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Saturday, December 31, 2011

Robert Reich Gets It Just About Right!

The Defining Issue: Not Government’s Size, but Who It’s For

Monday, December 19, 2011
The defining political issue of 2012 won’t be the government’s size. It will be who government is for.
Americans have never much liked government. After all, the nation was conceived in a revolution against government.
But the surge of cynicism now engulfing America isn’t about government’s size. The cynicism comes from a growing perception that government isn’t working for average people. It’s for big business, Wall Street, and the very rich instead.
In a recent Pew Foundation poll, 77 percent of respondents said too much power is in the hands of a few rich people and corporations.
That’s understandable. To take a few examples:
Wall Street got bailed out but homeowners caught in the fierce downdraft caused by the Street’s excesses have got almost nothing.
Big agribusiness continues to rake in hundreds of billions in price supports and ethanol subsidies. Big pharma gets extended patent protection that drives up everyone’s drug prices. Big oil gets its own federal subsidy. But small businesses on the Main Streets of America are barely making it.
American Airlines uses bankruptcy to ward off debtors and renegotiate labor contracts. Donald Trump’s businesses go bankrupt without impinging on Trump’s own personal fortune. But the law won’t allow you to use personal bankruptcy to renegotiate your home mortgage.
If you run a giant bank that defrauds millions of small investors of their life savings, the bank might pay a small fine but you won’t go to prison. Not a single top Wall Street executive has been prosecuted for Wall Street’s mega-fraud. But if you sell an ounce of marijuana you could be put away for a long time.
Not a day goes by without Republicans decrying the budget deficit. But the biggest single reason for the yawning deficit is big money’s corruption of Washington.
One of the deficit’s biggest drivers — Medicare – would be lower if Medicare could use its bargaining leverage to get drug companies to reduce their prices. Why hasn’t it happened? Big Pharma won’t allow it.
Medicare’s administrative costs are only 3 percent, far below the 10 percent average administrative costs of private insurers. So why not tame rising healthcare costs for all Americans by allowing any family to opt in? That was the idea behind the “public option.” Health insurers stopped it in its tracks.
The other big budgetary expense is national defense. America spends more on our military than do China, Russia, Britain, France, Japan, and Germany combined. The basic defense budget (the portion unrelated to the costs of fighting wars) keeps growing, now about 25 percent higher than it was a decade ago, adjusted for inflation.
That’s because defense contractors have cultivated sponsors on Capitol Hill and located their plants and facilities in politically important congressional districts.
So we keep spending billions on Cold War weapons systems like nuclear attack submarines, aircraft carriers, and manned combat fighters that pump up the bottom lines of Bechtel, Martin-Marietta, and their ilk, but have nothing to do with 21st-century combat.
Declining tax receipts are also driving the deficit. That’s partly because most Americans have less income to tax these days.
Yet the richest Americans are taking home a bigger share of total income than at any time since the 1920s. Their tax payments are down because the Bush tax cuts reduced their top rates to the lowest level in more than half a century, and cut capital gains taxes to 15 percent.
Congress hasn’t even closed a loophole that allows mutual-fund and private-equity managers to treat their incomes as capital gains.
So the four hundred richest Americans, whose total wealth exceeds the combined wealth of the bottom 150 million Americans put together, pay an average of 17 percent of their income in taxes. That’s lower than the tax rates of most day laborers and child-care workers.
Meanwhile, Social Security payroll taxes continue to climb as a share of total tax revenues. Yet the payroll tax is regressive, applying only to yearly income under $106,800.
And the share of revenues coming from corporations has been dropping. The biggest, like GE, find ways to pay no federal taxes at all. Many shelter their income abroad, and every few years Congress grants them a tax amnesty to bring the money home.
Get it? “Big government” isn’t the problem. The problem is big money is taking over government.
Government is doing less of the things most of us want it to do — providing good public schools and affordable access to college, improving our roads and bridges and water systems, and maintaining safety nets to catch average people who fall — and more of the things big corporations, Wall Street, and the wealthy want it to do.
Some conservatives argue we wouldn’t have to worry about big money taking over government if we had a smaller government to begin with.
Here’s what Congressman Paul Ryan told me Sunday morning when we were debating all this on ABC’s “This Week”:
If the power and money are going to be here in Washington, that’s where the influence is going to go … that’s where the powerful are going to go to influence it.
Ryan has it upside down. A smaller government that’s still dominated by money would continue to do the bidding of Wall Street, the pharmaceutical industry, oil companies, big agribusiness, big insurance, military contractors, and rich individuals.
It just wouldn’t do anything else.
If we want to get our democracy back we’ve got to get big money out of politics.
We need real campaign finance reform.
And a constitutional amendment reversing the Supreme Court’s bizarre rulings that under the First Amendment money is speech and corporations are people.

Friday, December 30, 2011

Forty Ideas To Consider

If you were looking for something to think about on New Year's Eve, the Business Insider offers these forty questions for your consideration.  Numbers 39 and 40 are extraordinarily important and have the power to transform the United States beyond recognition.  But building the Martin Luther King, Jr. memorial in China is beyond comprehension!!!

"If the mainstream media will not do it, then those of us in the alternative media will be glad to tackle the tough issues.  The following are 40 hard questions that the American people should be asking right now...

#1 If Iran tries to shut down the Strait of Hormuz, what will that do to the price of oil and what will that do to the global economy?
#2 If Iran tries to shut down the Strait of Hormuz, will the United States respond by launching a military strike on Iran?
#3 Why is the Federal Reserve bailing out Europe? And why are so few members of Congress objecting to this?
#4 The U.S. dollar has lost well over 95 percent of its value since the Federal Reserve was created,  the U.S. national debt is more than 5000 times larger than it was when the Federal Reserve was created and Federal Reserve Chairman Ben Bernanke has a track record of incompetence that is absolutely mind blowing.  So what possible justification is there for allowing the Federal Reserve to continue to issue our currency and run our economy?
#5 Why does the euro keep dropping like a rock?  Is this a sign that Europe is heading for a major recession?
#6 Why are European banks parking record-setting amounts of cash at the European Central Bank?  Is this evidence that banks don't want to lend to one another and that we are on the verge of a massive credit crunch?
#7 If the European financial system is going to be just fine, then why is the UK government preparing feverishly for the collapse of the euro?
#8 What did the head of the IMF mean when she recently said that we could soon see conditions "reminiscent of the 1930s depression"?
#9 How in the world can Mitt Romney say with a straight face that the individual health insurance mandate that he signed into law as governor of Massachusetts was based on "conservative principles"?  Wouldn't that make the individual mandate in Obamacare "conservative" as well?
#10 If the one thing that almost everyone in the Republican Party seems to agree on is that Obamacare is bad, then why is the candidate that created the plan that much of Obamacare was based upon leading in so many of the polls?
#11 What did Mitt Romney mean when he stated that he wants “to eliminate some of the differences, repeal the bad, and keep the good” in Obamacare?
#12 If no Republican candidate is able to accumulate at least 50 percent of the delegates by the time the Republican convention rolls around, will that mean that the Republicans will have a brokered convention that will enable the Republican establishment to pick whoever they want as the nominee?
#13 Why are middle class families being taxed into oblivion while the big oil companies receive about $4.4 billion in specialized tax breaks a year from the federal government?
#14 Why have we allowed the "too big to fail" banks to become even larger?
#15 Why has the United States had a negative trade balance every single year since 1976?
#16 Back in 1970, 25 percent of all jobs in the United States were manufacturing jobs. Today, only 9 percent of all jobs in the United States are manufacturing jobs.  How in the world could we allow that to happen?
#17 If the United States has lost an average of 50,000 manufacturing jobs a month since China joined the World Trade Organization in 2001, then why don't our politicians do something about it?
#18 If you can believe it, more than 56,000 manufacturing facilities in the United States have permanently closed down since 2001.  So exactly what does that say about our economy?
#19 Why was the new Martin Luther King, Jr. Memorial on the National Mall made in China?  Wasn't there anyone in America that could make it?
#20 If low income jobs now account for 41 percent of all jobs in the United States, then how are we going to continue to have a vibrant middle class?
#21 Why do the poor just keep getting poorer in the United States today?
#22 How can the Obama administration be talking about an "economic recovery" when 48 percent of all Americans are either considered to be "low income" or are living in poverty?
#23 Why has the number of new cars sold in the U.S. declined by about 50 percent since 1985?
#24 How can we say that we have a successful national energy policy when the average American household will spend a whopping $4,155 on gasoline by the end of this year?
#25 Why does it take gigantic mountains of money to get a college education in America today?  According to the Student Loan Debt Clock, total student loan debt in the United States will surpass the 1 trillion dollar mark in early 2012.  Isn't there something very wrong about that?
#26 Why do about a third of all U.S. states allow borrowers who don’t pay their bills to be put in jail?
#27 If it costs tens of billions of dollars to take care of all of the illegal immigrants that are already in this country, why did the Obama administration go around Congress and grant "backdoor amnesty" to the vast majority of them?  Won't that just encourage millions more to come in illegally?
#28 Why are gun sales setting new all-time records in America right now?
#29 Why are very elderly women being strip-searched by TSA agents at U.S. airports?  Does that really keep us any safer?
#30 The last words of Steve Jobs were "Oh wow. Oh wow. Oh wow."  What did he mean by that?
#31 How in the world did scientists in Europe decide that it was a good idea for them to create a new "killer bird flu" that is very easy to pass from human to human?
#32 If our founding fathers intended to set up a limited central government, then why does the federal government just continue to get bigger and bigger?
#33 Are we on the verge of an absolutely devastating retirement crisis?  On January 1st, 2011 the very first of the Baby Boomers started to reach the age of 65.  Now more than 10,000 Baby Boomers will be turning 65 every single day for the next two decades.  So where in the world are we going to get all the money we need to pay them the retirement benefits that we have promised them?
#34 If the federal government stopped all borrowing today and began right at this moment to repay the U.S. national debt at a rate of one dollar per second, it would take over 440,000 years to pay off the U.S. national debt.  So does anyone out there actually still believe that the U.S. national debt will be paid off someday?
#35 If the U.S. economy is getting better, then why are an all-time record 46 million Americans now on food stamps?
#36 How can we say that we have the greatest economy on earth when we have a child poverty rate that is more than twice as high as France and one out of every four American children is on food stamps?
#37 Since 1964, the reelection rate for members of the U.S. House of Representatives has never fallen below 85 percent.  So are the American people really that stupid that they would keep sending the exact same Congress critters back to Washington D.C. over and over and over?
#38 What does it say about our society that nearly one-third of all Americans are arrested by the time they reach the age of 23?
#39 Why do so many of our politicians think that it is a good idea to allow the U.S. military to arrest American citizens on American soil and indefinitely detain them without a trial?
#40 A new bill being considered by the U.S. House of Representatives would give the U.S. government power to shut down any website that is determined to "engage in, enable or facilitate" copyright infringement.  Many believe that the language of the new law is so vague that it would allow the government to permanently shut down any website that even links very briefly to "infringing material".  Prominent websites such as Facebook, Twitter and YouTube would be constantly in danger of being given a "death penalty".  The American people need to ask their members of Congress this question: Do you plan to vote for SOPA (The Stop Online Piracy Act)?  If the answer is yes, that is a clear indication that you should never cast a single vote for that member of Congress ever again."

A History Lesson

Anyone who thinks it will be easy to get the torrent of cash out of the government will find this interesting.  The Economist's year end issue has a short essay on the East India Company and the following paragraph is from that essay.  Remember this was the 18th Century.

"The Company created a powerful East India lobby in Parliament, a caucus of MPs who had either directly or indirectly profited from its business and who constituted, in Edmund Burke's opinion, one of the most united and formidable forces in British politics.  It also made regular gifts to the Court:  'All who could help or hurt at Court', wrote Lord Macaulay, 'ministers, mistresses, priests, were kept in good humor by presents of shawls and silks, bird's nests and attar of roses, bulses of diamonds and bags of guineas'."

Sound familiar?

Thursday, December 29, 2011

An Aside!

I was just looking at the Business Insider list of the top 25 highest paid executives in New York City.  It was compiled by Crain Publications, a trade magazine publisher.  I went back and classified them by industry.  I think you will find it interesting.

Finance                12
Entertainment         7
Manufacturing        6

Only 24% worked for companies that actually made things, i.e, Colgate-Palmolive, IBM, etc.

More On Jobs!!!!

Be sure to read Darin's comment on Jobs, Jobs, Jobs.  His is a voice from the front lines!

And in addition, he raises a vital question.  What do we do to take back our government from the special interest bought Congress?

I don't know the answer.  I bought into Larry Lessig's Rootstriker group and I am just starting his new book, "Republic Lost-How Money Corrupts Congress--and a Plan to Stop It".  I am greatly impressed by the opening sentences.

"There is only one issue in this country', former MSNBC commentator Cenk Uygur told Netroots Nation, in June 2001.  'Campaign finance reform'.

For the vast majority of America, Uygur's comment is obscure.  For a small minority, it is obvious."

So that puts us in the small minority.  (Note the date.)

In case you have forgotten, the Cowardly Lion (who I worked hard to get elected) promised to take the money out of politics and now has a re-election fund raising goal of ONE BILLION DOLLARS which he is raising hand over fist with $35,000 a plate dinners.  I am willing to bet that no one who reads this rant has ever attended a $35,000 a plate dinner with anybody.

Then there is another group, Americans Elect, which vaguely seems to have the same goal.  I am going to an organizing meeting on January 9, 2012 to see if I can figure out what they are up to, and I'll report back.

By the way, Cenk Uygur says that MSNBC told him that the channel was now "mainstream" with the government and he didn't fit in.  Anyway, he now has a program called Young Turks on a cable channel called Currrent TV.  I get it at 358 on Direct TV, and I watched it once.  His ideas are good, but the presentation is why over the top.

So we are back to Darin's question, I haven't got any other ideas.

Do you?  If so, let's hear them.

Wednesday, December 28, 2011

Jobs, Jobs, Jobs!!!!!!!!!!!!!!!!!!

Everybody who knows anything about how the U.S. economy works, knows that small businesses generate about 70% of all new jobs, year in, year out.

Small businesses in the U.S. are dying because they don't have enough customers so they don't have the cash flow to hire new employees.  Here are the stories of five small businesses that didn't have enough cash flow to stay alive, let alone hire new employees.  Instead, they joined the 400,000, or so, other small businesses that have disappeared since 2008.

Here is your assignment.  Read this short obituaries from the New York Times today, and tell me which story would have had a different outcome if they had had a Payroll Tax Cut? 

I am willing to guess that you will say, Not A Single One.  Now why can't the damn fools in Washington understand that simple fact???

5 Businesses That Failed To Survive Trials of 2011

It has been another tough year for many small businesses. One in four, according to the National Federation of Independent Business, believes the biggest problem is weak sales. No matter what other challenges they face, said William Dunkelberg, the federation’s chief economist, “the key to everything is cash coming in the front door.”
Inevitably there are businesses, like the Elizabeth Anne Bed & Breakfast in Crested Butte, Colo., that struggled. And inevitably, there are owners, like Kevin and Denise Reinert of Elizabeth Anne, who held on as long as they could. “We kept thinking we could turn it around,” Ms. Reinert said. “We rented out rooms until the day we moved out.”
Here are the stories of five small businesses that were not able to survive 2011.
A Poorly Timed Refinancing
The Elizabeth Anne Bed & Breakfast was bought in 2003 for $650,000 and closed last August.
AT ITS PEAK After buying the Elizabeth Anne, the Reinerts steadily increased revenue, from $78,000 in 2004 to $104,000 in 2007. “We got to know the guests,” Mr. Reinert said, “and they got to know each other.”
WHAT WENT WRONG In 2007, the couple refinanced, taking out some equity to renovate the kitchen. They wound up with a 10-year, interest-only loan that increased their mortgage payment by $1,700 a month. But with people taking fewer vacations, Mr. Reinert said, revenue declined 21 percent in 2009. In 2010, they fell behind on their mortgage payments and were not able to modify the loan. The bank foreclosed in June.
LOOKING BACK Ms. Reinert blames the refinancing: “It’s what did us in. Back then, we didn’t anticipate things slowing down.” Today, the Reinerts run KR Construction, which does handyman jobs. Ms. Reinert also works at a local restaurant, and Mr. Reinert plays bass in a Beatles tribute band, Dr. Robert.
‘We Did Everything Right’
Just Moulding, based in Gaithersburg, Md., sold and installed decorative molding. It opened in 2004 and closed last April.
AT ITS PEAK Mark Rubin and Kevin Wales started with a single workshop that handled small jobs larger installers did not want. In 2007 things were going so well they decided to sell franchises in the business and raised $700,000 from 21 investors. After Mr. Wales left the company in 2010, Mr. Rubin’s father-in-law, Richard Hayman, took over as president. Soon after, sales increased by 20 percent and the company became profitable.
WHAT WENT WRONG The recession. The company, Mr. Hayman said, sold a product that people wanted but did not need: “It was crown molding, not a furnace or a roof.” And while the business had the high legal and accounting costs associated with selling franchises, it had sold only three by the end of 2009. Potential franchisees had trouble raising the $100,000 to $250,000 needed to get started.
LOOKING BACK “We did everything right,” said Mr. Hayman, who sank $470,000 into the company. “We hired the best people and had a great product. We could not overcome the bad economy.” He and Mr. Rubin declined to discuss what they are doing now.
When 1% Is a Lot of Money
P & H Capital, a commercial mortgage company in Brooklyn that specialized in finding loans for small businesses, opened in 2009 and closed last March.
AT ITS PEAK Shawn Porat and Ismail Humet started P & H Capital with $4,000 while Mr. Humet was working as a Wall Street analyst and Mr. Porat was running Recovery of Judgment, which helps clients collect legal judgments. The friends saw the subprime crisis and tightening of credit as an opportunity, believing they could match small businesses with lenders offering alternative financing. In January 2010, Mr. Humet and Mr. Porat were piecing together a $500 million deal that they believed had a good chance of working. “Our commission was 1 percent,” Mr. Humet said, “and 1 percent of $500 million is a lot of money.”
WHAT WENT WRONG For one thing, the big deal fell apart. Lenders were skittish because the money would be used to build a factory in Asia, Mr. Humet said, and they were wary of dealing with a foreign government. In addition, lenders wound up imposing stricter parameters for alternative loans. He also said that P & H clients often had unrealistic expectations about how much money they could get. “We had a restaurant owner that needed $300,000 to open another location, but we could only get him $150,000,” Mr. Humet said. “He didn’t go through with it.”
LOOKING BACK Mr. Humet said he and Mr. Porat did not anticipate how difficult it would be to place even their best applicant’s loans. Since closing P & H, Mr. Humet has helped start, which promotes small businesses online using free giveaways. Mr. Porat operates Recovery of Judgment and Judgment Marketplace, an online marketplace where monetary judgments can be bought, sold and traded.
Poor Cost Projections
ScooterFood, a maker of all-natural dog food based in Brooklyn, opened in 2006 and closed last August.
AT ITS PEAK Shortly after Sept. 11, 2001, Michelle Lewis found herself unemployed when the online art gallery where she worked — in the shadow of the World Trade Center — went out of business. An animal lover with time on her hands, she began cooking all-natural meals for her dog, Scooter Mae, who did not like canned food. Friends suggested she turn the meals into a business, and in 2006, she started ScooterFood. The company was promising enough to win a second prize award of $5,000 at the PowerUP! Business Plan Competition at the Brooklyn Public Library in 2006.
WHAT WENT WRONG Ms. Lewis said her business plan was more hopeful than it should have been. Because her food was perishable, she sold it frozen — but did not realize that in 2006 few pet stores had freezer space. In part because frozen food was expensive to ship, ScooterFood was priced higher than other dog foods.
LOOKING BACK Ms. Lewis said she should not have done her own bookkeeping: “I didn’t project my costs well and never really knew if my revenue was covering them.” Over five years she invested about $60,000. With a clearer picture, she said, she might have closed the business sooner. In September, Ms. Lewis started Spoonable, a line of caramel sauces. She has hired outside bookkeeping help.
The Missing Profits
SmartyVA was an online training program for virtual assistants who specialize in social media management that was based in San Luis Obispo, Calif. It opened in 2009 and closed last February.
AT ITS PEAK In 2009 Starr Hall, a public relations consultant who was overwhelmed with requests for social media help, saw an opportunity. She invested $10,000 to create SmartyVA training materials and a Web site with a search engine that aggregated job leads. The six-week training program cost $1,000 and was aimed at stay-at-home mothers and disenfranchised women, like victims of domestic violence. When graduates took jobs through leads on the site, SmartyVA received 10 percent of their earnings. The company generated $100,000 in revenue its first six months.
WHAT WENT WRONG SmartyVA’s profitability depended on graduates following up on job leads they received through the system. “A hundred virtual assistants finished the program, but only 21 of them were working,” Ms. Hall said. “If all of them had been working, profits would have been huge.”
LOOKING BACK “I didn’t anticipate how different the mindset of the women I was training was from my own,” she said. Ms. Hall has returned to consulting. Her new book is, “The Social Wave: Why Your Business Is Wiping Out with Social Media and How to Fix It.”

Continuing The Fact vs Opinion Discussion

We talked about the difference between facts and opinions concerning end of life issues.  Now let's take the same discussion to the second most important aspect of U.S. health care costs, e.g., Chronic Diseases.  And obesity, and the related diabetes, are the second largest cost in U.S. health care (after end of life issues).

Here are some related facts:
*The U.S. spends 16%-18% (depends on who is counting) of our Gross National Product (our national income) on health care.
*That is about twice as much as any other developed country.
*We get worse results from that expenditure than any other developed country, i.e., higher infant mortality, shorter life span, etc.
*Health care costs are growing 3%-4% (again, depends on who is counting), and that is faster than the economy is growing and faster than inflation is growing.
*One third of the U.S. population is overweight and another third is clinically obese.
*The trend to obesity is found throughout the developed world.
*If the current rate of growth of health care costs is not stopped, health care costs will bankrupt the country sooner or later.
*There is nothing in Obamacare to stop this growth, or even slow it down.

Having said that, there is a large "disagreement" in the scientific community about the role of environment in the development of obesity.  This article in today's Los Angeles Times makes that point brilliantly clear.

A vast child obesity gap between affluent city, lower-income one

Manhattan Beach has the lowest child obesity rate in L.A. County, Bell Gardens the highest. Their demographics are starkly different, and residents' perceptions on the issue can contrast sharply.

By Anna Gorman, Los Angeles Times
December 28, 2011
Doris Chang limits her three sons' intake of sweets and doesn't feed them any processed or frozen food. At their Manhattan Beach home, she monitors the boys' time in front of the television and keeps them busy with baseball, basketball and karate.

About 20 miles to the northeast, Lorena Hernandez takes her 6-year-old daughter to McDonald's at least twice a week and frequently gives her Kool-Aid and soda. They go to the park often, but when they are in their Bell Gardens home, the television is usually on.

The families' divergent attitudes toward food and exercise reflect just part of the challenge facing officials as they try to close a vast and costly gap in obesity rates across the region.

Just 4% of children in affluent, mostly white Manhattan Beach are considered obese, the lowest rate countywide, according to public health officials. In poor, predominantly Latino Bell Gardens, the rate is 36% higher than in any other city.

"They are like two different worlds," said Paul Simon, who directs chronic disease prevention for the county health department.

Obesity among the young is starting to level off in California and around the nation. But stark disparities persist, posing vexing obstacles to further change.

In Los Angeles County alone, the obesity epidemic costs about $12 billion a year for healthcare and in lost productivity, according to a 2006 report by the California Center for Public Health Advocacy.

The challenges are plain at the Bell Gardens Community Health Clinic, where physician Jacqueline Lopez, deals with the consequences: diabetes and heart disease. She delicately coaches families to pick healthful foods and break through cultural barriers. Many Latino parents, she said, simply don't recognize the risks of their children being overweight.

"There is a misperception that bigger children are healthier children," she said. "I am trying to be sensitive, but really what we are talking about is these children are at risk of having a shortened life span."

Arturo Gonzalez said his 13-year-old daughter's doctor recently told him she is 30 pounds overweight and showing early signs of diabetes. "I am worried," he said, watching his 5-year-old son play on a swing set in a Bell Gardens park. "We talk about the consequences of being overweight.... She listens, but it goes in one ear and out the other."

Gonzalez said his children watch too much television, snack too much and complain when he makes them take walks. He has enrolled his daughter in an after-school program to cut down on TV time and snacking.

But he doesn't think poverty is a culprit. "In Mexico, we were poor, but we weren't overweight," he said, recalling that children in his homeland drank water instead of soda and walked a lot.

Bell Gardens' officials are trying to combat the problem. They recently declared obesity a "serious public health threat," banned sodas from park vending machines and are discussing adding track and fitness equipment as part of a park renovation.

"We are trying policy-wise to make changes, but we can't dictate what parents do in their homes," said city recreation director Pam Wasserman. For parents on tight budgets, she said, healthful food isn't always the least expensive option. "It is hard for us to compete with 10 tacos for $10."

Lorena Hernandez said her family often chooses fast-food restaurants because they are cheap. At home, she cooks Mexican specialties, such as beans, rice, tortillas and soups. Her husband has diabetes, but both she and her 6-year-old daughter, Leanne, are thin, so she doesn't worry about what they eat. "We don't really talk about it at home, honestly," she said.

Bell Gardens falls at the opposite end from Manhattan Beach on many economic and demographic indexes.

About 80% of Manhattan Beach's 36,000 residents are white, and the median household income is $127,000. Only 3% of people are living in poverty and three-fourths of residents over 25 have college degrees. There was a single homicide and 48 other violent crimes in 2010, according to the FBI.

There are relatively few fast-food restaurants and several upscale grocery stores emphasizing fresh foods, including Trader Joe's, Whole Foods and Bristol Farms.

In Bell Gardens, 96% of the 44,000 residents are Latino, and median household income is less than one-third of Manhattan Beach's. Nearly one in four residents lives in poverty and just 4% of those 25 or older have a college degree. Crime is far more prevalent, with five homicides and 210 other violent crimes in 2010.

A 2009 survey by the Campaign for a Healthier Bell Gardens, started by a community clinic, found 141 convenience or fast-food restaurants within the city's 2.4 square miles. Many grocery shopping options are smaller corner stores, where fresh produce choices and availability tend to be limited.

Researchers have drawn strong links between obesity and such socioeconomic disparities. Families in low-income areas are less aware of the harm that beverages and foods sweetened with high-fructose corn syrup can cause, said Dr. James Marks of the Robert Wood Johnson Foundation. And schools in low-income areas generally have fewer physical education programs and may offer less healthful options in school cafeteria lunches, he said.

"If people who want to make the healthy choices are unable to, they are not going to succeed," Marks said.

County health officials have noted more obesity in communities with less parkland, where children can get out and exercise. Manhattan Beach, for example, has 5.7 acres of parkland per 1,000 residents, more than three times the ratio in Bell Gardens, according to a 2007 report. And parks in poorer areas may be considered less safe and operate fewer hours, researchers say.

Health advocates are working with Bell Gardens' city government, businesses and educators, as well as the county, to plant gardens, hold mini-farmers markets and take mobile health clinics to schools, encouraging the students to become advocates of better diets and more exercise. A major challenge is getting families to prepare healthful versions of traditional Latino dishes.

"We are nowhere near where we need to be," said Lani Cupchoy, who is directing the health improvement campaign. "We can't really say we have a healthy city, but we are on the path."

Manhattan Beach Mayor Nicholas Tell noted that his city has a natural advantage to encourage healthy lifestyles: two miles of open waterfront. Residents ride bikes, run along the beach-side path or go surfing and play volleyball on the sand. "We have this amazing beach that tells people to go outside," he said.

Manhattan Beach resident Barbra Fontana, 46, a former professional volleyball player, said her sons — ages 6 and 8 — go boogie boarding or bike riding on weekends and play soccer, basketball and baseball other days. On a recent afternoon, they kicked a ball around Sand Dune Park as she looked on.

"This is what I like my kids to be doing," she said. "Sitting at a computer or a TV isn't my cup of tea."

The differences extend indoors. At the Manhattan Beach Trader Joe's, Chang, 39, filled her basket with fruit, bread, vegetables, eggs and yogurt. She generally avoids junk food, but lets the grandparents occasionally take the children out for ice cream or to McDonald's.

"I'm not inspecting every single package," she said. "But I try to eat wholesome foods.


Now, having read that article highlighting the different environmental conditions in the two cities, it seems likely that you would attack obesity by changing some people's environments.  But wait a minute here.  What if a propensity to be obese is inherent?  What would you do then?  But why would Manhattan Beach children have a different propensity than children in Bell Gardens?  So it appears we have a hugely complicated mixture of opinion and mini-facts.  How do we sort them out?

December 28, 2011

The Fat Trap

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again. “It has always seemed strange to me,” says Proietto, who is a physician at the University of Melbourne. “These are people who are very motivated to lose weight, who achieve weight loss most of the time without too much trouble and yet, inevitably, gradually, they regain the weight.”
Anyone who has ever dieted knows that lost pounds often return, and most of us assume the reason is a lack of discipline or a failure of willpower. But Proietto suspected that there was more to it, and he decided to take a closer look at the biological state of the body after weight loss.
Beginning in 2009, he and his team recruited 50 obese men and women. The men weighed an average of 233 pounds; the women weighed about 200 pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks. Ten weeks in, the dieters lost an average of 30 pounds.
At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.
While researchers have known for decades that the body undergoes various metabolic and hormonal changes while it’s losing weight, the Australian team detected something new. A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.
“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”
While the findings from Proietto and colleagues, published this fall in The New England Journal of Medicine, are not conclusive — the study was small and the findings need to be replicated — the research has nonetheless caused a stir in the weight-loss community, adding to a growing body of evidence that challenges conventional thinking about obesity, weight loss and willpower. For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more. While there is truth to this guidance, it fails to take into account that the human body continues to fight against weight loss long after dieting has stopped. This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat.
I have always felt perplexed about my inability to keep weight off. I know the medical benefits of weight loss, and I don’t drink sugary sodas or eat fast food. I exercise regularly — a few years ago, I even completed a marathon. Yet during the 23 years since graduating from college, I’ve lost 10 or 20 pounds at a time, maintained it for a little while and then gained it all back and more, to the point where I am now easily 60 pounds overweight.
I wasn’t overweight as a child, but I can’t remember a time when my mother, whose weight probably fluctuated between 150 and 250 pounds, wasn’t either on a diet or, in her words, cheating on her diet. Sometimes we ate healthful, balanced meals; on other days dinner consisted of a bucket of Kentucky Fried Chicken. As a high-school cross-country runner, I never worried about weight, but in college, when my regular training runs were squeezed out by studying and socializing, the numbers on the scale slowly began to move up. As adults, my three sisters and I all struggle with weight, as do many members of my extended family. My mother died of esophageal cancer six years ago. It was her great regret that in the days before she died, the closest medical school turned down her offer to donate her body because she was obese.
It’s possible that the biological cards were stacked against me from the start. Researchers know that obesity tends to run in families, and recent science suggests that even the desire to eat higher-calorie foods may be influenced by heredity. But untangling how much is genetic and how much is learned through family eating habits is difficult. What is clear is that some people appear to be prone to accumulating extra fat while others seem to be protected against it.
In a seminal series of experiments published in the 1990s, the Canadian researchers Claude Bouchard and Angelo Tremblay studied 31 pairs of male twins ranging in age from 17 to 29, who were sometimes overfed and sometimes put on diets. (None of the twin pairs were at risk for obesity based on their body mass or their family history.) In one study, 12 sets of the twins were put under 24-hour supervision in a college dormitory. Six days a week they ate 1,000 extra calories a day, and one day they were allowed to eat normally. They could read, play video games, play cards and watch television, but exercise was limited to one 30-minute daily walk. Over the course of the 120-day study, the twins consumed 84,000 extra calories beyond their basic needs.
That experimental binge should have translated into a weight gain of roughly 24 pounds (based on 3,500 calories to a pound). But some gained less than 10 pounds, while others gained as much as 29 pounds. The amount of weight gained and how the fat was distributed around the body closely matched among brothers, but varied considerably among the different sets of twins. Some brothers gained three times as much fat around their abdomens as others, for instance. When the researchers conducted similar exercise studies with the twins, they saw the patterns in reverse, with some twin sets losing more pounds than others on the same exercise regimen. The findings, the researchers wrote, suggest a form of “biological determinism” that can make a person susceptible to weight gain or loss.
But while there is widespread agreement that at least some risk for obesity is inherited, identifying a specific genetic cause has been a challenge. In October 2010, the journal Nature Genetics reported that researchers have so far confirmed 32 distinct genetic variations associated with obesity or body-mass index. One of the most common of these variations was identified in April 2007 by a British team studying the genetics of Type 2 diabetes. According to Timothy Frayling at the Institute of Biomedical and Clinical Science at the University of Exeter, people who carried a variant known as FTO faced a much higher risk of obesity — 30 percent higher if they had one copy of the variant; 60 percent if they had two.
This FTO variant is surprisingly common; about 65 percent of people of European or African descent and an estimated 27 to 44 percent of Asians are believed to carry at least one copy of it. Scientists don’t understand how the FTO variation influences weight gain, but studies in children suggest the trait plays a role in eating habits. In one 2008 study led by Colin Palmer of the University of Dundee in Scotland, Scottish schoolchildren were given snacks of orange drinks and muffins and then allowed to graze on a buffet of grapes, celery, potato chips and chocolate buttons. All the food was carefully monitored so the researchers knew exactly what was consumed. Although all the children ate about the same amount of food, as weighed in grams, children with the FTO variant were more likely to eat foods with higher fat and calorie content. They weren’t gorging themselves, but they consumed, on average, about 100 calories more than children who didn’t carry the gene. Those who had the gene variant had about four pounds more body fat than noncarriers.
I have been tempted to send in my own saliva sample for a DNA test to find out if my family carries a genetic predisposition for obesity. But even if the test came back negative, it would only mean that my family doesn’t carry a known, testable genetic risk for obesity. Recently the British television show “Embarrassing Fat Bodies” asked Frayling’s lab to test for fat-promoting genes, and the results showed one very overweight family had a lower-than-average risk for obesity.
A positive result, telling people they are genetically inclined to stay fat, might be self-fulfilling. In February, The New England Journal of Medicine published a report on how genetic testing for a variety of diseases affected a person’s mood and health habits. Over all, the researchers found no effect from disease-risk testing, but there was a suggestion, though it didn’t reach statistical significance, that after testing positive for fat-promoting genes, some people were more likely to eat fatty foods, presumably because they thought being fat was their genetic destiny and saw no sense in fighting it.
While knowing my genetic risk might satisfy my curiosity, I also know that heredity, at best, would explain only part of why I became overweight. I’m much more interested in figuring out what I can do about it now.
The National Weight Control Registry tracks 10,000 people who have lost weight and have kept it off. “We set it up in response to comments that nobody ever succeeds at weight loss,” says Rena Wing, a professor of psychiatry and human behavior at Brown University’s Alpert Medical School, who helped create the registry with James O. Hill, director of the Center for Human Nutrition at the University of Colorado at Denver. “We had two goals: to prove there were people who did, and to try to learn from them about what they do to achieve this long-term weight loss.” Anyone who has lost 30 pounds and kept it off for at least a year is eligible to join the study, though the average member has lost 70 pounds and remained at that weight for six years.
Wing says that she agrees that physiological changes probably do occur that make permanent weight loss difficult, but she says the larger problem is environmental, and that people struggle to keep weight off because they are surrounded by food, inundated with food messages and constantly presented with opportunities to eat. “We live in an environment with food cues all the time,” Wing says. “We’ve taught ourselves over the years that one of the ways to reward yourself is with food. It’s hard to change the environment and the behavior.”
There is no consistent pattern to how people in the registry lost weight — some did it on Weight Watchers, others with Jenny Craig, some by cutting carbs on the Atkins diet and a very small number lost weight through surgery. But their eating and exercise habits appear to reflect what researchers find in the lab: to lose weight and keep it off, a person must eat fewer calories and exercise far more than a person who maintains the same weight naturally. Registry members exercise about an hour or more each day — the average weight-loser puts in the equivalent of a four-mile daily walk, seven days a week. They get on a scale every day in order to keep their weight within a narrow range. They eat breakfast regularly. Most watch less than half as much television as the overall population. They eat the same foods and in the same patterns consistently each day and don’t “cheat” on weekends or holidays. They also appear to eat less than most people, with estimates ranging from 50 to 300 fewer daily calories.
Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, says that while the 10,000 people tracked in the registry are a useful resource, they also represent a tiny percentage of the tens of millions of people who have tried unsuccessfully to lose weight. “All it means is that there are rare individuals who do manage to keep it off,” Brownell says. “You find these people are incredibly vigilant about maintaining their weight. Years later they are paying attention to every calorie, spending an hour a day on exercise. They never don’t think about their weight.”
Janice Bridge, a registry member who has successfully maintained a 135-pound weight loss for about five years, is a perfect example. “It’s one of the hardest things there is,” she says. “It’s something that has to be focused on every minute. I’m not always thinking about food, but I am always aware of food.”
Bridge, who is 66 and lives in Davis, Calif., was overweight as a child and remembers going on her first diet of 1,400 calories a day at 14. At the time, her slow pace of weight loss prompted her doctor to accuse her of cheating. Friends told her she must not be paying attention to what she was eating. “No one would believe me that I was doing everything I was told,” she says. “You can imagine how tremendously depressing it was and what a feeling of rebellion and anger was building up.”
After peaking at 330 pounds in 2004, she tried again to lose weight. She managed to drop 30 pounds, but then her weight loss stalled. In 2006, at age 60, she joined a medically supervised weight-loss program with her husband, Adam, who weighed 310 pounds. After nine months on an 800-calorie diet, she slimmed down to 165 pounds. Adam lost about 110 pounds and now weighs about 200.
During the first years after her weight loss, Bridge tried to test the limits of how much she could eat. She used exercise to justify eating more. The death of her mother in 2009 consumed her attention; she lost focus and slowly regained 30 pounds. She has decided to try to maintain this higher weight of 195, which is still 135 pounds fewer than her heaviest weight.
“It doesn’t take a lot of variance from my current maintenance for me to pop on another two or three pounds,” she says. “It’s been a real struggle to stay at this weight, but it’s worth it, it’s good for me, it makes me feel better. But my body would put on weight almost instantaneously if I ever let up.”
So she never lets up. Since October 2006 she has weighed herself every morning and recorded the result in a weight diary. She even carries a scale with her when she travels. In the past six years, she made only one exception to this routine: a two-week, no-weigh vacation in Hawaii.
She also weighs everything in the kitchen. She knows that lettuce is about 5 calories a cup, while flour is about 400. If she goes out to dinner, she conducts a Web search first to look at the menu and calculate calories to help her decide what to order. She avoids anything with sugar or white flour, which she calls her “gateway drugs” for cravings and overeating. She has also found that drinking copious amounts of water seems to help; she carries a 20-ounce water bottle and fills it five times a day. She writes down everything she eats. At night, she transfers all the information to an electronic record. Adam also keeps track but prefers to keep his record with pencil and paper.
“That transfer process is really important; it’s my accountability,” she says. “It comes up with the total number of calories I’ve eaten today and the amount of protein. I do a little bit of self-analysis every night.”
Bridge and her husband each sought the help of therapists, and in her sessions, Janice learned that she had a tendency to eat when she was bored or stressed. “We are very much aware of how our culture taught us to use food for all kinds of reasons that aren’t related to its nutritive value,” Bridge says.
Bridge supports her careful diet with an equally rigorous regimen of physical activity. She exercises from 100 to 120 minutes a day, six or seven days a week, often by riding her bicycle to the gym, where she takes a water-aerobics class. She also works out on an elliptical trainer at home and uses a recumbent bike to “walk” the dog, who loves to run alongside the low, three-wheeled machine. She enjoys gardening as a hobby but allows herself to count it as exercise on only those occasions when she needs to “garden vigorously.” Adam is also a committed exerciser, riding his bike at least two hours a day, five days a week.
Janice Bridge has used years of her exercise and diet data to calculate her own personal fuel efficiency. She knows that her body burns about three calories a minute during gardening, about four calories a minute on the recumbent bike and during water aerobics and about five a minute when she zips around town on her regular bike.
“Practically anyone will tell you someone biking is going to burn 11 calories a minute,” she says. “That’s not my body. I know it because of the statistics I’ve kept.”
Based on metabolism data she collected from the weight-loss clinic and her own calculations, she has discovered that to keep her current weight of 195 pounds, she can eat 2,000 calories a day as long as she burns 500 calories in exercise. She avoids junk food, bread and pasta and many dairy products and tries to make sure nearly a third of her calories come from protein. The Bridges will occasionally share a dessert, or eat an individual portion of Ben and Jerry’s ice cream, so they know exactly how many calories they are ingesting. Because she knows errors can creep in, either because a rainy day cuts exercise short or a mismeasured snack portion adds hidden calories, she allows herself only 1,800 daily calories of food. (The average estimate for a similarly active woman of her age and size is about 2,300 calories.)
Just talking to Bridge about the effort required to maintain her weight is exhausting. I find her story inspiring, but it also makes me wonder whether I have what it takes to be thin. I have tried on several occasions (and as recently as a couple weeks ago) to keep a daily diary of my eating and exercise habits, but it’s easy to let it slide. I can’t quite imagine how I would ever make time to weigh and measure food when some days it’s all I can do to get dinner on the table between finishing my work and carting my daughter to dance class or volleyball practice. And while I enjoy exercising for 30- or 40-minute stretches, I also learned from six months of marathon training that devoting one to two hours a day to exercise takes an impossible toll on my family life.
Bridge concedes that having grown children and being retired make it easier to focus on her weight. “I don’t know if I could have done this when I had three kids living at home,” she says. “We know how unusual we are. It’s pretty easy to get angry with the amount of work and dedication it takes to keep this weight off. But the alternative is to not keep the weight off. ”
“I think many people who are anxious to lose weight don’t fully understand what the consequences are going to be, nor does the medical community fully explain this to people,” Rudolph Leibel, an obesity researcher at Columbia University in New York, says. “We don’t want to make them feel hopeless, but we do want to make them understand that they are trying to buck a biological system that is going to try to make it hard for them.”
Leibel and his colleague Michael Rosenbaum have pioneered much of what we know about the body’s response to weight loss. For 25 years, they have meticulously tracked about 130 individuals for six months or longer at a stretch. The subjects reside at their research clinic where every aspect of their bodies is measured. Body fat is determined by bone-scan machines. A special hood monitors oxygen consumption and carbon-dioxide output to precisely measure metabolism. Calories burned during digestion are tracked. Exercise tests measure maximum heart rate, while blood tests measure hormones and brain chemicals. Muscle biopsies are taken to analyze their metabolic efficiency. (Early in the research, even stool samples were collected and tested to make sure no calories went unaccounted for.) For their trouble, participants are paid $5,000 to $8,000.
Eventually, the Columbia subjects are placed on liquid diets of 800 calories a day until they lose 10 percent of their body weight. Once they reach the goal, they are subjected to another round of intensive testing as they try to maintain the new weight. The data generated by these experiments suggest that once a person loses about 10 percent of body weight, he or she is metabolically different than a similar-size person who is naturally the same weight.
The research shows that the changes that occur after weight loss translate to a huge caloric disadvantage of about 250 to 400 calories. For instance, one woman who entered the Columbia studies at 230 pounds was eating about 3,000 calories to maintain that weight. Once she dropped to 190 pounds, losing 17 percent of her body weight, metabolic studies determined that she needed about 2,300 daily calories to maintain the new lower weight. That may sound like plenty, but the typical 30-year-old 190-pound woman can consume about 2,600 calories to maintain her weight — 300 more calories than the woman who dieted to get there.
Scientists are still learning why a weight-reduced body behaves so differently from a similar-size body that has not dieted. Muscle biopsies taken before, during and after weight loss show that once a person drops weight, their muscle fibers undergo a transformation, making them more like highly efficient “slow twitch” muscle fibers. A result is that after losing weight, your muscles burn 20 to 25 percent fewer calories during everyday activity and moderate aerobic exercise than those of a person who is naturally at the same weight. That means a dieter who thinks she is burning 200 calories during a brisk half-hour walk is probably using closer to 150 to 160 calories.
Another way that the body seems to fight weight loss is by altering the way the brain responds to food. Rosenbaum and his colleague Joy Hirsch, a neuroscientist also at Columbia, used functional magnetic resonance imaging to track the brain patterns of people before and after weight loss while they looked at objects like grapes, Gummi Bears, chocolate, broccoli, cellphones and yo-yos. After weight loss, when the dieter looked at food, the scans showed a bigger response in the parts of the brain associated with reward and a lower response in the areas associated with control. This suggests that the body, in order to get back to its pre-diet weight, induces cravings by making the person feel more excited about food and giving him or her less willpower to resist a high-calorie treat.
“After you’ve lost weight, your brain has a greater emotional response to food,” Rosenbaum says. “You want it more, but the areas of the brain involved in restraint are less active.” Combine that with a body that is now burning fewer calories than expected, he says, “and you’ve created the perfect storm for weight regain.” How long this state lasts isn’t known, but preliminary research at Columbia suggests that for as many as six years after weight loss, the body continues to defend the old, higher weight by burning off far fewer calories than would be expected. The problem could persist indefinitely. (The same phenomenon occurs when a thin person tries to drop about 10 percent of his or her body weight — the body defends the higher weight.) This doesn’t mean it’s impossible to lose weight and keep it off; it just means it’s really, really difficult.
Lynn Haraldson, a 48-year-old woman who lives in Pittsburgh, reached 300 pounds in 2000. She joined Weight Watchers and managed to take her 5-foot-5 body down to 125 pounds for a brief time. Today, she’s a member of the National Weight Control Registry and maintains about 140 pounds by devoting her life to weight maintenance. She became a vegetarian, writes down what she eats every day, exercises at least five days a week and blogs about the challenges of weight maintenance. A former journalist and antiques dealer, she returned to school for a two-year program on nutrition and health; she plans to become a dietary counselor. She has also come to accept that she can never stop being “hypervigilant” about what she eats. “Everything has to change,” she says. “I’ve been up and down the scale so many times, always thinking I can go back to ‘normal,’ but I had to establish a new normal. People don’t like hearing that it’s not easy.”
What’s not clear from the research is whether there is a window during which we can gain weight and then lose it without creating biological backlash. Many people experience transient weight gain, putting on a few extra pounds during the holidays or gaining 10 or 20 pounds during the first years of college that they lose again. The actor Robert De Niro lost weight after bulking up for his performance in “Raging Bull.” The filmmaker Morgan Spurlock also lost the weight he gained during the making of “Super Size Me.” Leibel says that whether these temporary pounds became permanent probably depends on a person’s genetic risk for obesity and, perhaps, the length of time a person carried the extra weight before trying to lose it. But researchers don’t know how long it takes for the body to reset itself permanently to a higher weight. The good news is that it doesn’t seem to happen overnight.
“For a mouse, I know the time period is somewhere around eight months,” Leibel says. “Before that time, a fat mouse can come back to being a skinny mouse again without too much adjustment. For a human we don’t know, but I’m pretty sure it’s not measured in months, but in years.”
Nobody wants to be fat. In most modern cultures, even if you are healthy — in my case, my cholesterol and blood pressure are low and I have an extraordinarily healthy heart — to be fat is to be perceived as weak-willed and lazy. It’s also just embarrassing. Once, at a party, I met a well-respected writer who knew my work as a health writer. “You’re not at all what I expected,” she said, eyes widening. The man I was dating, perhaps trying to help, finished the thought. “You thought she’d be thinner, right?” he said. I wanted to disappear, but the woman was gracious. “No,” she said, casting a glare at the man and reaching to warmly shake my hand. “I thought you’d be older.”
If anything, the emerging science of weight loss teaches us that perhaps we should rethink our biases about people who are overweight. It is true that people who are overweight, including myself, get that way because they eat too many calories relative to what their bodies need. But a number of biological and genetic factors can play a role in determining exactly how much food is too much for any given individual. Clearly, weight loss is an intense struggle, one in which we are not fighting simply hunger or cravings for sweets, but our own bodies.
While the public discussion about weight loss tends to come down to which diet works best (Atkins? Jenny Craig? Plant-based? Mediterranean?), those who have tried and failed at all of these diets know there is no simple answer. Fat, sugar and carbohydrates in processed foods may very well be culprits in the nation’s obesity problem. But there is tremendous variation in an individual’s response.
The view of obesity as primarily a biological, rather than psychological disease, could also lead to changes in the way we approach its treatment. Scientists at Columbia have conducted several small studies looking at whether injecting people with leptin, the hormone made by body fat, can override the body’s resistance to weight loss and help maintain a lower weight. In a few small studies, leptin injections appear to trick the body into thinking it’s still fat. After leptin replacement, study subjects burned more calories during activity. And in brain-scan studies, leptin injections appeared to change how the brain responded to food, making it seem less enticing. But such treatments are still years away from commercial development. For now, those of us who want to lose weight and keep it off are on our own.
One question many researchers think about is whether losing weight more slowly would make it more sustainable than the fast weight loss often used in scientific studies. Leibel says the pace of weight loss is unlikely to make a difference, because the body’s warning system is based solely on how much fat a person loses, not how quickly he or she loses it. Even so, Proietto is now conducting a study using a slower weight-loss method and following dieters for three years instead of one.
Given how hard it is to lose weight, it’s clear, from a public-health standpoint, that resources would best be focused on preventing weight gain. The research underscores the urgency of national efforts to get children to exercise and eat healthful foods.
But with a third of the U.S. adult population classified as obese, nobody is saying people who already are very overweight should give up on weight loss. Instead, the solution may be to preach a more realistic goal. Studies suggest that even a 5 percent weight loss can lower a person’s risk for diabetes, heart disease and other health problems associated with obesity. There is also speculation that the body is more willing to accept small amounts of weight loss.
But an obese person who loses just 5 percent of her body weight will still very likely be obese. For a 250-pound woman, a 5 percent weight loss of about 12 pounds probably won’t even change her clothing size. Losing a few pounds may be good for the body, but it does very little for the spirit and is unlikely to change how fat people feel about themselves or how others perceive them.
So where does that leave a person who wants to lose a sizable amount of weight? Weight-loss scientists say they believe that once more people understand the genetic and biological challenges of keeping weight off, doctors and patients will approach weight loss more realistically and more compassionately. At the very least, the science may compel people who are already overweight to work harder to make sure they don’t put on additional pounds. Some people, upon learning how hard permanent weight loss can be, may give up entirely and return to overeating. Others may decide to accept themselves at their current weight and try to boost their fitness and overall health rather than changing the number on the scale.
For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight. And even though all the evidence suggests that it’s going to be very, very difficult for me to reduce my weight permanently, I’m surprisingly optimistic. I may not be ready to fight this battle this month or even this year. But at least I know what I’m up against.
Tara Parker-Pope is the editor of the Well blog


And finally, remember at all times, we are always talking about money here, and that we are currently borrowing $4 out of every $10 we spend.  And the Cowardly Lion just raised the limit on the National Debt to $16 Trillion!  Does anybody know what a Trillion means?

Some Good News For A Change

Let me make a point first.  Anon recently accused me of having an "opinion" about removing the cap from Social Security to solve that problem forever.  In this rant, I try to present a wide variety of opinions that I think have a real basis in facts.  But when I present a fact directly, it is just that, A FACT.  Anon seems to have difficulty to understanding that distinction.

For example, I have found four very good research studies that meet all the requirements of scientific methodology and produce clear findings, and conclude that the majority of healthcare expenses in the U.S. are spent at the end of life.  That is a fact!  What is an "opinion" is what to do about it.

So the good news is that Steve Lopez (and I assume there are others in other media) is beginning to bring the topic out of the nether land created by the Wicked Witch of the North.  Death is not an Option.  How it happens is an Option.  And believe me, I am old enough so that this topic is not just academic.

So here is Steve Lopez in today's Los Angeles Times continuing his exploration of the topic.  Good on ya, Steve.

Open the discussion on dying

Taboos shouldn't prevent us from having important conversations about end-of-life issues to spare loved ones the trauma of making difficult decisions alone.

Steve Lopez
December 28, 2011
Last week, my dad was taken on a practice run from his Northern California nursing home back to his house. He'd had recent hip surgery, and the idea was that if he could master the challenge of getting in and out of the car and the wheelchair, he could leave the facility and begin hospice care in his own home.

But first he had to get there. You go down by the high school, my dad told his driver, an aide from the nursing center. The school, which my dad attended 65 years ago, was in precisely the wrong direction. But he told the driver to keep going, directing him past the primary school and toward the San Joaquin River, also in the wrong direction.

The confusion was cleared up with a call to my mother, who was waiting for them in the house that she and my father have lived in for the last half-century. My father hadn't remembered how to get to that house, but he had remembered how to get to the part of town where he had grown up, with five brothers and sisters, all of them now long gone. It was as though his mind had worked an elegant trick, guiding him back to where his life began, and, in a sense, truly taking him home.

In the past year, my dad has found himself in a lot of unexpected places — physically and emotionally — as he nears the end of life. And he's taken the family along with him. It's amazing to me now, looking back, how little I really thought about the end of life, other than its inevitability. I'm not alone.

About 75 million boomers are approaching old age, and it's no wonder they're beginning to have questions about the way we die, even if they're not sure how to raise them. My dad has always been one to start conversations with strangers, and a lot of people who've been reading about his challenges have wanted in on this one.

Over the past year I've had the privilege of meeting and talking to people as they approach the great unmentionable with varying degrees of fear and courage, resistance and surrender. Many more have shared the very personal details of their own journeys at, offering advice on the many medical, moral and legal end-of-life quandaries.

And it turns out we have a lot to learn from one another.

I'm thinking back now on my friend Lawrence Tolliver, a barber whose own son died of cancer this year just before my father turned critically ill. I accompanied Tolliver to a mortuary, where he bravely gave his son a proper haircut for his funeral. I'll never forget Tolliver's loving tribute from a church pulpit, celebrating his namesake's life and telling mourners his son's suffering had come to a merciful end.

In Los Feliz, Freddie Ramos, who decided against more chemo to treat his advancing cancer, told me that "living in fear of death is no way to live." And in Santa Barbara, Colleen Kegg lamented the absence of a death with dignity law in California and discussed her plan to starve herself when a terminal neurological disorder advances. "I am a strong believer in the fact that life is about quality, not quantity," she wrote in a statement documenting her end-of-life wishes. In Santa Clarita, as he made house calls, geriatric doctor Gene Dorio told me of his deep respect for his patients' choices — those who want to let go and those who insist on fighting for every breath.

What I've learned along the way is that we have to get past the fears and cultural taboos that prevent us from discussing death with loved ones. We need to make our wishes known in advance healthcare directives, sparing friends and family the psychological trauma of impossibly difficult decisions. We need more information on end-of-life choices and broad reforms of Medicare, which gladly pays for the tools of slow suffering in terminal patients — feeding tubes, hip replacements, etc.— but is stingier about paying for palliative care despite lower costs and higher patient satisfaction.

One of the great tragedies and cruel ironies of American politics is that we stand no chance of hearing workable solutions or honest discussion from candidates in an election year. So a popular demand for policy changes may be the only hope, and I invite you to make yourself heard at The Times' Life and Death page. I'm sure my dad would appreciate your contribution, given his genetic, long-standing lack of faith in the ability of Congress or the White House to lead the way on matters of great importance.

I flew north to see him Monday, and hospice care has gotten off to a rough start. Not so much for him; he's thrilled to be out of hospitals and nursing homes and back in his humble castle. But my mother and sister are the primary caregivers, and the physical and emotional demands are wearing them down. I worry as much now about their health as I do about my father's many life-threatening conditions. The task this week will be figuring out whether to hire backup help when hospice staff isn't there or to instead move him into assisted living, which he strongly opposes.

You see a once-vital man this compromised and your heart aches.

Maybe the last gift you get from someone you love, before they're gone, is a greater appreciation of life. Freddie Ramos put it perfectly. "Living in fear of death is no way to live."

On Monday, my family did what we've always done at this time of year. We had a nice meal, put on some holiday music and played cards. A part of my father was there with us. Another part of him may have been wondering how to get home.