Obesity — everyone knows it’s bad and that it’s everywhere.
Nearly 78 million adults and 13 million children in the United States deal with the health and emotional effects of obesity every day. The solution to their problem sounds deceptively simple — take in fewer calories a day, while cranking up the calorie-burning process with regular exercise.
But it’s not just a matter of obese people deciding they’re going to eat less, says Donna H. Ryan, M.D., co-chair of the committee that wrote the recent obesity guidelines and professor emerita at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge.
Not getting the cues
The body’s regulation of food consumption is a highly complex biologic system, designed to promote food intake and survival, she explains. Body organs like the stomach, intestines, fat and pancreas send signals to the brain that trigger hunger and make you want to eat. While you’re eating, signals tell the brain that you’re full and to stop eating. “This is called the homeostatic system,” Ryan said, and is why we get hungry at regular intervals during the day but don't get hungry at night when we’re sleeping.”
She adds that another system -- the reward system -- promotes food intake. When you see or smell appealing food, it can trigger the desire to eat whether or not you’re hungry. “Think of your experience in a restaurant after a meal when the dessert cart comes by,” Ryan said.
Recent studies show that obese individuals have less ability to resist food cues. Stress, mildly low blood sugar and other factors also play a role.
Adding to the challenge, trying to eat less magnifies the body’s appetite regulating signals and when you start to lose weight, appetite is increased and satiety is decreased.
What’s society telling me?
In addition to the biological factors regulating our weight, societal factors also come into play, although they’re debated by experts, Ryan says.
Healthy dining is difficult
Dining out is a challenge for anyone, even the most disciplined portion-controller. The average restaurant meal is four times larger than in the 1950’s, with sugary drinks increasing the most — from 7 ounces on average in the 1950s to 42 ounces today, according to the Centers for Disease Control.
No matter where you eat it:
- big meals,
- refined grains,
- red meat,
- unhealthy fats and
- sugary drinks
American’s are eating fewer fruits, vegetables, whole grains and nuts, according to a Harvard School of Public Health report.
While experts debate society’s role, Ryan lists several possible triggers for the obesity epidemic:
- increased availability of a variety of palatable and affordable foods;
- decreased physical demands of many jobs;
- increased "screen time" – television, computers and smart phones;
- “nutritional programming” -- overweight and obese mothers who may be increasing their unborn child’s risk of obesity;
- changes in sleep patterns and stress;
- possible changes in the bacteria in the digestive track;
- the temperature of our houses and workplaces.
Obesity is determined through a body mass index or ratio of weight to height. A final number of 30 or higher is considered obese. Some examples would be a women who is 5-foot, 5-inches tall and weighs more than 180 pounds. Or a man who is 5-foot, 10-inches and weighs 209 pounds.
Currently, one in three U.S. adults is obese, bringing forth a possible health toll, including high blood pressure, Type 2 diabetes, heart disease and stroke. Another third of Americans are overweight.
A National Institutes of Health report showed that from 1962 until 2006, obesity in adults age 20-74 more than doubled, increasing from 13.4 percent to 35.1 percent. The average adult weighs more than 26 pounds more than they did in the 1950’s, according to the CDC.
While there is a physical toll for the obese, there is also a fiscal toll – the disease costs $190 billion a year in weight-related medical bills, according to the American Heart Association.
The news has hit home, with obesity being considered one of the top three most urgent health concerns, only behind the cost and accessibility of healthcare, according to a November 2013 Gallup Poll.
Ryan said that successful weight-loss programs require multiple coaching sessions to help people fight obesity.
Successful strategies include:
- using a food diary;
- eating more filling, higher fiber foods to help satiety signals kick in;
- removing tempting foods from the pantry and fridge; and
- avoiding high carbohydrate foods that can produce mild reactive hypoglycemia.
What she says about the role of exercise in obesity management may surprise people. “Diet is most important in losing weight, Ryan says. “Exercise is most important in keeping it off.”
She explains that during weight loss, physical activity is important for maintaining muscle mass and promoting fat loss, but it’s an inefficient method for losing weight. “Moving more” is important for preventing weight re-gain.
Obesity experts like Ryan believe that obesity is not a matter of willpower. She says there are even physicians who still feel that their obese patients could succeed only if they tried harder to lose weight or had enough willpower.
“If you can see your patients struggles with their weight and weight loss efforts through the lens of understanding the biologic regulation of body weight, you see a patient not as weak and lacking moral fiber, but as someone who is struggling heroically and needs your help,” says Ryan. “I have come to the conclusion that the best way forward for this group of physicians is to fill the education gap that was not provided by their schools and training programs.”
She adds that society must become more accepting of a healthy range of body sizes.
“If you have not had a friend, family member or colleague who has struggled with their weight and particularly if you haven't tried to lose weight yourself, then it’s easy for you to ascribe negative stereotypical traits to overweight and obese people. It's a lot like alcohol and drug addiction. Our society is more accepting of these conditions as a disease and less so for obesity.”