THURSTON COUNTY - Debbie Riley doesn't mind that her bus driver's uniform hangs loosely on her body since she lost 45 pounds.
"I have my eye on a pink leather motorcycle jacket," said Riley, 48, of Tenino, who had "Lap-Band" weight loss surgery last August when she weighed 260 pounds. "But I'm going to wait until I get down to my goal weight before I buy it."
With 65 pounds left to go to reach her goal of 150 pounds, Riley is not alone.
According to statistics from the state Department of Health, the national obesity epidemic has hit Washington state:
- One in four Thurston County residents is obese, meaning they have a body mass index (BMI) of 30 or higher, and one in three is overweight, meaning a BMI of 25 or above, according to state Department of Health statistics from 2004. Those numbers are likely to be higher now. BMI is a standard calculation based on a person's weight and height.
- Statewide, obesity rates more than doubled between 1990, when 9 percent of adults were obese, and 2004, when 22 percent were obese.
- More than half of Washington's adult population is either obese or overweight.
Nationwide, Americans spend more than $30 billion annually on weight loss products and services - many of which don't work, experts say. Most researchers contend that attacking the cause of the rising obesity rate is key, but they also agree there is no single factor causing the epidemic.
"We live in an obesegenic environment - one that encourages unhealthy eating," said Dr. Laura Streichert, of the Exploratory Center for Obesity Research at the University of Washington in Seattle. "What's often said is, 'Genetics loads the gun, but environment pulls the trigger.' "
Despite its reputation as a bastion of outdoor activities and rugged good health, the Northwest has caught up with the rest of the nation and is wired for obesity, health and fitness professionals say. "There's this PowerPoint presentation with a national map showing red states, where 30 percent or more of the population is overweight," said David Ross, a personal trainer at the Valley Athletic Club in Tumwater. "It used to be mostly just red in the South and East, but year by year, the red portion is growing and expanding to the West."
Sedentary lifestyles, increased "stress eating," larger portion sizes, more restaurant and fast-food visits, low socioeconomic status, metal toxicities, lengthy commutes and lack of free time to cook healthy food all are part of the dynamic, researchers say.
"Twice as much time is spent in cars as 20 years ago, due to commutes from the suburbs," said Dr. David Heber, director of the University of California at Los Angeles Center for Human Nutrition and Risk Factor Obesity Program, in an interview with The Olympian. "Americans watch an average of seven hours a day of television."
'Stress eating' and toxins
Emotionally, a lack of personal empowerment contributes to "stress eating" and higher levels of the stress hormone cortisol circulating in the body, said Virginia Hadley, an Olympia herbalist, nutritionist and registered nurse.
"Cortisol and the effects of stress contribute more than most people realize to the development of metabolic syndrome" and adult-onset diabetes, Hadley said. Metabolic syndrome is described by medical professionals as a cluster of disease states, including high blood pressure, high blood sugar, high triglycerides (fatty acids in the bloodstream), low HDL ("good") cholesterol and obesity.
Hadley said that toxic chemicals from the environment also can contribute to obesity.
"Metal toxicity and other environmental pollutants create a situation where our body needs to protect us," Hadley said. "Toxins are diluted with extra water in the tissues, then stored into fat cells if the toxic compounds can't be excreted fast enough."
The way we eat also is a factor.
Deborah Kesten, a Tacoma nutrition researcher, educator and author, said she has identified six eating behaviors that lead to obesity. The behaviors were in the results of a 2003 study Kesten ran with her husband, Larry Scherwitz, director of clinical sciences at AIBMR, a natural products research institute in Puyallup.
Those behaviors are: eating alone; not tasting food; eating processed food; eating out of negative emotions; doing other things while eating; and not appreciating food or where it came from.
"The Enlightened Diet," Kesten's third book on the topic of cultural, psychological and behavioral approaches to food, is due out this fall from Ten Speed Press in Berkeley, Calif.
"It's clear that why and how we eat, what we eat and with whom are all crucial to weight control," Kesten said.
Added Scherwitz: "The more we nourish ourselves physically, emotionally, socially and spiritually, the less we are likely to overeat and gain weight."
Similarly, Olympia nutritionist Laurie Schaetzel-Hill said that worrying about being fat and obsessing about food choices and diet are overtaking many of her clients' lives, draining time and energy they could use for more productive and creative pursuits.
"If all of us used that energy for something else, we all - women, especially - could move mountains," Schaetzel-Hill said. "It's an incredible thought - one that brings tears to my eyes."
In addition, many who are overweight suffer from a deep disconnection with their spiritual natures and a feeling of separation from other people, said one Tumwater woman whose involvement in the 12-step group Overeaters Anonymous requires that her name not be used. OA connects people to a Higher Power - whatever form that takes - as well as a support network, she said.
"You hook up with other people and talk about the program," the woman said. "It helps you deal with the craziness of life that you have to deal with every day."
Culture and public policy
The effects of culture cannot be underestimated. Researchers at the University of Minnesota last month reported that teenage girls who read magazine articles about diets and weight loss were more likely five years later to exhibit extreme weight-loss measures, such as vomiting or taking laxatives, than girls who did not read the articles. The researchers' study appeared in January's issue of the journal Pediatrics.
Alison Field, a Harvard Medical School eating disorders researcher, said the magazine articles might seem to be about nutritional topics such as trans fats or whole grains, but "the underlying messages they send are, 'You should be concerned about your weight and you should be doing something.' "
Government initiatives to counter the obesity trend have mostly failed, according a report last year from the nonprofit Trust for America's Health.
The report, "F as in Fat: How Obesity Policies are Failing in America," ranked Washington tied with Idaho for the 31st heaviest state, with an average obesity rate of 22.4 percent for the years 2003 to 2005. That was a 0.7 percentage point increase compared with the previous three-year average obesity rate of 21.7 percent, said Nicole Speulda, a Trust spokeswoman. "Basically, Washington got fatter - and it was a statistically significant raise," said Speulda, noting that the Trust report was culled from U.S. Centers for Disease Control and Prevention data on hypertension, body mass index and diabetes.
"Government must step up and provide sustainable funding for sound policies that produce significant results," said Jeff Levi, the Trust's executive director.
In Washington, the state Department of Health works with the CDC to track health data and also coordinates healthy eating programs with many area nonprofit groups.
Dr. Diana Yu, Thurston County's public health officer, said the "Steps to a Healthier Future" initiative run by the county focuses on obesity as well as diabetes and asthma. But Yu, who said she has struggled with weight issues most of her life, added that government programs can only do so much - the rest has to come from the individual.
"Nobody can get you to exercise," Yu said. "You have to decide this is what works for you."
Surprises in research
But as Streichert of the University of Washington noted, public policy and culture are part of the environmental influences on obesity. Not to be overlooked are genetic and biological factors, such as substances in the brain that react to food.
For example, scientists are looking at dopamine, a brain chemical that surges when a person feels pleasure. Researchers have found that dopamine, once activated, tries to repeat the pleasure by increasing the brain's drive to obtain more of whatever brought it on in the first place.
That dopamine pleasure--seeking cycle can set the stage for many addictions - including certain foods, such as sugar or chocolate, according to scientists at the National Institute on Drug Abuse, as quoted in the January issue of O: The Oprah Magazine. In addition, the hormones leptin and grehlin, both of which affect appetite regulation, also are under study at many labs. At Streichert's center in Seattle, rats that were unable to process leptin were obese. After they were injected with a virus carrying a leptin receptor, they slimmed down to normal weight. But genetics and biochemistry can only go so far, UCLA's Heber said.
"Natural selection favored those people with the genes to store fat, and today this accounts for the very common nature of obesity," said Heber, a professor of medicine. "However, psychology trumps physiology, so that there are many with the genes for obesity who never become overweight."
For South Sound residents such as Debbie Riley and her sister, Cyndy McLeod, neither government fixes nor genetics can get at what they see as the core of their obesity. For them, difficult feelings and emotional stressors are the triggers for their compulsive overeating.
"I've really realized how much my eating was attached to my emotions," said McLeod, 50, a site supervisor at Lewis County Head Start. McLeod, who had Lap-Band surgery on the same day as Riley, has shared Riley's habit of using food to cope with emotional stress. Since the surgery, McLeod, of Chehalis, has lost 39 pounds, down from her original 290 pounds. Riley said she would typically starve all day while keeping busy at work, and then gorge as soon as she came home at night.
"Now I exercise when I'm frustrated, instead of eat," she said. "When life gets stressful, I used to just shovel - now I have to slow down and take little bites" because of the band around her stomach.
Riley said she no longer uses overeating to deal with the demands of work, running a household and resolving interpersonal conflicts. "I see that I need to take time for me," Riley said. "This makes me slow down and learn to take a little better care of myself."
Television icon Oprah Winfrey, who has logged many years of high-profile struggles with her weight, talks about emotional eating in the January issue of her magazine.
"It took me a while to get to the truth," Winfrey said. "I didn't love food. I used food to numb my negative feelings."
Keri Brenner is a reporter for The Olympian. She can be reached at 360-754-5435 or firstname.lastname@example.org.
MORE Online resources
The Exploratory Center for Obesity Research: http://depts.washington.edu/uwecor/
Trust for America's Health: www.healthyamericans.org
Washington Department of Health: www.doh.wa.gov/cfh/NutritionPA/facts_and_figures/obesity_rates_wa/default.htm
Centers for Disease Control and Prevention: www.cdc.gov/nccdphp/dnpa/obesity/index.htm
Steps for a Healthier Life in Thurston County: www.co.wa.us/health/steps/index/html
Body Mass Index (BMI) calculator: www.thelapband.com/bmi_calculator.aspx