Diet and Exercise: Russian and American Obesity - East Meets West
by Dr. Alex Pozhitsky

Many of my Russian American paitents who are obese and complaining of lower back pain, often ask me for advice on the best way to loose weight. Usually they tell me that they have tried many popular fad diets and then ask me what diet do you recommend. After getting their attention by explaining to them that the cause of their back pain is related to their over-weight condition, with a smile on my face I tell them about the "exercise diet". Puzzled at first, it doesn't take them long to smile back and understand what I'm saying. I tell my patients what they already know. But I try to give them an explanation that they can understand:
Aim for a well balanced diet and combine that with an exercise program. Don’t choose between diet and exercise. Exercise will burn excess calories, speed up your metabolism and allow you to eat more without gaining weight. They like the "eat more" part.

Often I get a question comparing dietary causes of obesity in the United States versus Russia. I think my patients are sometimes surprised, in my attempt to dramatize the importance of diet, when I say Russian obesity is comparable to American, but unlike Americans, Russian people do not acknowledge that they are fat. That usually gets their attention. In the United States, 61 percent of all adults are overweight. In Russia, the figure is 54 percent. Russian people, especially those who live in the rural area, like to eat bread, sugar and animal fat - quite "harmful" high-calorific foods. A lot of people use lard instead of oil for frying. Needless to say traditional Russian food does not differ much from American burgers. I go on to say that popular perception about Russians is that Russian people move a lot, they eat a lot less and look very well, not to mention the fact that Russian girls are most beautiful ones in the world. Needless to say this is a misconception and that in reality, as far as the style of life is concerned, it would be wrong to say that Russians are very mobile and sporty people. They can eat a whole platter of pasta before going to bed and then watch TV for an hour with a big can of beer and several packs of potato chips.One may say that Russians have been rather successful in adopting the Western lifestyle.

Another misconception is that, generally speaking, Russians exercise more than Americans and are more physically fit. Reflecting back, 20 years ago, I would have said it was unthinkable to see an obese person on a Moscow street. Why? During that time, in addition to the Russian regime's emphasis on sports, it is well known that the average Russian citizen was confronted with a daily life of relative deprevation in one form or another. Contributing factors were low wages, high food prices and limited availability, very few personal vehicles and therefore walking miles to the market was common place. Yes, Russians looked fit. They were fit! You might say..diet and exercise out of necessity and circumstances! Today however, things are much different. The New York Times has reported about Russia's concern about lack of exercise, a story about the increasing sloth among the Russian population and President Vladimar Putin's call for increasing physical activity among all its citizens. Putin noted that the sports infrastructure in Russia had so decayed in the last decade that only one in 10 citizens exercised or played sports. He also noted in a somewhat alarmed manner that any "further decay" would have a "ruinous impact on the nation's health." The response from Russian legislators was a five-year proposal to build 1,000 new sports and health centers across the country. In a addition, Russians who live in big cities, are walking less due to the increased use of personal cars. Statistics show that the number of passenger cars on Russia's roads has more than tripled over the last decade. Also, let's not forget the negative impact of fast-food contributing to Russian obesity over the past decade. Like Americans, Russians are eating more and exercising less.

So, what's going on in America in regard to obesity? In the last three decades, the level of obesity in the U.S. has steadily increased. Currently, there are approximately 127 million adults in the U.S. who are overweight, 60 million who are obese, and 9 million who are severely obese. Obesity can be caused by a combination of factors, including social, cultural, genetic, physiologic, metabolic, behavioral, and psychological issues. Obesity is a growing problem, so much so that, next to smoking, obesity is the second leading cause of preventable death on the U.S. Being obese, or even simply overweight, increases the risk of illness from about thirty serious medical conditions, such as heart attack, high blood pressure, and diabetes. Currently, 36% of American adults are attempting to lose weight and 56% are trying to maintain their current weight and keep from gaining more. Essentially, the only way to lose weight and keep it off is through a combination of eating healthier, eating less, and exercising more.