One is hard-pressed to say just why black women bear this burden more than black men, or nonblack women. A 2005 study of women’s health in New York City found than black women earning less than $25,000 a year were most likely to be substantially overweight. The New York Times cited health officials as saying that “lack of access to quality food, the cheapness of unhealthful fast food and processed goods, as well as more subtle societal influences, like differences in acceptable body images among different ethnic groups, all contributed to greater obesity among women with lower incomes and those in certain ethnic groups.” And traditional Southern foods that many of the women grew up with were high in fat, sodium, and calories.

  While we focus on many of the challenges of the black community such as improving education and creating new opportunities for young people, this clear and statistically significant problem remains essentially unaddressed, effectively swept under the rug, despite high human and social cost. The FDA’s “Action Plan to Confront the Nation’s Obesity Problem” barely mentions black women. Often in this book we draw out statistical trends that are hidden; this one has been well documented by researchers, but little addressed by policymakers. So as America begins to address the big problem of obesity, it has to be sure to be inclusive of everyone as part of this national effort to improve our health and well-being.

  THE INTERNATIONAL PICTURE

  Americans are not alone in their widening waistlines. The rise in weight gain has become so universal that the World Health Organization has given a name to this impending epidemic: “Globesity.”

  For sure, hunger and malnutrition remain serious problems (and perhaps faster killers) in much of the world. But to put the numbers in perspective, there are an estimated 1 billion people worldwide who are overweight, compared to about 800 million who are undernourished.

  “Obese” people worldwide now number over 300 million, up from just 200 million in 1995. The World Health Organization predicts that in the next few years, obesity-related killers like heart disease, stroke, diabetes, and hypertension will be the leading worldwide cause of disease and death.

  What’s most notable about Globesity is that it’s not just affecting developed nations. In developing countries, says the New England Journal of Medicine, as many as 60 percent of households with an underweight family member also have an overweight one. Indeed, except for countries in sub-Saharan Africa, there is hardly a country in the world where the average body-mass index (a more precise measure of fatness than weight) has not been climbing to levels that portend serious chronic disease.

  Mexico, for example, is the second-fattest country in the thirty-member Organisation for Economic Cooperation and Development—just behind its neighbor to the north. And in the mostly Hispanic population that lives just on either side of the Mexico-U.S. border, fully 74 percent of men and 70 percent of women are overweight or obese. Diabetes is now the number one cause of mortality in Mexico, up from thirty-fifth place in 1968. That is a higher rate than any other large country in the world.

  In China, since the late 1990s, the proportion of overweight men has gone from 4 to 15 percent. The proportion of overweight women has gone from 10 to 20 percent. By 2010, more than half the people in the world with diabetes will be Asians.

  And to bring it all back home to the U.S., where African-American women are suffering morbid obesity at dramatically higher rates than anyone else, let’s look at Africa. The malnourishment rates there are higher than anywhere in the world. Yet—

  More than one-third of African women, and one-quarter of African men, are overweight, and the World Health Organization projects that those numbers will rise to 41 and 30 percent, respectively, in the next ten years.

  In South Africa, 56 percent of women are obese or overweight, compared to fewer than 10 percent who are underweight.

  In Cameroon, Gambia, and Nigeria, something like 35 percent of the population is obese or overweight.

  To be sure, the diabetes rate is still only 2 percent in Africa, compared with nearly 8 percent in Europe and North America—but Africa is quite ill-equipped to diagnose it early or treat it effectively. So while diabetes may seem like a “rich man’s,” well-fed disease, it can actually take a far worse toll when it afflicts the poor.

  Why the crazy, global explosion of fat? Experts say it’s all about the worldwide shift in diet from vegetables and grains to highly refined foods and saturated fats. Across the globe, food is cheaper than it has ever been, but especially calorie-laden food. Our meals and snacks are more drenched in sugar and oil than they have ever been. Mexicans—the second-fattest country in the OECD, you will recall—now drink about as much Coke as milk.

  And whereas folks used to walk and ride bicycles, now cars, or at least scooters, are practically universal. Urbanization, TV, and much more sedentary lifestyles have turned everyone into couch potatoes.

  Ironically, obesity is a symptom of growing prosperity: Food is cheap, and most of the world can get it. But when it’s mostly empty calories—combined with decreasing levels of both manual labor and exercise—it turns into sagging waistlines, and all the health problems that go with them.

  Starving for Life

  As we just discussed, America is fat. Childhood obesity is up, diabetes is up, and they’re having to make our seats wider in buses and airplanes. We know—it’s a national crisis.

  But maybe because Big People tend to crowd the view, it is possible that we are paying too little attention to a group of Americans who are literally, physically wasting away—not because of want, or illness, or out of political protest, but in a very deliberate quest for longer life.

  These Thinning Thousands are not your garden-variety anorexics (although sadly, they, too, are on the rise). They are not chasing a particular body weight, and they’re not necessarily repelled by food.

  Nor are these people your super-fit Gym Junkies, working out every day and boasting teen-type weights in their Golden Years. (Americans 55+ are said to be the fastest-growing group of gym members.)

  No, these apple-for-breakfast, lettuce-for-lunch Century Chasers are a discrete, intense group of people who believe—based on some decent scientific evidence—that cutting their calories to near-starvation levels will lengthen their lives by ten to twenty years.

  Crazy? It’s been proven over and over in other mammals. In the 1930s, a scientist at Cornell found that cutting rats’ calories by 30 percent lengthened their lives by 40 percent, mainly by reducing cancer and other age-related diseases. Similar experiments have shown the same effects in mice, hamsters, spiders, worms, fish, flies, monkeys, and dogs. And when they eat that much less, these animals not only live longer—they are healthier and more vibrant right until the end.

  One indication that Calorie Restriction (CR) works the same way in people comes from the Biosphere 2 experiment in the 1990s, when eight bioscientists locked themselves in an airtight terrarium for two years, only to find that the ecosystem, intended to be self-sustaining, barely produced enough food to keep them alive. But rather than abandon the experiment, they were persuaded by their physician, Roy Walford—who fifteen years later founded the Calorie Restriction diet—to live at mere subsistence levels. When the Biospherians came out from their bubble, doctors said they were healthier in every respect than when they’d gone in.

  And more recent studies seem to keep proving it. Scientists have found that people on CR diets have lower blood pressure, lower levels of LDL (the bad cholesterol), lower body temperature (which may slow aging), and lower levels of clogged arteries.

  Here’s what also draws people in. The society with the largest proportion of centenarians in the world—34 out of every 100,000 inhabitants, compared to just 10 in 100,000 in the U.S.—is the Japanese island of Okinawa. Apparently, Okinawans exercise a lot, have low-fat diets, and eat a huge amount of soy. But in addition, they practice a dietary philosophy called hara hachi bu, which means “eight parts out of ten full.” In other words, they eat to only 80 percent satiation, or about 1,800 calories a day—compared to the average American’s 2,500 or more.

  You mean that instead of cycling through fad diets—from low-fat to low-carb to brown bread to just-lamb-and-pineapple—I should just eat . . . less? And that would not only make me skinnier, but add years or even decades to my life . . . ?

  Calorie-Restrictors think so, and some of them take in as few as 1,200 calories a day. Their (tiny) meals are what you’d expect: fruits, vegetables, nuts, wheat germ. They’re as rail-ish as you’d think. And while some experts warn that CR can risk bone brittleness or reproductive problems, even the ones who doubt the claims that CR extends life by 6 or 7 percent admit that it probably does so by 2 percent.

  But it means no food. Are people really doing it? According to the North Carolina–based Calorie Restriction Society, lifelong CR adherents are a small group, numbering in the low thousands. But something like forty new members join every month. And in the next few years, extensive CR research underway at the National Institutes of Health will raise greater and greater awareness of this approach, especially if the results are good.

  CR is unlikely to sweep the nation as the next Atkins, or South Beach. At least those diets traded one vice for another—you had to cut down on potatoes, but you could eat more butter. In CR, the rules are: Eat Practically Nothing. Given the abundance of food in America, that’s like sending a 10-year-old into a candy store and telling her she can only have one jelly belly.

  No, at the moment, Calorie-Restrictors are more like an elite secret society at Yale—a small group of people convinced that someday their formula will be the formula for life success. They are smug in the knowledge that the rest of us are eating ourselves into the grave—although at the same time, they struggle daily to reject the pleasures of food beyond subsistence.

  Even if the approach never gains more than tens of thousands of hard-core devotees, greater publicity around it could reorient the way Americans think about food. If we suddenly started thinking about food in terms of life span rather than waistband, it could be a rather serious paradigm shift. And that may have real implications in modern life. Now that more and more people are delaying childbearing until their 40s, might they not seriously ask themselves: Do I want an extra 500 calories a day, or do I want to live to know my grandchildren?

  Of course, we won’t go instantly from Fast Food Nation to No Food Nation. There won’t suddenly spring up “No Eating” sections in restaurants, and Jack Black and Roseanne Barr won’t turn overnight into Calista Flockhart and Twiggy. But if enough people shift their orientation toward food, it could trigger changes in our culture. Restaurants and food manufacturers may take more pains to tell us just how many calories we’re ingesting. And policy-wise, low-cal eaters are likely to become increasingly impatient with the overindulgent rest of us. If they are going to live significantly longer, they’ll want public resources saved for Social Security and other elder needs—not used up on the medical care of people who wouldn’t stop scarfing down 2,000 or more calories a day.

  And healthy, long-lived CR devotees would be a sweet, sweet prospect for insurance companies—the Met Life–sponsored Calorie Restriction Public Awareness Campaign could be just the beginning, as they offer double indemnity for people who reach 100.

  Diet and body image go in cycles, with different cultures at different times favoring either the full-figured or the svelte. But (with the possible exception of Social Security actuaries) the desire for long life goes in just one direction: up. If it can really be proved that in humans, too, fewer cals in the extreme lengthen lives, that finding might give food a run for its money.

  Caffeine Crazies

  Perhaps the most obvious trend in America is the vast and increasing consumption of bottled water.

  In the early 1980s, the idea of paying for bottled water, instead of taking it perfectly free from the tap, was laughable. But these days, you almost never see anyone—from athletes to blue-collar workers to business executives—without their little brand-name H20s. As of 2004, Americans drank over twenty-three gallons of bottled water per person per year—almost ten times the amount we drank in 1980. In 2006 alone, sales of Coca-Cola’s Dasani and PepsiCo’s Aquafina (both of which, by the way, come from local tap water) grew by more than 20 percent, putting them both on the list of top ten refreshment beverages in the United States.

  Add some vitamins, minerals, flavors, and/or fizzies to our water, and we leap even higher. According to consumer surveys, people drink bottled water because they think it is cleaner, healthier, and safer than tap water—and if the bottlers add something “useful” to it like vitamins or minerals, we’re even happier. According to the Beverage Marketing Association, in 2006, beverages with “functional benefits” grew at two to three times the rate of conventional beverages.

  But while some of us are seeking the purity of bottled water, others have gone in the opposite direction, driving the high-caffeine drink to new heights of profit. The totally artificial, stimulus-producing, murky brown stuff that couldn’t be more different from water in taste, texture, and packaging. As of 2007, almost 6 in 10 Americans drink a cup of coffee every day, up from under half just three years ago. At-work coffee drinkers are nearly 1 in 4, up from only 1 in 6 in 2003. Starbucks revenues alone grew from $1.7 billion in 1999 to a phenomenal $5.3 billion in 2004.

  Coffee shops say they’re getting espresso customers as young as 10 and 11. Even church groups lure youth in with coffeehouse-like atmospheres—complete with coffee.

  And, of course, carbonated soft drinks are towering over other American beverages—at a staggering 52 gallons per person per year. According to a 2005 study, soft drinks are now the leading source of calories in the average American diet, accounting for almost 1 in every 10 calories consumed. (In the early 1990s, the leading calorie source was white bread.)

  Even tea sales have more than tripled since the early 1990s. And innovators are launching new caffeinated breakfast products—like “Buzz Donuts” and “Buzzed Bagels.” In case it was too much work to ingest your morning carbs and your morning caffeine in two separate mouthfuls.

  Indeed, some people in America will give up the social aspect, and the flavor, of coffees and colas—if they can just have the caffeine straight. By far the fastest-growing beverages in 2006 were energy drinks, like Red Bull and Monster. Your basic 12-ounce can of Coke has 34 milligrams of caffeine. Red Bull has 80. Rockstar Zero Carb has 120. The new “Censored” Energy Drink—known until May 2007 as “Cocaine”—has 280.

  In 2006, nearly 200 new such energy drinks hit the shelves, propelling the industry to 50 percent growth and nearly $4 billion in sales. From virtual obscurity just a couple years ago, Red Bull now ranks number seven in U.S. refreshment beverage company revenues, well ahead of Ocean Spray and just a notch or two behind Kraft Foods (which makes Country Time, Crystal Light, Kool-Aid, and Capri Sun). Apparently, Red Bull is the third-largest source of beverage profits in convenience stores across the U.S.

  And no one thinks this trend is easing. In 2007, both PepsiCo and Coca-Cola are launching drinks with two to three times the caffeine content of their regular brands.

  Yes, even back when I was in college in the 1970s, kids took No-Doz to cram the night before a big exam. But No-Doz has only 100 milligrams of caffeine per tablet, at most. What’s a little 100 mg pill compared to Cocaine (the formerly named drink), at almost three times that dose? Indeed, the combination of high pressure to perform, lackluster judgment, and easy availability of caffeine is causing teens and young adults to drive the hyper-consumption of hyper-caffeinated drinks. According to a three-year study of calls to a Chicago Poison Center released in October 2006, the average age of caffeine overdosers—many of whom required hospitalization and, in some cases, intensive care—was 21.

  Why the caffeine craziness? What is all the raging buzz for buzz?

  Part of it, of course, is the 24/7 wakefulness of American life. From round-the-clock shopping and entertainment, to round-the-world colleagues and clients, life in America today is a rest-less frenzy. Americans already sleep an average of 25 percent less per night than we did 100 years ago, and so to some degree we are trying to make up for it with beverages turbo-packed with caffeine. Today’s students, especially, feel themselves to be under more pressure to excel than students of prior generations—and with late nights out, 24-hour convenience stores, and little adult supervision, more and more of them are going Caffeine Crazy.

  Another reason for the surge in booster drinks is that energy is at an all-time premium in American culture. For a population that is as old as it’s ever been, we value vim, vitality, and vigor like never before. Gym memberships are soaring, especially among seniors. Plastic surgery—to make us look younger, at least—is on the rise. Viagra use, between 1998 and 2002, grew over 200 percent among men aged 46–55—and over 300 percent among men aged 18–45. Can it be that regular human performance is simply not enough these days? Many of us want to be super-alert, super-charged, and super-men. And if Red Bull, or a venti latte, can get us there—even if we’re 12 years old, or if it’s our third such drink that day—so be it.

  The health effects of the Caffeine Crazy trend are worrisome. It is well documented that caffeine, especially in high doses, can cause insomnia, anxiety, headaches, stomach problems, cardiac arrhythmias, and weight gain—especially if lashed to sugary soft drinks and caramel macchiatos. The quest for super-energy, ironically, can weigh us down.

  It’s even worse for children, who may be the fastest-growing subgroup of caffeine consumers. Not only are American kids already becoming obese at alarming rates, but a child who drinks one can of caffeinated soda apparently experiences the same effects as an adult who drinks four cups of coffee. While the full effects of energy drinks like Red Bull have yet to be determined, some countries—like France, Norway, and Denmark—have outlawed them entirely because of alleged links to sudden deaths.