Obesity Research

This is such a good topic to follow Girl Scout Cookies!!

I was trained as a demographer. There are three basic areas of demography--mortality, fertility, and migration. These are the only three ways in which the size and characteristics of a population can change. Early on I decided to focus on mortality. Partly because I really liked the professor who taught that course and partly because it was the closest to medicine (which is what I always wished I would have studied.) Also, death was a clear cut event. In fertility research there was a lot of discussion about intentions, attitudes, knowledge...too messy for me.

As it turns out, most people who die are old, so most people who study mortality are studying older people. It is true that there is great interest in infant and child mortality, because a life "saved" at that point has greater demographic, social, and economic consequences. Still, you can't get around the fact that in the US today nearly 90 percent of people born live to be age 65. It also turns out that most people are sick before they die, so in order to understand the changes in mortality you need to understand the changes in morbidity.

When I was in graduate school in the mid to late 1980s one of the big questions of the field centered on the fact that life expectancy was steadily increasing. The questions was, "Are those years of added life years of good health or years of disability?" At the time we had very little information on which to base an answer and there were contradictory pieces of evidence. Slowly the consensus emerged that a greater proportion of the added years were years of good health. Great.

In recent years, however, the question has re-emerged. There is an increased prevalence of obesity in the adult population. We know that obesity is related to a variety of health problems. Will this increase in population obesity translate into greater disability and poor health in later life down the road? That is the new question, and the motivation for my academic research.

I spent Friday at Cornell University attending a small conference on obesity research. It included physicians, nutritionists, economists, and other assorted types (like me.) The keynote address was one of the best lectures I've heard in a long time (and I hear a lot of them.) Michael Rosenbaum from Columbia University talked about why it is so hard to lose weight and keep off the weight. I'm sure you have all heard about "set points," your body's natural equilibrium. Turns out you can put your setpoint higher, but not lower. If you lose weight you need to continue those new behaviors forever or you will regain the weight. That is, if you cut your diet by 200 calories a day you will need to continue to do that for life. If you increased your activity by 20 minutes a day, you will need to continue to do that for life. I found this somewhat discouraging, as did most of the attendees. He was basically arguing that interventions targeted toward losing weight are TOO LATE. You need to stop people from gaining weight to begin with. It also explains why it is so hard to maintain a weight loss. In order to do so you must make fundamental changes in your diet and lifestyle that maintain forever. That is hard for people to do.

Let me just share how difficult that can be. One of the interesting things about obesity conferences is that the food is always VERY healthy. Desserts are fresh fruit, breads are whole grain, the protein is beans, tofu, or salmon. I love this food and have no problem with that....but I have to admit that on the way home I stopped at McDonald's for a quarter pounder (no cheese), fries, and a diet Coke.....all of that good eating down the drain.....and my struggle continues......