XL Love: How the Obesity Crisis is Complicating America's Love Life by Sarah Varney

XL Love: How the Obesity Crisis is Complicating America's Love Life

bySarah Varney

Hardcover | August 19, 2014

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With two out of every three Americans overweight or obese, it''s all hands on deck—scientists are studying how excess fat changes physical and mental health, demographers are calculating how it''s shortening life spans, and economists are debating the impact it has on America''s productivity and global competitiveness. But how weight affects intimacy and sexuality is barely discussed.

Yet it''s a question of high importance for the tens of millions of Americans who are overweight or obese and having difficulty sexually and romantically. It is changing and complicating the mating game and married life alike; stunting the ability of young people to find happiness; and tipping some heavy, but otherwise happy, couples into divorce. For many, a larger body has meant a more troubled mind: a decline in sexual quality, an increase in self-loathing, and a tendency to let these factors stand in the way of love.

In XL Love, Varney travels the country and tells the personal stories of men and women who are experiencing what millions of others feel every day, along with the stories of those who are in the business of helping them: physicians, researchers, scientists, psychologists, sociologists, and more. Analytic and immersive, personal and eye-opening, XL Love tackles the question: How is sex changing in America as the shape of Americans changes?
SARAH VARNEY is a senior health policy correspondent with Kaiser Health News. Her stories air regularly on NPR News and the PBS News Hour and appear in the New York Times, Washington Post, USA Today, Politico Magazine, The Atlantic.com and KHN''s other print partners. She has reported extensively on health policy and health disparities...
Title:XL Love: How the Obesity Crisis is Complicating America's Love LifeFormat:HardcoverDimensions:256 pages, 9.2 X 6.2 X 1 inPublished:August 19, 2014Publisher:Potter/Ten Speed/Harmony/RodaleLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:1609614836

ISBN - 13:9781609614836

Appropriate for ages: All ages

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Read from the Book

CHAPTER ONEBeginnings: Puberty, Puppy Love, and the PromNorth of Jackson, the Mississippi Delta opens into a flat stretch of saturated, fertile earth between the Yazoo and Mississippi Rivers. In the winter and early spring, the fields along the country roads here are covered with snarled, dormant kudzu vines. The eerie gray vines are everywhere, and the totality of the takeover is startling: They hang in a brittle mop from trees; they turn hillsides into resting Snuffleupaguses with unruly coats of gray fur; they threaten to overtake dirt driveways. Kudzu has become the curse of the Delta: Farmers have tried to burn it, only to witness the irrepressible vines roaring back to life with lush leaves in summer. Entrepreneurs have tried to turn it into an earth- friendly biofuel, with little success. Livestock producers have set ravenous goats afield, only to find their four-chambered stomachs no match for the invasive plant''s virility.Like the impressively resistant kudzu, the disease of obesity, too, has crept into the Delta and the nation beyond. A rarity just a few decades ago, it is overtaking everything in its way--spreading through homes and schools, across cotton fields and catfish farms; altering the genes that parents pass down to their children; and disrupting how and when the very stages of life are marked, including the awkward progression from childhood to the sexual self.The Delta town of Belzoni--70 miles from Jackson--owes its existence to the slithering path of the Yazoo River and the tenacious and ugly catfish that bathe in its waters. The river forms the southern border of the town and provides the water for the area''s fabled catfish farmers. Some 40,000 acres are underwater, sunken to provide vast pools for farm-raised bottom- dwellers. The small town has dwindled in size in the last decade, but Belzoni persists in its claim as "Catfish Capital of the World." On the town''s main thoroughfare, 5-foot-tall painted catfish sculptures stand on their tails: a Superman with a curious brown fedora; a farmer in blue overalls; a whiskered dandy in a green bow tie.Propped up on the tidy brick sidewalk next to one of the sculptures is a handwritten chalkboard announcing the day''s lunchtime special at the Greasy Row Grill: fried pork chops. Inside the diner''s kitchen, a vat of grease crackles with a new order of fries. Just about anything goes into the fryer to be encased in a crispy, high-calorie coat of oil: green beans, mushrooms, cheese sticks, tamales, pickles, crawfish tails, and, of course, catfish.Yet even in a state that leads the nation in obesity, towns like Belzoni-- and the bodily changes in their children and teens--stand out.A team of researchers from the state health department descended upon nearly a dozen public elementary schools in the Delta during the winter of 2009-2010 and precisely measured the height, weight, and waist circumference of some 1,100 children between the ages of 6 and 11. Researchers determine body mass index--a common measurement of body fat--by dividing one''s weight in kilograms by the square of one''s height in meters, and for adults, BMI is widely viewed as a reliable indicator.1 But these researchers were even more concerned about the risks to children with rounded bellies and excess abdominal fat.Why? This type of fat puts them at greater risk for chronic diseases, such as type 2 diabetes and heart disease, than fat that sits on the hips and buttocks. The lead researcher, Abigail Gamble, PhD, and her colleagues suspected that the "normal," "overweight," and "obese" standards set by the Centers for Disease Control and Prevention were less reliable for children, and particularly for African American children, since the location of body fat in different racial groups can vary even when BMI is the same.2Instead, Dr. Gamble and her researchers would measure the children''s waist circumferences and determine their waist-to-height ratios. Those measurements, in addition to BMI, would give a more complete picture of the health of kids in the Delta.What they found was troubling even for a region in the Deep South used to bad news about big bodies: Based on BMI, nearly half of the elementary children were overweight or obese (18.3 percent were overweight and 28.8 percent obese).3 However, when they looked at the waist circumference measurements, almost 60 percent had enough fat around their bellies to put them at risk for weight-related chronic diseases, and 42 percent were at risk based on the waist-height ratio. And reflecting nationwide trends, the rate of obesity by BMI in the nearly all-black school districts was higher (31.9 percent), as were the percentages of children at risk for chronic diseases.A big belly is a dangerous thing, and to call the abdominal adipose tissue merely "fat" is to underestimate its power. Children as young as 9 have been found to be in a constant state of low-grade, systemic inflammation.4 As Health Affairs senior editor Jonathan Bor explained in his excellent piece, "The Science of Childhood Obesity," "Adipose tissues that gather around the waist contain not only fat, but immune-system cells called macrophages. These normally work to remove pathogens and dead cell debris from the body. But when secreted by fat, they can inf lame arteries and trigger cancers."5 These same white blood cells release chemicals that can lead to insulin resistance; as these children get older, they are more likely to face type 2 diabetes. Indeed, researchers now estimate that one out of every three boys and two out of every five girls born in the United States in the year 2000 will be diagnosed with diabetes during their lifetime.6Obesity and its perils now start almost as life begins, and its degree is becoming more extreme: One in eight preschoolers in the United States is now obese, and the percentage of obese children ages 6 to 11 years old increased from 7 percent in 1980 to nearly 18 percent in 2010. More children are pushing the boundaries of severe weight gain;7 the proportion of boys and girls with extreme waist circumferences and waist-to-height ratios has been increasing nationwide.8 And the heaviest children are becoming even heavier.Once the weight is on, it often stays on. Fatness in childhood is destiny later in life: 80 percent of obese teen boys and 92 percent of obese teen girls will remain obese during adulthood and will face far higher risks for heart disease, kidney failure, cancer, and stroke at younger ages.9 All of this excess weight on American children is enough, experts say, to reduce the average life expectancy in the United States by 5 years or more over the next several decades.10 Even if current obesity rates remain steady, the country''s health care system is headed toward a cost crisis: By 2030, epidemiologists predict medical expenses alone could increase by up to $66 billion a year.11Public health advocates have been buoyed by signs that the surging national childhood obesity rate is beginning to level off and perhaps even decline for toddlers. But these fledgling declines have been uneven across the country, and poverty-stricken areas and those with large black and Latino populations have seen little improvement.And nowhere is that pattern more apparent than in the Deep South. Dr. Gamble''s findings12 were a reminder of the tenacious hold that obesity has there. She suggested in her findings that despite a Mississippi state policy that directs schools to increase physical activity and promote healthy eating, obesity was manifesting "in minority children of low socioeconomic status at an increasingly younger age." And obesity wasn''t merely showing up on arms, legs, and tummies. It was making its presence known in more private places, too.THIS was not news to Carlton Gorton, MD, of Belzoni, who has been treating young girls--fans of Dora the Explorer and Curious George--who are growing pubic hair.Out the back door of the Greasy Row Grill and across a dirt courtyard is the Gorton Rural Health Clinic, where Dr. Gorton and his father, Mack, have been taking care of generations of families. Carlton''s grandfather owned a drugstore in Belzoni, and his father set up his practice more than 4 decades ago. Most of the clinic''s patients--young and old--are overweight; many are morbidly obese, Dr. Gorton told me when we met one afternoon at the clinic. They arrive with a Medicaid or Medicare card, or no insurance at all, and pay what they can.Dr. Gorton was sitting at a stately wooden desk when I walked into his office. The walls were covered with football memorabilia and photographs from Ole Miss, where Dr. Gorton attended medical school. He is handsome and unassuming, and he speaks in a mellifluous tone that makes even unpleasant facts tolerable to the ear.With deep concern in his voice, he told me that during routine exams in his clinic, he has discovered girls as young as 5 and 6 years old who are developing pubic hair. These alarming signs of puberty are usually related to his patients'' ample body fat. "They''re usually off the growth chart," said Dr. Gorton. A few of the girls come to the clinic each month for a hormone shot prescribed by a pediatric endocrinologist. "It''s holding them off from going through puberty," he said plainly.Kindergartners with pubic hair are discomforting proof of obesity''s powers over the unfolding human body. To Dr. Gorton, it was part of life in the Delta.AND yet, the chemical tide of hormones and synthetic com£ds that scientists believe is prematurely ripening girls'' bodies continues to surge forward both here and elsewhere. Some 15 percent of American girls now begin puberty by first or second grade,13 and over the last quarter century, the age when American girls begin menstruating has decreased by 2.5 months.14