Posts Tagged ‘overweight’

Kaiser Permanente was about fitness before fitness was cool

posted on May 9, 2012

By Wendy Edelstein
Heritage associate

Third in a series

The Kaiser company sponsored a women’s basketball team during the Richmond Shipyard days. Bancroft Library photo.

Getting regular exercise plays a key role in staying physically and mentally healthy. A given in 2012, the relationship between physical activity and good health has only been well understood for the past few decades.

While work once involved physical labor for a majority of Americans, early 20th century technological advances changed most jobs into something requiring much less exertion. Henry Ford introduced the assembly line into his Detroit factory to produce cars more rapidly, and mechanization spread to other industries, including farming.

Getting workers into ship-shape

The man behind California’s Richmond Kaiser Shipyards understood the value of good health. Industrialist Henry J. Kaiser knew that keeping workers and their families healthy and happy was vital for the success of his business. Competition among Kaiser teams to produce the most ships at the fastest pace was intense.

To keep workers fit, and to boost morale, the Kaiser Shipyard management provided many opportunities for employees to be active. Softball and basketball games were scheduled so that day, swing, and graveyard workers could participate. And bowling, skating, swimming, tennis and horseshoes were available any time.

Most able-bodied American men were away fighting on the war front, so women workers (who became collectively known as “Rosie the Riveter” and “Wendy the Welder”) took on jobs that in peaceful times would have been considered men’s work. The work was demanding – and early on women found their jobs requiring more strength and stamina than they could muster.

Richmond Shipyards shopfitters baseball team during World War II. Bancroft Library photo.

When shipyard gynecologist Hannah Peters recognized many of the women were resigning because the work was too hard, the yard began providing them with strength training.  The women learned how to climb ladders, lift loads, and how to combine the two skills to climb with loads.

A mid-century check-up

By the early 1950s, the effect of industrialization began to show, and Americans were judged to be less physically fit than previous generations. “Muscular Fitness and Health,” a 1953 article published in the Journal of the American Association for Health, Physical Education, and Recreation, asserted that the sedentary 20th century American lifestyle had led to a loss of muscle tone in this country’s citizens.

Co-authors Hans Kraus, MD, and Bonnie Prudden cautioned that Americans needed to adopt physical fitness regimens to regain the level of fitness of earlier generations who used their feet to get around and sweated through their work day.

Kraus and Prudden’s message gained traction when mainstream publications such as Newsweek, U.S. News & World Report and Sports Illustrated picked up on a study Kraus had done that showed American youth to be significantly less fit than their European counterparts.

In the early 1950s Kraus studied students between the ages of 6 and 16 and measured their strength and flexibility as they performed sit-ups, leg lifts and toe touches.

A startling 56 percent of the 4,400 American students tested by Kraus and his colleague Sonja Weber, MD, failed at least one of the fitness components. In contrast, only 8 percent of the 3,000 European students (who hailed from Switzerland, Italy or Austria) failed even one part of the test.

Kraus blamed the American students’ poor showing on their pampered lifestyles: Their parents typically drove them to school, and they did only light chores and played within their own neighborhoods. Their European peers, on the other hand, typically walked miles to school, rode bicycles and performed strenuous chores such as chopping wood.

John and Jackie Kennedy on the cover of Sports Illustrated, Dec. 26, 1960

When President Dwight D. Eisenhower suffered a heart attack in 1954, America received a lesson in preventive care from Dr. Paul Dudley White, the president’s physician. Dr. White used television – 65 percent of Americans had a TV at home by 1955 – to tell Americans they could stave off heart attacks by exercising more, giving up cigarettes, and by eating healthier food, and less of it. President Eisenhower followed his doctor’s advice and went on to establish the President’s Council on Youth Fitness in 1956.

Sowing the seeds of a fitness revolution

In December 1960, then President-elect John F. Kennedy spearheaded a public awareness campaign promoting physical fitness. In “The Soft American,” an article he wrote that appeared in Sports Illustrated, Kennedy cited the results of the Kraus-Weber Test as well as an annual physical fitness exam at Yale University: 51% of the class passed in 1951, 43 percent passed in 1956 and 38 percent passed in 1960.

“Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity,” wrote Kennedy. “The relationship between the soundness of the body and the activities of the mind is subtle and complex. Much is not yet understood. But we do know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong; that hardy spirits and tough minds usually inhabit sound bodies.”

Once he took office, President Kennedy’s message reached an even wider audience via a public awareness campaign, President’s Council-sponsored pilot projects to test children’s fitness levels, clinics and educational films and booklets.

Outdoor aerobics class led by registered nurses in Hawaii, 1982

When Kaiser Permanente (KP) opened the doors of its Health Education Research Center in Oakland in 1969, its overarching educational theme was, “You have only one life to live – live it in good health.” The experimental center featured a patient health library and health exhibits. “Story of Life,” one of the most popular displays about human reproduction and family planning, used life-size, three-dimensional models and color slides.

Another area of the center presented information about health hazards: weight problems, smoking, venereal disease, cancer, and alcohol and drug abuse. The “Pathway to Positive Health” exhibit focused on how visitors could stay well by paying attention to nutrition, dental hygiene and the physical, mental, emotional and social aspects of good health.

The Health Education Research Center was an outgrowth of a pilot project that explored education’s role in increasing the effectiveness of preventive care. This was a new approach to prevention; it spread through the Kaiser Permanente system and beyond. By 1987, 85 percent of all U.S. hospitals offered health education programs.

From aerobics to yoga – 1970s ushered in fitness craze

Unofficial estimates in the early 1980s suggested that more than half of all Americans pursued some sort of recreational exercise, such as bicycling, swimming, tennis or running.  This new dedication to physical activity signaled a change.

“Until recently, modern generations of Americans by and large failed to act on a compelling accumulation of knowledge linking individual lifestyle with individual health. As a nation, our eating habits violated accepted standards of nutrition. We shunned devoting our leisure time to regular physical exercise,” declared the writers of Kaiser Permanente’s 1984 annual report.

Fitness guru Richard Simmons leads a class in aerobics.

During the 1970s and 1980s many Americans got swept up in the fitness craze. Wearing leotards, neon spandex and leg warmers, they headed to health clubs and performed leg lifts and side bends and hoisted dumbbells to upbeat music. Or they popped Jane Fonda’s Workout in the video cassette recorder (VCR) and worked up a sweat at home. Others jogged their way to good health after reading Jim Fixx’s 1977 bestseller The Complete Book of Running.

Americans had different motivations to exercise, according to a 1978 Harris poll. Twenty-four percent of regular exercisers cited their reason was to strengthen their heart and/or lungs, 41 percent sought to lose weight, 24 percent wanted to become healthier, and 45 percent hoped to stay healthy.

A 1976 Centers for Disease Control and Prevention study of the 10 leading causes of death in the United States looked at the importance of four factors. Lifestyle, including exercise and diet, figured most prominently at 51 percent, followed by heredity (20 percent), environment (19 percent) and inadequate access to health care (10 percent).

Garfield’s Prescient Total Health Care Project

KP founding physician Sidney Garfield’s crowning achievement, the Total Health Care Project, came towards the end of his life in 1984. Among the Total Health Care Project’s goals was “to provide comprehensive primary care services for both wellness and illness and to provide incentives to professional staff to keep members well rather than just treating them when they are sick.”

An aggressive outreach plan to new members encouraged them to schedule a health evaluation appointment to review their current health and to develop a personalized Health Improvement Plan (HIP).

Colorado KP employees and members participate in an aerobics class. Kaiser Permanente 1984 Annual Report photo.

Members received a mailing with the instructions: “If you are feeling fine, we also want to see you to make sure you are in good health and assist you in preventing future problems. We really think the BEST time for you to get acquainted with us is when you’re feeling good, without the pressure of illness.”

Members who visited the Total Health Care Center for initial and periodic examinations assessed their own health via a questionnaire. They were asked about their eating habits, their lifestyle and how frequently and intensely they exercised. Part of the assessment was a treadmill endurance test to determine cardiovascular fitness.

Through the Total Health program, the center staff guided members in their quest for good health. Handouts offered tips such as how to select an activity that you will stick with as well as how to take your own pulse.

In the 1980s, popular health books included Pritikin Program for Diet & Exercise, Better Homes & Gardens’ Good Food & Fitness and Covert Bailey’s Fit or Fat? Fitness programs and initiatives began to take root throughout Kaiser Permanente’s regions. For instance, in 1984, the Ohio Region launched its “Annual Frost Belt Classic,” a series of five-, 10-, and 15-kilometer cross-country ski races. The race drew 500 skiers in 1987.

In the early 1980s, every KP region sponsored or supported a race or fun run. As part of its Dr. Wizardwise health education program, the Hawaii region sponsored a run for children.

Also in the 1980s, Kaiser Permanente’s Northern California Region established partnerships with about 15 local health clubs, enabling its members to join for a low or no initiation fee and a reduced monthly rate.

The current picture of health

Members of the Kaiser Permanente Dragon Boat Team, the KP Dragons. KP 2007 Annual Report photo.

Today medical assistants in Kaiser Permanente’s Southern California, Northern California, Colorado and Northwest regions ask patients about their exercise habits as a matter of course. Exercise as a Vital Sign was launched in Kaiser Permanente’s Southern California region first in 2009 to capture information about members’ physical activity.

Medical assistants routinely ask two questions: 1) On average, how many days a week do you engage in moderate or greater physical activity (like a brisk walk)? 2) On those days, how many minutes do you engage in activity at that level? Those answers are entered into the KP member’s computerized health record, and his or her physician can view that information along with the rest of the patient’s vital signs.

Kaiser Permanente also promotes healthy living through its Every Body Walk!, Thrive Across America, Healthy Eating Active Living and KP Healthworks programs and by sponsoring walks, runs and cycling events and offering an array of fitness classes at its medical centers.

Weight of the Nation - HBO series on obesity

Home Box Office series premiers May 14

With Exercise as a Vital sign in the exam room and a broad array of healthy living initiatives, Kaiser Permanente’s longtime fitness message endures: regular exercise is one of the cornerstones of preventive care and ultimate good health.

Kaiser Permanente is one of the sponsors of the Home Box Office (HBO) upcoming documentary series “Weight of the Nation,” which covers the issue of obesity in America. The four-part series will be aired May 14 and 15. For more information about KP’s involvement in the fight against obesity:

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Obesity: a runaway trend predicted to sabotage health of the nation

posted on May 8, 2012

By Lincoln Cushing
Heritage writer

"Fear of Fat" in the March 1984 KP Reporter newsletter warned of going too far with weight consciousness.

Second in a series
Efforts to combat obesity, childhood obesity in particular, are making news. Examples include First Lady Michelle Obama’s signature public health campaign “Let’s Move!” the Home Box Office (HBO) documentary series “The Weight of the Nation,” and the popular charge to incite health providers, schools and communities to join the fight to stop the spread of obesity.

But the current attention devoted to this issue in a culture obsessed with fad diets and alarmist health news raises the question: Is this really a significant problem?

To begin with, medical experts do not universally acknowledge “obesity” as a disease, like AIDS or lung cancer. There have always been overweight people, and for many the driving concern for weight loss has been more about the aesthetics of body image than physical health.

But two significant and disturbing facts have changed over the past two decades. First, for reasons not fully understood, there has been a measurable increase in the numbers and demographic distribution of obese people. And second, there has been an accumulation of research linking excess body weight to bad health.

The obesity epidemic

Data reveal our population’s progressive ponderosity over time. Medical concern over weight and obesity show up in the mid-1960s. A 1965 UC Berkeley student paper by a physician noted “Estimates run as high as 25 million overweight Americans (based on desirable weights taken from actuarial tables). Some epidemiologists might consider that we have an epidemic of obesity in America. . . A tremendous amount of time, effort, and money is being devoted to the understanding of the problem of obesity and its significance and solution. Diet foods are a multimillion dollar industry. The military attempts to legislate weight and physical fitness with compulsory standards.”1

A 1984 article in Kaiser Permanente’s KP Reporter noted that the Metropolitan Life Insurance Tables showed that a “surprising” 40% of American men and 55% of American women were overweight, currently defined as those having a Body Mass Index (BMI) between 25 and 29.9. The more serious condition is obesity, with a BMI over 30. (BMI is computed by dividing a person’s weight by the square of his or her height.)

A 1987 Planning for Health Kaiser Permanente (KP) member newsletter article stated that “Obesity is our nation’s number one nutritional problem.”  Last year the Centers for Disease Control and Prevention reported that between 1980 and 2008, obesity rates had doubled for adults and tripled for children. During the past several decades, obesity rates for all population groups — regardless of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region — increased markedly. More than one-third of U.S. adults (over 72 million people) and 17% of U.S. children are considered obese.

KP promotional brochure for its Oakland weight control program in 1973

The main reasons proposed for this alarming phenomenon include a more sedentary lifestyle, unhealthy diet, a proliferation in the use of sweeteners (first the “white death” sugar, eclipsed now by high-fructose corn syrup) in food products, and lack of exercise.

Even greater use of worksite microwave ovens during the 1980s was described as adversely affecting healthy eating habits. But other, more complex, causes have been proposed as well, and Kaiser Permanente has embraced a range of treatment modalities and education techniques to help keep members healthy.

Nutrition and health

Doctors advise patients to eat right and in moderation, with increasing medical evidence supporting the case that excess weight contributes to life-shortening conditions such as diabetes, heart trouble, and high blood pressure. Kaiser Permanente early on recognized that the changing dietary behaviors of its members were having a negative effect on waistlines.

Fast food chains, offering cheap high-fat, high-sugar, and high-salt meals, grew enormously during the 1960s and 1970s. Soon KP challenged this trend as an unhealthy one.  A 1987 Planning for Health newsletter posed the question, “Burger King, McDonald’s, Wendy’s, Jack-In-The-Box. Everyone is familiar with the names of these fast food restaurants. But how many of us are aware of the ingredients found in their food? Take a few moments to complete our Fast Food Facts quiz.”2

Mary Wheeler, PhD, with young Ohio patient enrolled in the Optimal Growth Center weight management program. KP 1979 Annual Report photo.

Influencing young people to eat a healthy diet and control their weight is crucial. In 1975, developmental psychologist Mary Wheeler, PhD, and pediatrician Karl Hess, MD, in KP’s Ohio Region started the Optimal Growth Center to help overweight children learn new eating habits. They addressed the social stigma of being overweight, with the long-term view that if they didn’t change their condition they would face significant risks of hypertension, heart disease, and diabetes as adults. 3

Education and outreach

As early as 1956, the Oakland Kaiser Permanente staff realized that peer groups could help people lose weight, and they instituted a group treatment program for overweight patients. In small, informal, round-table support groups of eight to 10 participants, physicians offered information and the group discussed mutual problems.

How much should you weigh? An illustration from "The Importance of Diet" in Planning for Health KP member newsletter, Spring 1965.

In the late 1980s, Kaiser Permanente Nutrition Services Departments hosted workshops for members on subjects such as “The Right Way to Good Nutrition.” One Health Plan member who benefitted from the program commented, “When I had a physical last fall, my physician said I was showing signs of arteriosclerosis (hardening of the arteries). After taking three nutrition workshops, I recently had another physical. My cholesterol count was down 20 points and I’ve lost 11 pounds.”4

One successful medium for reaching youth is KP’s Educational Theatre Project. For 25 years the troupe has used live performances at public schools to engage youth audiences on a range of health subjects, including childhood obesity in “1½” and “Give Peas a Chance.” In 2007 KP partnered with educational publisher Scholastic, Inc., to launch an online game based on another play, “The Amazing Food Detective,” teaching children about healthy eating and maintaining an active lifestyle. The game automatically shut off after 20 minutes and encouraged players to get up and exercise or perform some activity away from the computer screen.

Kaiser Permanente was also quick to acknowledge the role that gender and social (rather than medical) standards played in defining “desirable” weight.  Second-wave feminism of the 1970s challenged the standard guidelines, noting that women were particularly susceptible to exaggerated concerns about weight that could have negative health consequences of their own.

A 1984 KP Reporter article “Fear of Fat” asked: “Why have we saddled ourselves with an ideal of beauty which torments most women over the age of 20, not to mention many teenagers? One reason is purely commercial. Fifth Avenue has chosen human clothes-hangers who can model any style of clothing.” It goes on to say: “Kaiser-Permanente offers weight-loss programs that do not make a fetish about fat but rather stress good nutrition, exercise, and behavior modification.”

Obesity as a shield against attention

Another connection between self image and weight came out of research conducted by the Southern California Permanente Medical Group. In 1982 Vincent J. Felitti, MD, then a San Diego Kaiser Permanente internist, developed a program to help obese people lose weight, which matured into the Positive Choice Weight Loss Program in 1985. He was confounded by the observation that many of those who experienced success began to drop out. After studying hundreds of patients he learned that many were unconsciously using their obesity as a shield against unwanted sexual attention, a behavior based on experiencing physical or sexual abuse as children.

Subsequent research resulted in a comprehensive assessment protocol, Adverse Childhood Experiences (ACE), that examines the hidden legacy of childhood trauma and helps identify patients for whom conventional weight reduction programs don’t work. More than 17,000 San Diego KP members have been diagnosed using ACE and the study has produced 72 scientific publications thus far.

Weight of the Nation - HBO series on obesity

Home Box Office series premiers May 14

As Dr. Felitti describes it, “The program involves the essential linkage of two disparate elements: prolonged absolute fasting using the supplement “Optifast” to preserve health in the absence of food intake, and a psychodynamic approach whose function is to help each person discover the unconscious forces underlying their use of eating for its psychoactive benefits and the possible advantages of obesity in their life. Using this approach it is possible to reduce a person’s weight about 300 pounds in a year and help them tolerate that emotionally.”5

Kaiser Permanente has supported efforts to make fresh fruits and vegetables available to more people, helping local convenience stores stock healthier products and bringing grocery stores to “food desert” neighborhoods. Preston Maring, MD, started the first KP-sponsored farmers’ market at Oakland Medical Center in 2003. These efforts are now successfully replicated in many community and KP facilities, often coupled with nutrition information and other healthy lifestyle outreach. For more about KP farmers’ markets:

Kaiser Permanente is one of the sponsors of the Home Box Office (HBO) upcoming documentary series “Weight of the Nation,” which covers the issue of obesity in America. For more information about KP’s involvement in the fight against obesity:

Next time: Kaiser Permanente was about fitness before fitness was cool

1 “Obesity and its Measurements as it Relates to a Multiphasic Screening Program,” by Clarence F. Watson, MD; student paper from UC Berkeley public health class PH274A, Fall, 1965. Dr. Watson’s essay makes the case that “skinfold measurement” using calipers rather than BMI is a more accurate indicator of obesity.

2 “Fast Food Facts,” Planning for Health newsletter (Richmond edition), Winter 1987-1988

“Helping Overweight Children,” KP Annual Report 1979

4 “The Path to Good Nutrition,” Planning for Health newsletter (Vallejo/Napa/Fairfield edition), Summer 1988

5 Email correspondence from Dr. Felitti 3/22/2012. For more about Dr. Felitti’s California Institutes for Preventive Medicine:

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