Obesity: The Going Large Epidemic

Testings. If you are concerned about your child’s school placement for the next school year, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Parent Education and Family Stabilization Course. We have been certified by the Department of Children and Families, State of Florida, to offer the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, this 4 hour class is state mandated for divorcing parents of involved children. This course is intended to teach parents about the effects divorce has on children, to lessen the impact of difficult transitions, and to improve the ways they communicate with each other and their children. Our course is provided live and in small groups. Please contact our office at 954 755-2885 for further information.

Low cost counseling: Denise Champagne, M.S., is offering low cost counseling as a mental health intern. She is currently seeing patients and is available to take on new patients. This allows those individuals who cannot afford treatment to obtain it and allows her to get the required training. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Qualified Supervisor. Dr. Joel Kimmel has been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Our E-Letter this month focuses on Obesity. Prior to the 20th century, obesity was virtually unknown. In the 21st century, obesity and being overweight have become global problems. In 2005, 1.6 billion people over the age of 15 according to the WHO were overweight and 400 million people were obese. 20 million children under the age of 5 were overweight. If the current trends continue, by 2015, just 2-3 years away, 2.3 billion people, that is 1/3 of the planet, will be overweight and 700 million people, 2½ times the entire population of the United States, will be obese.

Can you imagine the size of this epidemic? What will this do to the healthcare systems of the world as well as for the individuals involved? How will this tax our already strained natural resources and the healthcare that is available? Costs associated with obesity include not only healthcare for prevention, diagnosis, and treatment but also loss of income from decreased work production, restricted work activity, absenteeism, and premature death. Obesity increases the likelihood of heart disease, Type 2 diabetes, certain cancers, high blood pressure, liver and gallbladder disease, sleep apnea, breathing problems, osteoarthritis, and certain gynecological problems. It can lead to premature death and disability. Reducing obesity is healthy for our nation as well as for the individual.

Obesity has been defined as a medical condition where fat accumulation adversely affects a person’s health. It mainly occurs because of excessive eating of high-fat, energy-dense, nutrient-poor foods and lack of physical activity. It is commonly measured by the Body Mass index or BMI which is the ratio of weight to height as in the following formula:

                            703 x Weight in Pounds

              BMI   =   __________________________

                                 Height in Inches x Height in Inches

A BMI between 25 and 29.9 is considered to be overweight and a BMI of over 30 is considered obese. Between 18.5 and 24.9 is considered healthy and below 18.5 is considered underweight.

Experts believe that obesity is on the increase because food is plentiful and everywhere. Additionally, huge advertising budgets sell people on eating as a very common activity. People are lured to eat not only because of hunger but also because of price, looks, smells, shapes, participation in social activities, family togetherness, and to just feel good and forget one’s problems. People have been retrained by the media to believe that large portions are acceptable, that eating throughout the day is acceptable, that eating in the car is acceptable, that going to someone’s home requires bringing food, that eating sugar rich junk foods is acceptable, and that being a “couch potato” is acceptable.

Besides poor eating habits and poor choices of food, an inactive lifestyle is significant to causing obesity. Today, many of us are not very active physically. Many of us are exhausted from the numerous demands made upon us daily. When home, many of us eat quickly and sit in front of the television or computer. We want to rest but research has shown that more than 2 hours a day of regular television viewing has been linked to being overweight or obese. We also do not walk as much as needed. We rely on cars, have fewer physical demands at work due to technology, and do not engage in any physical exercises. Children also have a lack of PE classes at school. We don’t burn up the calories that we take in during the day and they get stored as excess weight.

Obesity and being overweight tends to run in families. Some identical twin studies have found that twins reared apart but have the same genetic background are overweight. It can run in families and obese individuals tend to choose and marry obese partners increasing the gene pool for obesity in offspring. In addition, children learn from their parents and model their eating behaviors. Adults who choose high-calorie foods and are inactive will teach their children to choose high-calories foods and to be inactive. Parents who eat fast food and eat on the run will teach their children to eat fast food and eat on the run.

Obesity can be overcome by a combination of dieting and exercise but both require commitment and sticking to it. Both of these is difficult and may require support from family and friends. The goal of dieting should be to learn to replace your old habits with new healthy ways of eating and making better choices. A nutritionist or your doctr can help you set realistic caloric intake that will provide good nutrition and weight loss. It is better to lose weight slowly and steadily while incorporating new patterns of eating. Pattern changes can include eating only at the table and not in front of the television, not while driving, not while on the computer, not in bed, and not while working. Other suggestions include choosing smaller portion sizes and counting your chews. Keep a food journal monitoring what you eat, when you eat, and where you eat. Manage stress by meditating, deep breathing, or journaling. Socialize with friends in activities that don’t involve food. Walk frequently even if it is just a few extra steps and exercise at least 3 times a week.

Finally, surgery may be an option if you are obese and cannot lose weight through diet and exercise. The 2 most common weight-loss surgeries are Laparoscopic Gastric Banding and Gastric Bypass Surgery. These procedures are not a quick fix and require commitment to diet and exercise after the surgery. Consult with your physician to determine if this is a reasonable option for you.

We offer the following information on Obesity: The Going Large Epidemic:

• Obesity is one of the most serious public health problems of the 21st century and a leading preventable cause of death with increasing prevalence in adults and children
• Obesity is the medical condition where excess body fat adversely affects one’s health
• BMI or body mass index is the most common measure of obesity; a person is obese if his BMI is over 30 or 20% above their normal weight
• The likelihood of heart disease, Type 2 diabetes, sleep apnea, certain cancers, and osteoarthritis are all increased by obesity
• Obesity is caused by excessive food intake and a lack of physical exercise, although genetics, medications, mental illness, and endocrine disorders may play a part
• Other contributing factors include insufficient sleep, decreases in smoking which suppresses appetite, environmental pollutants, anxiety and food advertising
• From 1971 to 2000, American obesity rates increased from 14.5% to 30.9%; women increased their caloric intake 335 calories per day while men increased 168 calories
• Obesity was rare before the 20th century and as of 2008, the WHO estimates that over 500 million adults are obese with higher rates among women
• Carbohydrate consumption has increased over fat consumption with the primary sources of the increase being sweetened beverages and potato chips
• The “buffet effect” occurs when people do not stop eating because they aren’t hungry; rather they’re attracted to foods of different tastes, shapes, colors, textures and smells
• Environmental contributors to obesity include lack of sidewalks and trails, long work schedules, huge food portions, constant food exposure, and cheap food availability
• 20.6% of medical expenditures or $190.2 billion was due to obesity in the U.S. in 2005
• Obese workers have higher rates of work absenteeism and take more disability; they have 12 times as many lost work days due to the common injuries of falling and lifting
• Physical exercise and dieting are the most popular treatments for obesity by decreasing intake of energy dense foods and increasing fiber intake
• The most effective obesity treatment is bariatric surgery which is associated with long term weight loss and  a decrease in mortality rates although there are risks

• If overweight or obese, discuss a weight-loss program with your physician
• Set realistic goals: exercise for at least 30 minutes a day 3 times a week and increase overall physical activity by walking, climbing stairs, and playing sports
• More specifically, eat only at the table and do not snack in bed, in front of the television, on the phone, on the computer, while driving, or while working
• Count your chews and use smaller plates and take smaller portion sizes; do not take advantage of special food discounts, supersizing, or other gimmicks
• Keep a food journal of what you eat, when you eat, and where you eatSeek professional help if you cannot lose weight or maintain a weight loss program

TD writes: My 2 boys, ages 9 and 11 years old, do not want to go to bed at night. My husband and I have set 9:00 as their bed time and they know that. Yet when that time comes, they refuse to go to bed. They start playing a game, get nasty, or start crying. We solve this by my husband going in with them and reading them a story or lying down with them until they fall asleep. We want to break this pattern. What do you think we can do?

Dr. Joel Kimmel replies: If you are sure that your children are not in distress and it sounds like they aren’t, then this seems to be a pattern of behavior that needs to and can be changed. You need however to see what is going on here.

My first question is do they have you trained? It seems that by their behavior, they are able to get your husband to lie down with them, give them attention, and be with them until they drift off to sleep. They seem not to be accepting of the 9:00 time boundary and are not accepting your expectation for them to go to bed. While this may only be an annoyance at this time, it signals that more manipulative behaviors will come in the future. They very well may be testing the limits of your authority. Realize that this is manipulation and not fears or other emotions.

It is very important for many reasons for you to establish clear expectations and for them to adhere to them. I would recommend that you start off by talking to both of them about what your expectations are for them going to sleep at night. I would then establish a ritual that takes no more than 30 minutes and must be done each night. Perhaps, you can start off at 8:15 with taking a bath or shower, brushing teeth, talking about the day, saying prayers, and reading a story. It needs to be a relaxing and calming down period with the understanding that by 9:00 the lights will be turned off and you or your husband will leave the room. Establish the rule that once they are in their room, they cannot leave unless they have to go to the bathroom. Keep the same ritual every night and alternate between parents. Leave at 9 even if they are not asleep after giving a hug and kiss. Do not answer any more questions or engage in conversation. Close the door if you need to. If either of them comes out of the room after 9, express your disappointment in their behavior, not them, and send them back into their room. If they continue to come out, tell them that you may have to lock their door and consider doing so. If they scream or have a tantrum, quiet them down and start the going to bed procedure earlier the next night until they realize that they are losing time with you because of their behavior.

It is important for you and your husband to be consistent with this procedure. In this way, you will train them to have good sleeping habits and minimize their attempts at manipulating you and your husband no matter how cute they are.

We would like to thank  Dr. J. for the following:

 The Difference Between a Mechanic and a Doctor

 A mechanic was removing a cylinder-head from the motor of a Harley Davidson Motorcycle when he spotted a well-known cardiologist in his shop.

The cardiologist was there waiting for the service manager to come and take a look at his bike when the mechanic shouted across the garage: “Doc, want to take a look at this?”

The cardiologist, a bit surprised, walked over to where the mechanic was working on the motorcycle.

The mechanic straightened up, wiped his hands on a rag and asked, “So Doc, look at this engine. I opened its’ heart, took the valves out, repaired any damage, and then put them back in, and when I finished, it works just like new. So how come I make $69,675 a year and you get the really big bucks ($1,695,759) when you and I are doing basically the same work?”

The cardiologist paused for a moment smiled and leaned over and whispered to the mechanic…“Try doing it with the engine running.”