Caught up in the frenetic grind of her fashion industry job, Allison Ferrell, 41, paid little attention to her increasing waistline. As Manager of Product Operation and Logistics for Abaete, a New York-based luxury apparel line, lunch was a luxury she couldn't afford. She said she was crazed and I couldn't spare the time so If I didn't eat by 1:00 p.m. that was it for the rest of the day.
After a 2005 surgery left her stomach upset, she routinely avoided a litany of foods and routinely skipped meals. Her erratic eating habits kicked her body into pre-starvation mode. Believing it was starving, her body stopped burning calories and began to store food reserves causing an increase in body fat. I'd had a good run, but my negative habits were catching up with me and now it was time to take care of myself."According to the American Council for Exercise, acceptable essential fat is 25-31% and obese is 32%; Ferrell measured almost 39%. Accustomed all her life to being thin, she was flummoxed by 23 pounds of extra fat.
Ferrell is hardly alone in her struggle to manage her weight. Plus sized women and strapping men are a celebrated norm within Black culture - the tacit acceptance of which is inhibitive to weight loss. From Thanksgiving and Easter dinners to barbeques and ho-downs, cooking and meal-sharing have been time-honored means of familial and communal bonding. Meals laden with fat, sugar, salt and cholesterol have long been cornerstones of traditional African American cuisine. While these foods are gastronomically appealing, they are detrimental to healthy living. It's difficult to change habits that are ingrained in our history, explains, dietician and nutritionist and co-owner of living Proof in New York.
Some of the culturally defining foods in Europe, Asia and the Mediterranean, such as olive oil, grains and vegetables are heart healthy. What is natural for African Americans is further down the food chain of nutritious. The American Obesity Association estimates that approximately 127 million adults are overweight, 60 million are obese and 9 million are morbidly obese. The escalating phenomenon of obesity has become a national crisis and is nowhere more evident than in African American communities. Recent statistics from the Center for Disease Control and Prevention show nearly 51% of black women are obese and a whooping 78% are overweight - the highest of all ethnic groups - almost 30% are obese and 67% are overweight.
Considering body type and height variations, the standard scale fails to provide an accurate measurement of body weight. The Body Mass Index (BMI) is a widely used formula which uses weight and height measurements to assess total body fat and provides healthy weight ranges for all ethnicities. BMI is also an indicator of heightened risk for developing diabetes, heart disease and other obesity-related illnesses. A BMI of 19-24 is considered healthy. However, a BMI of 25-29.9 is overweight and 30 and higher is obese. The waist circumference measurement calculates abdominal fat and is often used in conjunction with BMI to determine weight related conditions. Despite glaring evidence, many blacks have a poor perception of weight and fail to recognize their weight as problematic. Dr. Ian Smith, medical and diet expert for VH1's Celebrity Fit Club and ABC's The View explains that this speaks to the core concept of self-definition and what we think we look like. To change the tide, he insists, the imperative is to change the cultural mindset that promotes and sustains the behavioral habits cause obesity. The curvaceous, full-figured body is the feminine ideal in Black culture.
Many Black women are resistant to weight loss because they equate maintaining a healthy weight with losing their curves and by extension their attractiveness. Dr. Ian says, "There is a tendency to sexualize weight. You can be on the plus side but still be healthy. We shouldn't be defined by a condition that is damaging to our health, but instead by our courage, inner and outer beauty and our vigor for life." Dr. Leggett offers another perspective. There is no conflict between being sexy and physical fitness. Because individuals are resistant to exercise, they convince themselves that being overweight is a paradigm for sexy.
While a variety of factors contribute to obesity and overweight, the root causes remain the same: lack of exercise and poor nutritional choices. Dr. Christopher Leggett, Director of Cardiology for Medical Associates in Georgia and one of the country's foremost interventional cardiologist says that people enjoy sedentary lifestyle and the lack of dietary discretion in what, when and how much they eat, none of which is tempered by balance. Moreover, larger food portions, dependence on fast food and the barrage of media marketing by the food industry have played a major role in the erosion of overall health. Today's historic numbers are also largely attributed to the double-edged sword of technological advancement.
The ease and simplicity of modern living made possible by computer and digital technology discourages physical activity and permeates every aspect of society: food delivery, surfing the internet, computer-based office jobs and play station. Dr. Ian explains that people are less inspired to move and this means calories sit on their bodies and become fat. In addition, relentless work demands - commuting, long hours, working through lunch - requires that the basic necessities of self-preservation are cast aside. As the singular head of the household, black women are often responsible for balancing home, work, childcare and sometimes education with little time to squeeze in exercise. Dr. Leggett refutes this claim saying that many women spend hours on beautifying their external appearance when they set aside thirty minutes each day for exercise. Until individuals become actively engaged in healthy living the medical consequences of obesity will continue to escalate.
The consequences of obesity present a smorgasbord of debilitating illnesses including diabetes, heart disease, stroke, hypertension and certain cancers and have a domino effect on the body's physiology. What has been commonly considered "a little sugar" has morphed into a runaway epidemic affecting an estimated 18 million Americans, with Blacks at a 1.6 greater risk of developing the disease than whites. It also has consequences of stroke, kidney failure, amputation and blindness, and ranks first in direct healthcare costs, consuming $1 of every $7 spent on healthcare. Dr. Leggett explains Obesity is the primary cause of Type II diabetes which increases the occurrence of cardiovascular disease, resulting in an 80% death rate from heart attacks. Excess abdominal fat is highly active. It expands, releasing chemicals that ensure its continued existence. This in turn creates a resistance to the hormone insulin, which controls blood sugar. Increased insulin-resistance exhausts the pancreatic gland resulting in high blood sugar levels, which sets the stage for diabetes.
The cardio-vasculature of the body is impacted by elevated cholesterol and lipids in the blood. A build-up of Low-density lipoprotein (LDL or "bad" cholesterol) and other food slush form plaque within the coronary arteries, the vessels that supply blood to the heart. This deposit eventually narrows the opening of the blood vessels that supplies organs with oxygen and nutrients. Dr. Leggett says that rupture of the arteries causes kidney and spinal chord stroke, in the coronary arteries causes heart attacks and in the carotid arteries, stroke or thrombosis, an obstruction of blood flow throughout the circulatory system. Blockages in the lower extremities often cause poor circulation, joint pain and even amputation.
With 45% of women and 42% of men twenty years or older suffering from the condition, African Americans have the highest rate of hypertension in the world. Research conducted by the National Obesity Association indicates that hypertension occurs 9% more frequently in obese individuals. Poorly controlled hypertension leads to stroke, which is the third cause of death and the primary reason for disability. As fat increases, so does the demand for oxygen and nutrients. The upsurge of blood circulating throughout the body adds pressure to the artery walls causing them to narrow and stiffen, resulting in an enlarged heart, stroke and kidney disease.
An American Cancer Society study shows that up to 90,000 cancer deaths annually can be attributed to obesity and overweight. Increased production of insulin and estrogen stimulates the growth of cancer cells. In women, obesity is related to elevated risk of uterine, breast, cervix, ovarian, renal cell and endometrial cancers; in men, with colon and prostate cancers. The high incidence and virulence of obesity-related diseases are exacerbated by lack of preventive care and appropriate health screenings. Dr. Ian posits that Blacks tend to visit the doctor later and by then these illnesses are less treatable and curable and the body is weakened. That's why whether it's talking to your physician or going to a free clinic, we must become more proactive about our own health.
An unspoken consequence of obesity is the double jeopardy of weight discrimination within the healthcare industry. Doctors' subjective opinion and prejudice negatively impacts medical treatment, care and outcome. A recent study by the New England Journal of Medicine shows discrimination in treatment of kidney failure, cancers and heart disease, despite the fact that these illnesses are more egregious in blacks than in whites. A physician may withhold treatment or a procedure, which may be optimal, based on latent feelings that the obese patient is lazy, lacks discipline and self-respect or will not follow the prescribed regimen.
With a distressing 30% of children ages 6-19 overweight and 15% obese, the prevalence of childhood obesity has skyrocketed over the past twenty years, ensuring a future wave of chronic, obesity related diseases, diabetes, hypertension and other ailments. According to the American Academy of Pediatrics, the probability of an obese child becoming an obese adult increases approximately 20% at four years old to 80% by adolescence. Alarmingly, African American girls across all socio-economic levels have the highest incidence: of ages 6-11, 38% are overweight and 22% are obese; ages 12-19, 45% and 27% respectively.
The calamitous combination of super-sized fast foods, video game culture and physical inactivity, enabled by parental complicity has swept the tide of childhood obesity to unprecedented heights. The typical adolescent diet is comprised of fats, cholesterol, sugar, Trans fat and devoid of fruits and vegetables; beverages are carbonated and loaded with high fructose corn syrup. Nutritionist Lisa Jubilee maintains there are numerous ways parents can set better examples for children. She says if you must eat fat food, skip the fries sometimes, get a smaller size or choose a salad. Instill the habit of eating a fruit as an after-school snack or have one with cereal in the morning."
Today's children are the most inactive in history, largely owing to the pervasiveness of stationary entertainment such as Play station and X box games and video television. Urbanization and the reduction of physical education in schools have resulted in the frequency and decline of exercise. The American Academy of Pediatrics report shows that 25% of children 8-6 years watch at least four hours of television daily and having a television in the bedroom is a strong indicator of obesity development, even in preschool-aged children. Inner city children are purportedly hindered by the inability to walk or bike safely to school or play outside later. Moreover, many lack the means and the inclination to venture outside the familiar confines of their neighborhood and into suburban or rural environs.
Children are becoming fatter at a younger age, Dr. Leggett observes. Some are presenting early sign of heart disease and blood vessel damage. But you can't blame them when parents are supposed to be in charge of the food environment. The list of obesity-related illnesses in children is comparable to adults'. Hypertension occurs 9% more frequently in obese children and doctors have also observed signs of heart disease. In 1997, the growing number of children with environmentally-influenced diabetes prompted a name change from adult-onset to Type 2 diabetes. Excess weight also triggers bronchial spasms, the hallmark of asthma. Other consequences include sleep apnea, orthopedic complications and delayed menstruation in girls. The psychological effects are immensely damaging and often persist into adulthood. Obese children experience social alienation and teasing which become catalysts for depression, eating disorder and high risk behaviors.
Make no mistake - being fat costs. Obese and overweight individuals can expect higher medical expenses and insurance premiums, tend to earn less and create less wealth in their lifetime. As the country faces a burgeoning healthcare crisis, the medical cost of obesity-related illnesses is an estimated $93 billion, 85% of which is covered by government programs such as Medicaid and Medicare. The cost to each tax payer is $180 annually. Routine care for preventive, diagnostic and treatment services can reach $7,000 in yearly out-of-pocket expense. Decreased productivity, absenteeism, sick days, disability and restricted movements are costly to both workers and employers. Weight penalty is also exacted through social stigmatization and impediments to career advancement. Many experience difficulty finding employment, securing a promotion or a coveted assignment based on the belief that they are lazy and weak-willed.
Is it possible to halt the upward trend of obesity? Healthcare experts agree that education and moderation are keys to incorporating healthy habits into daily living. Despite the promises of diet pill pushers and the growing popularity of bariatric and gastric bypass surgeries, the surest solution to weight loss remains diet and lifestyle changes. Jubilee, who requires clients to keep a food journal, formulates eating plans tailor-made for the lifestyle and needs of the individual. She suggests that individuals begin by walking every day and introduce new, wholesome foods into your diet so you can live longer than your forefathers. For Ferrell, she suggested different ways to prepare old favorites such as baking instead of frying and minimizing the amount of batter used to make biscuits. Small steps are necessary to make the big changes that will sustain weight loss. Ultimately, African Americans have the means and opportunity to overcome the tide of obesity and overweight by setting new, grander examples of healthy living for this generation and the next.