FRONTLINE 1708 "Fat"
Air date: November 3, 1998
Written, Produced and Directed by Antony Thomas
Narrated by Antony Thomas
NARRATOR: Fat-soothing, comforting fat. The smell, taste and texture of it intoxicates the senses.
VOICE OF COOKING DEMONSTRATOR: Fat is the magic ingredient. When fat is used in cooking the food, you get that extra sensory experience. It's what makes things have a great texture. It can be a crispy texture. It can have a wonderful fudgy texture, in the case of a delicious piece of chocolate cake. This inimitable "mouth feel" that we get from fat is what delivers flavor to our palate.
SUSAN JEBB, Obesity Specialist: Fat adds taste and texture and palatability to food. We do seem to like the taste of fat. When we expose people to high-fat foods, they very frequently and regularly overeat. They consume far more energy than necessary, and we just don't get that same phenomenon when they're exposed to either high-carbohydrate or high-protein foods.
NARRATOR: There are reasons, sound evolutionary reasons, why all animals crave fat. Fat cells are the body's larder, storing energy against times of famine and extreme cold. And the human brain, like any animal brain, craves it. It is a primitive survival instinct.
Prof. PHILIP JAMES, Anti-Obesity Task Force, World Health Organization: Fat is a very precious commodity in the world that we emerged from in the African jungle, where people lived on fruit and berries and wild game, where there was almost no fat. The choicest foods were the fatty, flavorsome foods. And I think that the human brain - and many animals, as well - have been built to recognize fat, sugar and salt as part of the primeval survival mechanisms. Now we're handicapped because we have fat everywhere, but we still have those brain mechanisms charging away.
NARRATOR: And the world is getting fatter. Thirty-nine million Americans are obese - that's 20 percent above the ideal weight - and the numbers are doubling every seven years. Yet at no time in history has more money been spent on diets, low-fat and sugar-free foods, slimming pills and fitness programs. And never before have we been so obsessed with a cult of thinness, so repelled by fat.
Thirty miles south of Phoenix, Arizona, the Casa Blanca highway skirts the border of the Gila River Indian Community. For at least 2,000 years, the Pima people lived and farmed here. But in the early years of this century, white settlers diverted the upper waters of the Gila river. The Pima's irrigation canals ran dry, and the land died.
Then, after years of hardship, their fortunes suddenly changed. In 1984, the Pima were granted a casino concession in the heart of this prosperous American state, where casinos are otherwise forbidden.
The links to their ancestral lands broken, the Pima have joined the American mainstream. Today the Arizona Pima share the American culture, the American lifestyle and the American diet. But in one important respect they've outdone their fellow Americans: They are now the fattest population group in the fattest country on Earth.
RECEPTIONIST: I have 12:45, 1:45, 2:45. That's on the 11th.
NARRATOR: In this state-of-the-art hospital, the Pima cope with diseases that doctors have linked to obesity: hypertension, high blood pressure, several forms of cancer, bone, joint and muscle strains, sleep apnea and diabetes. A staggering 60 percent of Pima adults are diabetic. A dialysis clinic operating 14 hours a day, 6 days a week, treats 18 patients at a time.
In this hospital they are proud of their achievements, and rightly so. No one pays for treatment, and the whole population is carefully monitored. The Pima have also allowed the American government to use their hospital as a human laboratory. Eleven thousand Pima volunteers have participated in an important long-term study of diabetes and obesity for the National Institutes of Health.
The Pima of Arizona know that theirs is a community in crisis.
Five hundred miles to the south, high in the Sierra Madre mountains of northern Mexico, there's another Pima Community of just 700 people whose ancestors separated from the main tribe and migrated here nearly a thousand years ago. These Pima of the Sierra Madre are on average 60 pounds lighter than their American cousins. Diabetes and obesity are virtually unknown here.
The only thing that distinguishes the two groups is lifestyle. The Mexican Pima farm and live as their ancestors did. There are no labor-saving devices here, not even electricity or piped water. You walk, you ride, and if you're late for school like Maria and Icedro, you run all the way, three miles.
The Mexican Pima spend 22 hours a week in hard physical exercise. In Arizona the figure is less than 2. And here they eat a traditional diet of fruit, vegetables and corn tortillas, high in fiber and low in animal fat.
For scientists, the striking physical difference between the two branches of the Pima nation perfectly illustrates the impact of modern living on weight and health.
Dr. GEORGE COWAN, Baptist Memorial Hospital, Memphis: We live in a food-toxic environment. We don't live in a normal environment like people lived in a century or two centuries ago, where you had to go out and really labor for your food, and continue laboring and burning those calories and get precious little food in return in most times. Today it's all over.
NARRATOR: Over the last 50 years, there's been a drastic fall in the amount of exercise we take. At the same time, a complete transformation in the way we eat and in what we eat. Food has been industrialized. It is a massive global industry, in the United States the third largest, ahead of electronics, aerospace and computers.
Dr. WALTER WILLET, Harvard School of Public Health: The transition of food to being an industrial product really has been a fundamental problem. First, the actual processing has stripped away the nutritional value of the food. Most of the grains have been converted to starches. We have sugar in concentrated form, and many of the fats have been concentrated and then, worst of all, hydrogenated, which creates trans-fatty acids with very adverse effects on health.
Prof. KELLY BROWNELL, Dir. Yale Center for Eating and Weight Disorders: Unlike any time in history, we are exposed to an environment where food is widely available, heavily promoted, available at low cost, and it tastes good.
NARRATOR: In the United States, the food industry spends $36 billion a year on advertising, and much of it is aimed at children.
Prof. KELLY BROWNELL: The average American child sees 10,000 food advertisements each year on television alone. Ninety-five percent of those are for one of four types of foods, dense in calories and fat: fast foods, sugar-coated cereals, soft drinks or candy. And that's 10,000 messages by the brightest minds in advertising to convince children to eat foods that are bad for them.
NARRATOR: Bad foods are ubiquitous, and they crop up in the last places one would expect. The catering contract at Glendale High School in California has been awarded to the fast-food companies. Credit for this initiative goes to Richard DeBurgh.
RICHARD DeBURGH: I talked to students. I asked students what they wanted. And time and time again, the students wanted what we refer to as fast food- not just a hamburger, but a hamburger with a logo on it.
INTERVIEWER: So advertising definitely works.
RICHARD DeBURGH: I don't believe they'd be spending hundreds of millions of dollars on advertising if it didn't work. Students are targeted for advertising, and if what they see on television, they see on the billboards, they hear on the radio stations and they see in a newspaper- I think it really does work.
NARRATOR: Does Rick DeBurgh have any qualms about selling kids high-fat food?
RICHARD DeBURGH: Oh, there's are all kinds of weirdos and food police that come in and have their own various theories on what's healthy and what's not. But I don't feed food police. I feed kids.
NARRATOR: And that story is being repeated across the globe. Today the Chinese, and particularly the young, want everything we have to offer. And of course, we're always happy to sell it to them.
In 1992, the McDonald's Corporation set up shop in Beijing. Soon other fast-food chains and all the main American food and soft drink manufacturers had joined them in the rush to secure a slice of this lucrative and expanding market. And just like everywhere else, the advertising and promotion of junk food is principally aimed at children.
In this small clinic, one of several in the city of Beijing, Professor Chung treats a thousand obese children, almost all of them boys. Obesity was practically unheard of here a decade ago. Now, according to Professor Chung, a tenth of urban children are obese, and the numbers are rising steadily. She attributes this to an invasion of Western junk food and soft drinks and the ascendancy of the motor car, the familiar story.
Professor Chung's prescriptions are conventional: appetite suppressants, a diet of lean meat, fruit, vegetables, massive doses of encouragement, and exercise- lots of exercise.
The twin evils: junk food and our sedentary lifestyle. But is that the full picture? Why are a tenth of Beijing children and a quarter of American children obese, while others still appear to be unaffected? Is it just down to greed or laziness or parental indifference?
Well, obviously not in this case. Something else made these children susceptible to weight gain. According to the experts, that something else is in our genes.
Dr. GEORGE COWAN, Baptist Memorial Hospital, Memphis: Our obesity is in our stars. We are genetically determined, our size. We know that us guys, we have a bigger belly. That's a genetic thing, part of the Y chromosome. Women, they have a bigger butt, bigger thighs- "haunch and paunch," if you like. These are endowments that we all agree are genetic, even to the relative distribution of fat. There's only one thing left out that people somehow do not accept as genetic, and that's the amount of the obesity.
Prof. PHILIP JAMES, Anti-Obesity Task Force, World Health Organization: There really is increasing evidence of genetic susceptibility to obesity, with staggering evidence of individuals having a single dominant gene that's a major problem. We can no longer just say genes are unimportant.
Dr. GEORGE COWAN: Here we are set up with the genetics, turned-on genes and we're in an environment. It's a perfect set-up for people in a food-toxic environment to be big. They just can't help it, if you have this tendency. And they indeed are caught in a "fat trap."
NARRATOR: It has never been easier to become fat. It has never been harder to be fat. Few people appear to understand that some are much more susceptible to weight gain than others, and that this susceptibility is inherited. And even fewer appreciate that the poorer you are, the more reliant you become on cheap, toxic food.
Lynn McAffee is one fat lady who has been allowed to state her case.
INTRODUCER: [at employee conference] Obesity is not a character flaw.
NARRATOR: The directors of a leading pharmaceutical company have invited Lynn to sensitize their employees with her story of a lifetime's struggle with her body and prejudice.
LYNN McAFFEE: [at employee conference] It's important for me to talk to you today about the experience of being fat because I'm a 500-pound woman and I'm the worst-case scenario. I'm what you're all afraid of. I'm why you are afraid to eat that extra piece of pie. I'm the cautionary tale that you all live by.
This is a picture of me when I was on my first diet. No, it's not a joke. I really was 3 weeks old when I was on my first diet. I was taken to the doctor for my weight at that age because I was getting too tall and too fat, and my parents were scared.
This is a picture of me when I was age 7, with my first boyfriend. Do I look happy in that picture? Do I look happy? I don't think happy is the right word. I was very, very stoned. I was on amphetamines, and I spent the afternoon running around the house trying desperately to get that energy out of me, that feeling that I didn't understand that happened to me when I took the amphetamines.
Here's another picture of me when I was 15. This is when I started on my really big diet. I was taking phentermine, and I was using up prescriptions like crazy. And the doctor just gave them to me because, after all, it was more important that I be thin. And so I did everything I had to do to lose it and to try and keep it off.
This is Michael Patrick Guliano. He was one of my best friends in high school. He's about 15 or 16 here. This is when we were both taking phentermine, and we were phentermine buddies.
Michael was gay, and he was getting off a bus one day a night. And a gang of thugs surrounded him and said "Let's get the fat faggot." And so they beat him up, and because he had such a pretty face, as you can see, they mutilated his face. And he really couldn't live without that face because he certainly couldn't live with just his body, being fat, and he committed suicide rather horribly. He was just the first of many friends that I have lost to violence.
If you are super-size person, you are a target. I've personally had experiences where people try to run me down in cars, laughing at me. I have early childhood memories of children on bicycles surrounding me and trying to run over me, let the air out of me.
I hope in your entire life, you never need he courage that I need just every day to get up and get out the door.
NARRATOR: Prejudice begins at a very early age. In a London primary school, 24 children between the ages of 5 and 8 are given a test that was first used in an important American study of children's attitudes. Four photographs are handed out to every member of the class. They show a child in a wheelchair, a child who has lost her hair through cancer treatment, a child from a nation they would have had no contact with, and a fat child.
TEACHER: And what you've got to do is you've got to choose one which you wouldn't like to be your friend as much as the other three. Don't show anyone else. Once you've got that one person that you don't want to be your friend, bring it up and put it on the table up here.
NARRATOR: The most unpopular child by far, earning more rejections than the other three put together, was the child who is fat. [www.pbs.org: More on fat prejudice]
TEACHER: Why did you decide, Stacey, that you didn't want that little boy as your friend?
1st CHILD: Because he's fat.
2nd CHILD: Because he was too fat.
3rd CHILD: Because he was too fat.
TEACHER: Well, what are fat people like, Joshua?
4th CHILD: Lazy.
NARRATOR: We have made fat shameful, and it's a cruel paradox that the ideal of physical beauty is becoming progressively thinner at the very time when there are more and more reasons and inducements for people to put on weight.
CATHERINE STEINER-ADAIRE, Harvard Eating Disorders Center: It's crazy-making. People are bombarded with messages, "Eat this." "Eat this." "Eat this." "Eat, eat, eat, eat." Whether it's good or bad, "Eat." Then on the other hand, they are told, "Be healthy. Don't eat."
NARRATOR: Through cinema, magazines, and above all television, we are now exposed to more millions of images than anyone has seen in the history of the human race. Most of those images are American, and they are thin.
STEVEN BLAIR, Cooper Institute of Aerobic Research, Dallas: The ideal has come to a point that hardly anyone can achieve it, no matter what they do. And I think, particularly, it's worse for women than it is for men. The ideals of feminine beauty that we see in the movies and in the magazines and that sort of thing are just impossible for most women to achieve.
Prof. KELLY BROWNELL, Dir. Yale Center for Eating and Weight Disorders: I feel it is totally unfair that we're raising generation after generation of young people, especially women, to be at war with their own bodies.
I'm very concerned about my own daughter, Christie, who's 9 years old. She's to the point now where she likes her body. She's athletic, and she climbs trees and runs and plays games and really enjoys herself, and her body is her friend. But it's beginning to change because she's now comparing herself to models that she sees in magazines, and she's comparing herself to Barbie dolls and things like that, and doing so unfavorably. I start to see hints of it right now.
If she is the typical young female, the war with her body will begin at puberty.
NARRATOR: Fashion seems to have dictated that the female body should never mature beyond childhood.
Rehearsal time at a privileged English girls' school. Here there's every opportunity and every encouragement to be superbly fit. Yet most of the girls we spoke to were at war with their bodies, obsessed with weight and dieting.
EMILY: It's a constant thing. You've always got to be conscious of how you look, what you weigh. Get up in the morning, and the scales are the first thing.
NARRATOR: Charlotte has been dieting since she was 10 years old.
CHARLOTTE: If I looked in the mirror, I just looked at myself and my legs were fat. I was fat. I had a chubby face, and I didn't like it.
INTERVIEWER: You were becoming a woman, that was all.
CHARLOTTE: Yeah, I know.
NARRATOR: Natalie has been on a diet since she was 4. Why?
NATALIE: Because I saw these modeling programs, and all the models were thin and they had posh clothes and stuff, so I just decided I wanted to be like them.
NARRATOR: Ilona is 9 years old. Why is she on a diet?
ILONA: Because my mum asked me if I wanted to. She thought I should, and I wanted to because I like some clothes that I can't fit into.
INTERVIEWER: Why do you think your mum thought that you should diet?
ILONA: I don't know, really.
INTERVIEWER: Do you feel you're overweight?
ILONA: Sort of, yes.
INTERVIEWER: Who would you like to be like?
ILONA: Because she's got a good personality
INTERVIEWER: But that's nothing to do with weight.
ILONA: No, but- and she's so skinny.
INTERVIEWER: What do you feel about people who are really large, people who put on a lot of weight?
ILONA: I just think that they're lazy.
NARRATOR: Dana would like to be happy the way she is.
DANA: Well, I am, because that's the way I am made. And I'd like to lose a little bit of weight, but not too much so I'm like Natalie.
INTERVIEWER: Do you worry a lot about food?
DANA: Well, no, not particularly. I mean, I do eat lots of vegetables and meat and- I've stopped eating potatoes a lot now.
INTERVIEWER: Do you think it's much more attractive to be thin?
DANA: No, not really.
INTERVIEWER: [to Natalie] But you do? What makes you so sure?
NATALIE: I don't know, really. I just like being thin. I just like looks and stuff like that.
INTERVIEWER: You think looks are important?
DANA: I don't. I think it is the personality, really, that counts.
ANITA RODDICK, Founder, The Body Shop: I lay the blame on our educational system, that never celebrates young girls. I lay the blame on the fashion industry, where to be attractive, you have to have no breasts, you have to have no hips. You know, and you've got to be so bloody glum. I mean, talk about "sick cow disease," it's like "sad cow disease."
NARRATOR: The London Fashion Show. The cult of thinness has been pushed to such ludicrous extremes that some are literally prepared to die for it. More children than ever are now suffering from eating disorders, and it's affecting them at an earlier and earlier age. [www.pbs.org: More on girls and body image]
In this north London clinic, the youngest patient is 6 years old, and there are many who are under 10, boys as well as girls, all of them tormented by an irrational horror of fat.
INTERVIEWER: When you look into a mirror, what kind of person do you see?
ELLIE: A fat person, a person who I just don't like because it just kind of repulses me.
Dr. DEE DAWSON, Dir. Rhodes Farm Clinic: These children almost all have major problems in their lives. They have problems which make them have a low self-esteem.
NARRATOR: Dr. Dee Dawson runs this clinic.
Dr. DEE DAWSON: And they're looking for ways to boost that. And we hear all the time that to be a size 8 or 10 is perfection, and they feel that if they could be perfect, they would have more friends, they would be more confident, that everything would be better for them. And so they start off on a course to become very thin.
NARRATOR: Mealtime in this place is a painful, silent ritual. No one may leave until their plate is empty. This is the reverse side of the obesity crisis, but its origins are often the same, a relationship with food that has been so distorted by the power of influence and persuasion that life itself is under threat.
Dr. DEE DAWSON: The major risk is their fertility, that they won't ever be able to have children. Along with that goes osteoporosis, where their bones are so thin, that they've lost so much calcium from them that they break very, very easily. They risk damage to their heart, to their circulatory system, to their kidneys. They really can end up very damaged people.
INTERVIEWER: How do you disabuse them of this idea that you have to be stick-thin to be beautiful?
Dr. DEE DAWSON: Oh, I find it very difficult, especially every time I open Vogue magazine, I see stick-thin models being paid $10,000 a day to walk along the catwalk, and to look just like that, because they are obviously role models for our children
ALEXANDRA SHULMAN, Editor, "British Vogue": Well, not many people have actually said to me that they've looked at my magazine and decided to become anorexic or decided to diet so much that they became anorexic.
NARRATOR: Alexandra Shulman, the editor of British Vogue, has another explanation for our obsession with thinness.
ALEXANDRA SHULMAN: In a world where more and more women - or more and more people, forget women - are finding it unpleasantly easy to be overweight because you can just buy so much junk food, so much more easily and so much more cheaply than you can buy healthy food, it becomes more desirable to be thinner rather than fatter. I mean, it's just a very straightforward sociological fact.
VIDAL SASSOON: If the world is getting fatter, it's because they're eating too much. It's as simple as that.
NARRATOR: Vidal Sassoon sponsors the London Fashion Show and has influenced the way men and women look since the '60s.
VIDAL SASSOON: Will has got a lot to do with it, the will. And if you have the will to be in shape as an individual, there is so much more you can do as an individual.
INTERVIEWER: Do you feel any responsibility towards the teenage girl who starves herself in order to look like the fashion model she sees on the catwalk at events like today?
VIDAL SASSOON: Well, personally, I feel no responsibility at all. I sense that if a young lady feels that she has to be bulimic and anorexic to look like the girl on stage, then we're advertising the wrong model of health.
I have watched many models this week, very few that I would consider never mind anorexic, even skinny. I would consider them extremely healthy, with vital lives and a lot of interest in their lives, which helps. They are pretty healthy girls, and to my sense of proportion, and the way I look at the aesthetics of it all, rather lovely. At 70, I'm appreciating them even more.
ANITA RODDICK: Dream on, Mr. Sassoon! You go behind at the catwalk, you know the model that you see, the models- alcohol, smoking, diet pills. That's the reality.
CATHERINE STEINER-ADAIRE, Harvard Eating Disorders Center: If we have a culture that's being fed a starvation mentality-
NARRATOR: Dr. Steiner-Adaire treats eating disorders. In her view, anorexia and obesity are two sides of the same coin.
CATHERINE STEINER-ADAIRE: We know enough about the dynamics of starvation and restriction to know that if you don't trust your own body's desire to eat a full range of food, and if you begin to restrict or think obsessively about food, you are very likely to binge.
NARRATOR: After her experiences, Lynn McAffee is convinced this is true.
LYNN McAFFEE: I doubt I would have been the size I am now if I hadn't dieted and taken pills. I would probably always have been a very fat woman, possibly a super-size woman. I would not have been a 500-pound woman and if I had not had my relationship to food so disturbed, that if my body, I think, had not been so traumatized by the repeated pill taking.
NARRATOR: Are there any options open for someone who is super-size? The Baptist Memorial Hospital, Memphis, Tennessee. When all else fails, people come here, not for reasons of vanity, but because their weight is literally killing them. In the United States, the number of people in this condition, so-called "morbid obesity," has increased by 370 percent since 1970.
Dr. GEORGE COWAN, Baptist Memorial Hospital, Memphis: I have a war on obesity. It killed my father. It killed his mother. And it's killing over 300,000 Americans every year of obesity and related diseases.
NARRATOR: Dr. Cowan runs the Memphis Wellness Center.
Dr. GEORGE COWAN: You see, our society does not accept very well the obese individual. They're being treated today as the modern moral equivalent of lepers. And I'm a leper doctor.
NARRATOR: Patients come to the Wellness Center seeking the ultimate solution in their fight against fat. Dr Cowan has developed a radical surgical procedure that is a significant advance on the stomach-stapling operations pioneered in the '80s.
His technique is to divide the stomach and the intestine. All food has to pass through this tiny, half-ounce pouch, signaling to the brain that the stomach is full after only a few mouthfuls.
Dr. GEORGE COWAN: Thin people have one thing that big people don't have, particularly my morbidly obese patients. They can feel full. They can feel satisfied when they've had a certain amount of calories. It's God-given. It's in their genes. They are so fortunate. If I could learn how to turn the switch off, it would be one of the most beautiful God-given gifts to mankind, to be able to say, "Turn the switch. You're satisfied." That's what we try and do with our surgery.
NARRATOR: "Turning off the switch" with stomach surgery is as complex and risky as a heart by-pass operation, and Dr. Cowan has set down firm markers. He must be sure that patients' lives are threatened by their weight, that they are physically and psychologically strong enough to survive the operation, and that there really are no alternatives.
Dr. GEORGE COWAN: [to patient] Now, watch my finger.
NARRATOR: Surgery is a last resort for those who've tried every other means.
1st PATIENT: I've been overweight as long as I can remember. If there's a weight program out there, I've done it. A liquid diet is the one I've had the most weight loss with, and that was about 60 pounds. But the weight never stays off. It always comes right back. You gain it back, usually plus a few more pounds.
2nd PATIENT: I've tried Weight Watchers. I've tried SlimFast, Dexatrim, phenfen. I've tried magazine diets, soup diets, body wraps, and I have even had my mouth wired.
3rd PATIENT: I've got some back problems, pretty major back problems. And they haven't been able to treat the back problems because of the weight. And it's made me inactive, and the inactivity has made the weight go up, and it's kind of a vicious cycle.
4th PATIENT: I just got bigger and bigger, and couldn't hardly get around. I couldn't walk, and it made difficulty. So I met Brother Cowan, Dr. Cowan, and we talked about operations, you know? And so after he done his surgery, why, I have improved a whole lot.
Dr. GEORGE COWAN: I would love to see medications considerably more effective, and I'd gladly hang up my scalpel and just go away quite quietly. But they aren't there at present, and I just doubt that it's going to be that simple.
NARRATOR: Stomach surgery is a radical and still controversial procedure. In less experienced hands it can go badly wrong, but when successful, the results are dramatic.
BECKY SMITH: I was 64-and-a-half inches in the waist, and I looked pitiful.
NARRATOR: Before her operation, Becky Smith weighed 340 pounds. She now weighs 130 and works as a beautician.
BECKY SMITH: And just to show you, one of my favorite little blouses here, and this is a size 30.
NARRATOR: Suzi Johnson lost more than half her body weight.
SUZI JOHNSON: I wore size 28 pants, and these were my pants, and I looked like a blimp.
BECKY SMITH: Although I seemed real happy on the outside, I would go home, and I would just die on the inside because I was just so miserable and so unhappy, and it was just a horrible life.
SUZI JOHNSON: I weighed 273 pounds, and I brought a picture for you to see. I'm not sure which is bigger, the fish or me. But my grandchildren will look back at these pictures, and they won't know this person is their grandmother.
The tough part was just getting used to the weakness, the pain. I mean, there was a lot of pain afterwards. I would never tell anybody that it was a pain-free operation. It's very, very hard.
BECKY SMITH: Most of the time, you'll accumulate a hernia in your stomach after the surgery. And not only that, you have an irritated area where the skin's hanging over, and it's raw and it's red. And they go in and take the hernia out and take all the loose skin off. And normally, they come in and around the waist line and pull that in. And you know, that makes you have a flat tummy and eliminates the blisters and sores and things like that.
Prof. KELLY BROWNELL, Dir. Yale Center for Eating and Weight Disorders: It's a sad statement that somebody has to deform their body, somebody has to take an otherwise healthy organ like their stomach and have surgery done to it in order to remedy this problem. If we didn't have such a bad food environment, we wouldn't have so many cases of people that fall into this category, and people wouldn't have to subject themselves to the surgeon's knife in order to correct their problem.
NARRATOR: In the wild, there is no obesity crisis, and especially in regions where food is plentiful. These animals are in balance. When hungry, they kill to eat. When their bodies are fully nourished, they withdraw, leaving the unwanted remains to the scavengers. They seldom over-eat or approach the point where body fat is a danger to health.
Only in regions where food is scarce, and supplies can be cut off for long periods of time, have animals developed the ability to lay down large stores of body fat. Under these conditions, fat is a guarantee of survival, never a threat to health.
It should come as no surprise that our species, which has settled in virtually every habitat and climatic condition on Earth, should have developed such a variety of body shapes. The mystery, though, is why some of us should have lost that innate ability to know when we are full and are piling on excess fat.
ANDREW PRENTICE, Obesity Specialist: One of the things we've already discovered is that a high-fat, high-energy-dense diet, which is very prevalent these days, has a very powerful effect on misleading our metabolic control processes. And we're trying to find out what it is that goes wrong, why some people simply go haywire when put into conditions of a high-fat diet and low physical activity.
RESEARCHER: [to study participant] Morning, Chris. You can get up now, and just keep standing for the next half an hour.
NARRATOR: Through carefully controlled experiments, scientists are beginning to find the answers.
RESEARCHER: Okay, Chris, it's now time for cycling. Can you keep cycling for the next 40 minutes?
NARRATOR: This chamber allows precise measurement of energy output versus input, giving researchers accurate insights into the way exercise and diet affect body weight. By secretly boosting the calorie and fat content of ordinary meals to junk-food levels, scientists are learning how the modern diet fools the body's control systems, and that some people are much more susceptible to this than others.
Using human Guinea pigs who have been put through drastic diets, scientists are also learning how the mind and body fight to maintain fat when faced with the specter of starvation, and why this makes dieting so difficult. The good news is that the body does eventually stabilize at its new reduced weight.
Scientists are also tackling the problem of obesity at its most basic genetic level, and have already transformed fat rats into lean rats by gene manipulation.
Dr. RUDOLPH LEIBEL, Geneticist, Columbia University: From mice and rats, we have learned that there are single genes that can cause very profound obesity, and we have found in every instance that there is a corresponding gene in humans.
So if we went out on the street right now and I showed you a group of adults with heights ranging from 4-and-a-half feet to 6-and-a-half feet or 7 feet, you would make no comment about this. It's expected. We all expect to see wide variations in height. We accept that this is due to very strong genetic influences.
My perception of this is that there are equally potent genetic influences on body weight as there are on height, but the population, because of our lack of understanding of all the mechanisms, simply has not come to accept this yet.
NARRATOR: Unfortunately, most doctors have been just as reluctant to recognize these genetic influences, and still use a crude formula to calculate the "ideal" weight range for a particular height. Those who are outside that range are warned that they are endangering their health.
DOCTOR: You're at a much increased risk of developing problems related to being overweight, diabetes or high blood pressure or high-
NARRATOR: The charts that doctors use allow for differences between the sexes, but make no other distinctions, whether on the basis of age, heredity or body shape- no suggestion, in fact, that the point where weight becomes unhealthy might vary from one person to the next.
Today more and more people are beginning to see medical charts as unscientific, impersonal, even dangerous. David Alexander is in peak condition. He is 5 foot 8 and weighs 250 pounds, 100 pounds more than the recommended "ideal" for someone his height, and yet he is training for one of the most grueling competitive sports, the triathlon.
In a typical week, Dave will swim 5 miles, run 30 and cycle 200. He has completed 264 triathlons, everywhere from tropical Jamaica to northern China. Yet in spite of this record, David's weight supposedly puts him in a life-threatening category known to doctors as "morbid obesity." Their recommended ideal for someone Dave's height is a weight range between 130 and 165 pounds.
DAVE ALEXANDER: That would be impossible for my body type, the size of my bone structure. My total lean body mass weighs more than that.
INTERVIEWER: Where have the medical doctors perhaps got it wrong?
DAVE ALEXANDER: Everyone's different, and I think the range is much broader than they will admit. I've had problems with insurance companies wanting to rate me in high risk, and yet I can get up and run a marathon right now, and I'm sure the man giving me the physical can't do that.
Dr. CRAIG PHELPS, Dir. Phoenix Sports Center: Dave is overweight, but he's fit. It seems that there's a population out there demanding to be heard. "I'm overweight, but I'm exercising, and I'm fit."
NARRATOR: Craig Phelps has been Dave Alexander's doctor for 12 years.
Dr. CRAIG PHELPS: Dave's resting pulse is in the 60s, like a trained athlete. His blood pressure is usually in the 120s over 80s, which, once again, for most people is a very normal blood pressure. We've exercised him to the point of exhaustion on the treadmill many times to check and make sure there's no risk of any obvious cardiovascular disease, and that has turned out normal. So we have to kind of say that Dave is fit.
NARRATOR: The case of David Alexander may not be as unique as it seems. Professor Steven Blair is also clinically obese. He runs 35 miles a week and is in perfect health at the age of 59. As a scientist, he understands his place in the evolutionary scheme.
STEVEN BLAIR, Cooper Institute of Aerobic Research, Dallas: I think I'm probably very well suited to a life as a serf on the Russian steppes. I am strong. I can work hard. I conserve body mass. I could probably make it through the famine. I'm not quite so well suited to be a scientist leading an essentially sedentary life onto which I graft this kind of artificial dose of exercise every day.
NARRATOR: Since 1970, 25,000 people of all shapes and sizes have passed through Professor Blair's Dallas laboratory. Their fitness levels were measured and their subsequent medical histories closely followed for the next eight years. The results fly in the face of medical orthodoxy.
STEVEN BLAIR: Surprisingly, we found that the men who were fat, but who were also fit, actually had no increased mortality rate. In fact, the fat fit men had far lower death rates than the normal-weight men who were unfit.
So the bottom line in this research, at least in this set of observations, is that lack of fitness seems to be much more important than fatness as a predicator of which men were going to die during this eight-year follow-up.
INTERVIEWER: So maybe the medical profession has been a little bit too rigid in telling us what is the ideal range of weight for a certain height?
STEVEN BLAIR: I don't like the term "ideal weight." I don't think we know what any person's ideal weight is. Human beings come in different sizes and shapes. On any characteristic you care to name, there's tremendous variation, from eye color to hair color, for those who have hair and those who don't have hair, and we vary. Some of us are short and stocky. Some are tall and skinny. So to claim that some formula can produce a so-called "ideal weight" that we can then apply to an individual I think is faulty logic.
INTERVIEWER: That's a revolutionary idea that it's perfectly possible to be fat and fit.
STEVEN BLAIR: I think it's a good-news public health message.
NARRATOR: And it cannot be overemphasized. In her teens, Jackqueline Hope was caught in a cycle of dieting and bingeing which pushed her weight up to 340 pounds. But somehow she found the strength to ignore doctors and fashion and appreciate her own fat body. Paradoxically, once she learnt to love herself, the weight fell off. At 180 pounds still technically obese, Jackie is confident she has settled at the weight that is right and healthy for her.
JACKQUELINE HOPE, Founder, Big, Bold & Beautiful: I like being a big woman. I love having large breasts. I love having big hips. I like having a little belly. To me I look Rubenesque. I look in the mirror, and I'm naked and I'm vulnerable, and I like what I see. And who the hell is out there to tell me that anything is wrong with it?
NARRATOR: For Jackqueline, self-confidence is big business. From Toronto she produces her own fashion line, runs her own model agency and the largest plus-size boutique in the world, all under one flamboyant banner.
JACKQUELINE HOPE: It's a place where you can give a hug without someone standing back and thinking, "What are you doing? What do you want from me?"
I know what I was feeling as a large-size woman for many, many years. I felt that no one wanted to touch me. I felt that they thought what I had was contagious.
It's a place where you can tell them to show their bust or show their cleavage, and they won't take offense to it because they feel the way you do. They want to show their womanhood. They want to be able to come out from hiding.
NARRATOR: How exuberant. How confident. And what a contrast to the gaunt, bony, humorless world of contemporary high fashion. It's at times like this that one appreciates why the well-rounded female form has been celebrated, adored for most of human history. Generous, life-sustaining, sensual, but a vision of beauty that has now been entirely rejected.
ANITA RODDICK, Founder, The Body Store: Why? Why is the skeletal body more attractive or more wanted than a voluptuous body? What is it about this magnitude of flesh that is so gross? Do men really love to go to bed with a skeleton with no breasts and no hips, sort of like banging into a bloody coat hanger? I don't get it.
NARRATOR: Anita Roddick has launched a campaign which she hopes will restore that lost sense of beauty and give something back to the vast majority who cannot look like coat-hangers. This contribution came from a young photographer who has made what she calls "big" women her specialty, Melanie Coles.
MELANIE COLES: I'm trying to give back some self-esteem, some self-respect to big women, and make images proving that they are beautiful, they are worthy, they do have what it takes. I focus on big women because I am one, and because I feel that we've never had the level of self-respect that I think we deserve. [www.pbs.org: Explore the history of fat beauty]
NARRATOR: For those of us who have never once been branded "fat," Melanie's quest may seem unimportant, even pretentious, less so when one can understand that one of the major reasons why weight can get out of control is despair in the face of constant criticism and exclusion.
MELANIE COLES: We're not all he same height, the same color, and the same sex and the same size. It's just another part of being different. I'm constantly reminded by images around me in the shop that I'm not accepted, I'm not wanted, I don't fit in. And sometimes I don't care. Sometimes that doesn't bother me. You know, I am who I am, and I'm happy with that.
But you know, there are days when you just want to fit in. You just want to kind of disappear into society. When you're walking down the high street, you don't want to feel that you are the biggest person there, or that everybody's looking at you and judging you purely on how you look.
NARRATOR: Fat is an issue that goes far, far beyond the dry science of calorie counting and energy measurement. It touches relationships, even politics, the way we function as people and treat each other.
In this family, food is still a source of pleasure, eating a social occasion which every week includes the whole extended family. Where people still have this attitude to food and to each other, there is no obesity crisis, no diet industry, no cult of thinness. But what is the message for us?
Prof. KELLY BROWNELL, Dir. Yale Center for Eating and Weight Disorders: Whether we offer a message of hope or despair depends on a person's goal. If a person's goal is to have the ideal, perfect weight, despair is the only outcome because very few people can attain that. If people's goal is, "Can I lead a healthier life? Can I feel better about myself, have more energy, be healthier, live longer," the answer is unquestionably yes.
And I think the healthiest, most psychologically adaptive way to approach this is to do the right things in order to control weight. That is, eat a good, sensible diet. Follow the nutritional guidelines. Don't be crazy about it. Don't overdo it. Don't restrict yourself too severely. But eat a reasonable diet, follow a reasonable exercise program. That doesn't mean you have to become a marathon runner, but just follow a reasonable exercise program, and just see what happens to your weight.
And for most overweight people, those changes alone can lead to dramatic changes in weight. And if people approach this from a healthy point of view - that is, they want to be healthier, they want to feel better about themselves and get their mind away from the number on the scale - then they can achieve significant benefit and feel a lot better about themselves, improve their self-esteem and improve their health.
ANNOUNCER: For more on the obesity epidemic, visit FRONTLINE online for a rundown of useful information on fat and fitness, the genetic and environmental factors, a guide to reliable Internet resources on weight and health issues and more at www.pbs.org.
Next time on FRONTLINE: Once upon a time, seven friends shared a dream that would take them places. Ten years later, four have been imprisoned, one is dead by his own hand, and two are in the White House. What really happened Once Upon a Time in Arkansas?
To order a VHS copy of tonight's program, call PBS Home Video at 1-800-PLAY-PBS. [$19.98 plus s&h]
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