Saturday, 26 January 2008

Everything's big in America...

Hello. I’m back and I’m jet-lagged, as you can probably tell from the time of this posting.

I spent two weeks in Florida - Disney World to be precise. I’ve been there twice before; twenty odd years ago and again in the nineties when I took my son (and a few others) with me. I love the place and it has really improved in terms of value for money I think but I noticed a disturbing trend that I hadn’t seen before – lots of people who either couldn’t or wouldn’t walk around the parks.

I’ve told you all before that I spent the last year of university studying the trend for obesity and its possible consequences for medicine and particularly pre-hospital care. I’ve discussed it in the book and I make reference to it whenever I can because I still feel strongly about it. Now I have seen first-hand the dangerous changes that are taking place in one of the worst offending countries.

America has one of the highest growing populations of overweight and obese individuals. The USA’s National Centre for Health Statistics recently reported that 63% of Americans are overweight, meaning they have a Body Mass Index (BMI) of over 25 and 31% are clinically obese (a BMI of over 30). It also stated that childhood obesity has more than tripled in the past two decades. This is shocking but there are very good reasons why it is happening – not only over there but in the UK and many other developed countries.

Notwithstanding the odd argument about genetic propensity for fatness, our behaviours, opportunities for sloth and the easy availability of cheap and abundant food make us ideal candidates for an early death as a result of piling on weight. As simple energy-consuming machines, we are required to eat to create ‘fuel’ which is then used up in order to make life possible. Excess fats and sugars are stored by the body for later use, as and when required, which is useful when you are facing a cold winter and a depletion of natural resources for food. Body fat would be used to keep us alive until we can stock up on fresh food again. That’s the idea but it doesn’t work when the nearest source of food is the local Tesco and its open 24 hours a day. Neither does it help that today’s modern society actively encourages less physical activity, thus when you eat a certain number of units of energy, you use up less and store more.

Back to my Disney World observations. I noticed an excessive number of people using electric wheelchairs to get around. I can’t believe for one minute that they all had disabilities that made it impossible to walk – some of them were in their teens. A lot of them were wheeling about as couples. A few of them demonstrated their perfectly able bodies by getting out to walk to the food stands for lunch, only to return to their chairs afterwards. Most of them were obese.

Even more alarming was the sight of so many kids being pushed around in ‘strollers’ – buggies. Only a small number of them were of an age where walking would have been a problem; they either couldn’t walk yet or the distances would have been difficult for them to tackle on little legs. The vast majority were definitely old enough to get out and walk for themselves but the opportunity to be pushed around the parks by their parents proved too good to be passed up. Again, many of these kids were overweight or obese. I found it ironic that a few of them were being wheeled about whilst eating burgers and crisps, courtesy of their parents. Clearly the paradox now in play is that these kids will get bigger, thus heavier, thus less easy to carry, so the parents will simply continue to push them around because its a hell of a lot easier on their backs.

And here’s a conversation I witnessed on the bus between a four year-old girl and her father.

‘When we get to the hotel, we’ll be leaving straight for the airport.’

‘Yeah but you’re gonna roll me there in my stroller, aren’t you dad?’

‘Yeah, I can do that.’

The little girl was actually expecting to be wheeled from one place to another on demand. She will be eating the same diet as most kids her age I would imagine but she won’t be burning the excess stuff off and she will probably just get fatter until she no longer fits properly inside her stroller. A few of the children I saw inside these buggies were far too big to sit down properly and had to wedge themselves in side-ways.

Now I am not a skinny person who is finger-pointing at overweight people and I know that many of my readers may well (and statistically are) overweight or obese but when are we going to get real about this? It is an epidemic and it is killing people.

I’m also a realist and I know that overweight children (and adults if they want to) can and do lose lots of weight and become lean and healthy. I’ve seen it in my own family so it happens but it’s not a social trend. How on Earth is the USA going to put together a standing army to defend itself in the future when most of the kids in its population are just too fat to fight? The same applies to us.

Inside and outside Disney there are a few ‘alternative food’ stands scattered about and you can get apple slices or carrot sticks instead of chips if you want but most of the stuff on offer is heavy, fatty and completely unhealthy if you are already overweight. Burgers, fries, coke (I didn’t see much diet coke anywhere) and large portions of chicken are much more easily bought than fruit or salads. In fact, on a trip to SeaWorld, which is not owned by Disney, I tried to find a place where I could eat something healthy and the one and only salad bar they had was shut (probably due to lack of interest). Getting alcohol is often difficult and you are going to have your ID scrutinised if you look younger than 21 - they are very hot on this, yet over-eating is probably now a bigger potential killer than drinking booze.

Inside the parks, one of the most popular items on sale to eat on the go is smoked turkey leg. I have no idea of its calorific value or how fatty it is but for me it would be a two day meal. In fact, I couldn’t finish many of the meals I had over there, not because the food is unpalatable but because for a little Brit like me, it was just too much in one serving. Even the cakes and sweets are huge and, regardless of my sweet tooth, I couldn’t bring myself to try any of them – they looked too sickening.

This problem is entirely reversible but the giant food-churning corporations are making billions from our laziness. Fast food tastes good when you are hungry and it suits busy lives. I know this myself of course because sometimes I have to eat the stuff during heavy shifts but that supplies me with the energy I need to get through a 12-hour day, much of which will involve physical activity, so I feel confident that I am ‘burning’ off at least as much as I shove in. My weight hasn’t changed much over the years and apart from my well known chocolate habit, which I am addressing, I only eat when I am hungry. I try not to eat too much too often. It’s that simple.

Maybe an anti-snack patch needs to be developed, much as nicotine patches can dampen the desire to smoke. It could be slapped on the arms of every fat child who refuses to get off their wheels and walk. They might eat less, lose weight and realise they feel better for it. Or maybe that would just be another way of pandering to a lazy population. The fact is things are too easy, especially for people in developed countries: Lots of cheap food, available any time you want it, loads of excuses for not exercising and a trend for staying fat once you are fat. I’m even convinced that it is less of a stigma for children now because they are almost in the majority wherever you go. We might soon be hearing ‘thin-est’ jokes and my whole argument will be burned with all the research that has gone before as day by day the population dwindles and the healthcare bill grows. Who needs a war? We have food.

So, what’s the magic formula that will save the lives of hundreds of thousands of people who are too fat? Eat less, exercise more. Less in than out...or at least keep it balanced. For the kids of America I have this to say: get out of your strollers! Start a revolution and shock your parents. Convince them that you can and WILL walk around the Disney parks or wherever it is you are going. Walk until you are tired and need a nap. Walk off the fat and give yourself a healthier heart. Spend less time on your play-stations and more time playing real sports.

Our kids aren’t far behind, so we better keep an eye on this because it will get worse before it gets better.

If you want to check your own BMI click here. It’s not definitive by any means but, if you are honest about your height and weight, it will give you an indication.

Usual postings will start again shortly. I have a few from December that didn’t get published so I will do that over the weekend. I’m back at the helm next week and should be posting new stuff regularly. Thank you all for your kind comments about the book and my well-earned rest and please, keep everything I write in perspective.



BenefitScroungingScum said...

I couldn't agree with you more about the dangers the obesity 'epidemic'. However, I'm sure you already know this (but others may not) I would urge caution about thinking people are able bodied because they get out of their wheelchair and walk a short distance. I'm lucky enough to be naturally slim, and able to walk short distances, however when I get in and out of my wheelchair either to access something or make it easier for the pusher I get all sorts of 'Lou and Andy' looks because a slim, young looking attractive woman doesn't meet with their expectations of disability.
Bendy Girl

Ben said...

Good post and I agree with all of it (well apart from the need for fit people to fight as soldiers, but thats just politics).
No one cooks anymore, the supermarkets sell convenience food that is loaded with fats and salt to make it taste nice - because the fact it is preprepared means that all the flavour is gone. Everyone has huge entertainment systems or the internet to keep them interested and it ends up shutting them inside the house in front of a screen. Then when people get overweight they dont like the hard effort it takes to change and look for easy options like the 'diet de jour' or surgery!
I like the idea of free bicycles all through a town, increase the amount of cycle paths and give the communities more green spaces, plus something drastic like banning Hydrogenated fats, and regulate the sugar and sodium levels in food, sod it just tax the hell out of MacDonalds et al.

Superman! said...

"Burgers, fries, coke (I didn’t see much diet coke anywhere)" No, you wouldn't, it's only in Britain that we order a 'BigMac, large fries and a DIET coke!!
Forget about their health problems, what about the paramedics! I'm sorry but it's no mean feat lifting a 45+ stone fatty down 4 flights of stairs in a cramped, hot and sweaty council flat! I'm sorry if I have offended anyone, but something NEEDS to be done about this crap-guzzling pandemic!
I'm glad you had fun in America, looking forward to your posts!...
You forgot to put be safe at the bottom! I will put it for you...
Be safe xx

Lucy said...

Good to see you back!

This seems sad to me, because surely the best part of childhood is being physical - playing football, climbing trees, rollerblading... gosh, I used to love that stuff when I was little (still do if I'm honest!). There is nothing more satisfying then going to bed physically tired. I'm sure that exercising more would do a lot to combat people feeling depressed aswell.

When we rarely used to go on outings, having fast food was a treat. I know, I know, 'the good old days', eh? But I'm only 20 and my childhood was very, very different to this. I hope things continue to get better here in the UK, rather than worse, although I'm not terribly hopeful to be honest.

Xf said...


I usually only put 'be safe' at the end of my normal shift-related posts. I sign off as Xf on all others...but thanks for adding it anyway :-)

Anonymous said...

I also think that part of the problem is that people think that crap is cheap, when in fact, a single apple is probably cheaper than a mars bar, but given the choice, would you rather have an apple or a mars bar? Also, these kids don't excersize and as you pointed out, they are pushed around in their buggies. My neighbour is a childminder and looked after this really fat kid, when the kid came to her you could tell he never walked anywhere- he couldn't even climb onto the bus owing to the fact his legs were to tubby to lift, which for his age is completely unacceptable. I personally think that we should set up a fat camp and any one with a fat percentage of 28% (overfat) or more should be made (by law) to go and get fit. It would probably be cheaper for the government if we did, because these 'bariatric' patients (did you know the politically correct way of saying obese is now either; bariatric or hoizontally challenged, although I think 'horizontally challenged' may have been my crewmate winding me up!) are costing the NHS a fortune. The hospital we generally ferry patients to has recently had to spend thousands on wheelchairs, beds and bed hoists specially made for obese patients. Seriously, we have to do something before, using your example, it gets to the point that we are hearing 'thinnest' jokes!
Glad you enjoyed your break, although I missed your posts!

Xf said...


Yep, cycling would definitely help. In fact, a trip to somewhere like Centreparks, where it is almost compulsory to get around on a bike, proves that it really isn't that painful a transition...we just don't have the will or the money...or the infrastructure yet.

Anonymous said...

Completely off topic, but, have you ever 'saved' any one famous? Or even ferried them to hospital?

Anonymous said...

I agree with everything you said! I have just come off a 'three-in-a-row' night shift (and have had to lift 4 morbidly-obese patients up/down stairs in them)and it got me thinking about this global growing promblem, I haven't really thought about it before, but my crewmate and I were discussing what we would like to do with them, (he is feeling rather anti-podgy because he has just come off a weeks sick leave after doing his back in; lifting a human kilowhale down a steep flight of stairs!) We think the government should do something drastic like (as ben said) ban hydrogenated fats or create a compulsory 'fat camp' for obese people. We discussed this after glugging down about a litre of coke, two mugs of hot chocolate each and polishing off a pack of 10 doughnuts (99p from Sainsbury's- perhaps that's how people get soo fat, they are a little too cheap!) so we were a little bit hypocritical don't you think! But, may I just point out that at least we burn it off!

Anonymous said...

Given the huge (pardon the pun) costs obesity causes in the NHS, I'm all for stopping the obese having access to it. Give them help to loose the weight if they want to. I know some people have valid medical conditions as to why they can't loose the weight in which case they would be permitted on the NHS. The equation is simple, eat more calories than you use, weight goes up.

Anonymous said...

Well, apart from the weight issue, I hope that you had a good holiday! I agree that the food is a lot more than we are used to, but I found myself eating cherry pie and ice cream for breakfast as it was a novelty (and I was under order's to eat as much as I could as there would hardly be any lunch in the parks). They eat the food because it is there, in front of them. When I am at uni, I don't eat chocolate or crisps, but when I'm at home I do, because it's there. Bad excuse I know, but a reason none the less.

Anonymous said...

Welcome back, glad you had a good time.
It isn't just the young that are obese. I work in elderly care and have had to purchase bariatric turning sheets and heavy duty hoists cos my care staff cant manage without any more. Standard hospital beds are getting a little narrow for a lot of clients these days and these people should be aware there are only certain crematoriums that can cope with the remains. Visions of men trying to shove an obese body into the furnace is pretty undignified I feel. My husband has a BMI of over 60 he gets cross when I nag, so I just check the insurance regularly!
Take care and eat wisely ( Yes I could do with losing a stone too)

a tx rn said...

This one hits home for me. As an RN doing my job 10 yrs ago, I broke a patient's fall. Pt was 300+ lbs against my 100 lbs.....6 knee surgeries later, I am on disability and can no longer do the job I loved......

Anonymous said...

Welcome back! I have missed your regular posts but I'm glad you had a relaxing break. I'm another who agrees wholeheartedly with your post. I took up mountain biking with my husband a few years ago - I lost 3 stone in weight due to the exercise and a healthy diet! I have Arthritis in my spine which I believe is due to 17 years in the NHS, lifting obese/morbidily obese patients! (my Arthritis now rarely bothers me due to my weight loss!)It's time the NHS tackled this problem head on, not only for the sake of the people sufffering due to it but for NHS staff everywhere.

AJ in Australia said...

not sure if I've got my stats exactly right, but I read that to get 8000kJ ( a day's energy) it can cost up to $40 to buy that in fruit and veg but it would cost about $4 to buy in fats/junk food... do the maths I guess!
My son is 3 and as much as he has a bit of time in front of the tv (mainly so I can do the housework/put the baby to sleep), every day he's outdoors playing every game he can and loves it. He's even got a suntan on his feet in the shape of his sandals! He was out of his buggy before he was 2 as he just loves to run everywhere. He actually makes me feel young from being exhausted for a good reason!
(anyway long time reader, first time poster, love the blog!)
AJ in Australia.

Anonymous said...

Anon 1:57pm
We could shove them all in 'Bariatric Banks' or 'Fat Farms' or 'Chubby Clubs'!

a tx rn
I hope your knee gets better soon, I am guessing by your name that you come from Texas? Do you have to pay for medical treatment there? If so did the patient pay for your treatment? I would have made him!

martyn said...

I think it is a question of education, It is quite possible to eat a healthy diet just as cheaply as to eat McCrap. People are just not aware of the choices plus the franchises all have a me too attitude, trying to copy what is successful rather than breaking the mould

gardening nurse said...

Try being a nurse and having to lift morbidly obese people up and down the bed! We regularly get bariatric patients on our unit because a lot of them have sleep apnoea and therefore require CPAP overnight. I work on a small 8 bed High Dependency Unit and we have 4 RNs on duty. Some patients weigh 200 or so Kg and it is no joke. We once had a patient whose HERNIA alone weighed 50kg, he died not long after surgery. No wonder my knees and back are giving out.

Anonymous said...

This reminds me of a top tip I read in Viz magazine once...

"Fatties... Take a leaf out of smokers' books by sellotaping a crisp to the top of your arm each morning. The weight will soon fall off!"

Mayonnaise said...

I do believe there's an obesity problem, but I'm not sure those people in the chairs or children in strollers didn't need them. I remember being 11 years old, and fighting with my parents nearly the whole afternoon at Disney World because THEY wanted me to ride in a push wheelchair they rented, and I wanted to walk. I wouldn't ride in the chair, because it was embarrassing. I didn't want people looking at me and thinking the things you were. I finally conceded, rather tearily, after half a day of them sticking to their no-chair, no-rides policy, and it was a little less embarrassing when my 9 year old brother, probably operating on the same principal as some of those stroller kids, took advantage of the excess space in the chair to sit next to me and hitch a ride himself. At least then there were two of us. I'm sure at that point people were wondering what I was doing in the chair. So was I. I'm left only to take my parents word that I'd spent the previous day in bed totally out of it with a fever of 103. I didn't remember it then and I still don't.

On a whole other note, can you get Diet anything at a restaurant in the UK? Cause over here (I'm in New York) everyone's got diet cola, it goes without saying... but if you want diet lemon-lime soda they look at you as if you're from Mars.


Anonymous said...

It has been noted in various health and news articles that junk food is often cheaper and easier to obtain than healthy food, like fruits and vegetables. Many urban communities that are poor or unstable often do not have a proper grocery store for people to shop at.

I too have noticed the prevalance of parents pushing their older children in strollers and I often chalk it up to laziness on the part of the adults. Kids get tired walking around; parent doesn't want to lug a 4/5/6-yo around -Easiest for both? Stroller. The parents are doing the kids a huge disservice.

HeatherErin said...

I'm a rather lardy American truth be told. I have three children; 6 1/2, 4 today, and 10 months. I've also not used a stroller more than a few times in the last two years, and that was for the baby in the few weeks right after labor when I was too loopy to carry her.

Instead, I "wear" my baby in a sling. I look at it this way; she's only about 20 lbs, she loves it, she's quiet and happy, and I get a little extra workout for my walk. My oldest two walk with me as they've got perfectly good legs and need to burn off as much energy as possible.

However, I'm continually told "Oh, you'll need to put her into a pram/stroller/whatever." Why? She's not too heavy for me and that's with my excruciatingly bad back. She's happy, I'm happy, why should I limit our mobility with a stroller? I can carry her, my knitting bag, a spare nappy, and still have two hands free for my other children.

And people think I'm crazy. Sheesh.

If I can do it people, more of you all can.

Anonymous said...

I'm a paramedic as well, but in the US. South Carolina to be exact. The summer is too hot, the average weight of a female Pt is somewhere around 150kg (over 300 lbs!), and everything is loaded with sugar/ salt and is deep fried. I'm not saying I'm a rail, for from it actually. But I can lift a heifer or work a code without becoming out of breath. This blog is great! A very unbiased observation of what the US has become; fat and lazy! IT KILLS!!! The sooner the public hears that, the better.

It was a sad day when I had to make the decision NOT to work a code on a 36yr old Pt because there was no way I and my partner would have been able to get him out of the house. Even if we'd had help, this man was over 600lbs (270kg). Instead I had the heart-breaking task of telling his mother that there was nothing we'd be able to do. People are eating themselves past the capacities of my stretcher, and the medications we carry on the truck. We just don't have room to carry enough meds for some of these really large people. (Some of the drug doses are weight based!) And it's getting worse!

And so you all know, my 4yr old son hasn't sat in a stroller (pram) since he was 18mos. Sounds mean, but "you have 2 perfectly good legs, use them! And if you are hurt, Mommy's a medic...."

Kudos for the blog!! Stay safe out there! And should you ever decide to work over here, bring a floor lift!

Anonymous said...

I realise this post is over a year old (oh yes, that GCSE in Maths has its uses) but I've been reading back through your posts since coming across your blog a while ago.

The obesity epidemic worries me. But then, the messages [young] people are receiving about food/weight are not necessarily helpful. The people who really need to take notice seem oblivious; and the people who're actually doing okay end up at the opposite extreme, trying to live on a no-fat diet, avoiding all kinds of foods - and, in some cases, ending up with serious body image issues and/or an eating disorder.

I run a Brownie Pack in Inner London. 30 7-10 year old girls from a range of ethnic backgrounds. Almost all of them are slender (some are tiny, notably a wee Pixie with multiple life-threatening food allergies) or at the low end of a "normal" weight/size scale. They're also all very clued up about healthy eating and exercise (we've been doing the "Healthy Heart" badge this term). Actually, I had a hard job convincing them that the odd bit of fatty sugary food really was okay.

We always play at least one active game at every meeting. Usually more. We've collected Sainsbury's Active Kids vouchers the last two years & as well as getting things like skipping ropes and hoops (etc) we've had a couple of dance sessions. In the summer we go swimming & hold meetings in the local park so the girls have space to leap about like loons.

So yes, most of the girls I work with are not part of this obesity crisis. However, there's one girl in the Unit in particular who I do worry about. She is a sturdy lass and she often has to be pushed to take part properly in physical activity. I'm not too sure what her diet is like, to be honest, but I suspect it's not brilliant. And, tellingly, her parents seem to be unaware of how big their daughter is - her uniform (bought new) was too small when she got it & either it's got smaller or she's got bigger. Nothing wrong with the length of the stuff, but fabric strains & we are regularly greeted by the sight of her builder's bum when sitting in Brownie Ring. Yeah, nice.

Ah, the wheelchair conundrum. I have a wheelchair. I use it rarely - partly because self-propelling causes my shoulders to start doing the hokey-cokey. It gets a whole range of response from people: people think it's appropriate to quiz me on exactly WHY I'm in the thing; people look at me pityingly; people assume I am simple; people pretend not to see me... I've had to be rescued by a friend from Random French Bloke who was trying to drag me off for a donkey ride (not a euphemism, he thought I was a child); I've had MOPs refuse to move their buggies to let me into the wheelchair space on the bus; I've had people shove in front of me in museums (presumably because they felt I'd do better looking at their bottom than at the exhibit)... *sigh* I cannot, for the life of me, imagine why someone would WANT to be in one rather than be walking. You have less independence, it's tricky to get yourself about, you have a more restricted view... And walking-hopping-skipping is so much FUN!

As someone else commented earlier, it's hard to judge whether or not people are really in need of their chairs. Unless I am really not functioning well at all, I can usually manage a few steps & sometimes HAVE to to manage things like picking stuff up or opening doors or transferring onto the loo etc. I suspect you're quite right about most people not "truly" needing the chairs though. Maybe they were all planning on doing what I am sorely tempted to do one day: go to a public place and then leap from my chair crying "it's a MIRACLE! I'm HEALED!" and then run off...

Sorry, this has gone a bit bibbletastic. I had a point at some stage (I mean, a reason for making this comment, rather than a purpose for existing. Well I have one of those too, but it is less relevant here.) but I appear to have mislaid it. I hope some of this makes sense at least. If not, I blame the fact I Should Be Asleep. And possibly also my last lot of morphine. I'm sure that stuff plays at silly buggers with my poor little brain...