Growth Pattern The Dangerous Effects of Obesity Are Often a Lifetime in the Making

The way Dr. Glenn Bombardier sees it, if people are so embarrassed by what they eat, maybe they shouldn’t eat so much of it.

“When I counsel people,” he said, “probably nine out of 10 people who suffer from obesity and pre-diabetes say they never eat. In all my years of doing this, I’ve only had one patient who eats at McDonald’s. I wonder, do they not realize they’re going in there, or is fast food just very healthy, and everyone who eats there doesn’t have to go to the doctor?”

Ask any recovering addict — to alcohol, gambling, you name it — and they’ll say admitting the problem is the first step to conquering it. Bombardier, an internist with Pioneer Valley Pathology in Holyoke, is seeing just the opposite: a growing obesity problem among people who are reluctant to admit they need to change their habits. And the biggest deniers are typically men.

“I think men deny the problem more than women,” Bombardier said. “Women come in and recognize they need to lose weight. Men come in with a 50-inch waist and say, ‘this is hard as a rock! This is the same size pants I wore in high school,’ when in fact their pants are way below their belly. They seem to be less aware of obesity.”

And years of denial piling on top of each other can lead to far worse than the need for a new belt.

“The first thing to understand is that obesity doesn’t occur overnight,” said Dr. Gregory Giugliano, director of the Cardiac Catheterization Lab at Baystate Medical Center. “It’s a habitual process that begins early on in childhood, when kids start eating poorly, and throughout the adolescent years they continue to eat like that. And just as obesity doesn’t occur overnight, neither does high cholesterol or diabetes. They’re signs of a lifetime of bad habits.”

In fact, a soaring rate of diabetes is perhaps the most significant facet of the obesity epidemic, Bombardier said. “I’d say 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of my day is now spent counseling people about adult-onset diabetes; 20 years ago, it was 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. A lot of people say that no one in their family had diabetes, and you have to have a genetic predisposition to it. But people generally weren’t so obese, so they weren’t so exposed to the genetic predisposition.”

Worse, he noted, a quarter-century ago, adult-onset diabetes typically showed up around age 75 or older, and people didn’t live long enough to experience some of the long-term consequences, such as strokes and renal failure. Now, diabetes is showing up around age 40 or 50 in many cases, not to mention a higher incidence of juvenile diabetes for people under age 20. “That’s a huge number of people who will require dialysis in the future, and that’s going to be extraordinarily costly.”

Lifetime Habits

There’s a reason fast-food restaurants and suppliers of unhealthy snacks target children in their marketing, and that’s to hook them with habits that will last a lifetime. Doctors, Giugliano said, need to counter these messages.

“At an early age, you see kids that are thin and kids who are more obese,” Giugliano said. “If we can identify them and intervene at an earlier age, I think we can do a better job as a society. I know pediatricians are really on top of the kids above the curve on the weight chart, and they’re trying to address that earlier.”

He added that, when he speaks to high-schoolers about obesity, he references the documentary movie Super-Size Me, in which director Morgan Spurlock uses his own body as an experiment in non-stop fast-food intake. “It’s funny, but it has a serious side to it,” Giugliano said.

“Most of us, when we were in high school, ate at McDonald’s or Burger King on an almost daily basis,” he noted, “and with our metabolism at that age, most people can tolerate it without gaining too much weight. The problem is carrying that attitude into our 30s and 40s, when the body changes. We have to understand the importance of eating better and exercising more frequently. The combination of overeating, fast foods, and poor exercise habits lead to obesity and other problems, like high blood pressure and diabetes.”

Despite the health warnings, Bombardier said, many men don’t seem to have a commitment to change.

“I certainly don’t see men working at dieting as much as women do, or getting into things like Weight Watchers. Men don’t seem willing to do that,” he said.

“People know what to eat; it’s maintaining the diet that’s so difficult,” Bombardier continued, and part of the issue is that hunger isn’t the only reason people eat. Food is central to an endless parade of holiday celebrations and social gatherings, while other times people eat because they’re bored, sad, or depressed. And they live in a country that surrounds them at every turn with the message that it’s OK to overeat.

“In the U.S., 6,500 calories of food are produced per person per day,” he noted. “Most people need around 1,800. So imagine all that marketing energy to try to get you to eat. When you go by a store or a restaurant, people are trying to get you to eat to sell their products. And the other problem is that healthy foods are more expensive than unhealthy ones. People are even talking about taxing ‘sin foods’ to lower the price of fresh fruit and vegetables.”

Keep Moving

So what’s the solution? It takes discipline, and in some ways, Bombardier said, quitting an alcohol habit is less complicated than improving the way we eat, simply because one can avoid alcohol completely.

“It’s either drink or don’t drink,” he said. “If we could do that with eating, just never eat again, we’d do all right. But we have to eat to stay alive. Compare that to someone saying to an alcoholic, ‘drink a little bit every day, but don’t drink too much.’ That’s the challenge with eating.”

If men do change their habits, they might not reverse all the damage they’ve done to their bodies, but they can severely reduce the risk factors that can cause cardiovascular and other health problems later in life, Guigliano said. On the other hand, “if you’re a 25-year-old man with a big spare tire around your waist, you need to understand that, going forward, you could have trouble with diabetes, high cholesterol, even risk of an early heart attack. And if you throw in a really destructive habit like smoking on top of that, then you have really big problems.”

In addition to watching how they eat and avoiding smoking, Bombardier stressed the importance of a regular exercise routine, despite how difficult many men find it to maintain one. Not only does exercise relieve some of the daily stress that can contribute to compulsive eating, he explained, but the discipline of keeping the body active is crucial to maintaining good habits.

“Some studies have looked at people who maintained their weight loss, and the only people who did so for five years exercised every day,” he said. “I try to get people into an exercise program along with a diet. By exercising every day, it keeps you focused on the fact that dieting doesn’t ever end. So many people work to achieve their goal of weight loss, but then you can’t relax. You have to maintain it, or the old habits will come back.”

And for men and women alike, those old habits are just a drive-thru lane away — whether or not they remember placing the order.