Is Obesity Really a Problem?

“Adolescent obesity is like an epidemic.”​—S. K. Wangnoo, senior consultant endocrinologist, Indraprastha Apollo Hospital, Delhi, India.

AS THE above comment shows, many middle-class Indian families have changed to a life-style that is resulting in teenage obesity. This epidemic has become a pandemic that is spreading in many countries as more people exercise less and become addicted to junk food. A consultant in adolescent medicine stated: “The next generation [in Britain] will be . . . the most obese in the history of mankind.” The Guardian Weekly reported: “Obesity was once mainly an adult problem. Now Britain has a young generation whose eating habits and sedentary culture is leading them towards problems first seen in the US. Long-term obesity will predispose them to illnesses such as diabetes to heart disease and cancer.”

The writers of the book Food Fight state: “Overconsumption has replaced malnutrition as the world’s top food problem.” Don Peck, writing in The Atlantic Monthly, states: “Some nine million Americans are now ‘morbidly obese,’ meaning roughly a hundred pounds [45 kg] or more overweight.” Weight-related conditions lead to some 300,000 premature deaths a year in that nation, “more than anything else except smoking.” Peck concluded: “Obesity may soon surpass both hunger and infectious disease as the world’s most pressing public-health problem.” Therefore, who can afford to ignore the threat of obesity? Dr. Walter C. Willett writes in the book Eat, Drink, and Be Healthy that “next to whether you smoke, the number that stares up at you from the bathroom scale is the most important measure of your future health.” The key word here is future health.

How Do You Define Obesity?

When is a person considered obese and not just somewhat overweight? The Mayo Clinic in Rochester, Minnesota, U.S.A., states: “In simplest terms, obesity is being seriously overweight because of excess body fat.” But how do you determine what overweight is for each person? Height-weight tables can give an approximate guideline as to whether one is simply overweight or has passed into the obese stage. (See the table on page 5.) However, these don’t account for differences in body composition. The Mayo Clinic says: “Body fat, instead of weight, is a better predictor of health.” For example, an athlete is likely to have more weight because of muscle mass or large bone structure. What are the basic causes of overweight or obesity? The following article will discuss that question.

Obesity​—What Causes It?

“We are in the middle of an epidemic that may have profound health effects for our children. If society doesn’t act now to implement preventative measures, the increase of obesity will not stop.”​—William J. Klish, professor of pediatrics.

THE tendency of some who have no problem with weight is to view overweight and obese people judgmentally and dismiss them as individuals with weak willpower and poor motivation. But is the problem that simple? Are obese people necessarily indolent individuals who avoid any physical exercise? Or in many cases are there other far-reaching causes that are more difficult to control?

Heredity? Environment? Or Both?

The book Food Fight states: “There has long been debate pitting genetics versus environment in the genesis of obesity.” What is meant by genetics in this context? Some hold to the theory that the human body naturally stores excess calories for possible future needs. The same source continues: “The genetics of obesity has been studied for decades. . . . Much research has now been done on human genes and obesity. Sophisticated techniques are being used to identify genes that predispose people to weight gain and to diseases like diabetes. In scientific parlance, 25 percent to 40 percent of the variability in population body weight can be explained by genes.” The book continues: “Given that obesity is usually blamed on personal failing, these numbers underscore the importance of biology, but still, 60 percent or more of the influence can be attributed to the environment.” This means that a major factor in obesity is still the person’s life-style. Does the individual take in more calories than he or she expends each day? Are the wrong kinds of food being consumed on a regular basis? Is time set aside each day for moderate exercise?

The Mayo Clinic explains the cause of obesity in simple terms: “Genes may set the stage for overweight or obesity, but your body weight ultimately is determined by your diet and physical activity. Over the long term, eating excess calories, leading a sedentary lifestyle, or a combination of both leads to obesity.” (Italics ours.) The same source continues: “Your heredity doesn’t mean you’re destined to be fat. . . . No matter what your genes say, it is ultimately your choices in nutrition and activity that will determine your weight.”

The weight-loss industry generates millions of dollars as desperate people seek to regain their former figure. Yet, what do experts say about these programs? “Obesity is very difficult to treat, and most people who lose weight do not keep it off,” says the book Food Fight. “The most optimistic estimates are that 25 percent [one in four] lose weight and maintain the loss, often requiring many tries.”

Dangers of Obesity

Obesity can lead to severe health problems. Dr. Scott Loren-Selco, a neurologist at the University of Southern California Medical Center, warns of the danger of Type 2 diabetes for even young people who are obese. (See Awake! of May 8, 2003.) He says: “We are seeing it all the time now, and believe me, it is frightening. I tell [obesity patients] that I could take them up to the diabetes ward and show them their possible future: the blind, the amputees, the endless number of people who are completely infirm because of type 2 [diabetes]​—and who are all obese.” What is one contributing factor? “They can afford supersized burgers and fries​—and so they get them,” says Loren-Selco. “There’s no one out there telling them it is wrong​—certainly not the fast-food companies, and, frankly, certainly not most physicians, who still aren’t trained in nutrition.”

Dr. Edward Taub, a well-known writer on nutrition, states: “It has recently become more fashionable, and even politically correct, to believe that being overweight is just a normal and acceptable part of modern life. This is truly an amazing public relations feat accomplished by the economic interests that thrive on fattening us.”

Experts say that those who are “pear-shaped,” carrying extra fat at the hips, may be healthier than those who are “apple-shaped,” having fat distributed around the abdominal organs (especially if the waist exceeds 35 to 40 inches [90 cm to 100 cm]). Why? Because “fat in your abdomen increases your risk of high blood pressure, coronary artery disease, diabetes, stroke and certain types of cancer,” says the book Mayo Clinic on Healthy Weight. “If you have a pear shape​—large hips, thighs and buttocks—​your health risks are not as high.”

So, what is the solution for the millions of adults and children worldwide who are overweight and in danger of serious health complications? Is there an effective remedy?

[Box/Chart on page 5]

What is BMI? What does it tell you?

BMI (body mass index) is a height-to-weight ratio that can help to define whether a person is overweight or is already obese. According to the Mayo Clinic, a BMI rating of 18.5 to 24.9 is considered the healthiest. If your BMI is between 25 and 29.9, then you are overweight. Anything over a BMI of 30 is viewed as obese. How do you check out against the chart? Do you perhaps need to see your doctor for suggestions or confirmation of your status?

To calculate your BMI, multiply your weight in pounds by 705, divide the result by your height in inches, then divide that by your height in inches again. For example, if you weigh 200 pounds and are six feet tall, your BMI is 27 (200×705÷72÷72=27).

[Chart]

(For fully formatted text, see publication)

Healthy Overweight Obese

BMI 18.5-24.9 25-29.9 30 or more

Height Weight in pounds

4’10” 118 or less 119-142 143 or more

4’11” 123 or less 124-147 148 or more

5’0” 127 or less 128-152 153 or more

5’1” 131 or less 132-157 158 or more

5’2” 135 or less 136-163 164 or more

5’3” 140 or less 141-168 169 or more

5’4” 144 or less 145-173 174 or more

5’5” 149 or less 150-179 180 or more

5’6” 154 or less 155-185 186 or more

5’7” 158 or less 159-190 191 or more

5’8” 163 or less 164-196 197 or more

5’9” 168 or less 169-202 203 or more

5’10” 173 or less 174-208 209 or more

5’11” 178 or less 179-214 215 or more

6’0” 183 or less 184-220 221 or more

6’1” 188 or less 189-226 227 or more

6’2” 193 or less 194-232 233 or more

6’3” 199 or less 200-239 240 or more

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Adapted from Mayo Clinic on Healthy Weight

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What is a calorie?

How is a dieter’s calorie defined? It is a standard measurement of heat energy. Thus, when you perspire, you use up calories, or heat energy. “A calorie is the amount of heat that it takes to raise the temperature of one kilogram [2.2 lbs] of water by exactly one degree centigrade.” (Balance Your Body, Balance Your Life) Each person’s daily calorie, or energy, needs are different, depending on such factors as height, weight, age, and activity level.

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You are sedentary if you

◼ Spend most of your day sitting​—watching TV or at a desk or in a vehicle—​in other words, not moving

◼ Seldom walk more than 100 yards [100 meters]

◼ Have a job that keeps you inactive

◼ Do not take between 20 and 30 minutes to exercise at least once a week

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Based on Mayo Clinic on Healthy Weight

Obesity​—What Is the Solution?

AWAKE! interviewed Diane, a dietitian, and Ellen, a registered nurse, who have both specialized in working with overweight and obese patients. They were in agreement that certain diets that concentrate on eliminating carbohydrates and increasing the intake of protein (meats) can lead to weight loss. However, they say that over the long haul, there can be negative secondary effects.a This is confirmed by a medical chart called Maintaining a Healthy Weight. It states: “Low-carbohydrate diets, especially if undertaken without medical supervision, can be dangerous.” It continues: “[They] are designed to cause rapid weight loss by promoting an undesirably high concentration of ketone bodies (a byproduct of fat metabolism).” If you are considering a low-carbohydrate diet, be sure to consult a doctor first.

If it is your goal to lose weight, do not despair. “Weight control isn’t impossible, nor does it need to mean deprivation or a boring, repetitious diet,” says Dr. Walter C. Willett. “With conscious effort and creativity, most people can successfully control their weight for the long term with an enjoyable but reasonable diet and near daily exercise. A longer, healthier life is definitely worth the effort.”b​—Italics ours.

How Important Is Exercise?

Dr. Willett says: “Other than not smoking, exercise is the single best thing you can do to get healthy or stay healthy and keep chronic diseases at bay.” How often should one exercise? What are the benefits of physical effort?

Some experts advise that daily exercise, if only for 30 minutes, can be very beneficial. But it is suggested that even exercising three times a week can help one to avoid serious problems in the future. Exercise burns calories, and the predominant question for someone who is trying to lose weight should be, Each day am I burning up more calories than I am taking in? If the equation is reversed, then you will surely gain weight. So walk or cycle instead of riding in a vehicle. Climb stairs instead of taking the elevator. Exercise! Burn calories!

Dr. Willett explains: “For many people, walking is an excellent alternative to other types of physical activity because it doesn’t require any special equipment, can be done any time and any place, and is generally quite safe.” His advice, of course, refers to brisk walking, not just taking a stroll. He recommends 30 minutes of physical activity every day if possible.

Is Surgery the Best Solution?

In an effort to lose weight and to prevent future weight gain, some severely obese patients have followed the advice of bariatric (obesity) specialists who recommend various surgical procedures. Who might qualify for these surgical solutions? The writers of the book Mayo Clinic on Healthy Weight suggest the following: “Your doctor may consider surgery if your body mass index is above 40, an indication that you are severely obese.” (See the chart on page 5.) The Mayo Clinic Health Letter suggests: “Surgery for obesity is generally recommended only for people between the ages of 18 and 65 with a body mass index over 40 whose obesity is creating a serious medical risk.”​—Italics ours.

What are some of these surgical procedures? They are small-bowel bypass, gastric partitioning, gastroplasty, and gastric bypass. This latter procedure involves stapling across the top of the stomach, leaving a small pouch that holds only about half an ounce of food. The small intestine is then cut and attached to this pouch. Thus, most of the stomach is bypassed as well as the duodenum.

Now, what about people who have lost excess weight? Was it worth the effort?

[Footnotes]

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A Suggested Healthful Eating Pyramid

Fruits and Vegetables A wide variety of each (unlimited servings daily; a minimum of 3 each)

Awake! does not advocate any particular method of diet and weight control. It merely informs its readers of some of the options that are available. Individuals should consult with their physician before adopting any exercise or diet regimen.

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Based on Mayo Clinic suggestions

[Box/Pictures on page 8, 9]

To lose weight, some have tried these tips:

1 Be aware of the calories in what you are eating and drinking. Note: Drinks can be a major source of calories, especially sweetened juices. Alcoholic drinks are also high in calories. And beware of those widely advertised soft drinks. Check the calorie count on the label. You might be shocked.

2 Avoid temptation. If chips, chocolates, or cookies are on hand, you will inevitably eat them! Replace them with low-calorie snacks, such as apples, carrots, whole-grain wafers.

3 Have a snack or an appetizer before eating a meal. It will take the edge off your appetite and may induce you to eat less.

4 Don’t eat everything put in front of you. Be selective. Reject what you know will give you too many calories.

5 Slow down. Why hurry? Enjoy your meal by noticing what you are eating​—the colors, the flavors, the interaction of foods. Listen to the body’s signals that say, “I’m full. I don’t need any more.”

6 Stop eating before you feel full.

7 Restaurants in some countries are notorious for serving excessive portions. Leave half of your entrée behind, or share the plate with someone else.

8 Desserts are not essential to complete a meal. It is better to finish off with fruit or another low-calorie item.

9 Food manufacturers want you to eat more. Profit is their bottom line. They will try to exploit your weaknesses. Don’t be taken in by their clever advertising and pretty pictures. You can say no!

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List adapted from the book Eat, Drink, and Be Healthy, by Dr. Walter C. Willett

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Exercise!

Fighting Obesity​—Is It Worth the Effort?

AWAKE! interviewed several people who have battled with obesity problems. Did they get good results? What do they suggest for other victims of this epidemic?

◼ Let us check with Mike, aged 46, who is six feet [183 cm] tall and presently weighs 285 pounds [130 kg]. At his peak, he weighed 347 pounds [157 kg].

Mike: “Even as a youth, I was overweight. It runs in the family​—my brother and my sisters are all overweight. Our tradition was that we never left anything on our plate, even if it was overloaded. What made me change my eating style? When the doctor told me that I was at high risk for diabetes! The idea of being on insulin all my life really scared me. I also had a bad cholesterol problem and was having to take medication.

“I was in a sedentary occupation, and that has not changed. So in order to compensate, I have a regular schedule of exercise, which includes use of a treadmill for half an hour at least three times a week. The next vital step was writing down what I ate each day. Knowing that the dietitian was going to check my list each week helped me to put on the brakes. The thought came to my mind, ‘If you don’t eat it, you won’t have to write it!’

“As a consequence, I have lost 62 pounds [28 kg] over the past 15 months, although I still need to lose more, as I want to get down to 225 pounds [102 kg]. To achieve this, I have eliminated snack foods, potato chips, and casseroles. I have eaten more salad and vegetables in recent months than I had in all my life previously!

“Another factor that motivated me to take action was that as a truck driver, I have to have a medical check-up each year in order to renew my license. I was in danger of losing my license because of the threat of diabetes. Now things have changed. I no longer need to take medication to keep my cholesterol in check. My blood pressure is down, and I am taking less medication for it. I have more energy, and even my severe back problems have eased. I am also slowly getting out of the obese category!”

Awake!: “Can a wife play a positive role in bringing down weight?”

Mike: “When you are fighting overweight, you need to have someone backing you up. My wife used to feel that she was showing me affection by keeping me well fed. But now she helps me to control the portions on my plate. I cannot afford to relax my vigilance because if I do, before I know it, I am putting on pounds once again.”

◼ Consider another man named Mike, from Kansas, U.S.A. He is 43 years old and is five feet eight inches [173 cm] tall. We asked him about his peak weight and the causes of his weight problem.

Mike: “I peaked at about 300 pounds [135 kg]. I was always tired and had no energy for anything. I could not sleep because of breathing problems. So I went to a doctor, and he diagnosed one of the causes of my weight problem as obstructive sleep apnea.a He also noted that I had high blood pressure.”

Awake!: “What was the solution to your problems?”

Mike: “The doctor prescribed an apparatus that supplies continuous positive airway pressure when I am sleeping. That way my throat is not obstructed, and I can breathe normally. As a result, I became more active during the day and began to lose weight. I also started using a treadmill three times a week. I went on a diet, which meant controlling the portions I ate and avoiding second helpings of food. I have now lost 50 pounds [20 kg] in just over a year, and I need to lose 50 [20] more. It is a slow process, but I know I can do it.”

Awake!: “What other motivation have you had to lose weight?”

Mike: “It is not pleasant when you have to listen to snide and unkind remarks about your appearance. People tend to think that you are just a lazy person. They do not realize that obesity can have many causes. I believe that in my case, the problem could partially be due to hereditary factors, since most in my family have a weight problem.

“However, I acknowledge that to lose weight, I must keep active and strictly control my diet.”

◼ Awake! also interviewed Wayne from Oregon, aged 38. When he was 31, he weighed 246 pounds [112 kg].

Wayne: I had a sedentary job and was getting no exercise. When I went to my doctor, I was shocked to learn that I had high blood pressure and was in danger of heart complications. He sent me to a dietitian. She put me on a strict regimen of exercise and of controlled portions at meals. I began to walk three miles [5 km] nonstop every day, and I got up early each morning to exercise. I had to reeducate myself regarding my eating and drinking habits. I eliminated junk food and cut back on bread and sodas, replacing them with more fruit and vegetables. Now my weight is down to 175 pounds [80 kg]!”

Awake!: “What benefits have you noted?”

Wayne: “I feel that I am healthier and that I am really living again. Before, it was as if my life were on hold, as if I were stagnating. Another benefit is that I have been able to drop the medications for high blood pressure. And I feel that I can look people in the eye, knowing that there will be no implied criticism because of excess weight.”

◼ Charles (not his real name) is six feet five inches [196 cm] tall. At his peak weight, he weighed 370 pounds [168 kg].

Charles: “I had major health problems, and things were getting worse. I could not climb stairs. I lacked the energy I needed to get my work done. I have a sedentary occupation, and my work involves research and responsibility. I knew that I had to do something about my weight, especially after seeing my doctor. He warned me that I was on the way to having a stroke. I have seen what that does to a person. This convinced me that I needed to take action. My doctor put me on a supervised exercise regimen using a treadmill, and I was given a strict diet to follow. Now, after about a year, I am down to 300 pounds [136 kg], but I know that I must lose more. The benefits I have already noticed convince me that it is worth the sacrifice and the effort. Now I can climb stairs, and I have more energy.”

◼ Marta, originally from El Salvador, reached a point where she weighed 182 pounds [83 kg]. This classified her as obese for her height of five feet five inches [165 cm].

Marta: “I went to a doctor, and he strongly recommended that I start losing weight. I respected his professional opinion. He sent me to a nutritionist for counsel. The nutritionist explained the whys and wherefores of the regimen I was going to follow. She showed me how to limit my portions and how to keep a check on what I was eating. At first, I had to report to her each week; and later, each month, to show how I was doing. Both the doctor and the nutritionist encouraged me for the good progress I was making. Eventually, I lost 27 pounds [12 kg], and I am holding my own at about 150 pounds [68 kg].”

Awake!: “What about exercise and medication?”

Marta: “I did not have a cholesterol problem, and I had no need of medication. I did start incorporating more brisk walking in my daily routine.”

Awake!: “What did you do when you visited friends and they insisted that you eat more than your normal portions?”

Marta: “I would just say to them, ‘My doctor wants me to follow this diet for my health’s sake,’ and they would usually not insist.”

So if you are overweight or obese, what can you do about it? The old adage is true, “Where there’s a will, there’s a way.” Do you have the motivation and the willpower to do something about it? As an overweight child or an overweight adult, what are your choices? Lose weight or possibly lose years of life. Adopt an active life-style, and feel the satisfaction of accomplishment​—even in small things, such as smaller sizes in your clothing!

[Footnote]

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Is liposuction the answer for you?

What is liposuction? One dictionary defines it as: “Usually cosmetic surgical procedure in which excess fatty tissue is removed from a specific area of the body, such as the thighs or abdomen, by means of suction. Also called suction lipectomy.” (American Heritage Dictionary) However, does that mean it is a remedy for obesity?

The Mayo Clinic on Healthy Weight says that liposuction is cosmetic surgery. It is not a weight-loss plan. Fat cells are sucked out of the body by means of a narrow tube inserted under the skin. Several pounds can be removed in one session. However, “the surgery isn’t a treatment for obesity.” Is it a safe procedure? “People with certain weight-related medical conditions, including diabetes and heart disease, are at increased risk of complications from liposuction.”