SALT LAKE CITY — On the day of his graduation, Josh Hansen said he "felt like dirt."
The reason? His weight had reached a new high and his graduation gown ripped in the middle of the ceremony.
"When I was 400 pounds, I was numb. I was numb with the emotions, the feelings, the thoughts of the world around me and I couldn't live that way. Nobody can live that way," he said.
Hansen set out to win the battle against weight that had plagued him for most of his life. Over two years he lost 175 pounds and has maintained that weight loss for a year and a half.
He is part of the changing demographic in Utah and the United States, where obesity rates have leveled after rising for the past three decades, according to a report released last week by the Robert Wood Johnson Foundation and the Trust for America's Health.
Utah tied with Montana as the seventh least obese state in the nation, according to the study.
Those with body mass indexes of 30 or higher are considered to be obese, according to the report, which used the National Institute of Health's measurement.
The report, "F as in Fat: How Obesity Threatens America's Future" was made up of data compiled from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance Survey and almost 300 other sources and surveys.
Adult obesity rates in Utah rose slightly from 23.8 percent in 2011 to 24.3 percent in 2012 and remained steady nationwide, with the exception of Arkansas, which saw an almost 4 percent jump in rates between 2011 and 2012, according to the study.
Although rates are leveling, adult obesity levels are still historically high. Currently, all states have levels higher than 20 percent; 41 states are at least 25 percent obese and 13 states have rates higher than 30 percent.
In 1980, no states had levels higher than 15 percent. In 1991, none were above 20 percent obese; in 2000, that level had reached 25 percent and in 2007 only one state, Mississippi, had obesity levels higher than 30 percent.
Utah has the lowest rate of childhood obesity, with 11.6 percent of obese 10- to 17-year-olds.
Cut obesity, gain health
Health outcomes in the state are reflecting these low levels of obesity. Utah is tied with Montana with the second-lowest rates of diabetes at 7.2 percent; the second lowest levels of inactivity at 16.6 percent; and the lowest rates of hypertension at 22.9 percent.
Among other significant findings, the study showed that extreme obesity levels have risen in the United States, and that obesity rates are influenced by education, income, age and region.
Those who graduated from college or technical college saw obesity rates around 21.3 percent nationwide, while more than 35 percent of those who did not graduate high school were obese.
Income also influenced rates, with those earning $50,000 or more annual income seeing levels around 25.4 percent, compared to the 31 percent of obese adults 18 or older who make less than $25,000 per year.
Rates varied by age, with an obesity rate of 32.3 percent for those ages 45 to 64 in Utah, compared to a high of 40 percent in Alabama and Louisiana. Those 65 and older in Utah saw rates around 25.6 percent, compared to Louisiana's 30.4 percent. Those ages 18 to 25 in Utah also performed well, at 12.7 percent.
"If we fail to reverse our nation’s obesity epidemic, the current generation of young people may be the first in American history to live sicker and die younger than their parents’ generation," the report said.
A "whole host of factors" contribute to obesity, according to Albert Lang, communications manager for the Trust for America's Health. Some clear contributors, though, lie in convenience of healthy food and exercise.
It is easier to get high-calorie, low-nutrition food, and more difficult for many Americans to access fresh produce. In addition to this, neighborhoods across America have developed in ways that are not conducive to exercise, with few sidewalks and poor lighting in areas.
"We've kind of moved in a way that makes the healthy choice the hard choice. We've made it incredibly hard for people to be healthy," Lang said.
He has seen more of a "buy-in" from communities to create safer neighborhoods and routes to school and in the creation of policies that "have health in mind."
One of the factors in Utah's success could be the Utah's Nutrition and Physical Activity Plan, according to Rebecca Fronberg, program manager for Utah Department of Health's healthy living through environment, policy and improved clinical care program. The department received federal funding to implement the program that aims at getting Utahns to increase their intake of fruits and vegetables, physical activity and breastfeeding, and decrease their "screen time" with electronic devices, consumption of food with a lot of fat and sugar and intake of sugary drinks.
"One of the things that we've really been working hard on is trying to change the environment," Fronberg said, "to make the healthy choice the easy choice."
As part of this initiative, the Utah Department of Health is reaching out to health care workers, employers in the state, schools and communities. It is also working with schools to improve the health of meals offered and to increase physical activity during school hours.
Fronberg also mentioned the state's high activity levels, due to the availability of outdoor recreation in Utah and the state's movement toward more accessible public transportation. Public transportation could be one solution to help increase activity levels, especially among low-income and minority groups, according to a 2005 study by the Centers for Disease Control and Prevention. Those who used public transportation walked an average of 19 minutes each day, to and from transportation sites.
"I just am excited to see that we're finally showing some results," Fronberg said.
For Hansen, success came from being patient with himself.
In the past he would start diets and when he would cheat, he would be frustrated with his mistake and go back to his old eating habits.
This time, he took a different approach.
"I basically just started with baby steps," he said.
How to succeed
He started a food journal and wrote down what he ate for a week. Then he would review what he ate that week and try to improve during the next week. He started drinking more water. He noticed how far he would walk and try to walk a little farther the next day.
A visit to the doctor revealed that he had hypothyroidism, which contributed to his weight retention and recurring depression. He started on thyroid medication and followed his doctor's advice to become more active.
Now Hansen, 32, is a new man. Since 2012 he has run in three marathons and on Saturday competed in his 42nd half marathon, well on his way to accomplish his goal of completing 100 marathons and/or half marathons before he turns 40. He tracks his progress on a blog he keeps to help inspire others to make similar changes.
In his work as an office manager at the University of Utah, he has seen a spike in his energy level and looks forward to running errands around campus, a task he used to dread.
One of his favorite quotes is by Shakespeare, who said “Strong reasons make strong actions.” Hansen's strong reason came from knowing he was worth the change, and from coming to love and trust himself.
"At my lowest point I was numb. And now that I've been able to control my diet and now that I'm exercising regularly and everything, I feel like that helps me enhance and really ... enjoy those moments, really be able to feel life."
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