In a very touching article on August 27, 2012, St. Louis Post-Dispatch sports columnist Bernie Miklasz discusses his relationship with Rick Majerus, the head basketball coach of St. Louis University, who just took a leave of absence because of health problems related to obesity.

The article begins with an account of a dinner conversation Miklasz and Majerus had in March 2012. They spent two hours talking about a wide range of topics including basketball, politics, movies, restaurants, baseball, books, journalism and social media. As Miklasz says, in short, “we talked about life.”

Miklasz obviously knew of Majerus’ problems with obesity, which had led to five coronary operations. Majerus had been given the standard advice about reducing the chances of further heart damage. He needed to eat a more healthy diet with a focus on fruit and vegetables. He had to eat smaller portions and spread his meals throughout the day. Even though he was a basketball coach, he needed to get more exercise.

Majerus took the advice and applied it, much of the time. He is a man who enjoys a good meal, particularly when he sees one. His profession is in the sports arena, but his body weight makes it difficult for him to ask of himself anything close to what he demands of his players. He has been a sedentary coach whose effectiveness lay in his remarkable insight into the game. He knows how to outfox coaches who have rosters considered to be far superior to the players on his team. Last year, he took what was considered to be an ordinary St. Louis University team to a 26-8 record, including a much unexpected victory over  Memphis University in the first round of the NCAA tournament.

As Miklasz and Majerus talked, Miklasz looked across the table and in many ways saw an image of himself. More than twenty years ago, when Miklasz came to the Post-Dispatch from Baltimore, he was a very large man, way too heavy for his height. From time to time, he has referenced his weight issues, but not on a regular basis and certainly not to ask for pity. But this particular dinner conversation, as well as many others that Miklasz and Majerus had had, dealt with issues such as life, death and mortality.

Here were two men, both very intelligent, conversant on a wide variety of subjects, well read, and with strong wills, discussing their battle to overcome obesity. Both had done more than talk about it; they had gone on the diets and taken the doctors’ advice. But when you “do the right thing” long enough and the returns are limited, you tend to go back into old habits. Such had been the case with both of them.

In recent years, much has been said and written about the problem of obesity in the United States. The statistics are indisputable; the percentage of individuals who are significantly overweight has grown considerably over the past several decades. As obesity has escalated, so have the campaigns against it. So far, the growth of the girth is winning.

What we do know, and Michelle Obama has been a strong advocate of this, is that childhood obesity can be greatly reduced. The keys for children are the same as those preached for adults – a healthier diet and more exercise. Many children who follow this advice are able to avoid the travails of obesity or lose the weight that they may have gained while eating junk food and engaging almost exclusively in sedentary activities rather than exercise.

Once a youngster grows and reaches a certain age, the battle of the bulge becomes much more difficult, as Miklasz and Majerus have experienced. Steps that they might have taken when they were younger and been successful just don’t have the sustained effect now. They fight the battle, but it’s an uphill fight.

The issue of obesity received more attention during the Republican National Convention, when the keynote speaker was New Jersey Governor Chris Christie. He is morbidly obese, but to his credit, in spite of his weight problem, he was considered ready for prime time. However, he was the butt of countless jokes and is generally considered unqualified to pursue a higher office unless he can somehow win the weight battle, one that he has undoubtedly been fighting all his life.

As a society, we have a tendency to glorify those who are slim and fit. We demean those who are overweight. It is not for me to say “fat is beautiful” and “slender is ugly,” although there are some societies that look at it this way. What I can say is that many individuals who are grossly overweight are not slovenly and lazy. They work hard at losing the fat that encumbers them. Yet they are often the targets of jokes by those who are not overweight. They are seen as having character flaws by many individuals, including some who are health professionals.

As we all know, each person has his or her own story,  including those who are overweight. Before we condemn them, mock them, or shower them with advice, let’s remember that we don’t know their full stories and the battles they have fought. Rarely does the truth come out as openly and honestly as it did in the March dinner conversation with Bernie Miklasz and Rick Majerus.

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Unless you’ve been living in a cave, you are familiar with first lady Michelle Obama’s Let’s Move program to combat childhood obesity. You are probably also aware of the flak she has received from conservative pundits, who claim that the program is an effort by the government to tell Americans what to eat. With an epidemic of obesity in the U.S., it is difficult for most of us to believe that low-income people often suffer from malnutrition despite the relative low cost of food compared to other countries.

I’ll use the St. Louis area, where I live, as an example. But what I’m describing could probably apply to many American urban areas.

Anyone who has driven through parts of the city of St. Louis has noticed the neglected and dilapidated homes; the abundance of fast food restaurants, chop suey joints, and liquor stores; and the lack of full-service grocery stores within walking distance of residential neighborhoods.  Even with this reminder of class and social status, many St. Louisans have difficulty understanding that in our community, people suffer from hunger and malnutrition.

Cynthia Davis (R), former state representative from St. Charles, Missouri says, “People who are struggling with lack of food usually do not have an obesity problem.” An informal poll taken by this author recently showed that ten out of eleven respondents have heard the following statement spoken by acquaintances: “I don’t believe that poor people are really malnourished, because so many of them are overweight.”  This attitude seems to be a pervasive myth particularly among political conservatives.

 Myths

Most people, when they hear the word “hunger,” form a mental picture of a skin-and-bones person living in Sudan or India. Perhaps a more precise term to use would be “malnutrition.” As defined by Merriam-Webster, malnutrition means “faulty nutrition due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization.”  By this criteria, a person can be well-fed calorically, yet suffer from malnutrition because of what he eats, rather than how much he eats.

Research has shown that malnourishment causes a host of physical ailments, and can predispose one to infections like tuberculosis.   A common form of malnutrition, called “overnutrition,” is often seen in countries where there is an abundance of rich, fatty foods — like those found on a typical American fast food menu.  Metabolic syndrome, the increasing inability to process glucose, leads to the onset of Type II (adult-onset) diabetes and is closely associated with the consumption of sugars such as corn syrup, the largest ingredient in soft drinks like Coke.  Such a diet can lead to hypertension, coronary artery disease, and stroke. Overnutrition frequently causes obesity.

Stats

According to a 2010 report, Missouri is  the 12th most obese state in the country. The state’s adult obesity rate is 29.3 percent, and in Missouri. men are more obese than women, at 29.9 percent. More than two-thirds of states have adult obesity rates above 25 percent.

The same report states that Mississippi leads the nation in obesity, at 33.8%.  Mississippi also has the highest poverty rate in the United States at 21.3%, according to U.S. Census data.

In contrast, St. Louis City has a 26% poverty rate, per the most recent available data from 2010.  Obesity, poor nutrition, and the resulting diseases carry a high cost both to the individual and to the individual’s society as a whole, in increased utilization of scarce medical resources, morbidity, and mortality.

A dangerous combination

How can obesity, malnutrition/over-nutrition, and poverty possibly be related? The answers are many.  It begins with education and knowledge of nutrition. Children in the St. Louis City school district have only a 60% graduation rate (2011 statistics). High school is typically when students take health classes and learn about nutrition. A lack of knowledge about nutrition often leads to poor dietary choices. Parents of these children often do not understand nutritional labels on foods and thus are unable to teach them how to choose between a high-calorie, low-value food and one that provides essential vitamins and minerals at a lower calorie cost. Recent data shows that the rate of diabetes in the U.S. is directly proportional to both the educational and income level of the population.

Access to affordable food supermarkets offering healthy food choices is essential. There are few large chain grocery stores in low-income city areas. These stores offer a wide variety of healthy food selections such as fruits, vegetables, low-fat dairy products and meats, and alternatives to high-sodium and high-fat snacks.  Most grocery stores available to residents in these regions carry few perishables and instead rely upon prepared and frozen foods with low nutritional value.  Most of these stores accept food stamps for what is considered by health experts to be “junk food.”

The few restaurants in these areas typically tend to be of the fast-food type, which feature high-fat and high-calorie choices.  Even the ubiquitous Chinese take-out places feature breaded and fried meats with heavy sauces and high sodium content – rather than the vegetables and plain rice that the Asians themselves eat—because this is what Americans demand.

St. Louis has many fine food pantries that distribute, for free, canned and packaged goods to low-income citizens. Unfortunately, the food pantries often have limited storage space for perishables such as fresh produce and meats, so are unable to offer them to their clients.

Breaking the cycle

All of society has a stake in providing every one of its citizens with the tools to maintain a healthy lifestyle. It does no good to provide food vouchers and food stamps if the low-income residents have no access to quality food sources.  Politicians must find ways to provide incentives, perhaps in the form of lowered taxes, to induce large chain grocery stores like Schnucks or Shop-and-Save to locate more facilities in low-income residential neighborhoods.

Further, education on nutrition must be provided to both younger children and to their parents.  Schools can play an important part both by offering nutritious meals on campus, and by teaching students how to make wise choices.  These measures are far less expensive, in the long run, than treating the diseases caused by modern malnutrition. Closing the national dialogue on the topic by stating nonsense such as, “What she is telling us is she cannot trust parents to make decisions for their own children, for their own families in what we should eat…” (Sarah Palin, 2010) does no one a favor.

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