February 8, 2023

(From the picture below I think it must be two out of three)
(Thanks Mark!)

Americans who live in sprawling towns where the car is the only reliable
form of transport are up to six pounds heavier than those who live in

A deadly slice of American pie
If the UK is facing a ticking timebomb of ill health due to obesity, in
parts of the US that bomb has exploded. Health Editor Jo Revill visits
San Antonio, the fat capital of the world
Sunday September 21, 2003
The Observer
The Texan town of San Antonio is sometimes described, a trifle
optimistically, as America’s answer to Venice. Instead of gondolas,
there are magenta-coloured barges which transport tourists along a
two-mile stretch of river, past the native cypresses and gaudy
glass-fronted hotels.
This is a town where you can really eat. The choice of caf閟 lining the
riverside is dazzling: Tex-Mex, Chinese, Italian, Spanish and Indian all
vie to outdo each other on price and size. Steaming platters of
enchiladas are carried out to customers. The chips seem to last forever.
Pepsis and Sprites come in a ‘double-gulp’, bucket-sized cone.
Lodged in the arid plains of southern Texas, this colourful town is best
known as the home of the Alamo, the fort defended by Davy Crockett and
Jim Bowie against the Mexicans.
Now a more dubious distinction has put it on the world map. Last year,
it was named as the fat capital of the States. This title extends to the
globe, as the US has the highest international rates of obesity. Just
over 31 per cent of its citizens are obese, meaning that they have a
body mass index of 30 or more. For a 6ft man, that equates to weighing
16 stone or more. A 5ft 6in woman would have to be more than 13 stone to
qualify. The survey of risk factors compiled by the federal Centers for
Disease Control and Prevention found that more than two thirds of the
district’s population is overweight.
Stroll downtown and the statistics become very real – and very open.
Women who would put a strain on any set of bathroom scales wear shorts
and T-shirts, not the long skirts or leggings which are used to shroud
the flesh in Britain.
More than one million people live in and around Fat City, as San Antonio
is known. Many are poor, a state which is linked to a sugar and fat-rich
diet. Poor mothers tend to have underweight babies who through their
lack of nutrition in the womb become biologically programmed to store
fat super-efficiently in their youth. Around 40 per cent of the
population is of Hispanic and South American extraction, and they appear
genetically prone to being overweight.
In San Antonio, it is almost impossible to walk anywhere as the blocks
are so large, the roads so wide. The only people you see using their
legs are tourists or the homeless.
But, as in Britain, the major cause of adult obesity can be traced to
schools. A breakdown of the daily lives of San Antonio’s youngsters
provides grim reading for those concerned about Britain’s growing
obesity crisis. Most children are bussed in or driven to school. They
have school lunches provided by Pizza Hut and other companies which have
an enormous commercial interest in trapping a new generation.
Belatedly the politicians have woken up to the scale of the epidemic –
but they are finding it almost impossible to act. A first easy step
might be to take fizzy drinks out of school corridors, but even that is
beyond them. In Texas, the food giants put $54 million a year in to
schools to sell their wares in vending machines, and that money goes
directly into buying books and computers. The only action officials can
take is to insist that healthier drinks are also sold in the machines.
Dietary lessons are carried into adulthood. In April, the town comes
alive with a 10-day festival, where every street is filled with stalls
selling tacos, sweetcorn, enchiladas, chilli hot dogs and cakes.
But it is not the annual fiesta which is to blame for San Antonio’s
crisis – it is a whole way of life. The food is plentiful and cheap. In
the local Steak Escape, for example, a meal of a seven-inch steak, chips
and coke costs just $6.09 (�3.78). A chilli-cheese hot dog in the A&W
All American food bar, containing more than 700 calories, is $2.79 (�1.73).
American experts came to Britain last week to warn about the dangers of
‘supersizing’, the marketing of bigger portions of fatty snacks to
ensnare consumers. Dr Jeff Prince used a distinctly unscientific term,
‘humungous’, to describe the size of the portions which American snacks
have reached. A chocolate chip cookie, he revealed, is 700 per cent
bigger than in 1982.
If it all begins in school, it ends in the clinic of the local bariatric
surgeon, who for several thousand dollars will perform a gastric bypass
operation which ensures rapid weight loss for at least three months.
When patients become morbidly obese, carrying around 100 excess pounds,
they are eligible to receive surgery under their health insurance. By
that stage, they will be suffering from related conditions such as
diabetes and heart problems, and surgery is their only chance of
avoiding a premature death.
Down at the town’s Santa Rosa medical centre, Dana Reiss, one of the
town’s four bariatric surgeons, said: ‘These patients are desperate.
Many will have been on diets for most of their adult life, but they
never work. This surgery is a last resort, but it does force patients to
change how they eat.’
Many patients are not eating out of hunger, but out of habit and because
they cannot face other problems in their lives. ‘This is a disease of
plentifulness,’ said surgeon Paul Selinkoff. ‘There’s so much
opportunity to eat all the time.’
Alexandra Tavassos, 36, does not know how she became so fat – large
enough not to fit in restaurant seats or wear a seatbelt in the car.
Last year she had the surgery, and lost 96 pounds. Now she is struggling
to understand why people treat her differently. ‘I’m an architect,’ she
explained. ‘I’ve done the same job for years, but I’ve begun to notice
that colleagues stop and chat to me. These are people who used to pass
by my desk. Did I really seem so different to them when I was fatter?’
The answer has to be yes.
Big in America
58 per cent of Americans are overweight, and almost 21 per cent obese.
The rate of obesity has more than doubled in the past 18 years.
The size of portions has soared. The average muffin is 333 per cent
larger than it was 20 years ago.
One in five American children is overweight.
Americans who live in sprawling towns where the car is the only reliable
form of transport are up to six pounds heavier than those who live in


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