Donut-Burger Combo Epitomizes U.S. Obesity Dilemma

"Baseball's Best Burger" may hit one out of the park, but chances are its consumers won't be able to circle the bases. It's up to family physicians to coach their patients along the base path.

In the midst of a U.S. obesity epidemic, eastern Illinois' Gateway Grizzlies have concocted a hamburger that will have fans conceding more than their wallets at the concession stand. "Baseball's Best Burger" is a bacon cheeseburger sandwiched between the two halves of a Krispy Kreme donut. The burger has 1,000 calories and 45 grams of fat, nearly twice the calories of a Big Mac and one-third more fat.

"Twenty years ago, the trend was toward healthier items like yogurt and fruit and nuts. Now we've gone the other way, to enjoying unhealthy foods," said Darwin Deen Jr., M.D., M.S., professor and director of the Department of Family and Social Medicine at the Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y. "We have an obesity epidemic and we've got a lot to do," he said.

The demographic groups Baseball's Best Burger targets are, indeed, expanding -- both in sheer numbers and in terms of weight. According to a study in the April 5 Journal of the American Medical Association, the prevalence of overweight among children and adolescents and the prevalence of obesity among men both increased significantly between 1999 and 2004.

Specifically, the percentage of children and adolescents ages 2 to 19 years who were considered overweight increased from 13.9 percent in 1999-2000 to 17.1 percent in 2003-04. In addition, the percentage of men age 20 or older who were considered obese increased from 27.5 percent in 1999-2000 to 31.1 percent in 2003-04..

This may be good news for many advertisers, but it's bad news for family physicians and their patients.

"The average family physician needs to ask patients about what they eat," Deen said. "If they have something like (Baseball's Best Burger) once a year, it's no big deal. I'm more interested and concerned with the people who eat this on a regular basis, because they have a diet so high in fat that this doesn't bother them."

Another study in the same issue of JAMA reveals that overweight people who cut their calories by 25 percent for six months reduced fasting insulin levels and core body temperatures. Living with these two markers at lower levels has been associated with increased longevity.

At the other end of the spectrum, Deen himself, as well as physicians in Boston and Texas, have reported cases of type 2 diabetes, a known possible complication of overweight/obesity, in children as young as 8 years.

"Fat slows down the movement of food through the gastrointestinal track because fat takes longer to be absorbed," Deen said. "If you eat a low-fat diet in general, eating something like this (burger) will just sit in your stomach and make you feel uncomfortable.

"Think of it as the Thanksgiving effect," Deen continued. "At the end of the meal, you're not comfortable. You're uncomfortably full. You don't need to eat to the point of being uncomfortably full."

But more Americans are not only eating to the point of being uncomfortably full, they're eating past that point. Still, the novelty of eating something so unhealthy may be hard for some to resist.

"If this is something someone feels they absolutely must experience, I'd suggest cutting it in quarters and sharing it with three friends," Deen said.

He also suggests that FPs encourage patients who want to eat high-fat foods to make food such as Baseball's Best Burger their "big ticket" item of the week and eat whole grains for breakfast and get plenty of exercise to allay the damage.

"I'd say to take the stairs instead of an escalator (to ballpark seats), but unfortunately you'd probably miss most of the game," Deen said. "The problem is, the people eating this are going to be sedentary, drinking beer. They are going to have a hard time getting rid of the extra calories."

Americans have yet to acknowledge the problems that arise from widespread obesity, Deen said. Maybe exploiting the ridiculousness of extra-unhealthy foods like Baseball's Best Burger; deep-fried Twinkies and candy bars; and hot dogs topped with mountains of bacon, chili and cheese is the key to creating awareness.

"Doctors might want to take a picture of this donut-burger and put it up in their office," Deen said. "Use it as something to talk about. Like the film ‘Super Size Me,' this might be something to jump-start the conversation and get people talking."