Health, Exercise, and Weight Loss in America

Introduction: The American Health Crisis

The United States has been criticized by doctors, researchers, and government officials as one of the most overweight and unhealthy countries in the world. The American population currently faces numerous problems related to health, weight loss, and childhood obesity. Historian Harvey Levenstein (1988) contends that the most dramatic changes in the American diet occurred between 1880 and 1930. These changes resulted from many sociological factors and technological advances, including the development of the modern cooking range, new methods of food preservation, and the birth of the modern processed food industry. Levenstein (1988) also identifies the greatly expanded food supply that followed the settling of the American West, as well as Prohibition, as contributing factors.

This paper examines the problems in the way Americans eat, beginning with a brief historical background of food consumption in the United States. It also addresses various sub-topics of health and weight loss, including exercise, diets, diet pills, nutrition and food, surgical options, and associated health issues.

Brief Overview of the American Diet

Americans living in the thirty-four years between 1880 and World War I experienced radical changes in the food industry. The Midwest began producing large quantities of wheat and dairy products that were shipped by railroad to the East.

The greater volume of food production created a need for new technology to enhance preservation. Giant food corporations emerged and manufactured processed foods that were accepted across all social classes. Around 1900, a major sugar corporation mounted a successful campaign to denigrate brown sugar. Consumers were already convinced that white products were superior to brown ones. Even the poorest farmers gave up molasses and homemade sorghum, while workers abandoned brown sugar. In the thirty-five years between 1880 and 1915, the per capita consumption of white refined sugar doubled. Historically, these events marked the beginning of a sugar-consuming, increasingly unhealthy population.

By 1930, Prohibition had been in effect for ten years. It caused many fine restaurants — whose liquor sales had provided the majority of their revenue — to close. The French chefs employed by upper-class establishments and elegant restaurants were left unemployed or returning home. In their absence, small diners catering to the lunch-hour market quickly appeared. These luncheonettes and self-service cafeterias served canned foods, soft drinks, salads, cold dishes, and sandwiches on toast. Levenstein (1988) documents the sweeping changes that took place in American restaurants following Prohibition: the menu with unpronounceable French names gave way to the Americanized menu, and trained chefs were replaced by unskilled laborers who could easily open a can and heat its contents. This was, in effect, the beginning of the fast food industry.

The American Diet Shift

Changes in the diet were also driven by economic differences between classes. Because of the costly refining process, white flour and white sugar were more expensive, while molasses and brown sugar remained more common in middle- and lower-income households. The upper classes consumed more red meat and other costly items, whereas the poorer classes ate a more limited variety.

The shift in the American diet can be attributed to the changes that took place across successive decades. In 1880, people were eating authentic food prepared from scratch. By 1930, people were eating more processed food, including canned and fresh vegetables that had previously been unavailable or cost-prohibitive. To be "pleasingly plump" was in style, and it was not until decades later that super-slim models took over the runway and being thinner became the cultural ideal.

Dieting: Low-Carbohydrate Plans and Their Risks

By the 2000s, the goal of being thin had become a widespread preoccupation in the United States, with slim celebrities and role models featured prominently across television, film, and magazines. Childhood obesity was identified as a significant problem for the first time during this period, with fast food giants such as McDonald's blamed as a major cause of this epidemic. Miracle diets, diet pills, and surgical weight-loss options appeared rapidly and became a fad. People followed the example of celebrities and turned to quick remedies such as stomach stapling and liposuction. The United States became a country where, paradoxically, widespread obesity coexisted with a population constantly on a diet and trying to lose weight as quickly as possible.

Recent media reports have publicized the short-term weight loss that sometimes occurs through the use of low-carbohydrate weight-loss diets (Physicians Committee for Responsible Medicine, 2006). The theory behind low-carbohydrate diets is that if dieters avoid foods containing carbohydrates — starches and sugars — they will lose weight. One prominent example is the Atkins diet, which drastically restricts the intake of fruit, fruit juice, starchy vegetables, beans, bread, rice, cereals, pasta, and other grain products, leaving a diet dominated by fat and protein: meat, cheese, and non-starchy vegetables. As the diet progresses, the carbohydrate restriction relaxes somewhat, but fatty, high-protein foods continue to dominate.

A typical day on the Atkins diet might begin with four slices of bacon, coffee, and two scrambled eggs. Lunch might consist of a bacon cheeseburger without the bun, two slices of bacon, one ounce of American cheese, a small tossed salad without dressing, and seltzer water. Dinner might include three ounces of shrimp cocktail with mustard and mayonnaise, a cup of soup, a six-ounce T-bone steak, a tossed salad, a cup of Jell-O with whipped cream, and a beverage of choice. The maintenance phase allows slightly more flexibility but continues to emphasize fatty, high-protein foods.

The Atkins diet has received sustained criticism. A review of 107 research studies on various low-carbohydrate, high-protein diets concluded that weight loss is not due to any special effect of restricting carbohydrates; rather, it depends on the extent to which total caloric intake is reduced and how long the dieter maintains the regimen (Physicians Committee for Responsible Medicine, 2006). Other reports have similarly found that calorie reduction is the most important factor in weight loss, with no special advantage from carbohydrate restriction alone.

A review of the safety of low-carbohydrate diets found that Atkins-type diets carry a greater risk of being nutritionally inadequate and raised concerns about potential long-term health effects (Physicians Committee for Responsible Medicine, 2006). Long-term population studies and short-term clinical studies of individuals on low-carbohydrate diets raise concerns about colon cancer — one of the most common cancers in North America and Europe and among the leading causes of cancer-related mortality — as well as heart disease, since weight loss tends to reduce cholesterol levels while the saturated fat and cholesterol abundant in such diets tend to raise them. Studies have not been of sufficient duration to evaluate the potential effects of these diets on kidney function (Physicians Committee for Responsible Medicine, 2006).

Conclusion

Prior research studies consistently indicate a direct relationship between severe health risks and unsafe weight-loss regimens, such as diet pills and unnecessary surgery. Surgery appears to be a viable option only for the morbidly obese, and the best general approach remains a combination of regular diet and exercise. The theoretical implications of these findings suggest that overweight and unhealthy individuals face a significantly elevated risk of chronic hypertension as well as other serious health problems such as heart disease and cancer. The practical implications are that the ongoing epidemic of obesity and unhealthy weight-loss practices in the United States must be addressed systematically to protect the nation's health. Future research on safe treatment strategies, evidence-based dieting, and effective exercise and weight-loss programs will play a critical role in combating the health risks associated with obesity and unsound weight-loss practices.