Introduction (Amber Karim, pre-medical student at the University of Oklahoma)

Over the past century, the world around us has changed at an unimaginable rate. Technological advances have changed our lives remarkably since the time our ancestors lived as hunters and gatherers. With these drastic changes in lifestyle there have been great consequences to our health and well-being. As a biomedical engineering student on OU’s campus, I worked alongside colleagues to create innovative solutions to the latest healthcare problems. However, ironically myself and the students around me often made compromises to our health that may lead to the very problems we are attempting to solve. Late nights studying, grabbing fast food for convenience, and staring at a screen for hours on end will likely have long term implications on our health. As an alternative to creating solutions for these future problems it may be worthwhile to reevaluate our lifestyle choices and take preventive measures.

The scope of Obesity in Oklahoma (Rakesh Kumar Shah, MBBS, Nepal)

As per the latest data available on the Center for Disease Control website, more than two in every five adults living in the United States are obese, and this prevalence is even more common among the non-Hispanic Black population. The scenario in Oklahoma is not much different: here, nearly seven out of ten people are either overweight or obese. The prevalence of obesity in Oklahoma has increased by more than three times in the last 30 years.

Two months ago, I arrived in Norman, Oklahoma, from Nepal. I have been rotating with Norman Endocrinology Associates and volunteering at Manos Juntas, a free clinic. During my stay and work here, I have encountered many patients each day. Behind numerous patient complaints, a common issue stands and that is “the weight problem”. From the very first day of medical school, I was taught that obesity is a man-made disease that is associated with countless disease conditions. In addition, I was also told that obesity is not something that occurs of itself, but rather is a reflection of our lifestyles.

Recently, I visited a local pharmacy close to where I am residing. It surprised me to learn that U.S. pharmacies are not just small, hole-in-the-wall stores filled with boxes of medications; they’re also grocery and convenience stores. Moreover, I discovered that Walgreens is not just a pharmacy chain, but the nation’s largest producer of processed foods.

Coming from a nation where many women and children are still dying from undernutrition, seeing people suffer as a result of overnutrition makes my peers and I raise a question. Isn’t it time to rethink the way we live?

Weight gain during the pandemic (Diwakar Phuyal, MBBS, Nepal)

During my online Endocrinology class, I had the opportunity to learn more about the serious preventable medical conditions facing humanity today, including Diabetes and Obesity. Perhaps COVID-19 was not the only pandemic in the last year. Many people also suffered from COVID-15. This new term was created to indicate a weight gain of 15 pounds during the quarantine.

But we saw an increase in social media posts on healthy cooking and home exercises. Even the restaurants and bars were closed. So what happened?

The majority of weight gain was due to decreased overall physical activities, increased stress, and increased snacking. Even though bars closed, consumption of alcohol at home increased. It is the body’s physiological stress response to demand food and slow the metabolization under the influence of cortisol.

This scenario is the same in every part of the world. It is time we also act on the prevailing pandemic that is excessive weight gain. During the pandemic, the lines between our work and home blurred. We found ourselves working around the clock with international collaborations such as this online Endocrinology class. We find ourselves hunched over our computers for hours on end. How is this new way of life going to affect our health and overall well being? What can we do differently?

American lifestyle in comparison to other countries (Kusum Joshi, MBBS, Nepal)

The US is a country which most of the global population looks toward for inspiration. Despite it being one of the world’s largest economies, it also ranks among one of the countries with the highest percentage of obesity and diabetes. This may be due to the lifestyle that Americans are adapted to. Most Americans have easy accessibility to food due to enormous supermarkets, many fast food chains, and a car driven societal culture. This is contradictory to many developing countries as well as developed countries in Europe and Asia. Additionally, the food portion size is significantly larger compared to other countries.

Food is a basic necessity of everyone’s life but due to increasing consumption of too much food it has emerged as a huge problem and reservoir for many diseases. Due to busy lifestyles and lack of small convenience stores in America, people tend to buy food in large quantities when visiting the supermarket. This is different in many countries. For example, there are 20 small grocery shops within 30 minutes of where I live in Nepal. Thus, if we are in need of particular food items, we are able to purchase it when needed which aids in decreasing a food hoarding habit. Besides, the presence of large freezers in households further adds to the tendency to buy more items and store them. This is due to the convenience of being able to limit the number of trips needed to visit the grocery store.

Furthermore, compared to other countries, Americans have tended to rely more on fast food/frozen food as opposed to cooking at home due to their hectic lifestyles. In my country, fast food is really expensive and we occasionally eat at restaurants. In my opinion, aiming to cut down on junk food and sugary drinks (e.g. soda) while replacing them with healthy alternatives will positively affect food habits.

To maintain this busy American lifestyle, transportation is essential. For Americans, cars are a necessity in the means of commuting to work and facilitating everyday needs which is why a car-oriented culture has been established. Yet, people in developed countries aside from the U.S. tend to walk and use public transportation more as compared to using private vehicles. And in developing countries, cars are a luxury. Perhaps walking a few miles every now and then instead of using cars for every occasion can be helpful to create a more active lifestyle.

It is time to rethink the lifestyle we are slowly becoming vested into. As humans evolve, we try to create a more sophisticated environment for us that aligns with our society as it advances. The pros are it makes our life simpler and easier but the con is that we become lazier. The whole world looks up to America and their lifestyle in hopes of copying them. But is it really worth it for us humans in the long run in terms of our health? It really is time to rethink.

Redesigning suburbia (Lubna Mirza, MD, Endocrinologist, Norman Regional Hospital)

I live in Norman, Oklahoma where I have been taking care of patients with diabetes and Obesity since 2010 after graduating from the University of Oklahoma. After my visit to Tokyo, I was very motivated to start walking to work. My house is only 1.8 miles away from my office and there is no reason why this simple activity cannot be incorporated into my daily schedule other than when the weather is bad. I am an international medical graduate from Pakistan. I recently came across a photo of some people eating at a Pizza hut in Sukkur. I was surprised to find out that Pizza has found its way to the city far away from the United States where I spent my youth. Cities and towns are very different in Japan, Europe, or India with small shops and restaurants in neighborhoods with workplaces and schools at walking distances. The restaurants in India close between meal times for cleaning and the preparation of meals. Suburban sprawls in the US over the last hundred years created this illusion that we could separate our work lives from homes and create peaceful living environments to enjoy with our families. Our family sizes shrank while our homes got larger and larger. The truth is that this lifestyle depends largely on the consumption of fossil fuels. Having large store chains such as Walmart or Target at driving distances have created this culture of storing foods in our pantries and refrigerators. Vast residential subdivisions can be creatively transformed and adaptively reused as people still want to live in them. Perhaps, it’s time to create housing communities that encourage walking and make small restaurants in neighborhoods where people could get together to eat only at specific times. Perhaps, it is not prudent to reach for fast foods or personal cars at all times of the day and night? Perhaps, it is time to rethink suburbia. It’s also an opportunity for the larger world to understand the health implications of suburban lifestyle.

Do we need refrigerators or pantries at home? (Sameh Elawady, MD, Egypt)

It wasn’t until after World War II, when a full mass production of modern refrigerators began and many people started to have them in their homes, but was it necessary? Was it a good idea to have something that can store food? Does it prevent food wasting? Refrigerator sizes are getting bigger, and people proudly talk about refrigerator size and how much food they hold. So what is the drive for storing so much food? food insecurity. The fear of running out of food or money may be the drive. According to research done, Emery et. al at Ohio State University Food, food insecurity is a significant predictor of obesity. It was found that obese participants have a higher capacity of food storage appliance (i.e. more refrigerators and freezer).Thus, when people have more space, they tend to buy more and eat more. Seeing food is a significant stimulator of appetite. The average weight of Americans has gradually increased from 161 pounds in 1990 to 181 pounds today. Many people can argue that refrigerators prevent food spoilage and waste, but unfortunately the estimated spoiled food loss from refrigerators is about 103 pounds every year per person. So, although food inaccessibility and starvation are problems, it seems that frequent access to food is also a huge problem that we need to put a spotlight on.

Do we need to drive everywhere? (Shreeyanta K C, MBBS, Nepal; and Reem Imtiaz, MBBS, India)

In my opinion, driving to every place is not essential. Although driving is easy and shortens travel duration, a healthy walk to a nearby mart or even strolling around for refreshment will optimize your exercise requirements and help to reduce the risk of obesity. Several studies have shown that lack of physical activity increases the risk of obesity. Driving everywhere is an add-on to sedentary hours rather than physical activity. If small grocery shops are available nearby, we can go shopping for a short time on foot everyday instead of stocking our refrigerators for the whole week and eating it all. Stocking makes food easily accessible and we end up eating more than what our body needs. Walking to the small grocery shops would both be good exercise and help us keep our weight in check. Having pocket parks in our locality where we could easily go for a walk and get fresh air for refreshment is essential. We could walk or bike instead of driving. It may be difficult to live without driving in suburban areas where workplaces and marts are far. But in cities we could try, I guess. So maybe, we should think about changing our lifestyle and switch to walking more often than driving. It could be a health promotion activity to prevent obesity. This needs attention.

Recommendations (Ripudaman Singh, MBBS, India; and the team)

  • Cutting off artificial light or television at night would be beneficial for weight reduction as artificial lights mainly produce stress response in the body. Thus, as artificial lights are used they induce cortisol release that increases hunger at night which too increases weight.
  • Driving cars has contributed to weight gain as physical activity like walking and taking public transit to work has declined. This results in a sedentary lifestyle and weight gain. Thus, using cars less and incorporating more public transits/cycling will cause a weight reduction as physical activity will increase. This will aid in weight maintenance and keeps you feeling energised.
  • Not having parks, sidewalks, or gyms nearby homes contributes to physical inactivity for many individulas. Aside from this, oversized food portions increase the calorie intake of people, requiring them to increase the amount they exercise.
  • Some people may not have access to supermarkets that sell healthy foods such as fresh fruits or vegetables which may encourage them to eat unhealthy food contributing to weight gain. Food markets should be built nearby suburbs that use advertising via social media regarding healthy foods. This will make healthier food options more accessible to people for effective weight reduction.
  • Playing more outdoor games compared to indoor games like video games makes one physically and mentally strong.
  • People tend to eat when they are bored, angry, upset, or stressed. These mood variations decrease satiety and contribute to weight gain. Meditation may aid in improving mood and avoid overeating.

Edited by Amelia Momtazzadeh, pre-medical student at the University of Oklahoma

Dr Lubna Mirza and NRHS Associates
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