When you turn left from the Northwestern University medical building on Chicago Avenue that houses Dr. Robert Kushner’s office, you practically trip over one of the art cows spot-grazing our city for the summer. This one has a cheesecake on its back to presumably draw attention to nearby Eli’s the Place for Steak, which, of course, is a Chicago landmark known for its cheesecake.
None of which entirely bothers Kushner, medical director of the Nutrition, Fitness and Weight Management Programs, a preventive medicine service at Northwestern. What far more concerns Kushner is the number of obese and overweight people in this country–about 55 percent of adults at last government count. It’s America’s No. 1 health problem, he says, especially considering that about one-quarter of U.S. children carry an unhealthful load of extra weight.
Q: Obesity is medically classified as being greater than 20 percent over healthful body weight. For example, A 5-foot 6-inch woman is obese by government standards if she weighs more than 180 pounds. About one-third of American adults are obese, but as many as 55 percent have enough extra weight to negatively affect health, right?
A: I call it an epidemic. Fifty-five percent, by any definition, that’s epidemic. Being obese or overweight impacts on many factors of health. It’s not just cosmetic or fitting into a chair. It’s not just clothes size. It is costing us billions in health-care dollars.
You don’t have to qualify as obese to experience symptoms such as blood sugar fluctuations, heartburn or knee pain. It impacts on people’s work productivity.
Q: And eventually can lead to heart disease, even death?
A: Yes. It’s so subtle. People aren’t even aware of what’s happening to them. Tongue in cheek, I say it’s an alien plot to fatten up Americans.
Q: Back on Earth, what’s the story line?
A: A recent U.S. Department of Agriculture report showed Americans eat out more than ever before. The proportion of meals went from 16 percent in 1970 to 29 percent now, or about one in three meals. Here’s the problem: People still think eating out is a time to treat yourself, eat whatever you want. Restaurants accommodated customers. That worked 20 years ago, but it doesn’t work when people eat out pretty much daily. It’s no longer a luxury, yet people are still choosing meals with high fat, high calories and large portions.
Q: The amount of food you get in many restaurants is hard to believe. There are lots of doggie bags, but there is a temptation to overeat because the food is on your plate.
A: I believe you can liken the restaurant industry to the tobacco industry in the 1960s. The industry’s attitude is, We are responding to what the public wants.
Q: Like supersizing drinks and french fries.
A: Only with food is the concept that more demands better value holds true. Everything else we purchase, if we want more, it costs more. At some point with a car, home or computer, you have to say, “You know what, honey? We can’t afford paying any more. We have to modify our purchase.”
But it doesn’t work that way with food. We expect to pay just cents more for double the popcorn at the movie theater.
Q: You have said “obesity should be categorized as a disease like diabetes or hypertension,” that we don’t always understand the reasons why someone is obese, that there are “causes and drives other than whether people can’t say `no’ at the dinner table.” You have some strong ideas about how food manufacturers can do their part to halt America’s collective weight gain.
A: We should seriously consider warning labels on processed and packaged foods. You can build right off the recommended daily allowance (RDA) of 2,000 calories and say something like, “Warning: This food item contains 50 percent of your total healthy caloric allowance for a day.”
Most Americans struggle with estimating how much food they consume. You would get 100 different guesses from 100 people if you put a plate of food in front of them.
Q: Lots of those plates are served at restaurants.
A: I say go right to the National Restaurant Association, ask for a voluntary program. Here are three starting points:
– Eliminate any fees for sharing. It’s ludicrous to charge people more money when they want to eat healthy, to eat less, then get penalized for it.
– All menus should offer half-orders and highlight the possibility.
– Each entree or side dish should be analyzed as a percentage of daily caloric RDA.
The problem is not eating. It’s eating too much of the wrong foods.
Q: It seems best-selling diet books, if you analyze the foods recommended, are just a way of telling people to eat fewer calories.
A: But you don’t have to totally deprive yourself. If somebody likes McDonald’s, we say, “OK, but make it less frequent.” Our patients tend to compromise and eat turkey sandwiches or salads for lunch rather than a daily hamburger.
Our No. 1 recommendation is to eat more–more fruits and vegetables. Most people simply don’t eat them. Instead, they go five hours without eating or even drinking enough water because they don’t want to gain weight. They run down and are basically starving for the next meal. Then they overload, get a full stomach and feel sluggish. A universal benefit of weight loss is more energy.
Q: We’re not doing any better getting people to be more physically active. I mean, who even knows who runs the President’s Council on Physical Fitness or if it even still exists?
A: People think becoming more physically active is having to go to the health club and sweat, which can make them short of breath or embarrassed. But everything you do above regular daily activity burns calories.
For example, why not walk on escalators? Why do people who are just steps before walking briskly suddenly stop at the escalator?
In England, the tube stations have steep escalators. It is common practice that you stand on the right and leave a clear path on the left for anyone who wants to walk.
Q: Technology takes away so many physical opportunities. You almost have to look for ways to be active.
A: Definitely. Even 10 calories here and 10 there can add up to hundreds per day. It can be the difference between a healthful weight or being overweight.
Q: You clearly fit the former.
A: I do as I say. Actually, I was not always so healthy. I grew up in Chicago on corned beef sandwiches, skirt steaks, hard salami.
My friends know me as someone who loves dessert. It helps that I run two to three times each week and play tennis.
Q: We don’t all have to be runners, of course.
A: It’s about how you see yourself and how others view you. Are you known as someone who can’t pass up a meal and always gets the big popcorn? Or do people see you as a person who uses the stairs and really thinks about what goes in your body?
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An edited transcript
