A few years ago a thirty-two-year-old man named Morgan Spurlock became Ronald McDonald’s worst nightmare. Intent on correlating the rise of obesity in our nation with the fast-food giant, the independent filmmaker conducted a personal experiment—using himself as the guinea pig. For thirty days he ate nothing but McDonald’s food. He downed three meals a day, sampling every item on the Golden Arches’ menu. And whenever he was asked if he wanted his meal supersized, he accepted.

With cameras rolling the entire time, Spurlock transformed his body into a flab factory while consuming an average of 5,000 calories a day and gaining almost 25 pounds in a single month. He also turned his Academy Award–nominated documentary, Super Size Me, into a statement heard around the world.1

The jury is still out on whether Americans were actually paying attention. Though recent statistics indicate that the obesity rates in the United States may be stabilizing, they’re still at unprecedented, staggering levels.2 Since the 1960s, the proportion of obese Americans—now an astounding 34 percent—has more than doubled.3 Obesity currently kills an estimated four hundred thousand Americans each year and is the second-leading cause of preventable deaths in this country.4 The number one avoidable killer? Cigarette smoking.5 That means maintaining a healthy weight is up there with quitting smoking as the most crucial lifestyle change you could ever make. Because we’re seeing a trend of people deciding to quit smoking, I predict that obesity will soon pass smoking as the number one avoidable killer of Americans.

Unfortunately, many doctors, nutritionists, and dietitians seem to completely miss or ignore this fact. They love to offer topical “Band-Aids” that alleviate patients’ symptoms yet fail to tackle the root issues or consider the long-term ramifications of neglecting their patients’ weight. One recent report from the Centers for Disease Control and Prevention (CDC) found that about a third of obese adults have never been told by a doctor or health-care provider that they were obese.6 Unbelievable! The results speak for themselves. In fact, they’re screaming while most practitioners turn the other way.

As our nation faces the biggest health-care crisis in its history, it’s time for us to realize that the answer isn’t going to come from doctors, clinics, or the U.S. government. It’s going to come from each person taking responsibility for their own health. And because obesity and overweight are at the root of so many health conditions, it only makes sense to start by getting yourself to a healthy weight.

Defining the Problem

Before we delve into what has so many people visiting the plus-size department, let’s clarify the terms overweight and obese. Many people have a general sense as to how these words are different, yet in recent years the delineation has become clearer. Various health organizations, including the CDC and the National Institutes of Health (NIH), now officially define these terms using the body mass index (BMI), which factors in a person’s weight relative to height. Most of these organizations define an overweight adult as having a BMI between 25 and 29.9, while an obese adult is anyone who has a BMI of 30 or higher.7

It’s worth mentioning that a very small portion of individuals are overweight or obese according to their BMI (over 30) yet have a normal or low body fat percentage. Professional athletes, for instance, often have a high-muscle, low body fat makeup that causes them to weigh more than the average person, yet they are not truly obese (some football linemen and sumo wrestlers excluded, of course).

However, I have found that most of the people who come to me seeking help are not just overweight but technically obese, with a body fat percentage greater than 25 percent for males and greater than 33 percent for females.8 Throughout this book when I discuss having a high BMI (over 30), I will be referring to obese people and not those few muscular types with high BMI but a normal or low body fat percentage.

The Fat Cost of Obesity

When all is considered, obesity comes with a fat price tag (pun intended) of nearly $122.9 billion each year.10 Recently William L. Weis, a management professor at Seattle University, calculated the total annual revenue from the “obesity industry”—which includes fast-food restaurants, obesity-related medical treatments, and diet books—as more than $315 billion. That amounts to nearly 3 percent of the United States’ overall economy!11 As shocking as that sounds, no dollar amount can do justice to the real damage being done.

If you are overweight or obese, you increase your risk of developing thirty-five major diseases, including (take a deep breath) heart disease, stroke, arthritis, type 2 diabetes, sleep apnea, gastroesophageal reflux disease, hypertension, high cholesterol, high triglycerides, Alzheimer’s disease, infertility, erectile dysfunction, gallstones, gallbladder disease, adult-onset asthma, and depression. In fact, we now know that being overweight or obese increases your odds of developing more than a dozen forms of cancer. After reviewing more than seven thousand medical studies over the course of five years, a team of highly respected scientists from around the world concluded in 2007 that diet and weight have a direct effect on the chances of developing cancer. With help from the World Cancer Research Fund and the American Institute for Cancer, they listed the top ten recommendations for cancer prevention; body fat came in at number one. Their report also strongly recommended maintaining a normal range of body weight, which they identified as a body mass index between 18.5 and 24.9, to assist in cancer prevention.12

If you are an obese woman, you have a significantly higher risk of postmenopausal breast cancer—one and a half times more than a woman with an average healthy weight, to be exact. You also increase your chances of developing uterine cancer because of your weight. For pregnant mothers, the risk of delivering a baby with a serious birth defect is doubled if you are overweight and quadrupled if you are obese.13 Men, your chances of developing prostate cancer are almost double if you are overweight, and even greater if you are obese.14 (Prostate cancer is the second-most common cancer among men behind skin cancer.) A separate new study indicates that the greater a man’s weight, the greater his chances of dying from a stroke.15 Finally, for both men and women the odds of getting colon and kidney cancer increase with weight. And being obese triples your risk of developing Alzheimer’s disease.

This is just a sampling of the physical implications of obesity. There are social and psychological ones too. Obese individuals generally contend with more rejection and prejudice than the average person. Often they are overlooked for promotions or not even hired because of their physical appearance. Most obese people struggle daily with self-worth and self-image issues. They feel unattractive and unappreciated and are at an increased risk of depression. Many of us have experienced the humiliating experience of an obese person trying to fit in an airplane, stadium, or automobile seat that is too small. Maybe you have been that person. If you have, you are well acquainted with how obesity can affect the way others treat you, as well as how you treat yourself.

Globesity and a Culprit

Tragically, millions of others outside the United States struggle with the same issues. The World Health Organization calls obesity a worldwide epidemic. Obesity, along with its expanding list of health consequences, is now overtaking infection and malnutrition as the main cause of death and disability in many third-world countries. Globesity, as it has been termed, has officially arrived. And it seems Morgan Spurlock was on the right track in discovering a major reason why.

In Fast Food Nation, author Eric Schlosser reports that in 1970, Americans spent about $6 billion on fast food; in 2000, we spent more than $110 billion. Because corporate America is a global trendsetter, other countries have followed suit. Between 1984 and 1993, the number of fast-food restaurants in Great Britain doubled, as did the obesity rate among adults. Fast-forward fifteen years, and you will find the British currently eat more fast food than any other nation in Western Europe.

Meanwhile, the proportion of overweight teens in China has roughly tripled in the past decade. In Japan, the obesity rate among children doubled during the 1980s, which correlated with a 200 percent increase in fast-food sales. This generation of Japanese has gone on to become the first in the nation’s history known for its bulging waistlines. Approximately one-third of all Japanese men in their thirties are now overweight.16 Yes, the entire world is beginning to look more like Americans by adopting our fast-food eating habits.

A Child Shall Lead Them

How has an entire generation of hefty eaters changed the face of the world? By starting young. And once again, this unflattering trend originated in America. In the United States, one-fifth of our children are now reported to be overweight, and one out of ten (24 million adults) have diabetes. The CDC predicts that one out of three children born in the United States in 2000 will develop type 2 diabetes at some point in their life.18

As a result of childhood obesity, we are seeing a dramatic rise in children with type 2 diabetes throughout the country. And because of the connection obesity has with hypertension, hypercholesterolemia (high cholesterol), and heart disease, experts are predicting a dramatic rise in heart disease as our children become adults. The CDC reports that overweight teens stand a 70 percent chance of becoming overweight adults, and that is increased to 80 percent if at least one parent is overweight or obese. Because of that, heart disease and type 2 diabetes are expected to begin at a much earlier age in those who fail to beat the odds.19 Overall, this is the first generation of children that is not expected to live as long as their parents, and they will be more likely to suffer from disease and illness at an earlier age.

If you do not lose weight for yourself, at least do it for your children. Children follow by example, by mirroring the behavior of their parents. Don’t tell them to lose weight without doing it yourself. I’m sure most of you love your children and are good parents. But ask yourself: Do you love your children enough to lose weight? Do you love them enough to educate them on what foods to eat and what foods to avoid? Do you love them enough to keep junk food out of your house and instead make healthy food more available? Do you love them enough to exercise regularly and lead by example?

If you answered yes to those questions, it is important that you not only take action for your children’s sake but also that you make changes for them that last. I am ecstatic that you have picked up this book. I believe you now hold the key to truly changing your life. But let me be honest; this is not an easy fight when it involves your children’s lives. The culture in which they are growing up is saturated with junk food that is void of nutrition but high in toxic fats, sugars, highly processed carbohydrates, and food additives. Consuming these foods has become part of childhood. For example, in 1978, the typical teenage boy in the United States drank seven ounces of soda a day; today he drinks approximately three times that much. Meanwhile, he gets about a quarter of his daily servings of vegetables from french fries and potato chips.24

If you’re planning on taking a stand against this garbage-in, garbage-out culture, expect some opposition from every front. During the course of a year, the typical American child will watch more than thirty thousand television commercials, with many of these advertisements pitching fast food or junk food as delicious “must-eats.” For years, fast-food franchises have enticed children into their restaurants with kids’ meal toys, promotional giveaways, and elaborate playgrounds. It has obviously worked for McDonald’s: about 90 percent of American children between the ages of three and nine set foot in one each month.25 And when they can’t visit the Golden Arches, it comes to them. Fast-food products—most of which are brought in by franchises—are sold in about 30 percent of public high school cafeterias and many elementary cafeterias.26

These fast-food establishments spend billions of dollars on research and marketing. They know exactly what they are doing and how to push your child’s hot button. They understand the powerful impact certain foods can have on you at a young age. Have you ever thought of when you first started liking certain foods? For the majority of people, those preferences were formed during the first few years of life. That is why comfort foods often do more than just fill the stomach; they bring about memories of the fair, playgrounds, toys, backyard birthday bashes, Fourth of July parties, childhood friends?.?.?.?the list goes on. The aroma of foods such as onion rings, doughnuts, or fried hamburgers can instantly trigger these memories, and as adults, we are often unconsciously drawn to these smells. Advertisers have keyed into this and learned to use the sight of food to stimulate the same fond childhood memories.

In the Genes or in the Water?

For every obese person, there is a story behind the excessive weight gain. Growing up, I would often hear it said of an obese person that “she was just born fat,” or “he takes after his daddy.” There’s some truth in both of those. Genetics count when it comes to obesity.

In 1988, the New England Journal of Medicine published a Danish study that observed five hundred forty people who had been adopted during infancy. The research found that adopted individuals had a much greater tendency to end up in the weight class of their biological parents rather than their adoptive parents.28 Separate studies have proven that twins raised apart also reveal that genes have a strong influence on gaining weight or becoming overweight.29 There is a significant genetic predisposition to gaining weight.

Still, that does not fully explain the epidemic of obesity seen in the United States over the past thirty years. Although an individual may have a genetic predisposition to become obese, environment plays a major role as well. I like the way author, speaker, and noted women’s physician Pamela Peeke said it: “Genetics may load the gun, but environment pulls the trigger.”30 Many patients I see come into my office thinking they have inherited their “fat genes,” and therefore there is nothing they can do about it. After investigating a little, I usually find that they simply inherited their parents’ propensity for bad choices of foods, large portion sizes, and poor eating habits.

If you have been overweight since childhood, you probably have an increased number of fat cells, which means you will have a tendency to gain weight if you choose the wrong types of foods, large portion sizes, and are inactive. But you should also realize that most people can override their genetic makeup for obesity by making the correct dietary and lifestyle choices. Unfortunately, many of us forget that to make these healthy choices, it helps to surround ourselves with a healthy environment.

That is becoming more difficult than ever as families give way to their hectic routines by grabbing breakfasts-on-the-go, ordering fast-food lunches, dining out for dinner, and skipping meals. After years of this, it is catching up to us. The average American adult gains between 1 to 3 pounds a year, beginning at age twenty-five. That means a twenty-five-year-old, 120-pound female can expect to weigh anywhere from 150 to 210 pounds by the time she is fifty-five years of age. Is there any wonder why we have an epidemic of heart disease, type 2 diabetes, hypertension, high cholesterol, arthritis, cancer, and other degenerative diseases? We have to put the brakes on this obesity epidemic—and a lifestyle approach to eating is the answer!

Adding Culture to the Mix

Just as environment often shapes your health habits, so does culture. The two walk hand in hand when it comes to causing obesity. As children, we develop our food preferences and habits based on our family environment. Yet every family is influenced by its surrounding culture, and culture often shapes the types of foods, recipes, and ingredients we choose on a regular basis.

I was raised in Mississippi. Ever since I was a child I remember how my mother’s coffee cup always sat on the stove in the kitchen. But instead of coffee, it was filled with bacon grease. Whenever she cooked vegetables—any kind—she would add a few tablespoons of that bacon grease to add flavor. She fried almost everything: fried chicken, fried hamburgers, fried salmon, fried fish sticks, chicken fried steaks, fried chicken livers, fried ham, fried pork chops, fried bacon?.?.?.?you name it. Why did she do this? Because her mother had taught her to fry virtually any meat.

Mom also usually made gravies, all of which were grease-based. Most meals were served with corn bread or biscuits, either of which contained a hefty amount of Crisco shortening. We rarely ate grilled food, and when we did, it was a fatty cut of meat. I still remember my father making me eat all the fat on my steak. Since I was a skinny kid, he would say, “Son, that fat is good for you—it will help to fatten you up.” I recall almost puking as I tried to get the fat down.

We were a typical Southern family. My brother, sister, and I were all raised to eat fried foods, greasy foods, biscuits, and corn bread—and top it all off with a large piece of cake or pie for dessert. Today, I see a similar thing happening in the southwestern part of the United States. This Southwest culture, which is in part defined by its Tex-Mex and Mexican eating habits, is helping to fuel the obesity epidemic. Most of these people are being raised on highly processed white breads or corn tortillas, white rice and fried white rice, corn chips, refried beans, fried tacos, enchiladas, nachos?.?.?.?the list goes on. Their diet typically contains a lot of fats, a lot of grease, a ton of highly processed carbohydrates, and a lot of sugar.

It is no coincidence that almost every year some Texas city has the unflattering distinction of having the largest number of obese individuals in the country. After Houston was named the “fattest city” multiple times in past years, 2008 saw Arlington, San Antonio, Fort Worth, El Paso, and Dallas all place among the top ten fattest cities of Men’s Fitness magazine’s “Annual Fattest and Fittest Cities in America Report.” The year before, four of those cities made the dubious honor.31 Not only do these overweight hot spots feature some of the country’s best Tex-Mex and Mexican style foods, but they also offer extra large Texas portions with a blend of some of the most calorie-dense cultural foods around. Is there any wonder why Texans have a major obesity problem?

Eating With the Head and Not the Heart

We have discussed how genetics can sometimes, though rarely, prompt an individual’s obese state. We have also talked about how the overwhelming majority of obesity cases are a direct result of environment and culture. These can be discouraging factors in light of the gloomy statistics and the ongoing epidemic. However, I want to end this chapter on a positive note by reminding you of a simple truth. In fact, it is what this book is all about.

Regardless of how difficult it sounds, your cultural tastes and foods can be changed over time with education, practice, and discipline. You can learn how to choose similar foods that have not been excessively processed as well as lower-fat alternatives. It’s possible to discover—or rediscover—portion control and healthy cooking methods. Sure, you may still love your fried chicken, mashed potatoes and gravy, and chocolate cake. But soon you will be able to enjoy the same foods with just a fraction of the fat, sugars, and calories.

When I wrote the book What Would Jesus Eat? about the Mediterranean diet, I learned that most Middle Easterners ate differently than the typical American. That sounds obvious, but what distinguishes the two isn’t. I found that those who are used to a Mediterranean diet typically would not leave the dinner table stuffed as most Americans do. Generally, they ate anything they wanted—but in moderation. They enjoyed their food and socialized while eating. They had the uncanny ability to enjoy just a few bites of their favorite foods such as wine, dark chocolate, or even chocolate ice cream. Unlike most Americans, who scarf down a dessert as if they were inhaling it, those eating a Mediterranean diet actually savored just a few bites.

The real pleasure in most foods is in the first few bites. We will discuss this later, but for now, know that you can break out of your old cultural eating patterns. You do not have to follow a parent’s poor food choices, and you can overcome your family’s eating cultural patterns. (I certainly did!) And in the process, you will discover the true joy of eating.