Indiana has the 12th-highest adult obesity rate in the nation, ranking one spot higher for childhood and teenage obesity. A study commissioned by the Richard M. Fairbanks Foundation estimates that one in three Hoosiers carries extra weight.
Obesity is defined as having a body mass index higher than 25, which is calculated using a patient's height and weight. Excess weight contributes to the country's health-care crisis and carries the risk of Type 2 diabetes, high blood pressure and more.
"A lot of research actually shows that the majority of obesity is related to nutrition — about 80 percent nutrition," Rachel Theodore, the vice president of Sports Medicine and Workforce Health at Logansport Memorial Hospital, said. "We don't eat natural food anymore. We don't cook at home… we're just on the go constantly. So we don't have a lifestyle in America that's conducive to eating healthy."
Theodore oversees Wellness Services at Logansport, which runs a program aimed at helping residents live healthier lifestyles.
"It's really rearranging the way we think about food. Food should be fuel for us," Theodore said. "I use the analogy of a car a lot — you have to put gas in your car for it to run. If you put something else in your car, it's not going to run very well. So think of your body that way, too. If you fuel it with the right things, it's going to run very effectively and very efficiently."
Theodore said the Logansport program started with a weight-loss portion that utilized group classes, nutrition plans and medical managers. Patients then get help maintaining their new weight and learning to implement new habits in their lives.
"It really just teaches how to make this a constant lifestyle change (and) a normal part of your day," Theodore said. "There is no quick fix to weight loss."
David Allison, the dean of Public Health for Indiana University, has studied obesity for over three decades. Allison said multiple factors could contribute to obesity in Indiana, such as lack of exercise, poor nutrition, food markets and even the use of certain pharmaceutical drugs or decreased smoking rates.
"But we wouldn't want people to smoke more so they lose weight; that's a terrible thing," Allison said. "The problem is getting enough effective treatment to people."
One-on-one clinical treatments, such as bariatric surgery, can be expensive, while community-based, early intervention programs, such as introducing fruits and vegetables into schools, haven't been as effective. While school-based programs might prove helpful for future generations, they don't appear to work as well for adults.
"What people seem to gravitate toward is wanting to do things on a more community level," Allison said. "Largely, those have been shown to be ineffective. … So that's a tough spot we're in."
However, Allison noted that research could find solutions in unlikely places, such as vaccines, guidance for pregnant women or gastrointestinal microbiomes.
Despite its prevalence in the United States, obesity still carries stigmas and discrimination. Studies show that doctors don't always believe reports of pain from patients who are overweight, salespeople are less likely to approach overweight buyers and parents are less likely to assist their obese children with college costs, according to Allison.
"Obesity is a tremendously stigmatized condition… We've gotten to the point in society where a late-night comedian can't tell jokes about disparaged people," Allison said, referring to racist or sexist jokes. "But (the comedian) can still make jokes about obesity."
Researchers and treatment providers are needed to not only prevent and treat diseases, such as obesity, but also to advocate for solutions, according to Allison. Work done by doctors transformed how the public perceived leprosy and HIV, he noted.
"We not only focus on the disease but alleviate suffering," Allison said. "That's something as a public health (profession) I think we have begun to do and can do more of to alleviate suffering."
FOCUSING ON GOALS
At Logansport, to circumvent these negative associations, the program avoided using words like obesity and focused on quality of life, Theodore explained.
"We discuss wanting to be able to do things that you haven't done before or done in a very long time. We discuss goals and 'Why are you here?'" she said. "It's a lot bigger than just body weight. A lot of people come because they want to go to Florida or hike a trail with their daughter. … We really try to focus on lifestyle and the goals they have."
The clinic avoided using BMI, instead focusing on body composition to get a more accurate understanding of their patients, some of whom have more muscle mass or bigger bone structures.
"I find that a lot of people are just tired. They're just doing so many things: working full-time jobs, raising multiple kids … food and cooking and exercise kind of just fall down on that list of priorities," Theodore said. "When you're your best, you can take care of your kids that much better; you can enjoy your time with your kids that much better."
Teaching people, especially working mothers, to prioritize themselves can be difficult but ultimately helps everyone, according to Theodore.
"The most important thing for people to understand is that there's no quick fix. It's a long journey," she said. "Small changes make a big difference."