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It’s dubbed an “epidemic” by the Centers for Disease Control and Prevention, but it’s not caused by any microbe or virus. Instead, most experts say obesity, which now affects 36 percent of American adults and 17 percent of children, is something we do to ourselves.

In 2009, Charles County was one of the heaviest in the state, tied with Caroline County for fifth out of 24, with 32.6 percent of adults obese. The rest of Southern Maryland fares better, with 28.4 percent of Calvert County residents and 28.8 percent of St. Mary’s County residents weighing enough to be officially called obese, according to CDC.

The CDC website states “For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the ‘body mass index.’ BMI is used because, for most people, it correlates with their amount of body fat. An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese.”

For example, a 5-foot, 9-inch tall adult is overweight at 169 pounds, and considered obese at 203 pounds.

Being overweight or obese carries serious health risks, including heart disease, diabetes, high blood pressure and cancer, according to CDC, prompting many to try — and often fail — to slim down.

Processed foods and a sedentary lifestyle are responsible for expanding America’s collective waistline, making a low-calorie diet and regular exercise the key to weight loss, said Calvert Memorial Hospital staffers who teach employees and the public about health.

“I think all of us concur that it’s technology. I think it’s the video games, that our kids are inside more than being outside,” said Margaret Fowler, director of community wellness. “Think about back then, when I was a kid: We went outside as soon as we finished breakfast and didn’t come back until it was dark.”

Karen Mohn, a dietician at the Prince Frederick hospital, said children should exercise an hour a day, and adults, half an hour, and eat moderate meals based on proteins like lean meat, and complex carbohydrates like brown bread.

The body is “like a car. You need to keep the gas tank full to get the full mileage out of it. Eat a little bit, use it. Eat a little bit, use it. That’s how you keep it from where you’re starving from hunger” when cutting back, she said.

Even healthy foods can be a problem, said Mary Bahen, a registered nurse.

“It doesn’t make a difference” what the food is, she said. “One hundred calories too much a day, an apple, in a year that’s 10 pounds. A calorie is a calorie, and more than you need is going to get stored and reflected in your weight. Eat less of it, less often, if it’s their favorite food, or maybe find a little substitution.”

Obesity is a serious health problem, potentially leading to heart disease, diabetes and cancer, Fowler said.

“Ultimately, people think about being overweight, it’s just a physical attribute, but it’s much more than that. It affects your whole life, your whole well-being. That’s why we feel it’s important at any point along the line to make those healthy lifestyle changes,” she said.

Some people have made those changes, or are trying to. Three dozen women gathered in Waldorf recently to sample low-fat cookies, step onto screened scales and cheer for one another’s successes.

If it were a Sunday morning instead of a Wednesday evening, the smooth jazz and positivity would give the proceedings the feel of a service in a storefront church. Leading the ceremonies is Rita Adu of Indian Head, a Weight Watchers true believer who slimmed down radically and now works for the company helping others travel down the same path. All Weight Watchers staffers are veterans of the program, Adu said, and must stay within 2 pounds of their target weight or lose their jobs.

That day’s theme, which Adu extolled from the front of the room with the help of a big TV screen, was the importance of a backup plan for sticking to an exercise program.

“Baby, you can make excuses or you can make it work. Ladies, we’ve got to find a way to make it work,” she said. Then people announced their own successes or inspirations — “Nothing tastes as good as being thin feels,” one participant said — while the others applauded.

“I follow the book to the T,” said La-Trice Batts of Lexington Park, showing off the bronze-colored keychain Adu gave her for losing a tenth of her body weight. A Weight Watchers manual, which she carries in her purse, assigns point values to every conceivable food — ostrich meat is listed in the index — and dictates how many points to eat for breakfast, lunch and dinner.

Even when she reaches her target weight, “I’m going to continue with it,” Batts said. “Some people want to stop. They think, ‘I got this under control.’ Then they put weight on. I think I’ll stick with it.”

Katherine Maringo of Nanjemoy appreciates the structure of the system, which makes it “pretty easy” to follow.

“It’s like a new schedule. You just get into the swing of it,” she said. She’s dieting for health and as a “self-confidence booster,” she said.

As the pancreas turns

Balancing “calories in, calories out” through diet and exercise is standard advice for people seeking weight loss or general health, but an alternative school of thought maintains that those decades of received wisdom are wrong. Gary Taubes, a journalist and author of “Why We Get Fat and What to Do About It,” holds that the developed world’s reliance on starches, and especially refined sugars, is to blame for disrupting body chemistry in a way that prompts a person to store more calories as fat than he otherwise would.

Eating carbohydrates prompts the pancreas to release insulin, which, among many functions, helps the body regulate blood sugar. The hormone also signals fat storage cells not to release fatty acids — the form of fat that cells can burn — into the bloodstream.

In Taubes’ telling, when a person regularly eats too many carbohydrates, his cells start to resist taking in unneeded sugar, prompting the pancreas to release more insulin to keep blood sugar under control. The body’s cells then become resistant to insulin, prompting the pancreas to release still more in a “vicious cycle.” All the while, the increasing insulin level performs its other function — causing the body to store more fat, and burn less — more and more, making it ever easier to gain weight and harder to lose it.

The solution, he said, is a high-protein, high-fat diet that minimizes carbohydrates, lowering insulin levels and prompting the body to burn fat. Counting calories becomes unnecessary in this system, because without the challenge of high insulin levels, the body is able to regulate its own energy needs.

The scientific establishment and the public have been resistant to research and writings promoting this view, because it challenges what experts think they know and because it simply seems too easy, Taubes said.

“I think self-correcting mechanisms can take a long time, even in sciences that have nothing to do with human life and exist outside of institutional social realms,” he said. “Like high-energy physics, for instance, even there it could take decades to correct from a major error. There’s a famous line: Science progresses funeral by funeral. People don’t like to admit they were wrong.”

Also, he admitted, most outsiders who challenge the scientific establishment deserve to be ignored, and society is skeptical that people who think as he does are exceptions.

“A huge proportion of people like me, making claims against established science are cranks — 99.99999 percent — so you could ask what are the odds that what I’m saying [is] likely to be right? The odds are going to be small, compared to the people like me who are always going to be wrong,” he said.

Even so, a low-starch, no refined sugar approach seems to be gaining ground as people try the Atkins diet or the “Paleo diet,” whose adherents try to eat a diet similar to what people ate before agriculture was invented during the Paleolithic Age, or Old Stone Age.

A side benefit to this approach is that it takes morality out of obesity, because people who weigh too much are then no longer thought of as lazy and gluttonous, but just as people whose own bodies are working against them as they struggle to be thin.

“Lean people certainly want to feel that way,” that they are virtuous for being slim, Taubes said. “If you read, every time The New York Times does a story on obesity … you read the comments and the people who are arguing it’s ‘eat less, exercise more,’ there’s this brutality [in the comments]: ‘If fat people, fatties, would just work out like I do and have some will power they’d be fine.’”

Surgical solutionsAll but removing starch from a person’s diet could seem radical, but some people turn to an even more radical solution, surgery, to combat incorrigible obesity.

Bariatric surgery is relatively dangerous and drastically reduces what and how much a person can eat, but for some it’s worth the price.

Joan Edwards of Waldorf had tried everything after putting on a great deal of weight after her husband’s death before finally opting for surgery. People have criticized her for her choice.

“They want to say, ‘If we can do it on our own, you can.’ If we could do it on our own we wouldn’t be as fat as we are!” Edwards retorted.

Edwards, who runs a bariatric surgery support group, has no regrets despite the price she has paid for the weight she lost. Her diet is extremely restricted — foods from chocolate to lettuce are off-limits. She has learned what to avoid by becoming ill after every mistake, because “every patient is different,” she said.

After one lapse, she became so ill she lost consciousness from the pain.

“I didn’t do it again,” she said.

For Dennis Gillikin, pastor of Encounter Christian Center in Charlotte Hall, surgery was the result of a “midlife crisis.” He decided to ditch the failed diets and do something drastic before his weight destroyed his health, he said.

“In my lifetime I’ve probably lost and gained over 300 pounds. I believe all diets work, but if you’re not ready for a lifestyle change you’re going to go back to what you used to do. It’s human nature to go back to what you used to do,” he said.

But now he can’t. For the six months after his surgery, he basically ate baby food. Now, after two and a half years, he can eat small meals, if he’s careful. At a steakhouse, he orders a petite steak and puts half of it into a to-go box before he starts eating; at another eatery, a spicy chicken sandwich takes an hour to finish.

“As a pastor I choose not to do many things: drinking, smoking, pornography. But this was a demon I couldn’t beat. … Some people say, ‘You took the easy way out.’ There’s nothing easy about having a stomach stapled up to prohibit you from eating. There’s nothing easy about that,” he said.

As time goes on, patients’ stomachs gradually expand again, and he tries to avoid pushing the envelope in his eating so that he keeps his stomach small. Surgery “basically gives you two to three years to fix 40 years of bad habits” before the body recovers again, he said.

Gillikin enjoys many things about his new physique, like how easy it is now to buy pants, but there are things he misses about his lost bulk. Before he became a pastor he lived a rougher life as a bouncer and bodyguard, and other men respected “Big D” because of his size, he said.

“When I was that big, I stood out. I enjoyed standing out. ‘Go get Dennis, he’ll take care of it. Go get the big guy.’ … Now I walk in here, 6 feet, 201 pounds, I’m just another guy. Nothing wrong with that, but it’s not like being a mountain man,” he said.

Daring to be fatHealth concerns and vanity are pressures to slim down, but an organization in California maintains that the medical consequences of obesity are overblown and that society should accept the overweight just as they are.

The National Association to Advance Fat Acceptance, which advocates for overweight people, urges people to be “healthy at any size,” eating good food and being active and not worrying about what the scale says. Other people should accept the overweight as they are, too, spokeswoman Peggy Howell said.

“We’re not denying that the population is getting larger, but they’re not only getting larger, they’re also getting taller and living longer, so I believe that some of the hype is for purely promoting products to sell. The pharmaceutical industry has a high stake in selling diet drugs, the diet industry has a high stake in selling food products, plans, equipment, clothing. There are a lot of things invested and tied up in this whole concept of our need to change ourselves,” Howell said.

NAAFA, as a civil rights group, also works to combat discrimination against the overweight, including in employment, Howell said.

“There’s a whole lot I believe that comes into play. I believe in some cases it’s personal bias and in some of the cases I think it has to do with health care companies are trying to charge more for fat people. I believe, just because of the social stigma attached, some companies don’t want a fat person representing their company, they feel that it’s going to reflect badly on them as a company,” Howell said. “They have a brilliant fat person working for them, you know? A well-qualified, brilliant, trained fat person. Why does their body size matter?”