Obesity, the Terror Within

By Judith S. Harris
Health Educator, USACHPPM

The "obesity epidemic" is attracting lots of interest from health care providers and health promotion/prevention advocates. U. S. Surgeon General, Dr. Richard Carmona, calls obesity "the terror within." People should be as worried about this terror as they are about all of the terrors swirling around our globe. Ironically, the broader issues of environmental hazards and international unrest are less visible in every-day life but receive far more attention. Meanwhile, the underground "fat advocates" - fast food chains; the candy industry; and purveyors of white bread, white rice, and, sugary cereals; among others - keep bombarding the public with the "buy-buy-buy" and "eat-eat-eat" message. It would seem that they are all aiding and abetting America's trek down the road to obesity because any energy-giving nutrient (fat, carbohydrate, protein) that you take in and don't burn up gets converted to fat.

So, let's talk about healthy eating. The basic underlying principle is that "calories out" have to equal "calories in" to maintain weight, and calories out must exceed calories in for weight loss to occur. In general, the best way to achieve this negative balance is to decrease food intake and increase calorie burning through physical activity. To do this, we first have to put food in its proper place in our lives.

Food as blessing, food as demon

The marvelous thing about good food is that it tastes great! For most people, eating is, and should be, a great pleasure. In the last article I talked about the clash that occurred some decades ago in the US as most jobs became sedentary and fast food became more available. The culture change came about so fast that our bodies didn't have time to adapt, from an ordinary standpoint, to lower nutrient demands before convenience and instant gratification grabbed our minds. "Sharing the bounty of this land" was an American philosophy from our earliest days as a nation. However, with each succeeding generation the concept of working hard to achieve one's share of the bounty became less and less closely associated with hard physical work (calories out), but there was no decrease in the sense that we deserved the same full measure of bounteous food. The food industry, while becoming farther and farther removed from the farm, was only too happy to comply. Eating out and fixing large, fancy meals became rewards that were only occasional indulgences at first. But as more and more households became concentrated in cities and suburbs, the convenience of eating out while staying close to home or office grew. The next logical step that enabled people to eat out more often was cheaper, faster food; or, if you preferred to be at home, more pre-packaged convenience foods and take-out. Quality, of course, was sacrificed to cheapness and fastness.

Why most "diets" fail

Most of us don't want to think about giving up the pleasure of good food. Many "diets" fail for this reason alone: deprivation leads to craving. Fulfillment of craving leads to guilt, and food becomes the demon at the center of a love-hate relationship. At the extreme, body image becomes severely distorted (anorexia nervosa) and/or the need to binge, then purge the demon (bulimia) is overwhelming. Many overweight people can't even conceive of a normal relationship with food, as epitomized by the phrase "everything that tastes good is bad for you." Is it possible to enjoy the bounty without the consequences? Fortunately, the answer is "YES"!

Tips for Healthy Eating

1. Forget the word "diet." No "diet" will work over the long haul. Metabolically, it is impossible to severely restrict calories or a specific nutrient without triggering a starvation response in which metabolism slows and the body tries valiantly (and successfully!) to store even more calories. Furthermore, deprivation causes craving - the mental equivalent of starvation mode that lures us toward forbidden items.
2. Recognize that sustainable weight loss is a slow process. It involves committed behavior change, persistence, and giving up the wish for instant results. The maximum safe, sustainable weight loss is two pounds a month, or 24 pounds a year.
3. Make "calories out must exceed calories in" your mantra. If you're willing to significantly increase the calories you burn, you won't have to decrease those you take in as much but the "negative balance" must be maintained for weight loss to occur. There are great tools available on the Internet for determining caloric intake.
4. Whole grains, vegetables, plant oils, and fruits, are the staples of a healthy diet.
5. The vast majority of your intake must be high-quality nutrients. Refined (white) wheat products, sugary carbohydrates, and fatty meats are not good sources of calories.
6. Nutrient balance is essential. Your body needs all three energy nutrients.
7. It is not necessary or wise to eliminate any food from your diet. Total deprivation leads to craving and loss of control over consumption. It is necessary to restrict such items as refined sugar, animal fats, and "empty" calories (sweets and sodas containing sugar).
8. It is virtually impossible to lose a significant amount of weight and/or maintain a healthy weight without a physical activity program.

There is some interesting new research being published about the relative proportion of nutrients that should be in our food choices. Basically, the Harvard School of Public Health and other research sources state that the amounts of cereals, grains, and pasta recommended is too high and a big contributor to overweight. Go to http://www.hsph.harvard.edu/nutritionsource/pyramids.html for an enlightening article. That doesn't mean that whole grains should not be a major part of healthy eating, just that we may have been going overboard on quantity (no surprise there!).

It is critical for long-term health that all of us learn to master the "terror within" - obesity. Healthy eating and physical activity are our most important weapons against this threat. Whether you need to kick out gremlins that are already present or keep them from entering, grab them and go for it! Check the new H4H Health Educator's Corner in June for an article to help you identify and banish menacing "diet gremlins".

Featured resource:

Portion Distortion is one of many interactive features on the "Aim for a Healthy Weight" web site available from the Obesity Education Initiative of the National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm

Visit the site, try out the interactive tools and find more practical tips to help you achieve and maintain a healthy weight.