Feature

The Last Lean Americans

Colorado’s obesity rates are the lowest in the country—but are we really as healthy as we think? Plus: We surveyed 400 Coloradans about their everyday health habits to see how—and why—our state has stayed on the good side of skinny.

October 2010

This article won a 2011 Top of the Rockies Excellence in Journalism Award.

Walk down just about any street in Denver or Boulder and you’ll see the evidence: Skinny people are everywhere. Young, slender women in yoga pants. Athletic-looking men in form-fitting T-shirts. Retirees out for a morning jog in Wash Park. It’s long been known—and proven time and again—that Coloradans (especially in the Denver metro area and the mountain counties) tread more lightly on the scale than almost any other American population. It’s true that on other streets in other cities in other states, time and again—that Coloradans tread more lightly on the scale than the residents of almost any other American state. On other streets in other cities in other states, the battle that Americans are losing with obesity is much more evident—and dire. The muffin-tops, the beer bellies, the thunder thighs: All are ubiquitous signs that Americans are facing an epidemic of flab. So why are Coloradans faring better?

The answer to that question is more complicated than one might think. When Washington, D.C.–based nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation released their “F as in Fat” report in June of this year, the fact that Colorado’s obesity rates were the lowest in the country was big news. “I think some people see a report like that and think it’s cause for celebration,” says Maren Stewart, the president and CEO of LiveWell Colorado, a nonprofit focused on reducing obesity. “But if you dig deeper, I see it as a cause for concern.”

It’s difficult not to agree with her. Although the study ranked Colorado as the leanest state, the report plainly showed that 19.1 percent of Coloradans are considered obese. Not chubby. Not carrying 10 extra pounds. Obese. Which means that excess fat has built up in the body to the point that it can negatively affect one’s health and shorten one’s life expectancy. Diabetes, heart disease, and cancer can result from a body mass index (BMI)—a measurement that compares height and weight—of more than 30, which is diagnostic for obesity. In fact, the Centennial State’s obesity rates have nearly doubled since 1995, which means our state is actually getting fat faster than the rest of the country. To make matters worse, our childhood obesity rates are startlingly bad: According to the Colorado Health Foundation, in the past handful of years our children have gone from the third leanest to the 23rd leanest in the nation.

Of course, that we are still comparatively trim is a good thing. “Colorado is uniquely positioned to look at these rising rates—and stop them,” Stewart says. “We are not too far gone at this point.” But obesity is a complex issue. Not only do we not know for certain why Coloradans are leaner (see the “High Altitude, Low Weight” sidebar on page 79 for possible explanations), but there is also no foolproof method to combat this complicated health matter. “It’s not fixed with a drug, and it’s not fixed with a good ‘Don’t Smoke’ message like tobacco,” Stewart says. “You can’t tell people not to eat. And that’s the real challenge.”

Instead, organizations like LiveWell Colorado, the Tri-County Health Department, the Colorado Health Foundation, and the Colorado Department of Health and Environment are trying to find ways—through funding, policy changes, and legislation—to help Coloradans make healthier choices and to provide access to healthier food. “It’s not hard to determine the reasons why and how Americans are becoming obese,” says Eric Aakko, director of the physical activity and nutrition program at the Colorado Department of Public Health and Environment. “But it’s difficult to change those reasons.” For decades America has been building itself to be reliant on cars. People moved away from cities. And they didn’t want their suburban homes nestled next door to commercial buildings. Walking to, well, anywhere became impossible. “Essentially, we engineered activity out of our lives,” Aakko says. Add to that the proliferation of inexpensive, high-calorie, processed foods, and you have a recipe for a fat population.

Now, experts say we have to swing back the other direction. We need to decrease our intake of processed foods, a step that involves more than just choosing a salad over a frozen dinner for many people. “Where there are high rates of poverty, there will be high rates of obesity,” Aakko says. “There is often a lack of access to grocery stores in impoverished areas, which means a lack of access to fresh foods. People often end up shopping at the corner store, where the best thing they have is an old brown banana.”

We also have to focus on what experts call the “built environment,” a principle of community design that encourages physical activity. “It’s not enough to have trails,” Stewart says. “Those trails must connect to each other, and to sidewalks and to bike lanes, and ultimately to places people need to go so that people can get around without a car.” Tista Ghosh, a medical epidemiologist with the Tri-County Health Department who’s researching obesity, agrees. “The grocery store could be right across the street, but if that street is an eight-lane highway and there’s no other way to go, people will not make that walk,” she says. But redesigning our environment to fit these specifications can (and will) take many years—years that some Coloradans in particular, and Americans in general, may not have in the fight to counteract obesity.

Which is why we wanted to find out how healthy Coloradans—the ones who seem to be keeping our obesity rates lower than normal—stay that way. Earlier this year, we partnered with Resolution Research, a Denver market research firm, to survey 400 Coloradans about their health habits. We asked these Coloradans about everything from how much they exercise to what they snack on. We also administered a survey at 5280.com to 412 of our readers to see how their answers differed. Then we, along with the help of some of this year’s Top Doctors (our annual list begins on page 80), examined their answers. The results were insightful, surprising, sometimes mystifying, and, we hope, ultimately helpful to anyone who needs a nudge in a healthier direction.

The Lean Coloradan

Hoping to delve into the mystery of why our state has stayed on the good end of skinny, we surveyed 400 residents about their health habits. Here’s what they said.

To participate in the survey, respondents had to consider themselves either moderately or very healthy; they must have never experienced obesity-related illnesses or obesity-related symptoms; and they had to agree that they exercised at least one time per week.

Methodology: To participate in the survey, respondents had to consider themselves either moderately or very healthy; they must have never experienced obesity-related illnesses or obesity-related symptoms; and they had to agree that they exercised at least one time per week.

Resolution Research administered this survey in collaboration with 5280’s editors. Resolution Research is a full-service market research firm specializing in qualitative and quantitative research designed to gather market intelligence and opinions. Resolution hosts www.resolutionpanel.com, a market research panel, and invites your participation to help influence the policies, products, and services offered by organizations across every industry. Resolution Research conducts online surveys, telephone surveys, focus groups, product tests, taste tests, clinical trials, mock juries, bulletin boards, and more. Client industries include the medical community, media, technology, utilities, higher education, retail, service businesses, and government institutions. For more information, visit www.resolutionresearch.com, e-mail [email protected], or call 1-800-800-0905.

EXERCISE

When you exercise, what activity do you do most often in summer? (up to two responses were allowed)
Run outside: 18 percent

Bike outside: 27 percent

Yoga: 12 percent

Organized sports (softball, basketball, tennis): 9 percent

Hike: 31 percent
Swim: 14 percent
Work out at the gym (run inside, lift weights): 34 percent

Other: 31 percent

On average, how many sessions of physical activity do you participate in per week?
1 to 2: 22 percent
3 to 4: 48 percent
5 or more: 30 percent
**5280 Readers’ Survey: 41.5 percent exercise almost every day.

Do you belong to a gym or a health club?
Yes: 42 percent
No: 58 percent

When you exercise, what activity do you do most often in winter? (up to two responses were allowed)
Work out at the gym (run inside, lift weights): 56 percent
Ski: 14 percent
Snowboard: 10 percent
Cross-country ski: 1 percent
Yoga: 18 percent
Organized sports (basketball, soccer): 6 percent
Other: 48 percent

Do you ever ride a bike or walk to work?
Yes, all the time: 13 percent
Every now and again: 22 percent
I live too far away to walk or ride to most things: 35 percent
Never: 30 percent

FAMILY

Do you and your significant other exercise together?
Yes: 18 percent
No: 26 percent
Sometimes: 31 percent
I don’t have a significant other right now: 25 percent

Have you ever entered an organized running race?
Yes, I can run a marathon in under three hours: 4 percent

Yes, I've struggled through a few: 27 percent

Does walking one count? Then yes: 20 percent
I’ve thought about entering, but haven’t had the nerve yet: 33 percent

I can barely jog around the lake in Wash Park: 16 percent

DIET

What kind of diet do you generally adhere to?
I’m a meat and potatoes kinda person (omnivore): 56 percent

Only veggies and grains for me please (vegetarian): 10 percent
Nothing that comes from anything with a face or that has a mother (vegan): 1 percent
Other: 33 percent (nearly all respondents who chose “other” would fall into the omnivore category)

When you go food shopping, what is your goal as far as healthy eating goes?
I look at every label for calories, fat, and suspect ingredients: 21 percent
I do my best to make healthy choices, but I’m no saint: 72 percent
I buy food that I like and don’t worry about the rest: 7 percent

Where do you shop for food most frequently?
Natural foods markets (Whole Foods Market, Vitamin Cottage, Sunflower Farmers Market): 23 percent
Farmers’ markets when available: 4 percent
Grocery chains (Safeway, King Soopers): 73 percent

What kind of food do you buy?
I try to buy local: 13 percent
I try to buy organic: 6 percent
I try to buy organic, natural, and local (anything that seems to offer less human intervention): 40 percent
Based on taste and preference rather than type or where it comes from: 28 percent
Whatever is cheapest: 13 percent

How often do you eat out?
Almost every night: 1 percent
A couple of times a week: 33 percent
Once a week: 42 percent
Very rarely: 24 percent

***Fast Fact: According to the National Restaurant Association, the average American eats out at a restaurant 4.7 times a week.

How often do you eat fast food?
Every day: 1 percent
Once a week: 30 percent
Once a month: 45 percent
Never: 24 percent

**Fast Fact: Numbers vary, but according to Fast Food Nation: The Dark Side of the All-American Meal by Eric Schlosser, the average American eats three hamburgers and four orders of fries every week.

How many meals do you eat a day?
Three squares: 39 percent
Five or six small meals throughout the day: 34 percent
I only eat when I’m hungry: 27 percent

If looking for a snack, which of the following would you most likely reach for?
Carrot sticks and maybe some hummus: 27 percent
An energy bar: 18 percent
Cheese and crackers: 36 percent
Cheetos and potato chips: 7 percent
I almost never snack between meals: 12 percent

How important is healthy eating in your family?
Extremely important—we do our best to make only healthy meal choices (low fat, low sodium, low everything) and rarely eat dessert: 12 percent
Important—but we also indulge in a scoop of ice cream every now and again: 79 percent
Less important—we don’t really go to any extra effort to eat healthy: 9 percent

Have you ever dieted?
No: 22 percent
I’ve never tried a specific diet but I’ve tried to lose weight by exercising and eating right: 37 percent
I’ve tried the occasional diet here and there: 37 percent
I’ve tried every fad diet on the market: 4 percent

LIFESTYLE

How do you view your current weight?
I’m pretty happy with it: 29 percent
I could stand to lose five pounds (but who couldn’t?): 47 percent
I’m always fighting to keep the same 20 pounds at bay: 11 percent
I’m overweight and need to do something about it: 11 percent
I’m overweight but I’m OK with myself: 2 percent

**5280 Readers’ Survey: 25 percent say they worry about their weight all the time.

How do you maintain your (healthy) weight?
I work out religiously so I can eat whatever I want, whenever I want: 9 percent
I monitor what I eat and don’t really work out that consistently: 15 percent
I try to find a happy balance between food intake and regular exercise: 69 percent
I have never found my “healthy” weight, much less maintained it: 7 percent

How often do you see your general practitioner (MD)?
Annually: 53 percent
Every few years: 12 percent
Only when I’m sick: 22 percent
I don’t remember the last time I went: 4 percent
Don’t have one: 9 percent

Do you smoke?
Yes: 7 percent
No: 85 percent
Every once in a while: 8 percent

**Fast Fact: According to the Centers for Disease Control and Prevention, 20.6 percent of adults in the United States smoked in 2008. It has long been thought that quitting smoking can lead to weight gain, but recent studies have shown that this weight gain (about four to 10 pounds) is typically only short term.

About how much water do you drink every day?
1 gallon: 53 percent
16 ounces: 39 percent
8 ounces: 5 percent
Almost none: 3 percent

How much alcohol do you drink?
A few drinks a day: 8 percent
A few drinks a week: 39 percent
A few drinks a month: 31 percent
I don’t drink: 22 percent

**5280 Readers’ Survey: 33 percent would choose to make a run to McDonald’s when they’re hungover rather than go for a cobweb-clearing jog.

How many times per week do you have sex?
5 to 7: 4 percent
4 to 6: 10 percent
1 to 3: 37 percent
Once or twice a month: 18 percent
I don’t remember the last time I had sex: 14 percent
I prefer not to say: 17 percent

**Fast Fact: Depending on your weight and the, um, vigorousness of your activities, you can burn quite a few calories in the sack. A 135-pound person can expect to burn anywhere from 61 to 124 calories during 40 minutes of sex, while a person weighing 185 pounds can burn from 89 to 170 calories during the same amount of time.

How would you characterize your sleeping habits?
I sleep like a baby every night: 21 percent
I get enough to get by just fine: 39 percent
I wish I slept much better than I do: 28 percent
I definitely don’t get enough sleep: 10 percent
I take sleep medication at night just to function during the day: 2 percent

**The Top Doctor Says: The way we sleep affects our daily lives. And if you’re overweight—or obese—and snore, your sleep may be hampered by sleep apnea. This condition occurs when the back of the throat is overcrowded, often by excess fatty tissue in people who are overweight. “Sleep apnea isn’t just snoring,” says Dr. Richard O’Brien, a sleep medicine physician in Denver. “Sleep apnea means that you are experiencing sometimes 200 or more partial stoppages of breathing throughout the night.” Those stoppages briefly make your body wake itself up, with resulting blood pressure spikes. Even if you don’t remember it, you’ve been awakened many, many times. “It results in a lousy quality of sleep,” the doctor says, “which can lead to bad behaviors during the day—like reaching for a candy bar for a sugar rush—that can worsen a weight issue that’s already causing problems.”

How would you describe your average stress level?
Extremely high: 4 percent
High: 28 percent
About average: 49 percent
Low: 17 percent
Non-existent: 2 percent

Do you consider your kids to be at a healthy weight?
Yes: 42 percent
No: 5 percent
Honestly, I’m not really sure: 1 percent
I don’t have kids: 52 percent

**5280 Readers’ Survey: 21 percent say they don’t ever worry about their kids’ weights.

**State of the State: Of our respondents who have children (48 percent), 87.5 percent say they consider their kids to be at a healthy weight. However, the Colorado Health Foundation reports that 14.2 percent of Colorado’s kids are obese.

Walk... With A Doc

A new community outreach program allows you to talk with a physician outside the doctor’s office.

Dr. Andrew Freeman says he sees the effects of obesity in his National Jewish Health–based cardiology practice every day. “The complications of obesity are ever-present,” he says. “But we, as doctors, often treat the problems, and the discussions about how to stop these issues in the first place frequently go by the wayside.” So, he decided to change that dynamic by starting a program called “Walk with a Doc.” /// The free monthly event, which takes place in a different local park each time, brings together the public, a handful of physicians, and a smattering of other health-care professionals like nurses, dietitians, and physical therapists. The session begins at 8 a.m. with a 10-minute seminar given by one of the doctors (usually a cardiologist or pulmonologist) and then moves on to the “walking” portion of the event. “We use exercise as medicine,” Freeman says. “There is almost no illness that doesn’t benefit from exercise.” So, the entire group begins a two-mile stroll around the park, during which “patients” can ask medical questions in a casual, comfortable atmosphere. The program’s mission is to encourage people to understand—and advocate—for their own health and to learn more about common medical conditions. “There’s really no excuse not to come,” Freeman says. “It’s free, it’s easy, and we’re giving out great advice without a co-pay.”

THE COLORADO EFFECT

How would you characterize your outdoor gear collection?
I could easily outfit an expedition to Mt. Everest with gear from my garage: 2 percent
I have the Colorado necessities: mountain bike, skis, snowboard, backpack, CamelBak, tent, fishing rods: 59 percent
I have some hiking boots in a closet somewhere: 22 percent
Gear? What gear?: 17 percent

Do you play outside (hike, throw ball, play tag, etc.) with your kids? Yes, all the time: 26 percent
Yes, when I have time: 58 percent
My kids are more of the video game type: 9 percent
No, I don’t like playing outside: 7 percent

If you are not a Colorado native, did your health habits change after moving here?
Yes: 28 percent
No: 28 percent
I’m a Colorado native: 44 percent

What activities or habits have you changed since moving to Colorado? (more than one response was allowed) Less TV viewing: 42 percent

Eating better: 77 percent

Less alcohol consumption: 21 percent

Exercising more: 82 percent
None of the above: 6 percent

Have you ever climbed a fourteener?
Yes: 30 percent
No: 67 percent
Tried but didn’t summit: 3 percent

Do you own any of the following? (more than one response was allowed)
A heart rate monitor: 20 percent
A pedometer: 46 percent
A mobile GPS (for running or hiking or cycling): 16 percent
A wet suit (for triathlons): 3 percent
More than one bicycle: 31 percent
Tele skis: 1 percent
A power meter (for cycling): 3 percent
None of the above: 34 percent

High Altitude, Low Weight

A few reasons why Colorado isn't tipping the scale.

Although there’s never been a study that researched why Coloradans are slimmer than the rest of the country, experts point to the following potential reasons why Colorado has fared better than other states.

The weather With at least 300 days of sunshine annually, generally low humidity, and relatively moderate temperatures year-round, our population has the opportunity to get outside more so than folks in cities in, say, South Carolina (hot!), Michigan (humid!), or South Dakota (cold!).

Our geography The call of the Rocky Mountains is difficult to ignore. And once you’ve heeded the call, you’re likely doing something active, whether it’s hiking, cycling, skiing, or snowshoeing. Plus, outdoor-loving transplants move from all over the country to Colorado to play in our hills, which means we’re drawing active people inside our borders.

The altitude Some researchers believe our low-oxygen environment may affect our weight. Not only is low oxygen an appetite suppressant, but it also increases metabolism.

Our culture The hippie-dippie, organic food–eating, communing-with-nature stereotype we all kinda hate probably does have something to do with our trim waistlines. If your co-workers are running marathons on the weekend and having organic tofu and iced green tea for lunch, it’s a lot harder to justify the 64-ounce soda and half-pound burger with bacon and cheese after a weekend of channel surfing.