Amy Phipps says she was “heavy the day I breathed air.” She attended her first Weight Watchers session at age eight and struggled with her weight as a teen and adult, topping out at 330 pounds. In 2004, she had lap-band surgery, in which a silicone belt is implanted around the upper part of the stomach, reducing its size; she lost 70 pounds but eventually regained 40.

Phipps acknowledges the seeming irony of being a nurse practitioner who once worked at an adolescent weight center. She knows what people think when they look at obese individuals. But she also knows what she’s observed in her career. At that weight center, for example, most of the teen clients consumed junk food: “Why were some 120 pounds, while others were 300 pounds?” Phipps queries. “We don’t know all the answers about what causes obesity.”

Many health care professionals view obesity as an increasingly costly health problem – medically, financially and psychologically – that has increased dramatically in the United States and many other countries over the past two decades. According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults – 35.7 percent – are obese, as are approximately 17 percent, or 12.5 million, of American children and adolescents ages two to 19.

Also prolific are so-called solutions to obesity, from fat-fighting pharmaceuticals to fad diets to extreme fitness routines. There’s no quick, one-size-fits-all fix, however. After gastric banding stopped working for Phipps, she turned to Moses Shieh, D.O.’99, FACOS, a former neighbor who is a bariatric surgeon with Surgical Healing Arts Center in Fort Myers, FL. Shieh was among the nation’s first surgeons to perform the sleeve gastrectomy procedure, in which a major portion of the stomach is removed, reserving its function but drastically reducing its volume.

“The surgery reshaped my stomach to be about the size and shape of a banana,” says Phipps, who had the procedure in 2010. “It’s not a get-out-of-jail-free card. It’s the start of a lifelong journey.”

“The Last Form of Prejudice”

At five feet, eight inches tall and 160 pounds, Moses Shieh doesn’t know what it’s truly like to be obese. He does know, however, how bariatric surgery – including gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy – can change the lives of people willing to take it as the first step in that lifelong journey Phipps describes.

“The surgery is the tool; the person’s lifestyle is the key,” Shieh says. “We tell people they’re our patients for life. Their success involves counseling, diet and exercise. Support groups are important, too, in helping patients keep each other on track.”

Some might consider surgery a drastic solution to being overweight, but alumnus Moses Shieh and many others consider obesity a drastic problem that merits it.

While significant advances and his own training in laparoscopic surgery – considered minimally invasive in its use of very small incisions – convinced him of the technique’s effectiveness, its impact on his patients continues to show him its transformative potential. He sees it every day: the 470-pound patient who originally came into his office on a scooter, nearly unable to walk; post-surgery and 125 pounds lighter, her scooter is gone. Another patient who, once 450 pounds, is now able to tie his own shoes for the first time in 20 years. The young woman now down from 460 pounds who was able to ride her first roller coaster. Many patients experience lower blood pressure, reduced risk of diabetes, less joint pain and other health benefits.

“This is a type of surgery that saves lives,” Shieh says. “People who have been overweight since elementary school are stigmatized and picked on. Obesity is the last form of prejudice.”

Phipps, now the bariatric program coordinator on Shieh’s staff, agrees. “Getting overweight early in life changes everything – one’s spouse, one’s career choice,” she says. “No one really likes obese people.”

Except for Shieh, she says: Phipps praises him for pursuing additional training in cosmetic surgery so he can remove the excess, baggy skin that some people retain after massive weight loss.

“For a normal-weight guy to ‘get it’ as much as he does makes him very special,” she says. “He wants to establish a place and culture where people can come and not be judged, but have their lives changed.”

How did we get so fat?

According to the National Geographic, the Puget Sound ferries in Washington have increased the width of their seats from 18 to 20 inches to accommodate people with bigger bottoms. A Colorado ambulance company has retrofitted its vehicles with a winch and a plus-size compartment to handle patients weighing up to half a ton. An Indiana manufacturer of caskets now offers a double-oversize model – 38 inches wide, compared with a standard 24 inches.

Why are we increasingly super-sized? Researchers are exploring the chemical and genetic factors that may foster fat. The hormones leptin and Peptide YY3-36 have been found to decrease appetite, while the hormone ghrelin stimulates it; scientists are investigating the implications of dosing or blocking these hormones. A study by a group of scientists in Washington found that obese dieters who succeeded in losing weight had higher levels of ghrelin than people of healthy weight levels, which might explain one way the body fights against weight loss. That was key to our survival over much of the course of human history, but today it might explain why so many dieters can’t maintain their weight loss.

That’s a case for surgical intervention, Shieh says, for patients with a high body mass index (BMI), an estimate of how much one should weigh based on one’s height. (To calculate your BMI, multiply your weight in pounds by 703, divide that answer by your height in inches, and divide that answer by your height in inches again.) An adult with a BMI between 25 and 29.9 is considered overweight; a BMI of 30 or higher puts one in the category of obese.

“Among people with a body mass index of more than 40, their chances of weight loss through diet and exercise is less than five percent,” he says. “In addition, their risk of disease like diabetes is very high.”

Diet, genetics and our environment all weigh in on our weight. Given the buffet of processed foods on our grocery store shelves and TV fare like “Man V. Food,” it’s a wonder anyone is thin.

More obvious reasons we’re rotund include our cheap, plentiful, lusciously fat- and sugar-packed foods, sedentary lifestyles and our tendency to take in more calories than we burn. Our environment plays a role, from aggressive food marketing and misleading or confusing food labels, to urban areas without sidewalks or safe parks and agricultural subsidies that make high-fructose corn syrup cheaper than produce.

“We have to make choices conscientiously, because our environment is set up to work against us,” says Pamela Duffy, Ph.D., P.T., assistant professor in DMU’s public health and global health programs. “In some areas, the unhealthiest foods are the cheapest.”

Changing Patters to Allow Better Choices

After she had sleeve gastrectomy, Phipps worked to change how she previously responded to environmental cues. “You have to recognize the patterns that you struggle with and create new ones that let you make better choices,” she says. “For me, every time I put gas in my car, I went into the 7-Eleven to get chocolate milk and cookies. I had to learn that was a danger zone for me, so now I strictly pay at the pump.”

Phipps also always packs her own lunch and talks with her two pre-teen children about healthy choices and portion control. While she’s not yet to her weight goal of 180 pounds, she’s dropped more than 110 since her surgery, a fact that’s allowed her, she says, “to go to a concert or get on an airplane and fit in the seat.” It’s also given her personal experience she shares with patients at Shieh’s practice.

“This job, for me, is such a gift,” she says. “To take all my years of failure – because no one gets here without years and years of failure and frustration – and put it to a positive use for other patients is so rewarding.”

Ben Ahrens admires classmate Stephanie Athman's spring roll handiwork.

Students stream into DMU’s wellness center kitchen, helping themselves to steaming cups of jasmine tea before settling into their chairs. A whiteboard on the wall lists today’s multicourse menu, from soup (miso) to nuts (tofu sesame almond cookies). Members of the wellness staff and faculty bustle around the counter, assembling tools and ingredients.

The scene feels like a dinner party among friends, which in a way it is, but the chefs and students have a mission in this meal: to apply their knowledge of nutrition in preparing healthy dishes that don’t require a doctorate in culinary arts. Joy Schiller, M.S., CHES, director of DMU’s wellness program, and David Spreadbury, Ph.D., chair of biochemistry and nutrition, have co-taught this popular elective course to DMU’s osteopathic students since 2007.

“I’m really interested in health and wellness. This is an opportunity to expand my horizons in cooking,” says Caleb Masterson, D.O.’14. “Plus we get to see Dr. Wilson in an apron.”

Don't let the apron fool you: Associate Professor Wayne Wilson gets serious when he demystifies miso soup.

That’s Wayne Wilson, Ph.D., associate professor of biochemistry and nutrition, who sometimes assists in the class. Swathed in an apron with a kilt motif, the native Scot tonight is in charge of the miso soup and steamed fish packets. Between those two dishes, Schiller demonstrates how to make a tofu-mintveggie spring roll, which garners a round of applause.

“Our goal is to provide basic hints on cooking more nutritiously as well as cooking more creatively,” she explains. “We’re somewhat technique-driven. We also encourage students to stock their pantries so that they can make a quick and healthy meal without having to shop.”

In addition, she and Spreadbury work to reduce food preparation’s fear factor. “Cooking is a creative outlet – it’s like quilting in the kitchen,” he says, effusing about the merits of fish sauce and other culinary delights. “Cook with abandon! There’s a whole world out there to try.”

Wellness Specialist Nicole Frangopol, Wellness Director Joy Schiller and David Spreadbury, Ph.D., stir-fry vegetables while Wayne Wilson sets out rice.

Students assemble spring rolls.

Equally important, class members learn that cooking can be healthy, affordable and doable, lessons that will serve them well in their lives and careers.

Kelly Hunter relishes one of the evening's offerings.

“It’s hard to find time to cook, but I’ve learned it doesn’t have to take a lot of time,” says Emily Morse, D.O.’14. “As physicians, it’s our responsibility to take care of our patients. We can show them that if we have time to cook healthy meals with our busy lifestyles, they can do it, too.”

Stacie Kamada, D.O.’14, says the class has motivated her to eat more vegetables and less fried foods and to think about counseling future patients. “I’ll need to give them practical ways they can reach healthy goals,” she says, as an ooh-and-ahh-inspiring pile of fresh vegetables crackles in two giant woks. “You can’t just tell people, ‘You need to lose weight.’”

What’s Driving Our Diet?

An elective in DMU’s public health program, “We Are What We Eat,” digs into the science of nutrition and then takes bigger bites into the economics of farm policy and food marketing, food origin and distribution, and implications for public health.

“We need to understand the basics of nutrition to shape food and public health policies,” says course instructor and Assistant Professor F.R. “Fritz” Nordengren, M.P.H. “We also need to understand that food systems have to be a keystone to any WHAT SHOULD WE EAT? health policy.”

Students in the course, offered for the first time last fall, examine the economic drivers in agriculture, food production and distribution that also drive our diet. Government subsidies for such commodities as milk and corn, for example, affect school lunch menus and the prices of foods filled with ubiquitous high-fructose corn syrup – in comparison to, say, fresh produce.

“Today’s consumers typically have access to 3,900 calories per day, yet the average person needs around 2,000,” Nordengren says. “At the same time, some people in the U.S. are food-insecure.”

Nordengren is no anti-government, antibig agriculture evangelist on food policy. He does raise free-range, antibiotic-free ducks, turkeys and chickens on his 80-acre property near Grand River, IA, an endeavor he clearly enjoys but one that taught him “small-scale production is not profitable.”

“We need large-scale farmers, processors and retailers to feed the world,” he says. “Food production is not a binary issue. We need producers of all sizes.”

Nordengren applies that balanced perspective in his role as president of the Iowa Food Systems Council. Established in 2000 by then-Iowa Governor Tom Vilsack, the now-member-driven nonprofit studies ways to address the needs of producers and consumers “from food to fork to disposal,” Nordengren says. Its members come from sectors ranging from farmers to food banks to physicians to public health leaders.

“It creates a safe and neutral environment for constituents to meet who otherwise might not come together,” he adds.

Controversies like outbreaks of food-borne illnesses and freerange versus concentrated animal feeding led in part to Nordengren’s work on a new public health course, “Don’t Put That in Your Mouth.” It will explore issues like food safety, security and sovereignty – “what we need to do as a state and nation,” he explains, “so we’re not dependent on things we can’t control.”

He adds that DMU can play a key role in tackling such issues.

“I think DMU is uniquely positioned to not offend producers, whether conventional or organic, because we can look at food issues from a nutritional standpoint,” he says.

Real Food for Real People

Back in the DMU wellness center kitchen, on the last meeting of the seven-week healthy cooking class, students take over, preparing a meal that reflects the healthful, largely plant-based principles and skills they’ve learned. By that point, they know, among other things, that slicing an onion is not brain surgery; that roasted Brussels sprouts are delicious; and, with a little planning, medical students do have time to cook.

Dig in: Watch a video of DMU’s healthy cooking class in action and try some of is recipes.

Despite the huge role diet plays in one’s health, the American Medical Association says few medical schools offer classes that give future physicians hands-on healthy cooking skills. But students in the DMU class say they’ll be better equipped to advise patients about improving their diets in ways that are practical, affordable and tasty. Given food’s role in our health, that’s something.

“We can do so much for our health with relatively minor changes, like introducing healthy foods that will push out some of the bad stuff,” Spreadbury says. “Equally important is how it all tastes. You can come up with the healthiest diet in the world, but no one will eat it if it doesn’t taste good.”

Not too many cooks in this kitchen (from left): Assistant Professor Melita Marcial-Schuster, D.O.; Wayne Wilson; Nicole Frangopol; Wellness Center Manager Missy Gripp, M.S.; David Spreadbury; and Joy Schiller.

“I’d be a vegetarian if bacon grew on trees,” read one attendee’s t-shirt.

Chalk it up to Iowa, the nation’s largest pork producer. Blame it on winter-weary, cabin-fevered people seeking fat with fun. But is a big-scale bacon binge – like deep-fried fast food, super-sized sugary drinks and fresh produce that’s too pricey or hard to obtain for some – yet one more example of how disastrous our diets have become?

According to the USDA, Americans spend just 9.47 percent of our disposable personal income on food, the lowest on the planet. But we spend far more on health care than any other nation, and – according to the CIA’s World Factbook – we rank 50th among nations in life expectancy. Is our diet killing us?

Without a dramatic change in our diets, a third of American adults will have diabetes by 2050 (up from one in 10 today). According to the Partnership to Fight Chronic Disease, obesity already accounts for 10 to 20 percent of the rise in health care spending; obese adults cost 35 percent more than do persons of healthy weight because of their chronic disease risks. The obesity pipeline might only get plumper, as more than one third of U.S. children and adolescents are overweight or obese.

These grim realities underscore the important roles that highly competent, compassionate health care professionals can play in counseling patients, advocating for programs and policies, and forming or joining coalitions to fight fat. Perhaps we need not eradicate bacon, but clearly we need guidance, incentives and environments that help us fill our plates – or push them away.

A diet for disaster?

At the Iowa State Fairgrounds in Des Moines, 4,700 people packed the Varied Industries Building to celebrate that much-maligned yet even more-loved meat: bacon. Was that just good fried fun or a sign of our epically bad eating?

A big appetite for better eating

DMU is one of the few medical schools in the nation to offer its osteopathic medical students hands-on experiences in the kitchen. Another DMU course digs into food policies, marketing and distribution. Students eat up both options.

Individuals, nations bear increasing burden of obesity

Some might consider surgery a drastic solution to being overweight, but DMU alumnus Moses Shieh and many others consider obesity a drastic problem that merits it.

Web extra: Students sink their teeth into health cooking

Watch DMU’s healthy cooking class in action! DMU is one of the few medical schools in the nation to offer its osteopathic medical students hands-on experiences in the kitchen. Find out why.