“America doesn’t have a weight problem,” says Darryl Roberts, filmmaker and director of America the Beautiful 2, which debuted last week at select college campuses.
“We have a health problem,” he clarifies.
Even with the number of obese Americans rising — over 72 million adults and 12.5 million children and adolescents — Roberts explains that talking about obesity is missing the mark.
“Focusing on weight loss is just never going to work,” Roberts says. “You’re never going to wake up and 90 percent of America is skinny. Focus on what’s possible.”
To support his point that healthy lifestyle trumps weight loss, audiences watch an obese Roberts during a doctor’s visit where he’s told that he has high blood pressure and a heart condition called atrial fibrillation. The doctor informs him that he has to start taking medications to treat both.
“When I asked her, ‘Can I just exercise and eat better?’ She said, ‘absolutely not,’” Roberts recalls, as the doctor explains that his condition, coupled with his obesity, was too far gone.
Scared by the medication’s side effects, he spends the next 45 days biking and eating more salads and fruit. When he returns to the doctor, his blood pressure has improved to 116/76, his cholesterol is lower, and his heart is beating in a normal rhythm again — all without the medication.
Yet, Roberts is still obese at this second visit, having lost only six pounds.
“I became perfectly healthy without losing [significant] weight,” he says. “The whole concept that being a certain weight equals health is erroneous.”
Roberts faults screening tools like BMI, or body mass index, for adding to the misconception.
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What’s your number?
BMI is a score calculated using a person’s height and weight. This score indicates whether that person is underweight, normal weight, overweight or obese. But, the calculation doesn’t account for varying body types or increased muscle mass.
“BMI allows us to place people into categories and [intervene] the closer they get to the higher BMI,” says Dr. Dwayne C. Proctor, team director for the Robert Wood Johnson Foundation’s Childhood Obesity Team.
“It doesn’t mean they must be at risk,” he adds. “It’s possible that anyone in great shape can have a seemingly high BMI.”
A woman who is 5-foot 6-inches and weighs 160 pounds, for example, would be considered overweight, with a calculated BMI of 25.8. If that same woman gains 30 more pounds, she is then considered obese with a BMI over 30.
“When the lay public just looks at that single number and nothing else, that number can be misleading,” says Constance Brown-Riggs, Registered Dietitian and National Spokesperson for the Academy of Nutrition and Dietetics. ”
Instead, Brown-Riggs teaches her patients to use BMI along with other measurements such as waist circumference, cholesterol levels, blood sugar, and body fat.
“BMI is part of the assessment,” she adds. “It’s not the end all, be all.”
Some argue that the actual measurement is arbitrary. In the 1990s, the BMI cutoff for the overweight category was lowered from 27 down to 25, increasing the number of overweight Americans from one-third of the population to half. As Roberts points out in his film — as a result, millions of Americans became overweight and obese, literally, overnight.
In America the Beautiful 2, Roberts examines whether measuring weight or BMI discourages more than it helps. He uses his own 45-day lifestyle changes as an example.
“Some people might ride the bike for a short period of time [like I did], look at the scale and see they only lost six pounds, then they quit,” he says. “The goal should not be to lose weight, it should be to become healthier.”
It’s not that easy
Losing weight or becoming healthy is not always as simple as making the decision to do so, says Proctor.
“If you can’t be active in your every day life because vehicular traffic prevents you from taking walks, if playgrounds aren’t safe, if there’s crime in your area, or if the only place you have to shop is a bodega,” he explains, “those are the barriers that keep people from being healthy.”
In fact, the Robert Wood Johnson Foundation Commission to Build a Healthier America published a map showing the difference in life expectancy based on which Washington, D.C. Metro stop a passenger commutes from. There is as much as a nine-year difference between certain stops.
“Environment really does shape outcomes,” says Proctor.
He cites Charlotte as another example. A year after Charlotte built its light rail system, a survey of light rail commuters found them, on average, six pounds lighter than those who drove.
But, both Proctor and Roberts agree that, regardless of environment, it’s about personal choice as well.
“I went back to my old neighborhood on the South side of Chicago. I went to the neighborhood grocery store and just sat there for an hour looking at everyone leaving,” Roberts says. “Nobody left with any fruits or vegetables. But, there were some on the shelf.”“We need incentives so people can purchase healthy foods,” says Proctor. “This calls for some education and some marketing.”
Incentives may, in fact, be on the way.
Mississippi lawmakers are now considering a bill that prevents families who receive state assistance from buying candy, sugary drinks or other unhealthy foods with their EBT cards.
Another potential solution lies in educating at-risk communities, but it’s unclear who’s responsible for that task.
Most doctors have received only a few hours of nutrition classes out of all four years of medical school.
“The average doctor doesn’t know any more about what we should be eating than we do,” says Roberts.
Brown-Riggs urges doctors to refer patients to a dietitian. A dietitian will typically have more time than a primary doctor to conduct thorough nutritional assessments and counsel patients on a weekly basis. Medicare has begun reimbursing clinicians for diabetes and weight management counseling, making it affordable for lower-income patients.
“Weight loss is harder without guidance,” Roberts says, in support of dietitians. “And, diets just don’t work.”
Over 90 percent of all diets fail within five years, he adds.
In fact, dietitians used to prescribe diets, and now they too are moving toward pushing healthy lifestyle overhauls.
“It’s not about getting thin for the moment just because we think this is important,” Proctor says. “Adjust lifestyles to the point where you’re living as healthy as you can, as much as you can.”
Making it work
“The all or nothing phenomenon is what gets people frustrated and turns them off completely,” Brown-Riggs says. “What I find works best are small gradual changes, meeting the individual where they are.”
She tells the story of one patient who ate chicken wings on a very frequent basis. Instead of banning fried chicken from the woman’s diet completely, she showed her how to incorporate it into a more balanced diet.
“Not everyone is ready to revamp their whole kitchen and change everything immediately,” says Brown-Riggs. “That’s how we fail.”
Much like Roberts, she focuses on the small gains — like getting an overweight patient to tie their shoes without coming up gasping for air — rather than the number on the scale.
“For someone who is 300 pounds, losing just 10 percent of their weight will make a major difference in their overall outcome,” she says. “But, when the doctor tells them they have to get down to 120, they think ‘Why bother doing anything at all?’”
Failing our children?
In addition to pediatricians, schools nationwide have begun measuring children and reporting BMI scores to parents.
Roberts highlights flaws in this approach in the film. One example involves a mother who struggles without guidance to come up with a plan to help her overweight daughter shed pounds after receiving a high BMI score. Another shows a clearly thin, lanky adolescent who tells Roberts on camera that according to his BMI he, too, is overweight.
“When schools started to report BMI, they learned so many lessons about what’s the right way to do it and the wrong way to do it,” says Proctor.
Browns-Riggs, however, is still concerned.
“What we’re going to see is more children with eating disorders as a result of this,” she says. “We have to be careful how we handle the whole thing.”
She adds that the conversation should “absolutely” happen with the parents, but not directly with the individual child.
Proctor praises a school system in Arkansas where, in addition to BMI scores, administrators sent home a list of four things parents should do: see a pediatrician to discuss the score, limit sugary beverages, remove televisions from bedrooms, and participate in one physical activity daily with the child.
In an effort to also tackle this crisis, for the first time in over 15 years, the USDA released new school lunch guidelines. The guidelines call for more fruits and vegetables and less fat. Regular milk will no longer be available — only fat-free or low-fat versions. And, schools must pay attention to portion sizes.
Proctor says these efforts are necessary.
“If these children are the first generation of children to live sicker and die younger than the previous generation, who’s going to be our workforce? Who’s going to defend the country?”
According to Roberts, this problem is indicative of a larger issue. He finds that this society places more value on celebrities and merchandise, like buying Jordan’s sneakers, than using that money for doctor’s visits.
“We, our society at large, capitalism, adults, have failed our youth — that’s why there’s an ‘obesity crisis,’” he explains. “These children were not properly educated by their parents, or their schools. They don’t know how to eat. They don’t exercise. We as adults have failed them.”
Roberts will continue to spread his message through America the Beautiful 2 on 150 college campuses over the next two months.