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    by melissa hendricks
    illustrations by joe cepeda

If there is one thing Kathryne Haywood has learned in her 45 years, it’s how to lose weight. “I think I’ve been dieting since I was 15,” says Haywood. She has tried Weight Watchers, the Atkins diet, the Zone diet, an all-liquid diet, a fruit diet. Many worked, but the red line on her bathroom scale always crept back up again.

Now, Haywood is trying again. She recently enrolled at the Johns Hopkins Weight Management Center, aiming to shed at least 100 pounds from her current 283. But the odds are against her, as even Lawrence Cheskin, the Center’s director, acknowledges. Only about one-third of the patients who lose weight through the Center manage to keep off at least half of it for more than one year—a relatively high success rate in the weight management field.

“The environment we live in and the culture make it easier to gain weight than to burn it up,” says Cheskin, MD, an associate professor with the School’s Center for Human Nutrition. “We’ve become very food-centric.” Americans are surrounded by a virtual orgy of food images, smells, and messages: Commercials urge us to “super size,” snack on cookies, celebrate with pizza, and show our loved ones how much we care by baking them a chocolate cake. At the same time, our lifestyle is moving farther away from the physical activities that would burn up some of those calories. The result: an obesity epidemic that refuses to ebb.

Diets can work. People can lose weight on the Atkins diet or the banana diet or other new-fangled diets, says Benjamin Caballero, the director of the School’s Center for Human Nutrition. Everyone is familiar with the testimonials and photos—a beaming, trim woman standing in the tub-size pants she wore before losing 100 pounds. But tinkering with the diet formula will not solve the obesity epidemic—the extra pounds carried by millions of Americans. Attempting to curb obesity without addressing the larger factors fueling the epidemic is like trying to cure childhood diarrhea when the water is contaminated, says Caballero, MD, PhD.

The solution, then, must include nothing less than changing the environment, say public health leaders. They are seeking solutions that will reduce obesity among populations, not just individuals.

By now, the statistics are familiar. In the past two decades, the percentage of American adults who are obese has doubled. Almost one out of three American adults is now obese, and 64 percent are overweight or obese. Compared to adults of healthy weight, overweight or obese adults face an elevated risk for a host of health problems. According to a recent study, severely obese people are seven times more likely to have diabetes, six times more likely to have high blood pressure, twice as likely to have asthma, and four times as likely to have arthritis. And some of these same diseases are now for the first time appearing in children, as childhood obesity keeps climbing at ever steeper rates. In two decades, obesity doubled among children and tripled among teens.

In recent months, the discourse on obesity has taken a new turn, as critics intimated that some of the blame for Americans’ bulging bellies lies with the very institutions that define nutritional standards.

Most provocative was a story by science journalist Gary Taubes in the July 2002 New York Times Magazine. On its cover, the magazine featured a photo of a big, fatty steak garnished with a large pat of butter. Taubes argued that the promotion of a low-fat diet, by the National Institutes of Health, the Surgeon General, and other authorities, and the marketing of reduced-fat foods drove Americans to consume more starches and sugar—resulting in increased obesity. “The percentage of fat in the American diet has been decreasing for two decades,” yet obesity has risen, Taubes reported in the story, which ran under the headline “What if it’s all been a big fat lie?”

Taubes proposed that people try the Atkins diet, a high-fat, high-protein, low-carbohydrate regime that has been denounced by the American Medical Association.

As for alternative explanations for the obesity epidemic, Taubes largely dismissed those. He mocked the notion that a “toxic food environment” (of high-fat foods and gigantic portions and ubiquitous food advertisements) could be driving the epidemic. Might declining physical activity play a part? No. Americans, he pronounced, are caught up in “a culture of physical exercise [that] began in the United States in the 1970s—the ‘leisure exercise mania.’ ”

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