Fat Town

Fat Town

The Obesity Crisis in Sin City

Las Vegas has very little construction to speak of these days. But if and when money surfaces for new projects or redevelopment, Monica Lounsbery would love to have a say in how it’s spent. The UNLV nutritional science professor wants to design anti-obesity elements into our neighborhoods, subdivisions and workplaces.

Lounsbery, who directs the university’s Physical Activity Policy Research program, believes Las Vegas has failed to incorporate into buildings and open spaces ways to counter obesity. Take our parks, for instance, she says. “You see people at a park and they’re usually sitting. They’re there to supervise a child or a dog.”

Justin Williams, Clark County’s senior park planner, was involved with Lounsbery’s recently completed O.P.E.N. (Observing Park Environments in Nevada) study. UNLV and county representatives monitored several Las Vegas parks over the course of a year to see how they were used. Williams will use the data in formulating suggestions for a future park in the Mountain’s Edge master planned community in the southwest Valley, and at the existing Bob Price Park in the northeast.

“Parks are designed to get people active,” Williams says. “But a lot of spectatorship goes with that, especially with kids sports. You’ll have kids running around, but twice as many parents sitting and watching. People take kids to the playground, and parents are sitting at the picnic table, too. It becomes a question of how to engage the spectator.”

At the Mountain’s Edge park, Williams says, elliptical trainers will be set up so parents can exercise while watching their children. Recently, the county put similar devices along walking trails at Bob Price Park.

Lounsbery and others believe more can be done beyond the park environment. In much of suburban Las Vegas, where most of the city’s residents have flocked the past few decades, businesses and homes often don’t front the street or sidewalk, she says. How many times must pedestrians traverse hundreds of feet of parking lot before reaching a neighborhood center?

Lounsbery believes designers should consider placing parking lots behind a structure, with stores, buildings and sidewalks closer to the street and natural buffers between the walkway and road. Narrower streets might encourage walking rather than driving, she says.

“I consider myself a reasonably healthy person,” she adds. “But sometimes there’s not even enough time for me to get across these (wide) streets. Think of a blind person or an older person.”

Carrie Sheets, who is doing postdoctoral study in clinical psychology, works at the Surgical Weight Loss Center and at Creative Health Solutions. During her student years back East, she often rode a bike to work and class; Las Vegas presents a natural deterrent to biking, she says.

“Once you have a close brush, or that one experience, you don’t want to chance it anymore,” she says.

 

More gain, less pain?

Two-thirds of the U.S. adult population is considered at least overweight, according to the Centers for Disease Control and Prevention. Obesity among children ages 6-11 has reached 20 percent, nearly triple the rate of 30 years ago. The Silver State ranked 37th in the Kaiser Foundation’s State Health Facts survey in 2010, with obesity rates near the overall U.S. level. The state spends nearly $350 million a year on obesity-related health care costs, the nation $130 billion, data show.

And while most of us are reminded frequently to monitor our intake of sugar, carbohydrates and fat, and to get to the gym, Marjorie Nolan of the Academy of Nutrition & Dietetics says our exercise regimen doesn’t have to be a killer. Slow, but regular physical activity throughout the day can replace hard workouts in the gym, she says, while promoting a slower weight loss that’s easier to maintain.

Nolan rejects the “no pain, no gain” ethos.

“Our bodies are designed to move relatively slowly, but constantly,” she says. “Our messages are completely off track with the ‘Biggest Loser’ and these programs that are putting these people into a ‘fat camp.’”

Nolan is amassing evidence for a book to show that vigorous exercise actually increases the “hunger hormone” ghrelin, which also is exacerbated by extremely low calorie diets that are often suggested with intense activity. In fact, she says, this coupling can result in a ghrelin spike and a fall-off in appetite-suppressing hormones such as leptin.

A 2009 study in Australia suggested that extreme weight loss promoted elevated ghrelin levels of roughly 20 percent in 50 men and women. Critics found the sample too small, but the results may spark a larger study.

Nolan sees “less pain, more gain,” for instance, as walking a quarter mile from the market to her Manhattan apartment while toting 20 pounds of groceries, or taking the stairs at work and brisk walks throughout the day, and a moderate intake of calories.

Lounsbery is interested in occupational energy expenditure, such as treadmill desks. TrekDesk and TreadDesk sell mobile workstations that keep users upright, enabling them to walk as they work if desired. The stations cost from $500 to $4,000.

She acknowledges it’s a stretch to compare New York’s walk-friendly urban environment to Southern Nevada’s suburbs. And she’s not advocating an overhaul of Las Vegas or the workplace per se. For now, she’s satisfied with the park plans, realizing much more must be done before society is ready to tackle the obesity problem head-on.

 

The mind game

Our suburban environments offer cues that favor a car ride over a walk, while the social message we receive is gluttony deserves physical punishment. That presents a quandary for most folks: Lace up the running shoes, or sink into the couch for more chips and cookies.

Dr. Kim Dennis is medical director for Timberline Knolls, a Chicago-area residential treatment facility for women and girls with eating disorders. The 122-bed facility, with many obese patients, usually has a waiting list on any given day, she says.

Many obese people, she adds, battle a food addiction that resembles a disease. Often the uncontrolled eating masks the physical and sexual abuse some patients experienced during childhood, Dennis says.

“They have no real control over (eating) without outside help,” she said. “Too many people go right to simple behavior modification, like a diet and exercise program. But there’s usually a deep emotional, spiritual, physical aspect that needs to be addressed.”

Still, surface-level behavior modification techniques have their place. Sheets encourages routines: leaving sneakers by the front door; eliminating junk food from the cupboards; using social media to engage with other active people and those in similar situations. Calorie trackers, pedometers and self-monitoring apps are increasingly popular, she says. Any way that technology fosters behavior change and maintenance is good, she adds. Even something as simple as having a family get-together at a park, rather than at a buffet, helps establish dietary control, Sheets says.

But simple behavior modification tips aren’t always enough, she believes. And Dennis says it’s common to see slimmed-down patients who’ve undergone weight-loss surgery now being treated for chemical or substance abuse. Focusing on the physical side of the equation to the detriment of the mental aspects won’t work, she says, adding that even physicians can get too locked in on body change alone.

“I still have doctors calling me and talking about great diet plans that can help patients get great results,” she adds. “It’s just not sustainable.”

Dennis says some obese people haven’t addressed the spiritual side of life.

“It’s simply a connection to something bigger and something other than themselves. We call it the ‘hole in the soul.’ These people have been neglected and abused on some level and they just look to substances like food, sex, bad relationships, you name it,” she says.

 

Playing hardball at school

A Kaiser Foundation report published earlier this year cited the importance of schools in helping allay obesity, particularly in youth. Understanding nutrition is key, experts say, which often puts the school lunch in the crosshairs.

Virginia Beck, the Clark County School District’s assistant director of food services, has been tinkering with the menu for some time now. Fresh fruit is now offered at breakfast and lunch. Even the pizza now has multi-grain crust and low-fat and low-sodium cheese, Beck says.

But if the kids don’t eat what’s offered, Beck adds, administrators will make different menu requests. “Administrators are supposed to adhere to the student wellness regulations, but not all of them do,” she says.

And some social factors are beyond the purview of schools, Beck says.

“The mudslingers want to blame everything on the school meals. … But there’s the media with the (junk food) commercials, and parents that don’t have the time to prepare a nutritious meal themselves. Then kids are sitting down to video games; you can’t just nail it down to one factor,” she says.

In a perfect world, Dennis says, schools would assist with nutrition, parenting and helping moms and dads meet their child’s emotional needs.

“If you don’t look at these other factors,” she adds, “it’s like treating someone with tuberculosis with a cough suppressant.”