• High blood pressure
• Type II diabetes
• High blood cholesterol levels
• Coronary heart disease

Getting ready to make that high calorie, packed-with-fat, family tradition as a holiday treat? Please resist the urge, prepare a fruit or vegetable delicacy instead, and invite your family and friends to take a walk.

We are in the midst of an epidemic that threatens our economic prosperity and physical well-being. The latest update from the Centers for Disease Control and Prevention indicates that Colorado is now the only state in which less than 15 percent of the population are obese. On the other hand, more than 20 percent of the people in 22 states are obese. Only 10 years ago no state had an obesity rate of 20 percent and only four states had obesity rates of even 15 percent.

Obesity threatens the economic well-being of our community because it causes high blood pressure, high cholesterol, arthritis, acid reflux disease, diabetes, heart attacks and strokes. Each one of these conditions requires expensive, long-term treatment that will add to the already overwhelming health-care obligations of employers, individuals, and the government. Money spent on health care cannot be spent on consumer goods. Obesity also threatens our economic well-being because it causes occupational disability.

Obesity threatens the psychological well-being of our community, too. Although I hope it never happens in Olmsted County, people in other communities are finding that their health plans are being converted from defined benefit to defined contribution. Marketed as a way to give consumers more choice, it is also a strategy that employers are using to limit their financial obligations.

Under a defined benefit plan, employees who exceed their employer’s maximum benefit have the “choice” of paying for additional services in any way that they wish. While defined benefit programs may limit employer obligations, they will do nothing to solve the problem of excess health care needs caused by the obesity epidemic. Eventually those who cannot afford to pay for their health care can be expected to ask for charity care at area emergency rooms, hospitals and clinics. Mayo Clinic has a tradition of never denying necessary care to an individual from the region, but can it keep this tradition forever? Not if the demands for charity care threaten to bankrupt the system. What will we do then?

Confronting the obesity epidemic does not mean telling people they are obese and need to lose weight. Responses to the annual CardioVision 2020 surveys indicate that, in general, the more a person weighs the more they want to lose weight.

Successfully confronting the obesity epidemic will require completing two tasks. First, we will have to understand why the epidemic is occurring, and then we will need to reach a consensus on what to do about it. Understanding why we are gaining weight is relatively easy. The obesity epidemic is in every region of the world except sub-Saharan Africa, and experts agree the common theme is easy access to high-calorie food and the disappearance of obligatory physical activity.

The second task will be much more difficult because it will require that we confront our attitudes about how we use food in our community, and it will require us to confront how we live and how we design our homes and workplaces. We need to treat obesity as both as an individual and as a community problem. Through personal commitment and community action, we can prevent the further development of this epidemic.

There are several reasons not to focus on weight alone. Genetics contributes to the determination of an individual’s weight, and unfortunately, most weight-loss programs can only produce a sustained weight loss of 10 percent. Also, many non-obese individuals may be promoting obesity by the way in which they prepare and serve food. Therefore, we need to emphasize behavior rather than weight. All individuals, not just the obese, must assume an obligation to practice an eating pattern that minimizes the risk of obesity. Such an eating pattern focuses on foods that are low in calorie density, and portion sizes that are appropriate for the individual’s caloric needs.

Finally, food should be offered only at meals or appropriate snack times. All individuals, not just the obese, must make a commitment to seek sufficient levels of physical activity – a minimum of 30 minutes on most, if not all, days of the week. Ideally, a person should be active 60 minutes a day with several periods of at least moderate-intensity physical activity.

We also need to take action as a community. We must accept that we have an obligation to provide opportunities for physical activity that are convenient and affordable. Such opportunities include the ability to walk or bicycle to work, shopping, play, worship, and other daily activities. We must accept that we have an obligation to promote and provide opportunities for physical activity and appropriate nutrition to people of all ages and all subpopulations.

I expect that many may be shocked by my suggestions. But what is the alternative? Is this imagination run wild? Perhaps. But on the other hand, can anyone create a realistic alternative? Stomach-stapling surgery for 20 percent of the population at more than $30,000 per operation? Try as I might, I don’t see us overcoming the obesity epidemic unless our community confronts it with immediate and concerted action. We can continue to enjoy the economic prosperity and physical well-being that has come to represent America in the past century, but if we are to do so, each one of us must contribute as individuals and we must unite as a community. Go out for a walk today and decide that you are going to personally contribute to the fight against the obesity epidemic by making holiday treats that are low in fat but still high in enjoyment.

This editorial originally appeared in the Rochester Post-Bulletin on Dec. 13, 2001.

• Give out non-candy treats (stickers, colored pencils, toy cars, lunch-size applesauce, pudding or juice packs, fresh fruit, packs of raisins, plastic Halloween toys.)
• Give out larger amounts of treats to early-birds and latecomers, to guarantee a minimum of leftovers.
• Don’t buy treats early because they are on sale. The longer they are in the house, the greater the temptation! Then you have to buy more and end up spending more.
• If your children bring home candy, discard or give away what they don’t like, so you are not tempted to eat it.
• Take a long walk around the neighborhood. Enjoy the decorations and your neighbors.

• Put your fork down and sip on water between bites. You won’t gain body fat with an extra glass of water.
• Chew food thoroughly to get maximum flavor and enjoyment from each bite.
• Cut food into smaller pieces. Then eat with the other hand to amuse yourself and maybe your family.
• Converse with others during the meal (but don’t talk with your mouth full!)
• Remember that it takes about 20 minutes after you start eating before the brain gets the message that you have had enough.

• Remember the last part of the phrase, “All you can eat... (without gaining weight!)”
• Take two trips. Choose only fresh fruits and vegetables the first time. The fiber helps fill you and takes the edge off your hunger.
• Take small portions of other foods and don’t allow them to touch each other on the plate.
• If your life depends on dessert, pick just one and split it.
• The fat in fried items and sauces can double or triple the calories. If you really want a sauce or dressing, order it on the side and only dip the fork in the sauce to minimize calories.
• Do not clean your plate. Better to have food go to waste than to your waist.

• Say, “Gee that looks great, but it always gives me, you know... ” then point at your stomach and grimace.
• Be polite but firm when refusing food you do not want or need. After a few times, most people will get the message and quit pestering you.
• When eating out, don’t allow others to order for you. Choose a place with menu items that meet your goals.
• If you have trouble being assertive, plan a response and practice it ahead of time. You will be more likely to achieve your goals.
• Remember, they may just be jealous of your success.

• For one event, suggest that you and your colleagues donate all or part of the food cost to a charity.
• Bring fresh fruit and vegetable treats instead.
• Make your own sandwich with whole grain breads and lean meats, low fat cheese and sauces and plenty of vegetables.
• Remove desktop goodie jars. Out of sight, out of mind, therefore it cannot reach your stomach and be absorbed into your fat stores.
• Eat less and use rest of mealtime to go for a walk in small groups.

• Use prepackaged foods.
• Do not make more than you (and your family) can eat, unless you plan on leftovers.
• Always take a little less than you think you want.
• Serve your plate away from the table. Then you have to get up if you really want more food.
• In restaurants, ask for the doggie bag to come with the meal. Box up the portion you wish not to eat before starting to eat.
• Use visual images (3 oz meat = deck of cards) and measuring utensils if you are unsure how much you are taking.
• Only eat the bites that taste the best, then stop!

• Eat something light (such as nonfat yogurt, fruit) and drink 1-2 cups of water before you go, to take the edge off your hunger.
• Go through the food line once before deciding what you really want to eat and drink.
• Then choose the smallest plate, take small portions, and remind yourself not to return for seconds.
• Enjoy the conversation as far away from the food as possible.
• Request the low or no calorie beverage for making a toast. If you want an alcoholic beverage, limit yourself to just one glass.
• Be tactful, yet firm in sticking to your priority to eat healthy.

• Be sure to plan some family activities that do not involve food and burn up calories.
• Have meals with “make your own” items that keep the family together and socializing around the table while food is being prepared.
• Most recipes can be modified in fat, salt and sugar content and still taste great.
• Chew food thoroughly to get maximum flavor and enjoyment from each bite.
• If certain baked goods are part of your tradition, limit them to a couple of favorites. Then pack any leftovers for other family members to take with them.

• Don’t forget to use all 10 tips throughout the year.
• Being in better control of your eating helps you feel in better control of other aspects of your life.
• Being physically active makes you feel better. As you lose weight, physical activity also becomes easier.
• Choose only one place for eating when at home with no reading or watching TV to distract you from enjoying the food.
• Eat 3 meals each day. Breakfast is the most important one. It energizes you and speeds up your metabolism.
• Drink at least 8 cups of water each day, including 1-2 cups before and during each meal.
• Fat free foods are not always low in calories. Portion control is still required.
• Think before you eat! If you are not hungry, do not eat it.