Chapter 1.  The Problem
If you have not looked at the most recent statistics about weight and health, you will likely find the results
staggering. An unbelievable
74% of American men and 64% of women are overweight or obese, about 70%
.  In 2016 the trend worsened.  The government reports that 40.4% of
women and 35% of men are now obese.

Currently, “body mass index”(BMI) is the popular shorthand for determining if someone is overweight (a BMI of 25
and over), obese (a BMI of 30 and over) or extremely obese (a BMI of 40 and over). For example, at 5'9" tall, my
current weight of 148 produces a BMI of 21.85, in the healthy range. If I weighed between 169 and 202, I would be
considered overweight. A weight of 203 would categorize me as obese, and a weight of 270 would make me
extremely obese. For Americans, 37.7% of both men and women are obese, and the fastest growing group–
literally–are the extremely obese. Currently, 9.9% of women and 5.5% of men are extremely obese.
 Calculate your BMI.You can find your BMI using a chart. Alternatively, you can calculate your BMI, either by using the formula (weight/(height in inches x height in inches)) x 703; or as a word problem, divide your weight by the sum of your height in inches times your height in inches. Multiply that total by 703 to find your BMI.You can also go online to a site like http://www.cdc.gov/healthyweight/assessing/bmi/. BMI is a convenient guideline for categorizing large numbers of people without regard to their sex or build.
The concept of shape.

An alternative to the scientific calculation of BMI is the simple concept of shape. We use the term frequently,
complaining that we are out of shape or need to get into shape. The concept has value. If you think of Leonardo
da Vinci’s 1490 diagram of man (Figure 1) as a healthy outline of the human shape, you can measure yourself
against it to see how out of shape you have become. The average American man found on the right in Figure 1,
is 5'9" tall, weighs 200 pounds and has a 40-inch waist. The average American woman is about 5'3" tall, weighs
166 pounds and has a 37.5-inch waist. The average American is not in shape.

The concept of shape also includes waist size, probably a more important indicator of health than BMI. The wider
your waist, the higher your chance of disease. Note the difference in the waist of da Vinci’s drawing and the
average American man.
 Figure 1.  The Average American, compared to Da Vinci's 1490 drawing, is not in shape.
The concept of shape extends beyond our bodies and to
our faces. We have so much excess fat that the terms
apple or pear apply not only to our bodies, but to the
shape of our obese faces as well. A mere 30 pounds
separates the two photos of me in Figure 2, but the
weight shows clearly in my face.

I am confident you have experienced meeting a person
who is so far out of shape that it is uncomfortable to even
look at him, that his body has gone so far beyond the
bounds of an ordinary shape that it looks like he is about
to burst. You do not need to calculate his BMI to know he
is unhealthy. Scientific formulas like BMI can be clinical
and hard to relate to. No math or formulas are needed
for you to evaluate whether you are in shape.
 Figure 2. I am only 30 pounds heavier in the photo on the left, but the weight clearly shows in my face.

A growing problem.

The expansion of Americans’ waistlines in recent years has been remarkable. For example, at age 12 when my
picture was taken in 1970 (Figure 3), just 4% of similar age children were obese. That is about one obese child in
a class of 25. Currently, 33% of similar aged boys are overweight and about 19% are obese, an almost five fold
increase from when I was a child (for girls, the numbers are not much better, currently 30% are overweight and
15% are obese).
 Figure 3. The photo on the left shows me at age 12.  The center photo is a sibling (and not the heaviest sibling) showing my genetic potential.  The photo on the right is me today.
For American adults, the results are even more alarming. Obesity maps of the United States, which you can find
animated online, show the  trend graphically (Figure 4). In 1990, no state had an obesity rate over 15%. In 2012,
no state had an obesity rate
under 20%, nine states and the District of Colombia had a rate of 20-25% and
thirteen states had a rate of 30% or more with Mississippi topping the chart at 34.6%
(note). Despite our societal
focus on health, we keep getting fatter.
 Figure 4. Obesity in the United States is a growing problem.
The problem with fat.

From a common sense perspective, being fat is not only unsightly, it is unhealthy. Think about all the extra work
your body must do to maintain the excess pounds. Your body must provide your fat with nutrition and waste
disposal. In addition, your bones and muscles must lug around the weight. Think of the stress 40 pounds in the
belly puts on your back, knees and ankles. No wonder so many heavy people walk with difficulty. It is kind of like
a city that has grown faster than its infrastructure. Surely you have been to a city where the population grew too
fast and the highways are clogged with bumper-to-bumper traffic. Emergency vehicles like ambulances get
caught in the traffic and fail to provide services in a timely manner. Electrical grids get overloaded and on high
use days there may not be enough energy to go around. Science tells us that the same kinds of things happen to
an overweight body.

Take diabetes for example. Diabetes is a term applied to two distinct diseases. Type 1 diabetes, sometimes
called juvenile diabetes, is where the pancreas does not produce enough insulin. Only about 5% of diabetics
have type 1 diabetes. The other 95% have type 2. Type 2 diabetes, sometimes called adult onset diabetes, is
where the body, due to heredity and weight, stops responding to insulin, resulting in a host of problems.
Before I understood my risk for diabetes, I only knew generally that it was a bad disease that sometimes resulted
in blindness and amputations. But increased knowledge has led me to see that the disease has even worse
effects and also that for most it is preventable and treatable, not by medications, but by diet!

The explosion of diabetes among Americans is shocking, but goes hand in hand with the increase in obesity.
Currently,
11.3% of the adult population has diabetes, that is more than one in ten of the people you see on
the street. A shocking
35% of the adult population has pre-diabetes, a condition which if not addressed will
lead to diabetes. Further, 50% of people over age 65 have pre-diabetes. Studies predict that within ten years,
77% of adult men and 53% of adult women will have diabetes or pre-diabetes.

Diabetes is an underlying contributor to a host of diseases. Diabetes can decrease life expectancy by as much as
eight years and seriously decrease the quality of life.

The American Diabetes Association says that:

•        Two out of three people with diabetes die of heart disease or stroke
•        Diabetes is the leading cause of kidney failure
•        Diabetes is the leading cause of new cases of blindness among adults
•        The rate of amputation for people with diabetes is ten times higher than for people without diabetes
•        About 70% of people with diabetes have mild to severe forms of nerve damage that could result in pain
in the feet or hands, slowed digestion, sexual dysfunction and other nerve problems

The good news is that reducing your weight by as little as 7% (12 pounds for a 175-pound person) and
increasing physical activity can significantly reduce your risk of getting diabetes.

For identical twins who develop type 2 diabetes after age 40, the disease almost always affects both twins. But
twins Tim and Paul Daly are an exception to the rule. At age 44, Paul Daly was diagnosed with diabetes. At 5'10",
Paul weighed 220 pounds. His twin Tim, who was pre-diabetic, weighed 200.Tim became part of a research study
about preventing diabetes. He was in a lifestyle intervention group that encouraged diet and exercise. Tim was
encouraged to lose 7% of his body weight and to exercise 150 minutes a week. It worked. Despite being pre-
diabetic and genetically headed for diabetes, 14 years have passed and he still does not have the disease. In
fact, the study showed that
diet and exercise are twice as effective as medication in preventing the
onset of diabetes
. Physicians are quick to prescribe medicine, but diet and exercise, key components of the
Simply Fit Diet, are a simple, free and natural way to help prevent diabetes.
Losing 7% of your body weight
can reduce your chance of diabetes by 60%.

Being fat increases your risk of diseases of the heart and circulatory system. It is easy to focus on the link
between obesity and diabetes, but even more people are affected by circulatory diseases like heart attacks,
stroke, and high blood pressure. I always knew that high blood pressure was undesirable, but I never really
thought about why. But this concept helped me understand. If you make your fist into a wide circle and blow
through it, the air passes easily. But if you clench your fist to make the space small, it takes a lot more effort to
move the air through the space. This is like the contrast between normal and high blood pressure. When your
blood pressure is high, it indicates that the veins and arteries are clogged with plaque and the heart has to work
harder to send blood to the places that need it. In my simplistic mind, I think of plaque as fat in the veins and
arteries.

Almost every American has plaque. Starting in the Korean War, doctors found that even young soldiers had
streaks of plaque in their circulatory systems. More recently, autopsies of children who died accidentally have
shown that the plaque now appears in our youth. This plaque is a precursor to the circulatory events that lead to
heart attack and stroke–similar events where blood is either blocked from the heart or brain.

In the past, scientists told us that once you had plaque deposits in your system, nothing could be done to reduce
them. However some physicians, like vegan doctor Neal Barnard, have published strong evidence that clogged
veins and arteries can be improved, and that improvement was accomplished with diet, not drugs.

Excess weight is directly linked to a host of diseases that decrease both how well you live and how long you live.
Excess weight increases your chances of getting:

•        Type 2 diabetes (11.3% of the population has diabetes and 35% has pre-diabetes)
•        Cardiovascular disease (37% of the population is diagnosed with cardiovascular disease, but the warning
signs appear in almost every American)
•        Hypertension (34% of the population has hypertension and another 36% has pre-hypertension)
•        Cancer (41% of the population will be diagnosed with cancer in their lifetimes)
•        Osteoporosis (50% of women and 25% of men will have an osteoporosis related fracture in their lifetimes)
•        Stroke (5% of Americans will die of stroke)
•        Dementia/Alzheimer’s (33% of seniors die with dementia, 50% of people over 85 have dementia)
•        Fatty liver disease (between 15% and 20% of Americans have some fatty liver disease, but 90% of obese
people and 50% of diabetics have the disease)
•        Sleep Apnea (About 4% of adult men and 2% of adult women are diagnosed with sleep apnea, and many
more are undiagnosed)

You only get one body. If you damage your body with bad food and bad habits, it may well be too late to do
anything about it. The time to act is now, not when you are struck by disease.
 The democratization of medical information.It used to be that you needed to go to a doctor to check your blood pressure or blood sugar. Nowadays, for modest cost, you can purchase machines to check these levels at home. A home blood pressure cuff costs less than \$40, and a home blood sugar test machine costs around \$15. These machines may not have the accuracy of a doctor’s office or lab (blood sugar tests can be off by as much as 20 points) but they can give you an indication of how you are doing between doctor visits.
Years ago, Americans became aware of the risk of increased weight, and a whole new industry sprang up to help
them control it. But after 50 years, the program appears to have failed.

It is not too difficult to figure out how we have gotten where we are–a fat nation. The other day I was in a fast food
restaurant (eating a virtuous salad), when I saw an extremely obese woman eating chicken nuggets. She was a
perfect example of how we have ended up where we are. Two hundred years ago, the fast and easy calories she
was consuming were not available. Even if she wanted to have fried chicken 200 years ago, she would have had
to chase down the chicken, pluck it and butcher it. She would have needed to gather wood and put a fire in the
stove, and then to pan fry the chicken. Cleaning the cooking utensils and dishes would have been another chore,
involving drawing water from a well and hand scrubbing the pots and pans. A fried chicken dinner 200 years ago
would have involved a heck of a lot more physical effort and probably also produced a healthier meal.

Today, for only a few dollars, you can go to a fast food restaurant and get a disease inducing meal with minimal
effort. You do not even need to get out of your car. Press the button on your power window and the food will be
handed to you. No need to do the dishes, just drop the refuse in the special can with a neck extended so that
drive-through customers do not even need to get out of their cars.

Heck, even in my youth there were fast food stands, but you had to walk to them to get your food. Most of the
cars of my youth had manual transmissions, manual steering and crank windows. Now cars have power steering,
one-touch up and down windows and the newest innovation, push button start where you do not even need to
take a key from your pocket and twist the ignition, you just push a start button.

We even keep the temperature in our environment at a comfortable 70 degrees. Two hundred years ago, when
there was no central air conditioning or heat, your body would burn extra calories staying warm on a cold day.
Today, even that basic caloric expenditure is unnecessary.

We are living in a virtual horn of plenty, bordered on one side by cheap, easy, unhealthful calories galore, and on
the other side by decreased physical activity (Figure 5). The result is a system that spits out overweight,
unhealthy people who decrease their life expectancy and quality of life. It is not surprising that we have become
fat.
 Figure 5. We live in a horn of plenty, bouncing betweenunhealthy food and inactivity and emerging fat and sick.
A basic premise of this book is that fat on the outside is an indicator of fat on the inside. That fat surrounds and
permeates the organs, it coats the insides of the veins and arteries and throws off the body’s delicate chemical
balance. Fat out means fat in. Fat causes or exacerbates a host of harmful diseases. Fat is bad. The solution is
to lose weight, and that can be accomplished by eating healthy food and increasing your activity level. In its
simplest form, we must narrow the horn of plenty (Figure 6).
 Figure 6. The horn of plenty can be reversedwith healthy food and increased activity.
The goal of becoming fit is not to live longer, but to live better. Currently, two of my siblings cannot walk normally
because of obesity related illnesses. One has lost his leg and another is so obese that unassisted walking is
impossible. By following the Simply Fit Diet, I am able to walk, climb stairs, run, swim, bicycle, and most important,
to enjoy my life. You can too.
 The limits of vanity.Vanity can be a strong motivating factor in weight loss, and I am happy to use it as a tool. However, with almost 70% of American adults overweight or obese, it is obvious that vanity is not enough. Making weight loss a matter of life or death provides a stronger motivation for getting fit. As you lose weight on the Simply Fit Diet, you will likely use vanity as a motivating factor, but I encourage you to remind yourself that although looking good is a byproduct of this program, health is the most important long-term goal.