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The Super-Sized Culture

June 10, 2008 - 7:30am
 
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The Super-Sized Culture

Image for visceral fat article Anna-Leena Rasanen had arrived in the U.S. from Finland only eight days earlier, but already she was getting the picture.

"The day we came, we went to a restaurant. First was a huge salad. Then chicken with spinach and pasta. That was huge. I didn't imagine a portion could be so big. Even my boyfriend [who's 6 feet 5 inches and weighs 230 pounds] said that he couldn't have eaten the whole portion."

Sam Moore, a Landover, Maryland, resident, made the same types of observations when he arrived from Sierra Leone in 1998. "People eat a lot more often here, and more in one helping," he found. "It takes a while getting used to."

But get used to it he did. "When I first came," notes the 5-foot 9-inch information systems coordinator, "I was around 165. Now I'm looking at pretty much close to 200. It creeps up on you."

The American Weigh

Moore is by no means an anomaly. Study after study is showing that when people come through Customs here, they customarily gain weight. In one report, it was found that a group of Tarahumara Indians from Mexico put on an average of about nine pounds within five weeks of adopting the typical American diet. Their blood cholesterol shot up 38 percent.

Additional studies have shown that the longer immigrants have been here, the more likely they are to be overweight or obese. A study in the New England Journal of Medicine found ten years to be the threshold, after which point weight gain sets in for US immigrants, Overall, however, foreign-born individuals are less likely to be obese than their American-born counterparts.

Lillian Cheung, PhD, RD, director of the Eat Well and Keep Moving Program at the Harvard School of Public Health's Department of Nutrition, says she gained "roughly 30 pounds in the first year or two" when she relocated to North America from Hong Kong several decades ago (and lost them when she reverted to a more "Asian" way of eating). "I couldn't get full," she says. "I'm used to the bulk in the Chinese diet"— clear soup with a lot of vegetables,' for instance, that lend satiety without adding a lot of calories. American foods, by contrast, provide a lot of calories in just a few bites, leaving your stomach feeling empty even though you've hit what should be your caloric limit.

What You See is What You Eat

Milly Hawke, a Boston-area nurse who first came over from England about 10 years ago, believes that part of the reason it's so easy to gain weight here is the ethic driven into people the world over to finish what's on their plates. Since there's so much put on people's plates in the U.S., they're invariably going to end up eating more.

"In particular, desserts are bigger here," she observes. "Huge slices of cake. It's enough for four usually, isn't it?" Hawke notes, too, that "a small ice cream cone in the U.S. is something we'd call an extra large."

Cleveland Park, Maryland, resident Anne-Pierre Pickaert has found the same disconnect in translating the words "large" and "small." "For soda, the glasses are huge," says Pickaert, a native of France. "It's like a vase. I can't see how somebody can be so thirsty."

Portion-Size, American Style

In fact, many foods, just like people, grow in size when they come to the U.S. from other countries. The American Institute for Cancer Research points out that the average croissant in a Parisian bakery weighs 34 grams, or slightly more than an ounce (28 grams). But at Au Bon Pain, a croissant weighs more than 2 ounces. And at Mrs. Fields, a butter croissant weighs closer to 3 1/2 ounces (and contains 320 calories).

Similarly, in Mexico, a quesadilla filling such as chicken and cheese is typically wrapped in a 5-inch tortilla, for a total of about 540 calories, according to the American Institute for Cancer Research. Here, quesadilla fillings are often stuffed into 10-inch tortillas. (You can do the math.)

These foods are also cheaper, particularly in fast food restaurants. "Fast food in the United States is probably cheaper than anywhere in the world," notes David Holben, PhD, RD. That and the fact that fast food is so convenient in this country compared to others no doubt influences the quick, sometimes wholesale, dietary acculturation of new immigrants, he comments.

Supermarket foods play a role, too, coming in larger packages here than elsewhere. "A milk container here looks like a petrol container in France," says Pickaert, "even the way it has that handle." In France, the biggest [milk container] you can get is a liter and a half."

"Convenience store sizes [that is, small containers] are more usual in Europe in general," comments Karen Drayne, an American who lived abroad for 15 years before settling in Chevy Chase, Maryland. Drayne, who spent time in England, Portugal, Sweden, and Austria, points out that the all-you-can-eat concept is peculiarly American, too. "I don't remember any all-you-can-eat plans in any of the countries I was in," she says. "In Sweden, there were smorgasbords. But there it was all you could eat of salads ."

Calorie Imbalance

Of course, it's not just the huge portions and the huge amounts of desserts and other sugary foods that make it all too easy to put on extra pounds in the U.S. We appear to expend fewer calories on physical activity as well. Data collected in the mid 1990s by John Pucher, a professor of urban planning at Rutgers University, indicate that at least 40 percent of trips in urban areas of Austria, Denmark, the Netherlands, and Sweden are made by bicycle or on foot. The same is true for at least 30 percent of all urban-area trips in France, Germany, and Switzerland. But in U.S. cities, only about 10 percent of travel occurs outside of cars (and buses and trains). Not surprisingly, the European countries with the highest amount of walkers and bicyclists also have lower rates of obesity, type 2 diabetes, and hypertension than the US.

This point hasn't been lost on Anna-Leena Rasanen, the Finnish heart disease researcher, who already is aware of how seductive American portion sizes can be. "I think I may gain some weight," she says. "I haven't found a gym yet."

RESOURCES

America on the Move
http://www.americaonthemove.org

USDA My Pyramid
http://www.mypyramid.gov

U.S. Committee for Refugees and Immigrants—Nutrition Outreach Toolkit
http://www.refugees.org/article.aspx?id=1818

CANADIAN RESOURCES:

Canadian Council on Food and Nutrition
www.ccfn.ca

Dietitians of Canada
http://www.dietitians.ca/

References

Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany. American Journal of Public Health,.2003; 93(9).

Koya DL, Egede LE. Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants. J Gen Intern Med. 2007;22(6):841-6.

McMurry MP, Cerqueira MT, Connor SL, Connor WE. Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet. N Engl J Med. 1991;325(24):1704-8.

Yang EJ, Chung HK, Kim WY, Bianchi L, Song WO. Chronic diseases and dietary changes in relation to Korean Americans' length of residence in the United States.J Am Diet Assoc. 2007;107(6):942-50.



Last reviewed February 2008 by Maria Adams, MS, MPH, RD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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