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January 14th, 2004 Taylor Clark | News Stories
 

The New Urban Sprawl

WHY ARE OREGONIANS SO DAMN FAT?

     
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Pssst. Hey, you.

There's something important I need to tell you. Try not to take it personally. I know it's awkward to hear these things, but someone needs to say it.

You're overweight.

You could really stand to lose a few pounds. Everyone at the office knows it. But don't feel too bad; they're probably overweight, too.

This claim may seem sensational, but the odds are stacked in my favor. According to Oregon's Department of Human Services, fully 22 percent of adult Oregonians are obese and 60 percent are overweight. In clinical-speak, "obese" and "overweight" are terms used for those who have a high Body Mass Index--a number calculated by comparing one's weight and height (see box for a full explanation).

Hold on a second, you're probably thinking. Don't single us out. Weight gain is a national problem; people are blimping up like zeppelins all over America. In Oregon, we're healthy. We eat our organic vegetables; we're the birthplace of Nike. Surely we're no worse than anyone else.

True, obesity rates across the U.S. are surging, but Oregon is leading the charge of the fat brigade in the West. According to Centers for Disease Control and Prevention data, Oregon's 22 percent obesity rate makes it the fattest state west of the Rockies. Nationally, we're No. 14.

Oregon was the first state in the West to cross the 20 percent line for obesity, and the rate in Oregon has doubled since 1991. We're getting so fat so fast that doctors don't know how to handle it.

"Obesity is far and away Oregon's leading emerging health problem," says Dr. Mel Kohn, the state epidemiologist.

Kohn can reel off a list of weight-related illnesses that are on the rise to prove that Oregonians are being crushed under their own weight: Type 2 diabetes, kidney disease, osteoarthritis, heart disease, stroke, sleep apnea, asthma...it goes on and on.

"The only bigger preventable killer in Oregon is tobacco," he adds, "but obesity is gaining on it."

Diabetes, for example, kills three times as many people in Oregon today as it did 15 years ago. And then there's the money drain. Kaiser Permanente studies claim that obese people use 39 percent more health-care resources and 100 percent more pharmaceuticals than people at or near ideal weight. Oregon DHS says the state hosted 48,000 weight-related hospitalizations in 2000. Cost: $730 million.

Now that we've reached statistical overload, here's the point: Health-care professionals know that we in the Beaver State are uniquely massive, but the question they all squirm at answering is why.

As Njeri Karanja, a researcher at Kaiser Permanente's Portland Center for Health Research, explains, the data aren't there to tell us what causes our chubbiness.

"We don't have enough knowledge of why things are," she says. "We just know that they are."

There are a number of obvious theories about why Americans are getting fatter: We drive more, eat worse, exercise less, watch more television and so forth. But what is it about Oregon in particular that is turning us into walking dirigibles?

Everyone has theories, though they're not always excited about sharing them. Drawing from stacks of research materials and interviews with health professionals, we've found that there are a few major factors that seem to explain why Oregonians are bulking up so fast. Here are four reasons we are the fattest state in the West, beginning with the sad fact that...

1. WE'RE HUNGRY.

Just over 6 percent of Oregon households go hungry each day, according to the Food Security Institute. That rate--twice the national average--makes us second only to Oklahoma as the hungriest state in the nation.

OK, so many of us are hungry. Shouldn't this make us thin?

No. Hunger stems from poverty, and in Alabama researchers found that people who make less than $15,000 per year were 50 percent more likely to be obese than those who made more than $75,000. The rates are similar here. According to Oregon DHS statistics, 70 percent of those who live in Oregon households making under $25,000 a year are overweight.

"In general, the lower the socioeconomic status, the greater the possibility there's going to be an issue with weight," says Dr. Phil Wu, a Kaiser pediatrician who frequently treats obese children. "High-calorie and high-fat foods are cheaper. It's easier to afford McDonald's than something that is fresh and healthy."

"If hunger is an issue, you are likely to eat whatever you can get whenever you can get it," explains Kohn. Not only do those in danger of going hungry tend to endure a gorge-starve cycle that for complicated physiological reasons only helps pack on pounds, but the food they're gorging on is the cheap, high-calorie kind that one finds in the poorest neighborhoods: fast food. And Oregonians love fast food.

There is evidence of this. The yellowpages.com website has a listings category called "Restaurants - Fast Food" for all of the western states and cities. Analyzing the ratio of fast-food joints in each state to the total population reveals that Oregon leads its 10 closest neighbors with 20.8 fast food restaurants per 100,000 people (see chart, right). Additionally, the city of Portland leads other western cities at an artery-clogging 30.3 fast-food joints per 100,000 people.

And we're certainly not running off the calories from those Whoppers, because...

2. OREGONIANS HAVE TRAMPLED PHYS ED IN SCHOOLS.

Oregon's pint-sized school year makes national headlines, and for any school looking to cut programs to save money, physical education and health classes are often the first to go. To the continued frustration of those who try to keep our kids active, this isn't just a recent thing.

"Oregon has taken a lot of big hits in terms of physical education over the last 20 years," says Minot Cleveland, the Milwaukie physician who heads the Oregon Coalition for Promoting Physical Activity. "PE specialists have been cut, and phys ed is now delivered by classroom teachers who are inadequately trained to teach it--and mostly don't want to."

This is where it would be nice to show how many schools are meeting Oregon's PE standards and how they compare to other states', but, as Cleveland explains, the bill that would have made districts keep data on such things got killed in the last legislative session.

"If you survey most of the districts in Oregon right now, you can bet that they aren't doing any PE assessments," he says.

In Colorado, the thinnest state in the nation, it's a different story.

"We monitor each school district," says Colorado Department of Education spokeswoman Cindy Howerter. "They have to show evidence that they meet or exceed all of the state's PE standards in order to stay accredited."

These standards aren't anything to scoff at, either. For example, one of Colorado's non-mandatory expectations is that 11th-graders be able to "navigate a kayak skillfully and safely through whitewater."

By contrast, Oregon DHS says only one in 10 female 11th-graders in Oregon has PE every day. Of the 60-plus Portland elementary schools, five of them have no PE programs at all. In Hillsboro schools, students can expect less than an hour of phys ed each week, according to a Hillsboro district representative.

At the same time, the number of obese eighth-graders in Oregon has risen 50 percent in the past two years, according to Oregon DHS. The truth is simple: Decreasing phys ed over 20 years means more fat kids. And fat kids almost always become fat adults.

"Kids are getting fat here at a faster rate," says Oregon Health & Science University pediatric endocrinologist Dr. Dan Marks, who claims that he is now seeing kids as young as 6 years old being routinely referred to his clinic for obesity. "We're starting to see things in kids we used to only see in elderly patients before, like heart failure."

Or like Type 2 diabetes, which has exploded by a factor of 10 in kids at OHSU over the last few years. Daily exercise would do wonders against the rise of this disease, but it's tough to get out there when...

3. WE'RE STUCK WITH TERRIBLE WEATHER.

There is some interesting evidence to suggest that weather plays a substantial role in Oregon's growing girth.

First, there's the problem that it rains a lot here, an obvious impediment to outdoor exercise.

"I see an awful lot of kids who say, 'When summer comes, I'm always out on my bike,'" says Wu. "But then there's fall and winter, when they can't go out as easily."

Is it really harder to exercise outdoors in Portland than most other places? Probably not. After all, the Northeast is one of the most inclement places in the nation during the winter months, but New Englanders are relatively trim.

What really may be important, though, is sunshine. According to the National Weather Service, Portlanders only see 68 sunny days a year, which makes us one of the least lit cities in the nation.

"In Colorado it's sunny 360 days of the year, and there are outdoor sports year-round," says Dr. Roger Cone, director of OHSU's brand-new Center for the Study of Weight Regulation and Associated Disorders. "In Oregon, if you're not wealthy and don't belong to the gym, it's not easy to stay active."

The lack of sunlight here poses a special problem; it depresses the hell out of us. The Pacific Northwest is widely regarded as the capital of the universe for seasonal affective disorder, a depressive state caused by lack of natural light. This may contribute to another one of Oregon's problems: suicide. The American Association of Suicidology says Oregon had the seventh-highest suicide rate in the country in 2000, 38 percent above the national average. And the most popular month to do oneself in here? January, when the sun hangs lowest.

But depression isn't just making us kill ourselves; it's also making us fat. According to studies at Brandeis University, being depressed leads to two things: We eat more, and our bodies get stressed (this also happens when we're poor, by the way). When we eat more and our bodies get stressed, we gain weight.

That's OK, though, because...

4. IT'S SOCIALLY EASIER TO BE FAT IN OREGON.

There's no use pretending--this one's pretty anecdotal. Can one prove scientifically that people like overweight people more here than anywhere else?

Actually, there are some answers. The people behind Match.com, a popular online personals service, keep track of the dating preferences of their 12 million members. When they looked to see which city's romance-seekers most often stated a preference for someone who carries "a few extra pounds," Portland came up the winner. (See box on page 15 for more about Portland's paradoxical weight issues.)

Oregonians, it seems, have a degree of fat acceptance. This isn't Southern California, where they sneer at those who aren't bikini-ready, or New York, where every square inch of space in the subway counts. (As one anonymous Manhattan resident and former Portlander told us, "If I don't watch it when I turn around in a restaurant, my ass might take out a whole table of supermodels.")

One way to measure our relative lack of vanity is to see how addicted to plastic surgery we are. For Portland, the Yahoo! Yellow Pages only lists 11 plastic surgeons per 100,000 people. That's fewer than Seattle (13.5) and San Francisco (15.4)--and let's not even talk about Las Vegas or Los Angeles.

This is Portland, the home of personal freedom. This is the city that earlier this year ambulance manufacturer American Medical Response chose to debut its "supersized" ambulance--a vehicle that can comfortably hold patients weighing up to 1,000 pounds.

This is a place where one could build a business on the concept that fatness is OK, even cool. Stacy Bias, a 29-year-old Web designer, is slowly doing just that. She argues that the issue of obesity is a big, chubby red herring.

"Weight isn't the issue," says Bias. "Fitness is the issue. Fitness and fatness are not mutually exclusive."

Tired of feeling pressure to slim her 350-pound frame, the 5-foot-10 Bias decided to strike back against the fat gestapo. Last year, she organized a multifaceted show called "FatGirl Speaks" at the Hollywood Theatre, which featured everything from workshops on fat phobia to a fat fashion show.

With little marketing, she sold out the 490-seat venue and had to turn 100 people away at the door. Plans are in the works for a bigger event at the Roseland this May. Bias wouldn't say whether she thinks she would have similar success in other cities; all she knows is that Oregonians love the idea.

"The only platform for lasting physical change is positive self-esteem," she says. "People here are excited about this."

We'll be the first to admit it: These are just theories. There are plenty of facts backing them, but there's also a healthy dose of anecdote. None of them offers catch-all, airtight proof.

And besides, is this list even useful? What are we supposed to do with it? Solving one of the factors above would require a level of government funding that isn't likely to arrive: We can't just decide to quit being so damn hungry. One factor we have no control over (the weather), and another we wouldn't want to change--we're certainly not saying that what Oregon really needs is a few more intolerant assholes.

We could take a hard stand on phys ed and issue an edict saying kids must exercise every day in schools. Cone thinks this would do the trick.

"If kids had 30 minutes of PE every day, it would have an impact," Cone says. "It may even pay for itself with a decrease in disease."

The argumentatively inclined could spend days shooting holes in these theories. But the one thing we do know for sure is that nobody else seems to know why Oregonians are particularly fat, either.

Take the genetic argument for fatness, for example. Certainly, there are many obese people who aren't hungry or lazy, don't mind the weather and feel immense social pressure to lose weight, but still can't melt off the pounds. Genetic inheritance can't be all of the problem, though; we weren't even half this fat two decades ago. Plus, Oregonian genes aren't recognizably different from anyone else's in the West.

"Our genes don't change that quickly," says Cone. "Genes take hundreds of thousands of years to change."

The one complaint that unifies all of the people we talked to is that there's just not enough information about who is fat and why to make for truly effective treatment strategies. They're working with best guesses.

Oregon's current efforts at slimming down the state revolve around promoting a healthy diet and getting more exercise, two stale old maxims. This is about like the state saying, "Hey, tubby! Quit eating those Krispy Kremes and go for a jog."

It seems the best we can do for now is try to learn more about the bulbous beast and bide our time pointing the finger of blame at various ills of society. As long as we don't know the enemy, it's going to be a long, hard slog to thinness.

ABOUT OUR COVER MODEL

Nate Conner is obese. He has no problem acknowledging this. With 300 pounds on his 6-foot skeleton, he has a BMI of 40.7, and it has always been this way.

"I've been big since I was young," says the 24-year-old Conner. "I tend to stand out. It's noticeable."

Being big has its perks and pitfalls, he says. On the upside, he never gets cold, so he can wear shorts year-round. On the downside, it takes $180 to get him drunk.

A security guard, minister and--as his business card states--"all around good guy," Conner was kind enough to give his perspective on our four reasons why Oregon is fat. By and large, he agreed with them, particularly the notion that Oregon is a very accepting place.

"When I was in Hawaii, I noticed a lot of discrimination," says Conner. "It's like that most places I go. Portland's the best place I've ever been. It seems to be a more accepting town for everything."

Conner, a Jefferson High grad, also says that playing sports in school kept his weight down considerably, but when he was a cash-strapped college student he had no choice but to eat unhealthy foods.

"In college, I worked at a McDonald's and was broke, so fast food was all I could eat," he says.

Since high school, Conner has spent less and less time exercising--a frustration he pegs to his line of work.

"I've had a desk job for a while now, and it's taken its toll," he says. "I wish I could change my hours and get more exercise into my schedule."


BMI equals...

What could be more enjoyable than finding out if scientists consider you fat? Calculate your approximate Body Mass Index with this arcane formula:

Take your weight in pounds and divide it by your height in inches squared. Now multiply the result by 703 and round to the nearest tenth. Check your results with this fun table.

Below 18.5--Underweight

18.5-24.9--Normal

25.0-29.9--Overweight

30.0-39.9--Obese

Over 40.0--Morbidly Obese

*These figures apply to adults only.

The fattest state in the union, Mississippi, is also the poorest, according to the U.S. Census Bureau.

A 1998 Purdue University study found a strong correlation between obesity and higher levels of religious participation. Southern Baptists have the highest average Body Mass Index, with Catholics in the middle and Jews and other non-Christians at the bottom.

One theory about America's reign of fat concerns portion size. University of Pennsylvania researchers found that restaurant portions in the U.S. are 25 percent larger on average than in France.

Another theory about the ballooning of America involves evolutionary instincts. Humans are programmed to pack on pounds for when lean years come, but today's agricultural productivity has basically made food shortages a thing of the past.

 
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