competitive gluttony and obesity

Monday, July 6, 2015

The Fourth of July is all about celebration. There are picnics, parades, fireworks and sport. While baseball is the all American sport and the country rallied behind the Women’s World Cup victory, perhaps nothing epitomizes the American spirit like the Nathan’s annual hot dog eating contest. Gluttony may be a deadly sin but it is also major programming for ESPN, the network that live broadcast the competition and aired replays over its numerous outlets. The winner, Matt Stonie, ate 62 hot dogs (including buns) in the 10-minute contest, and to make certain that equality has arrived to competitive eating, there was a women’s division, with Miki Sudo crowned champion after consuming “only” 38 dogs. Unlike Wimbledon, there was no junior division.

It should come as no surprise that the American public embraces competitive gluttony. Two thirds of the adults in this country are overweight and one third qualifies as obese. Overweight describes excess weight that comes from muscle, bone, fat or water. The excess weight in obesity all comes from fat. There is no benefit to obesity. It increases the risk of high blood pressure, high cholesterol and diabetes leading to more heart attacks and stoke. The skeleton of the body is also not well adapted to carry extra weight and that leads to muscle and joint problems including joint and back pain, arthritis and degeneration.

There is no single cause for the epidemic of obesity and there is no single approach that can be recommended or prescribed for prevention and treatment. Some who are obese look for an “easy” answer in a pill or through surgery, but it takes a lifelong combination of diet and exercise to control weight. Food, especially empty calories, are readily available and these empty calories are especially prevalent in poorer neighborhoods where food desserts are the norm and healthy eating alternatives are not available.


When it comes to weight loss, it’s all about the math…sort of. A pound of human fat contains 3,500 calories. A calorie is a unit of energy. Eat more than you burn and weight is gained, eat less and the weight comes off. In obese people, that weight loss will likely come from fat, with a smidge of water loss thrown in. Cutting carbohydrates means forces the body to used stored glycogen for energy and that releases a little water that gets peed out. Add protein and exercise and there may be increase in muscle mass, which is a good thing, but that may mean that the weight loss slows just a little. As the body gets closer to ideal body weight, some of that weight loss will come from muscle, as the body tries to retain some fat, just in case famine strikes.

The body is a machine and requires a certain amount of energy intake to function. If there is a calorie deficit, the body uses its energy stores to make up the difference. Weight loss takes dietary control and all food is not created equal. A glazed donut from Krispy Kreme contains 190 calories, while one from Dunkin Donut rings at 260 calories.

It takes effort to lose a pound of fat. A mile of walking or running will burn roughly 100 calories. It doesn’t matter how fast that mile distance is covered; the calorie burned is the same. Moving faster increases cardiovascular performance and allows more distance to be covered in the same amount of time. More distance equals more calories burned. All things being equal, and if food intake remains the same, walking an extra mile a day (about 2,000 steps), will result in a 10-pound weight loss in a year.

Weight control is a national obsession but a frustrating one. Good intentions can be waylaid by a few moments of indiscretion. The few minutes at the Nathans’ hot dog eating contest that crowned Matt Stonie champion, cost him more than 15,000 calories or almost 5 pounds. And we celebrate gluttony for why?

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Monday, June 15, 2015

The ESPN headline writer must have been having a slow day. The reporter must have been under pressure to find a story, any story about Stephan Curry and the aftermath of the payoff game where he had starred. There can be no other explanation for:


Stephen Curry treated for dehydration, expected to play in Game 6

…After his postgame news conference, the league MVP appeared to be in discomfort as his father Dell Curry and Warriors security guard Ralph Walker ushered him to the locker room. Once there, Curry received drinking fluids to relieve the dehydration. Curry was watching SportsCenter highlights of the game while receiving treatment, according to the team…


Like construction workers, kitchen workers and many other people who physically labor in hot environments, the body needs enough water to cool itself and continue to function. Fall behind in the water balance, and there can be a vicious spiral that progresses through the states of heat related illness, heat cramps to heat exhaustion and finally to heat stroke.

The body can cool itself in many ways, but sweating is the most efficient. When sweat evaporates, it efficiently cools the body and for that to happen a few things need to be in place. First, the body needs to have enough water to generate sweat, there needs to be air movement so that the sweat can be swept of the body and finally, the surrounding air needs to have room to accept that evaporation. If the air is fully saturated with water, (the humidity is 100%) then there is no place for sweat to go and the ability for the body to cool itself is severely compromised.

The body generates heat routinely as it performs its basic functions including breathing, digesting food and general movement and activity. The amount of heat generated by strenuous exercise or work can increase tenfold and the body can react by sweating up to a liter an hour, more than 2 pounds of water, to help with cooling. The cooling potential gets more efficient as a person gets acclimated to a hot environment and after a few days of working or training in the hot sun, the amount of sweat that the body can generated may increase to 2 or 3 liters per hour.

The body can adapt to adversity but it may be hard to drink enough fluids to keep up with that lost with sweat. The body lives in a very narrow range of normal and should it become dry, the ability to function can deteriorate quickly. Heat cramps are the first stage of heat related illness and it is often the large muscles that go into spasm. Sometimes though, the body skips this stage and goes straight to heat exhaustion. There is excessive sweating, lightheadedness, nausea and vomiting. The key to treatment for both these situations is to stop the activity, get away from the hot environment and replenish the fluid that has been lost.

If the signs of heat exhaustion are ignored, not recognized or not treated, the body can get worse very quickly. Heat stroke describes the situation where organs in the body start to shut down and that includes the brain. The body stops sweating,  temperature spikes out of control, blood pressure drops and there is change in the mental status. The person may be lethargic, unconscious or seizures may occur. Heat stroke is a life-threatening emergency and even with emergency care, death is a distinct possibility.

Back to Mr. Curry. It is hard to get excited about a player being treated for dehydration by drinking water or Gatorade while watching television, but the concept of rest and rehydration in a cool environment is most appropriate. The good news is that he did not have to return to play again that day. The same treatment plan works for roofers, foundry workers and high school football players. Too often, people feel the need to return too quickly to the environment that caused their illness, without enough time for the body to recover.

Perhaps the easiest way to know that the body is on the road to recovery is that the kidneys are making urine. Specialized cells within the artery walls of the kidney decipher the body’s water status and a complex hormone system decides whether it is appropriate to make urine to get rid of the body’s waste material, or whether that water is too precious to lose. Conserving water means making very concentrated, very yellow, very foul smelling urine. Drink enough fluid, the kidneys get happy and the urine starts to flow again.

Regardless of the cause, the body needs adequate water intake to allow it to function. Prevention is key when living or working in a hot environment. Listening to the thirst mechanism and watching urine output are ways for monitoring how the fluid balance of the body is tilted. How important must this be? Most of us don’t have ESPN headlines telling us we just need to drink a little more water.



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