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Pick One -- Eat Less or Move More

Obese people are all alike in the way they become obese, but every slim person is slim in his or her own way. That's what you might infer after reviewing the data from F as in Fat.
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Obese people are all alike in the way they become obese, to paraphrase Tolstoy, but every slim person is slim in his or her own way. At least, that's what you might infer after reviewing the data from the non-profit and non-partisan Robert Wood Johnson Foundation's F as in Fat 2010.

The report showed an increase in adult obesity in 28 states, with no state in decline. Only Colorado, at 19.1 percent, has a rate remaining below 20 percent. In 1980, the national average for the entire country was 15 percent. Calories do count, and the USDA informs us that in 2009 Americans consumed an average of 300 calories a day more than in 1985, and 600 more than in 1970. Almost 70 percent of us currently reporting as overweight or obese, which means three out of 10, or fewer, have beaten the odds.*

Here are the top 10 "thin" states.

1. Colorado
2. Connecticut
3. Massachusetts
4. Hawaii
5. Vermont
6. Rhode Island
7. Utah
8. Montana
9. New Jersey
10. California

The RWJF also surveyed levels of physical activity by state, and it would be logical to assume that one of the above will rank number one in that category too. Logical, but wrong. Colorado ranks number two, and Utah, Hawaii and Vermont are all in the "physically active" top 10, but New Jersey has a very inactive population. People move the most in Minnesota, which ranks as only the 19th thinnest state. Although this indicates that exercise alone won't make you thin, a closer look at Minnesota suggests that if you can't be thin, be active, because although slim and very fit Colorado has the lowest rates of type 2 diabetes and hypertension in the union, not-so-slim and but even more fit Minnesota has the second lowest.

When considering the Colorado/Minnesota conundrum, it becomes valid to question the meaning of "overweight." The RWJF definition (used by the World Health Organization) is a BMI of >25-30. "Obese" is > 30. You can calculate your BMI here. But definitions of "overweight" and "underweight" are cultural and thus mercurial -- so it seems rational to consider the fit folks of Minnesota and conclude that a BMI above 25 may be no cause for alarm, as long as the physical activity level is high enough to maintain large amounts of lean muscle. In other words, someone carrying a few extra pounds but eating a mostly healthy diet and exercising on a regular basis will not suffer because he or she lacks the "correct" BMI for his or her height. New Jersey, the "eat less and move less too" state has far higher rates of type 2 diabetes and hypertension than Minnesota. It is seemingly the combination of overweight and inactivity that puts people at a higher risk for complications from these diseases, and perhaps others.

Obesity, however, is another issue entirely. Mississippi ranks number one as the fattest state in the union. The heavier one is, the more difficult physical exercise becomes, so not surprisingly it is also number one in physical inactivity. It is also number one in hypertension, and number two in type 2 diabetes. (West Virginia is number one). Mississippi also ranks lowest in fruit and vegetable consumption, with only 8.8 percent of adults eating the USDA recommended two plus servings of fruits and three plus servings of vegetables per day.

There seems to be a correlation between low produce consumption and obesity -- eight of the states with lowest consumption are in the top ten states for obesity. Vermont ranks as the number one fruit and vegetable consumer and is the fifth thinnest state; however even in Vermont only 17.9 percent of adults eat the USDA recommended five plus daily servings.

We speak of food deserts -- the lack of availability of fresh produce in poor urban and rural areas -- and this is a valid concern. Populations within one half mile of a full service supermarket tend to consume more fruits and vegetables. But if Vermont leads the way with fewer than 18 percent of the adult population eating the USDA recommended daily allotment of fruits and vegetables, very few Americans are eating these foods on a regular basis whether they live in a food desert or a food oasis. Their house could be built inside of a Whole Foods Market and it might not make any difference. If this were a test, Mississippi, at 8.8 percent or Vermont, at 17.9 percent, would both fail.

In addition to weight control, there are of course numerous reasons to eat lots of fruits and vegetables, including prevention of a variety of diseases, and it is likely that those who manage to remain slimmest of all eat lots of them. They are nutrient dense, contain fiber, and are calories well spent. But they are superfluous to the Colorado/Minnesota debate -- neither state appears on the top ten fruit and vegetable list.

Fresh produce aside, what do you think? Should we rethink the old weight loss adage, and make it: Eat less or exercise more?

* Approximately 68 percent of American adults report as overweight or obese, but people tend to under-report their weight and over-report their height. However, another serious and not to be overlooked issue is the population (estimated at < 3 percent) suffering from anorexia nervosa, bulimia nervosa and binge eating.