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CHAPTER 1

Are You Fit to Live?

"It is not the strongest of the species who survives, Nor the most intelligent that survives. It is the one that is the most adaptable to change."--CHARLES DARWIN

I'm here to save your life--if you let me.

First, I'd like you to answer a simple question: Are you Fit to Live?

It's a scary question, isn't it?

In years past, this question basically meant, "Do you deserve to live?" The creepy people who asked this question had usually taken it upon themselves to choose what a good and worthy life looks like.

Here's the reality--we all make that choice for ourselves, every day. There's no external judge or executioner standing around taking measure of you and proclaiming you worthy or not. Your sole judge and executioner is you. You make the decision of whether or not you are Fit to Live by how you choose to think, what you put into your mouth, what you do with your body, how you spend your money, and how you exist in the world. You are answering the question, "Am I Fit to Live?" every day, with every choice you make.

For most of us, the answer is no--and we don't even know it.

We live in a post-9/11, post-Katrina world. Be honest--do you really have what it takes to survive life in the 21st century? If you had to suddenly leave your comfort zone and run for your life, hoist your body out of a broken elevator, run after a child headed toward a busy street, or grab a tree limb to stop from falling, could you do it? Are you Fit to Live?

As a physician, my guiding mission is to help people save their own lives. I see my patients struggling, defusing their 80-hour workweeks with buckets of fried chicken, and I know they're not alone. There is a better way, an easier way, a way that will allow you not only to survive, but also to enjoy your life and to challenge yourself, to live big and be bold. My goal is to help you achieve the mind and body that will let you be Fit to Live your dreams. With the plan in this book, I want to help you become Fit to Live . . .

To survive: fit through the exit door of an airplane, lift yourself up after falling, race down four flights of stairs, get through a medical emergency, handle a divorce, survive a financial crisis, be a chronic caregiver without self-destructing.

To enjoy life: sit on the floor with your kids or grandchildren, throw them up in the air without throwing out your back, run along the beach with your dog, garden, swing dance, look and feel fantastic and wear the clothes you love, volunteer in the community, take that yoga retreat.

To challenge yourself: write that book, start your first company, go back to college, become a community activist, start a charitable foundation, walk or jog a 5-K despite a chronic medical condition, rock climb, river raft in the Grand Canyon, bike across New England.

While the plan is simple, the reality of our lives is anything but. This book is a wake-up call to the fact that our lifestyle has rapidly and fundamentally changed and, for so many of us, become dangerously toxic. We've become not only Unfit to Live to survive life once we're forced out of our comfort zone, but we are actually wearing the weight of our Toxic Lifestyle around our bellies.

Forget about your thighs and rear end. The bottom line is the waistline.

For the first time in history, the bellies of the majority of American men and women are carrying around a life-threatening load of Toxic Fat. Our Toxic Belly Fat gets in the way when we try to zip up clothes or squeeze into the airline or theater seat. This fat is obstructing our ability to run for our lives if we needed to; it's driving us toward a host of diseases and disabilities. Toxic Belly Fat, more than anything else, keeps us from being Fit to Live--to be able to survive, enjoy, and challenge ourselves. To be lean, strong, and fearless.

In 2000, I wrote Fight Fat After Forty, the first consumer book about Toxic Belly Fat. Now I'm sounding the alarm that our ever-expanding waistlines are dangerous to our collective mental, nutritional, physical, financial, and environmental health.

Our Toxic Lifestyle

It's a Butt-on-Chair Life

"Things alter for the worse spontaneously, if they be not altered for the better designedly."--FRANCIS BACON

Over the past half-century, we've been asleep at the meal. Our waistlines have ballooned, adapting to a world of computers, cars, Crackberries, Cokes, and Krispy Kremes. We've morphed from fit primitive physical powerhouses to stressed-out, sleep-deprived, soft-drink-guzzling slouch potatoes. Check this out:

The average 5-foot 4-inch woman in the 1950s blew up from a 120-£d, 26- inch waist, size-6 body to, in 2006, a 157-£d, 34.5-inch waist, size-14 body.

An average guy 50 years ago fit into a 32-inch pant; today he's busting out of his 38-inch belt.

Already one-third of our children are seriously overweight; many kids ages 1 to 6 are too heavy for standard car seats.

Teen obesity surgery is the new rage; the number of obese teens has tripled over the past 20 years.

One out of every three children born in 2000 will have type 2 diabetes by the age of 30. They are the first generation who won't live as long as their boomer parents.

Scared yet? And despite the strong connection between excess £ds and all types of disease, overweight and obesity keep rocketing skyward. In the United States, the rate has gone from 58 percent of the population in 2001 to 63 percent in 2005, and type 2 diabetes has risen right along with it-- from 7.9 to 8.5 percent. In just 4 years!

We know that a healthy lifestyle is not rocket science. What part of "stop overeating and move more" are we not getting? Thing is, we've stacked the deck against ourselves. We've created a living (no sidewalks, unsafe neighborhoods, few parks, grab-and-go low-quality eating) and working (long car commutes, elevators, desk jobs, vending machines) obstacle course that seems to make it a mission impossible to achieve health and well-being.

None of these developments, or the others you will be reading about throughout the book, set out to make our bellies swell. But without intending it, we're wearing our stress, lack of focus, and time-starved lifestyle in the form of 30, 40, 50, and even 100 extra £ds.

This Toxic Lifestyle has detached us from our own bodies. Psychologists call it dissociation. We eat 24/7 and have no idea what real hunger feels like. We don't know how it feels to really use our bodies in a physical way. Our multitasking, distracted minds go a mile a minute. We've lost the ability to focus our time, money, or energy on things that really matter to us. We hide in the cocoon of our comfort zones.

Rather than change our lives, we just keep expanding--plus sizes, seat belt extenders, elastic waistlines, bigger chairs and stadium seats, double-wide wheelchairs and, ultimately, double-wide coffins. We put on "hide-it" clothes--dark colors, loose jackets, elastic waists, XXL T-shirts, baggy pants. The average 36-inch umbrella can't cover most people; the hottest seller is now 48 inches. Most older bath towels are 24 inches by 43 inches, which can't cover the average man or woman, but the new best-selling 45- by 102-inch towels do. We're even too big to fit through the airplane emergency exit row door, especially those small commuter hoppers. Planes take more fuel to get places because we're carrying too much fat.

This Toxic Belly Fat costs us more than our health. Our galloping "globesity" is gouging us financially. By the year 2020, if we keep gaining weight at the current rate, one in every five health-care dollars in the United States will be spent on obesity-related issues in adults ages 50 to 69. That's half again as much as we're currently spending. In 2006, the prime minister of England announced that escalating diseases from obesity, alcohol abuse, and smoking are threatening to bankrupt the National Health Service.

We made history when the World Health Organization declared that there are now more overfed than underfed people on this earth.

This is insane. This is too much fat.

Chances are this information is more than just numbers to you. You're probably at least 20 to 30 £ds overweight, your ever-expanding belly is making you crazy with frustration, and you're teetering on the edge of a host of debilitating diseases. But when people ask how you're doing, you say, "Fine."

We're fooling ourselves by thinking we're fine. We're fine until we're stressed. We're fine until one more thing goes wrong. Then, the comfort zone crumbles, and we have little or no reserves to get through.

I had a 42-year-old patient come in recently who was 75 £ds overweight and on a mountain of medications for heart disease and diabetes. Her opening remarks were "I'm fine. I just need to know how to eat a little better. I'm not interested in exercise."

A week later she fell down at home, lacerating her lower legs, and didn't have the strength to get up. It took her an hour to crawl to safety, infecting her wounds in the process. Her blood sugar shot up, and she ended up in the hospital for 2 weeks. Then she got depressed and dosed herself with her anesthetic of choice--Ben and Jerry's--blowing up her Toxic Belly Fat and sending her blood sugar and cholesterol through the roof and...well, you get the picture. Unbeknownst to her, she'd been sitting on the "fine" line between getting by and utter disaster.

Like this woman, we need to wake up and smell reality. Recently, a guy came up to me tugging on his gut and saying, "I want to introduce you to Bob-- Belly over Belt." He and I laughed, but he now knows that to save his life, he must say goodbye to Bob--and so must you.

You deserve to be Fit to Live your dreams. To bound through the day with energy to spare. To wear a belt and tuck in your shirt. To pick up anything off the rack and have it look great. To dance, to run, to have sex with the lights on, to do 10 pullups, to climb mountains if you want to. To feel invigorated and empowered instead of defeated and overwhelmed all the time. To save your own life.

Do you think I'm being dramatic when I ask if you're Fit to Live? Let me tell you about another patient. When she first came to see me, Miriam was 61 years old, about 30 £ds overweight, with a belly girth of 38 inches and a cholesterol level of 240. She was dealing with the recent death of her husband and her own retirement. She was overeating, not moving enough, and worried over whether she could live on her pension. Her only solace was her garden. But as she explained to me, "Now that I've finally got the time to garden, it's hard to bend over, I don't have the strength to carry the plants, and I can't see the flowers over my belly."

Miriam began to put into place my recommendations in the Fit to Live categories you're going to learn about. Over the next year, she removed that 30 £ds of Toxic Belly Fat, whittled her waist to 33 inches and her cholesterol to 200, and developed muscles in places she didn't know existed.

One spring day, she called my office and insisted on talking to me. "I finally got it!" she cried. "I need to see you right now."

"Well, I'm with another patient," I replied.

"That's okay," she responded. "I'll share it with them too."

Within a few moments, in she came, tracking mud from her garden and looking scuffed up. She was glowing. "I was in my rose garden, pruning away. Suddenly, I ran into the biggest, hairiest spider I've ever laid my eyes on. I leapt back, stabilizing my legs and grabbing on to the branches behind me for support. As I clung on for dear life, I turned my head and saw the nine stone steps I would have fallen down had I not had the strength to hold on. I firmly planted my legs and pulled myself to safety. Now I really get what you've been talking about! I was strong enough to save my own life!"

Because she was Fit to Live, Miriam did save her life in that dramatic moment--or, at the very least, saved herself from some awful injury and prolonged disability. She not only survived, but she looks and feels terrific and is able to really enjoy her life and challenge herself--by growing decorative cabbages outdoors in Eastern winters, for one. But she also saved her life in a less dramatic way, one that's equally important. By reducing her Toxic Belly Fat, she's reducing her risk for heart disease, diabetes, and cancer.

What's so toxic about belly fat anyway? Well, there are actually two kinds of fat that collect around our middles--outer and inner. The dividing wall between the two is the abdominal muscle. The outer fat is the stuff you can pinch. Some of us have lots of this, others virtually none. The inner fat, however, is like no other. We all have and must have this fat. Athletes with low body-fat levels have it. We need it to maintain our core body temperature, to buffer our organs from bumping into one another, and to draw on when we need energy reserves.

So it's a good thing. But like so many other good things, we run into problems when we have too much. Big problems. When there's too much of this inner fat, it interferes with the liver's ability to process cholesterol and insulin, which results in the likelihood of:

High blood sugar High triglycerides Low HDL ("good" cholesterol) High LDL ("bad" cholesterol) High blood pressure

Taken together, scientists have named this the metabolic syndrome, but you can think of it as the Toxic Belly Fat Syndrome. You have it if you have two or more of these abnormalities combined with a waistline (measured across the belly button) of more than 40 inches in men and 35 inches in women, no matter what you weigh. And your risk increases as you accumulate more of these five factors.

That's one of the reasons you'll be learning that weight is not really the issue--the size of your waist is. That's also why you may have read somewhere that it's better to be a pear--small waist and large hips--than an apple--round in the middle. It's all about avoiding Toxic Belly Fat Syndrome.