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The broadening of America is everywhere you look, or sit. The Puget Sound ferries in Washington have increased the width of their seats from 18 to 20 inches (20 to 51 centimeters) to allow squeeze-in room for people with bigger bottoms. In Colorado an ambulance company has retrofitted its vehicles with a winch and a plus-size compartment to handle patients weighing up to half a ton (0.45 metric tons). Even the Final Resting Place has had to accommodate our growing girth. An Indiana manufacturer of caskets now offers a double-oversize model—38 inches (97 centimeters) wide, compared with a standard 24 inches (61 centimeters).
Being overweight is associated with 400,000 deaths a year and an increased risk of heart disease, type 2 diabetes, and colon, breast, and endometrial cancers. Most poignant is the psychological pain of those stigmatized by obesity. In one study at Michigan State University, undergraduates said they would be more inclined to marry an embezzler or cocaine user than an obese person.
How did Americans get so fat? Where did we go wrong? It depends on whom you ask. I asked Robert Atkins last year, a month before the purveyor of today's hottest diet died from a head injury suffered in a fall. He sat in guru-like serenity behind a black leather-top desk in his Manhattan office. His expression remained impassive, with an occasional lapse into wryness. He seemed to float, as if hovering above the storm of contention his diet provokes.
"We went wrong by allowing the American Medical Association and the United States Department of Agriculture to say: 'You've got to go on a low-fat diet.' They failed to take into account that when people do that, they increase their carbohydrates."
For breakfast that morning, Atkins (who said he was six feet [two meters] tall, 189 pounds [86 kilograms]) had eaten a sausage-and-cheese omelet, two ounces (0.06 liters) of tomato juice, and tea without sugar. His wonderland diet books say yes to bacon, eggs, and lobster dripping with butter and tell readers to lay off the bread and fruit. Slashing carbohydrates and sticking to protein and fat, Atkins claimed, prompts the body to burn fat through a metabolic process known as ketosis. Another purported advantage: Remaining in near ketosis makes it easier for people to control hunger.
In the post-Atkins era, pork rinds have become a snack sensation, egg consumption has risen, and "doing Atkins" is now synonymous with adhering to a high-protein, low-carb diet. Since 1972 his Diet Revolution and the updated version published in 1992 have sold 18 million copies. The latest edition has been translated into 25 languages. But not, as yet, in Italian. "They didn't want to give up their pasta," he said.
To be sure, Americans are filling up on carbohydrates like pasta, potatoes, and bread. In the early '70s we ate 136 pounds (62 kilograms) of flour and cereal products per capita, and now it's 200 pounds (91 kilograms). Most of those products are highly processed grains, like white bread, that are low in fiber and absorbed into the bloodstream more quickly than high-fiber whole grains. Such foods have a high glycemic index, which means they prompt a sharp spike in glucose and trigger a corresponding spike in insulin production from the pancreas. Atkins and other advocates of low-carbohydrate diets claim that surges in insulin cause blood sugar to plummet, which in turn creates cravings for more carbs—and on and on in a spiraling raise-you-one war between glucose and insulin. The trouble is, research doesn't back that up: Low blood sugar hasn't been directly linked to hunger. And unless you have diabetes, blood sugar remains generally stable anyway.