Wednesday, April 22, 2009

The Extra-Wide Chair

Yesterday, when I walked into my primary care doctor's waiting room with my children, my younger daughter asked me to share a seat with her. She plopped down on an extra-wide chair in the office, the sole standout in a sea of regular-width chairs there. She thought it was a small couch meant for two, when in reality is it there to accommodate obese patients. I see more and more of these chairs in doctors' offices, evidence of the high obesity rate in America.

At first glance, the extra-wide chairs would seem out of place here, because I live in a very health-conscious city. Many people here ride public transportation, a choice that guarantees some exercise as you walk to and from your bus stop. The Central Valley and local farmers' markets provide a steady stream of fresh produce, and outdoor activities ranging from mountain hikes to tidepooling are just a short drive away.

But it's not always easy to make healthy choices. The public schools promote a Walk to School Week every fall, for example, but this is a somewhat pointless program here. The public schools in San Francisco have been decoupled from their neighborhoods in response to a series of lawsuits about the uneven quality of the education they provide. As a result, many children from kindergarten on up have to commute to school by car (driven by a parent) or school bus across town every day. Even if they want to walk to school, it isn't a possibility for them. With funding cuts reducing gym to an occasional rather than a daily class at many schools as well, schoolchildren are getting less and less exercise.

When my own children were born several years ago, I began to notice what I called the "thin grandmother" syndrome. At follow-up doctor's visits after their children were born, many new mothers brought their own mothers along to help watch the baby. Most of the grandmothers were thin, but, increasingly, many of the mothers were not. No doubt they still carried some weight from their pregnancies, but I suspect lifestyle was also a factor - lots of driving, unhealthy eating habits, stress, and very little exercise. All of this happened in just one generation. The CDC's survey of obesity trends from 1985 to 2007, based on data collected from state health departments, shows a sharp increase in obesity rates during that time. In 1990, obesity rates topped out at 15% in a the states participating in the survey. By 2007, obesity rates had increased to 30% or higher in three Southern states, and over 25% in thirty states altogether. The CDC's data shows obesity rates creeping upward and westward state by state since the mid-1990s.

I understand how we got here as a society - the lure of convenience foods, the busy work schedules that allow little free time for exercise, the stress of getting everyone where they need to go each day, the time it takes to cook a healthy dinner at home or pack a healthy lunch. When I see the extra-wide chairs in the waiting rooms, though, I start to question to idea of a national health care plan, because access to health care won't solve the problem of obesity. Increasing obesity rates and the many expensive health problems linked to obesity, in fact, could bankrupt such a plan.

It's important to provide coverage for the uninsured, with states such as North Carolina recently making news headlines because a record 25% of the state's residents don't have medical insurance. But health care needs to be just one of the tools used to fight obesity. The country also needs better public policies relating to public transportation, employment rights, housing and urban planning, public education, and other issues that directly or indirectly affect people's health. Americans also need to take more personal responsibility for their health, mindful that their children are watching and learning from them. Last but not least, their choices have consequences not just for themselves and their families but for the country and its welfare as well.

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