Americans pile on pounds: Education fails to trim fat

How do you prevent obesity in a food-focused society?

Nearly one-third of all adults in America are now classified as obese. Data collected from the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention in Atlanta, shows that 59 million adults 20 years of age and older have a body mass index (BMI) of 30 or more. This figure is 8% higher than in 1994.

There are several reasons why obesity is on the rise. A big factor is the number of calories Americans consume daily, says Christine Braun, MS, RD, chief of nutrition and food service at the Cheyenne (WY) Veteran Affairs (VA) Medical Center. "Food is readily available, and the portion size continues to increase," she explains. People are told to purchase the super-size and save money, and while they may be getting more value, they are also getting more calories.

Americans still are eating too much fat, and eating so many meals away from home contributes to that, says Braun. "We are a busy society, and it is convenient to run through a drive through vs. preparing meals at home," she says.

The breakdown of the American family has much to do with America’s obesity, says Miriam Simmons, MS, RD, LD, CDE, a clinical dietitian specialist at the New Mexico VA Health Care System in Albuquerque. Families rarely eat together anymore, and parents usually give children lunch money and let them make the food choices rather than packing a healthy lunch. "I think the role models for children aren’t teaching healthy eating habits," she says.

Inactivity also contributes to weight gain, says Sheah Rarback, MS, RD, a spokeswoman for the American Dietetic Association in Chicago. "We are a remote-control society. We hardly get up to do anything," she says. Favorite American pastimes now are watching television or going to the movies and surfing the Internet. In fact, people drive around the parking lot at the mall looking for a close space. People are having difficulty with their diet because there is a lot of stimulus in American society to eat, Rarback adds.

"If Americans have increased their average caloric intake per day and at the same time their physical expenditure has decreased, it is not difficult to see how that could cause weight gain," says Braun. In addition, as people age, their metabolism slows down. The way to keep metabolism at a higher rate and keep weight stable is to keep the level of physical activity high, she says.

Often people turn to fad diets to get the weight off because this weight-loss method requires little or no effort and they promise a quick fix, says Braun. It takes 3,500 calories to add one pound of fat, and generally people gain a pound or two a year for a number of years; and then when they reach middle age, their metabolism slows down. At that point, they have gained 20-30 extra pounds. "The fad diets promise that you can get the weight off in a month, even though it took 20 years to accumulate," she says.

Education breaks the cycle

The main problem with the American diet is lack of education, says Simmons. "People know what a serving size is according to package labels and what they get at restaurants," she says. Therefore, if they follow the Food Pyramid, which recommends six to 11 servings of grain, but don’t eat the correct portion, they overeat. For example, many commercial bagels are four to five bread servings. Eating a cup of pasta for dinner and a commercial bagel for breakfast provides nine grain servings for the day.

"The serving size on the Pyramid is based on nutrition analysis. For example, an ounce of bread is approximately equivalent to a third of a cup of rice in terms of calories, carbohydrates, and protein," says Simmons.

The Food Pyramid is a good visual tool teaching the different food groups and the number of servings in each category but people don’t know how to make appropriate choices within the categories. Often they overeat in the protein and carbohydrate category, says Braun. "Portion size is the single largest surprise," she says.

Braun teaches patients how to make healthier choices within each food group. Because fast food is so prevalent in the American diet, time is spent on reading nutrition facts for restaurants and selecting foods off their menu that will meet nutritional requirements without excess calories and fat.

"I think as educators we need to give more practical examples of how to implement the Food Pyramid guidelines and how to make healthier choices," says Braun.

Most grab and eat food found at gas stations and convenience stores that are not healthy. However, there are healthy grab-and-eat snacks that people can be taught to recognize, says Susan Moores, MS, RD, a spokeswoman for the American Dietetic Association. The small packages of cereal, even those with sugar, contain vitamins and minerals and are much better than a bag of chips. Also, a banana or bag of baby carrots are good grab-and-eat foods, she says.

One change at a time

It’s important to teach patients to make one small change in the diet at a time, says Rarback. "I think that the biggest mistake people make is feeling it is all or nothing and not understanding that every small change is a step in the right direction," she says. For example, if people aren’t eating fruit, she suggests they take an apple or banana to work for their break and eat that instead of pastry.

Keeping a food journal helps people become aware of what they are eating. It’s a good technique for weight loss because people tend to eat less if they write everything down, says Rarback.

She suggests that patient education managers make a list of preferred cooking methods and definitions that frequently describe food preparation methods in restaurants. People can use this sheet to make better choices when ordering meals out.

"Whenever I counsel a patient, I include physical activity as a very critical part of a weight-loss program," says Braun. She encourages patients to pick up an exercise machine such as a stationary bike at a yard sale and ride it while they watch their favorite TV show. The TV show usually is a habit, so it is easier for them to incorporate the exercise with it, she explains.

"I tell patients that they could lose 4.5 pounds in one year by not using their remote control," says Simmons. Teaching patients the amount of exercise required to burn a certain number of calories helps to put food choices into perspective, she says. For example, she teaches that to burn 100 calories a person must walk one mile. A one-ounce slice of bread has about 80 calories, so a person would need to walk 8/10 of a mile to burn the calories.

Motivation to change

While providing information on successful weight-loss methods is important, it won’t help if the lesson is not tailored to the individual, says Moores. It is difficult to change a person’s eating habits without understanding their lifestyle, what their priorities are, and what motivates them, she says. It is important for educators to listen to patients. 

Health care providers need to understand where a patient is in the stages of change before education begins, says Braun. If patients are in the pre-contemplation stage, then they aren’t even thinking about making a change in their diet, and they need to have their awareness raised.

It’s important to get information about weight loss and the health risks of obesity to the public on a regular basis so more people will move from the pre-contemplation stage to the action stage and make a change in their diet and exercise, says Braun. Creating information for the media such as radio spots, participating in community health fairs, and developing handouts can raise awareness. Having more information available in waiting rooms at physicians’ offices also is helpful, she says.

"A team approach helps. The physician and nurse practitioner need to help patients get past the pre-contemplation or contemplation stage so they are ready to take action by the time they come to see the dietitian," says Braun.

People need to be ready to implement a plan that will change their lifestyle habits, agrees Moores. "It’s finding a way to touch the hot button that will get them to want to change," she says.


For more information on combating the rising rate of obesity in American society, contact:

  • Christine Braun, MS, RD, Chief of Nutrition and Food Service, Cheyenne (WY) VA Medical Center. Contact by e-mail only:
  • Susan Moores, MS, RD, and Sheah Rarback, American Dietetic Association, 216 W. Jackson Blvd., Chicago, IL 60606-6995. Telephone: (312) 899-0040. Web site:
  • Miriam Simmons, MS, RD, LD, CDE, Clinical Dietitian Specialist, New Mexico VA Health Care System, Ambulatory Care Nutrition, 1501 San Pedro Drive S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 2662. E-mail: