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OBESITY

INTRODUCTION
Perhaps no area within the field of human nutrition is more intensively
researched and discussed that the subject of obesity. In spite of all the
research and discussion, it remains a disorder for which there is no clearly
known cause or reliable treatment. This major public health problems is one
of the most complex and misunderstood disorders of our time.

Obesity results when food intake exceeds the caloric needs of the body.
There are various classifications of obesity as defined by insurance company
studies. For example, those identified as obese, 90% are characterized as
mildly obese (20%-40% above ideal weight), 9 percent are moderately obese
(40-100% above ideal weight) and .5% or 1.7 million American adults are
morbidly obese meaning they are 100 lbs.overweight.

From the National Center for Health Statistics the news is discouraging,
even with all of the programs, diet books, diet foods available:

• In 1960: 25% of adult Americans were overweight.


• In 1988: 33% of adult Americans were overweight.
• In 1996: 49% of American women and 59% of American men are
overweight.

As you can see from the above percentages, there has been an increase from
third of all Americans to more than half in just 8 years. These latest
statistics are based on body mass index (BMI), which is a method of
determining obesity based on height and weight. The center has utilized
this method since 1960; however, with this most recent research a
lower cutoff point was set as a definition of overweight. This cutoff
point is NOW the new BMI guideline that was just published recently.
This action is not without controversy. Some who study obesity and the
effect it has on health, say this is exactly where they belong. There are
other weight researchers who disagree and feel that most of the
overweight people do not belong in the new category.
CAUSES OF OBESITY
There are various causes of obesity with the first being attributed to genetic
factors such as familial obesity. Family resemblance studies support the
impression that obesity runs in families. When one parent is obese, the
chances of a child becoming obese are greater than 40% than when neither
parent is obese; if both parents are obese, the chances become quite likely
that the child will also be obese (80%); and if both parents are lean there is a
10% chance of obesity.

Two theories about the causes of obesity have contributed to our


knowledge: the "Nature" theory and the "Nurture" theory. The Nature
Theory attempts to explain obesity by genetic traits:

• Obesity is linked to genetic trains inherited from parents


• There appear to be "natural" differences in individual rates of
thermogenesis
• Some animals are genetically obese, so perhaps some humans are, too
• Each person has a biologically determined weight

The Nuture Theory explains obesity in terms not related to genetic traits:

• Overeating habits are formed in childhood


• Obesity is related to psychological factors
• Routine availability of highly preferred foods
• Physical inactivity
• Increased fat cell numbers due to overeating

Learning plays a role in the development of obesity as lifestyle habits


learned in childhood tend to persist throughout life. Food-centered families
encourage such behaviors as overeating at mealtimes, rapid eating, excessive
snacking, and eating to meet needs other than hunger. Children readily
imitate overeating parents, and their behavior at the table tends to persist
outside the home.

Other causes of obesity are psychological factors such as depression, anxiety


and frustration. For many people, obesity results from overeating as a means
of coping with some emotional turmoil in their life.

In addition to the above causes of obesity, medical conditions such as


hypothyroidism (decrease of thyroid hormone in the body) play a role, as
well as lack of exercise and certain drugs such as oral contraceptives and
corticosteroids to list a few.

Obesity and overweight can cause such conditions as heart disease,high


blood pressure, malnutrition, kidney trouble, gallbladder disease, type 2
diabetes, complications in pregnancy,surgery and woundhealing, gout, some
cancers, arthritis, abdominal hernias, sleep apnea, and varicose veins.

According to Dr.Deborah Shih, developer of the medical weight


management program at Kaiser Permanente Medical Center in Santa
Clara,Calif., " If (overweight) people can lose even 10% of their total body
weight and maintain that weight loss for 3 years then they reduce their risk
for hypertension by as much as 75%, they reduce their risk for diabetes 40-
60%, and reduce their risk for heart disease 25-50%." She further claims
"that even a little bit of weight loss can go a long way but the key is to
maintain it."

A different viewpoint is taken by Glenn Gaesser, an associate professor of


exercise physiology at the University of Virginia and the author of 'Big Fat
Lies." He debunks the claim that excess fat leads to ill health and states that
" We get a different definition of (overweight) almost every year." Gaesser
feels that "weight-mortality and weight-health relationship, when you look at
all the data, is very perplexing." "The reason is because weight is a variable
influenced by many factors namely lifestyle and diet- that it really makes
this rather murky." Gaesser adds "that what is not murky is that people can
be fit and fat at the same time. Once heresy, the idea of fatness and fitness
coexisting is rapidly becoming merely controversial." Gaesser believes "that
the idea is to reach metabolic fitness." He defines this term as "having a
metabolism that maximizes vitality and minimizes the risk of disease." He
continues by adding " if fat is so bad, why is it that you can take a
significantly overweight or obese person who has problems and put them on
a good program of exercise and diet, and in a matter of weeks most of their
health problems clear up and can be normalized?" In conclusion, Gaesser
states "This creates a problem because our culture tells us we have to be
thin, but from a health standpoint, we don't have to be."
THE ROLE OF NUTRITION
In order to lose weight safely, a person must set up a sensible long-range diet
plan that includes all the essential nutrients and minerals. The basic
elements include: smaller food portions; fewer high-calorie foods, emphasis
on nutrient-dense foods; and more physical activity.

Food high in complex CHO (like pasta, rice, potatoes, breads, cereals,
grains, dried beans and peas ) are lower in calories than foods that are high
in fat and are good choices when one is trying to lose weight. In addition,
they are good sources of vitamins, minerals and fiber. Increasing one's
intake of fresh fruits and vegetables is an easy habit to incorporate. Limit
availability of high-calorie snacks and desserts. Roast, broil, and steam
foods rather than frying them. Select lean cuts of meat and low-fat dairy
products. Go easy on butter, margarine, sauces, and gravies. Eating slowly
will help to feel full sooner - and develop a feeling of satiety.

As a rule, the smaller the changes in personal behavior required by a weight-


control program, the greater the chances the program will succeed. For most
people, it is generally much easier to adjust to modest changes - such as
reducing portion sizes of foods or using stairs instead of elevators when
possible- than to make drastic changes.

WEIGHT LOSS AND THE ROLE OF EXERCISE


Exercise can play a significant role as well as diet in weight reduction. Diet,
together with exercise and behavior modification can eliminate, in
some cases, risk factors that cause obesity. Research has shown that
twenty minutes of sustained moderate-intensity activity at least four
days a week will improve the heart's capability. There are several
guidelines for this but the point is that "exercise" is doable even at a
low level and still produces benefits.

Weight control efforts that include a physical activity program offer


several bonuses. Exercise burns off calories, which contributes to
weight loss and weight control (if it is continued). Muscular bodies use
more calories for basal metabolism than do fatter bodies. Regular
exercise improves circulation, stamina, and in many cases, a person's
alertness and feeling of well being. It may also decrease appetite.
Again small changes that can be incorporated for a lifetime such as:
walk more; make a habit of using stairs whenever possible; make time
to enjoy participating in your favorite sport more often; doing floor
exercises while watching TV.

Losing weight is therefore, a matter of consciously curbing the amount


of food eaten, regulating the types of food we eat, and increasing daily
activity.

EATING DISORDERS
One of the conditions that seems to be increasing in prevalence is eating
disorders. I am providing a very brief discussion of this here in the lecture
on weight because it is a function of weight issues for most people.

Twenty years ago, few nutrition textbooks devoted more than a paragraph to
the subject of eating disorders. Although these disorders were known to
have serious effects on health, they were considered rare and of passing
interest. This cannot be said today. Anorexia nervosa and bulemia, the two
major eating disorders, are becoming increasingly common in the US; not
only in total numbers but in the age at which this condition is being
observed. More and more young women and girls are exhibiting the
symptoms. Females are 9 times more likely to devleop an eating disorder
than males.

People with either anorexia nervosa or bulimia are obsessed with the
appearance of their bodies and are preoccupied by thoughts of food, eating,
and dieting. No matter what their size, they tend to consider themselves as
"fat". In most cases this represents a very distorted body image.

People with anorexia nervosa are much more likely to be dangerously thin
than are people with bulimia. In order to lose more weight, a person with
anorexia will follow a strict, very low calorie diet and exercise at nearly
every opportunity.

People with bulimia are often of normal weight or slightly overweight, and
the signs of bulimia often do not appear until people are in their 20s or 30s.
Instead of dieting constantly, people with bulimia tend to interrupt their
usual eating pattern by binging - eating a large amount of food in a short
period of time. The foods chosen for binges are often high-calorie foods
such as ice cream, candy, potato chips, cookies, and other desserts. Food
binges by bulimics are generally followed by attempts to rid the body of the
food that was consumed so that they won't get fat. To do this, they purge
themselves of the food they have eaten by self-induced vomiting, taking
laxatives or diuretics and subsequent fasting.

Family environment seems to have the greatest influence on the


development of eating disorders. In addition, the US culture values thinness
and the view of a "perfect body" is still one that is unhealthfully thin.

Treatment and intervention is most effective, in general, with a


multidisciplinary team of psychologist/psychiatrist/mental health
professional, nutritionist and MD.

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