at the coffee shop. This is a large sample of Manitobans who've been followed for between three and 20 years. It's not results that can be easily discounted, even though it seems to be contrary to a lot of other stuff. It's really not something you can argue with."
But there's one significant caveat to the MCHP study: It didn't include children or adolescents. The next generation.
"That's one of those unknowable kind of things," Fransoo says. "If the obesity rates among adolescents and children into adulthood is getting higher... people are going to be exposed to all the various risks of obesity. So getting into the obese group when you're 50 is different from getting into it when you're 17. So the disturbing trends that are there for the child and young adult population don't bode well for the future.
"That's where the most alarming results are coming from. It is disturbing. There are some clear and troublesome signs about obesity levels among children. And that trend, to my knowledge, hasn't stopped yet."
No, it hasn't.
In 1978, only 15 per cent of children were overweight or obese. By 2007, 29 per cent of adolescents had unhealthy weights, according to a Statistics Canada study. Experts predict that without intervention, up to 70 per cent of all 40-year-old adults will be either overweight or obese by 2040.
"It just worsens and worsens," says Dr. Warshawski, of the Canadian Childhood Obesity Foundation. "We think about the tsunami of the greying population as more people (baby boomers) get older and are more expensive to care for. Well, overweight people are more expensive to care for, and that threatens to crowd out spending on other programs such as education, the environment, social programs. So this has huge ramifications for us all."
NEXT WEEK: PART 2, GENERATION XL
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Republished from the Winnipeg Free Press print edition August 24, 2013 D4
Updated on Saturday, August 24, 2013 at 6:47 AM CDT: replaces photo
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