In the U.S., food is abundant, diverse, delicious, . . . and very often, high in calories. The result of this embarrassment of riches is an alarming rise in the number of fat Americans. Overweight is a particular problem for those under the age of 50, especially women and minorities. Yet younger fat people stand to benefit even more from weight reduction than do the middle-aged and elderly.
Despite the nation’s ongoing fascination with fitness, Americans are suffering an epidemic of obesity. In 1999, the number of obese adults aged 30 to 39 jumped 10 percent in a single year. It is estimated that approximately 108 million Americans—61 percent of the population—are either overweight or obese.
Obesity and overweight are not the same thing, though the experts don’t agree as to what, precisely, obesity is. In general, the term “obesity” is applied when an individual is from 20 to 30 percent over the average weight for his or her age, sex, and height.
The medical community uses the body mass index, or BMI, to define obesity. BMI measures body weight relative to height and is strongly correlated with total body fat. A BMI of 30 and above is considered obese (see the accompanying chart “What’s the Right Weight for You?”).
The economic cost of battling these excess pounds is substantial: over $70 billion in healthcare costs and more than $33 billion a year in efforts to lose or control weight. The costs in terms of human suffering cannot be so easily quantified, but a recent study found that obesity was associated with a higher rate of chronic medical problems and a poorer quality of life than were alcohol abuse, smoking, and poverty.
Overweight encourages high blood pressure, high cholesterol, heart disease, diabetes, and a variety of other diseases.
For example, high blood pressure is almost six times more common among overweight people age 20 to 44 and twice as common in those 45 to 74. Overweight people are also three times more likely to develop diabetes. In fact, the Nurses Health Study, one of the largest disease-risk studies ever undertaken, showed that women who gain 15 excess pounds increase their risk of diabetes by 50 percent.
Figuring Your BMI
The Body Mass Index (BMI) incorporates both your height and weight to assess your weight-related level of risk for heart disease, diabetes, and high blood pressure.
To find your BMI, multiply your weight in pounds by 700, divide by your height in inches, then divide by your height again. For example, if you’re 5 feet, 10 inches and weigh 185 pounds, the math would go like this:
• 185 pounds x 700 = 129,500
• 129,500 /70 inches = 1,850
• 1,850 /70 inches = 26.4
Indications of Risk:
• BMI of 25 or less: very low to low risk
• BMI between 25 and 30: low to moderate risk
• BMI of 30 or more: moderate to very high risk
For men, the consequences of being overweight can be even more pronounced. A 27-year study of more than 19,000 middle-aged men found that those at their ideal weights lived significantly longer than those just 2 to 6 percent above what’s considered ideal. That’s not a lot of excess baggage. For a medium-framed man who’s 5 feet, 10 inches tall, 6 percent of an ideal weight of 158 pounds is only nine-and-a-half pounds.
The heavier the men in the study, the shorter their life expectancy. Those who were 20 percent overweight had a risk of death from heart disease that was two-and-a-half times that of men whose weight was ideal.
Obesity has also been linked with gallstones, back pain, sleep apnea (a condition characterized by brief periods when breathing stops during sleep), heartburn, stroke, gout, varicose veins, and even some types of cancer, including colon and prostate cancer in men, and uterine, endometrial, and breast cancer in women.
When researchers looked at 735 women who were treated for stage II and III breast cancers, they found that among women who were more than 20 percent over their ideal weights the risk of recurrence was a third higher than among their slimmer counterparts. As a result, many researchers regard obesity as an independent indicator of a poor prognosis for breast cancer, even when the best medical treatments are administered.
What seems clear is that the biochemical disruptions caused by being overweight are more complex and more prevalent than we thought. Medical researchers have discovered links between excess weight and an astonishing variety of health problems, ranging from osteoarthritis of the hands and knees to birth defects. All of these discoveries underscore the wisdom and benefits of weight control.
Osteoarthritis. It makes sense that there’s a link between osteoarthritis of the knees and being overweight: Carrying an extra 50 pounds of baggage can wreak havoc on the knee joints. But research from the University of Michigan found that people who were 20 percent or more overweight were also three times more likely than slimmer people to have osteoarthritis of the hands, and that their arthritis was more severe.
The Wages of Fat
|Excess weight is not responsible for everything that ails you, but it definitely is associated with some of America’s most dangerous disorders, including high blood pressure, heart disease, diabetes, and recurrent breast cancer. If you are overweight, your chances of developing high blood pressure are at least double what they would otherwise be, and your chances of becoming diabetic are triple. Among men tipping the scales at 20 percent above the norm, the rate of heart disease is two-and-a-half times the rate among men whose weight meets the ideal.|
Carpal-Tunnel Syndrome. Excess weight may also be a major contributing factor to a nerve conduction problem in the hand, commonly known as carpal-tunnel syndrome, or CTS. The Portland Hand Surgery and Rehabilitation Center found that overweight was the strongest single predictor of CTS—twice as influential as age. Surprisingly, the kind of work people did had virtually no bearing on whether or not they developed the problem.
Immune Deficiencies. An intriguing study from Japan suggests that obesity may also be a threat to the body’s immune system. Indeed, when obese people were put on strict diets, losing an average of 50 pounds each, activity of the T lymphocytes—the body’s defender cells—nearly doubled.
Birth Defects. Preliminary research also indicates that women who are extremely—not just moderately—obese have about twice the risk of giving birth to babies with very serious defects, including spina bifida, when protective bone fails to close around the spinal cord.
Social, Economic, and Psychological Stress. A certain degree of social contempt is probably the most damaging psychological consequence of overweight. People with weight problems have traditionally been regarded as sloppy, lazy, and lacking will power or self-control. They suffer discrimination at school and in the workplace. Indeed, public mockery of fat people is one of the last remaining socially sanctioned forms of prejudice. Repeatedly fruitless efforts to control their weight and years of subtle put-downs and overt criticism can tear away at the self-esteem of overweight men and women.
Why is overweight so prevalent in America? The answer is simple: Many of us are taking in more fuel than our bodies need.
Evolution perfected the fat storage mechanisms of the human body. For millennia, periodic food shortages—as a result of drought, or catastrophe—were a way of life for our ancestors. Those people most likely to survive were those who during good times could convert extra food into body fat that served as insurance against the famine. At approximately 3,500 calories per pound, fat is an extremely efficient repository of stored energy.
But life has changed, as have our diets and activity levels.
Today, periodic famine is unheard of in the industrialized world, yet our diets tend to be richer than ever. Indeed, Americans now consume 33 percent of their calories in the form of dietary fat, the food most easily converted to body fat. (For every 100 unused calories taken in as fat, 97 are stored as fat. For every 100 unused calories taken in as carbohydrates, only 77 are stored as fat; the rest fuel the process of converting those carbohydrates to fat.)
Other factors that have contributed to the epidemic of overweight include:
Highly processed foods. While there are exceptions to the rule, the healthiest foods tend to be subject to the least processing by food manufacturers. Whole grain cereal is more nutritious—and lower in calories—than fatty, sugary granola. A fresh peach is nutritionally preferable to a slice of peach cobbler. Many of us, unfortunately, have developed the habit of eating foods laced with excessive amounts of fat, sugar, and sodium.
Lack of exercise. While our caloric intake has increased, our caloric expenditures have declined. We Americans are leading far more sedentary lives than our parents and grandparents did. We have countless labor saving devices at home and at work; and our leisure time is more likely to be spent in front of a computer or a television than on a softball field or a bike, or even just walking.
Stress. Men and women—especially those between the ages of 25 and 44—typically lead tremendously demanding lives, juggling the multiple, often conflicting challenges of job, marriage, and family. Lack of time can lead people to grab less nutritious food and stress often prompts us to overeat or routinely snack on junk food.
Drinking. Alcohol accounts for 5 to 7 percent of overall caloric intake in the U.S. While some health claims have been made for the benefits of moderate consumption of alcohol, it still represents empty calories . . . and it can loosen one’s self-restraint in the presence of high-fat snacks like peanuts and potato chips.
The decline in smoking. Per-capita consumption of cigarettes in the U.S. has declined from a peak of 4,266 per year in 1961 and 1962 to about 2,500 per year in 1994 and 1995. Individuals who give up smoking gain an average of 10 pounds. Those trying to quit, however, can often avoid the problem by watching their calories and exercising. It is important to remember that smoking is far more dangerous than is a relatively small gain in weight.
It’s sad but true: Women gain weight more easily than men do, and women have to work harder to get it off. It’s all a matter of biochemistry.
A fat cell is designed to store calories (lipogenesis) when you don’t need them and release fat (lipolysis) when you do. The enzymes that help store fat are called lipogenic enzymes; the ones that help release fat are lipolytic enzymes.
Women tend to have more lipogenic enzymes for fat storage; and the more you can store, the bigger the fat cell. Men have more lipolytic enzymes for fat release and, therefore, smaller fat cells.
Testosterone, the male sex hormone, activates the lipolytic enzymes for speedy release of fat. Estrogen, the female sex hormone, activates and multiplies the lipogenic enzymes. (This explains the extra deposits of fat that women experience during puberty and pregnancy, and when they are taking oral contraceptives or getting estrogen-replacement therapy.) Estrogen not only stimulates the storage of fat, but also directs where most of it will be stored, concentrating it in the hips, buttocks, and thighs.
When Dieting Runs Amok
For far too many Americans, the feast/famine cycle of our earliest ancestors has resurfaced as the binge/diet cycle of today. Approximately 8 million Americans suffer from such eating disorders as anorexia (a refusal to eat due to an obsessive fear of fatness) and bulimia (binge eating followed by purging through vomiting or laxatives). Women seem to be particularly vulnerable to an abnormal preoccupation with food and a distorted body image.
Thirty years of deifying slimness in the media have led to this sad state of affairs. The fact is that five or ten excess pounds doesn’t make you obese, and thin does not equal fit or healthy.
While about a third of U.S. women are actually overweight, as many as 77 percent believe that they are too fat and 45 percent are on a diet at any given time. For many, it’s completely unnecessary.
Having evolved as protection against periods of famine, these fat-storage mechanisms are governed by the needs of each gender. A man’s body generally contains enough fat to protect itself for a few months. A woman’s body, on the other hand, stores nine months’ worth of fat—enough to protect her and her unborn child for the length of a full-term pregnancy.
Throughout their lives, women have more body fat than men. Even the bodies of young girls contain a higher percentage of fat than young boys’ bodies do. And at certain milestones in the female lifecycle—puberty, pregnancy, and menopause—women tend to put on more fat. That means that the older a woman gets, the more likely she is to stray from society’s ideal of female beauty.
To make matters worse, the thigh, hip, and buttock fat that estrogen helps deposit is metabolized more slowly than fat elsewhere, making those particular pounds especially difficult to reduce.
Don’t trust only your scale or your mirror; they tell just half the story. It is body fat, rather than weight, that may be the best indicator of whether or not you need to trim down.
Fat comprises about 15 to 18 percent of the total body weight of a healthy, physically fit man. For a woman, the ratio is slightly higher: from 20 to 25 percent. Remember: You can be overweight without being over-fat and over-fat without being overweight.
For example, a 6-foot-tall, 275-pound linebacker may be overweight according to formal height-weight tables. But, as a professional athlete, his body-fat content may be as low as 10 percent, making him fit, not fat. Conversely, a man whose weight falls within the “normal” range, but who gets little exercise and whose body fat measures 18 percent, could be classified as over-fat.
There are a number of techniques for calculating body fat. Most are based on pinching and measuring subcutaneous fat (the fat below the skin). However, the most accurate method involves being weighed in a water tank, since the measurement takes into account the fat that may be marbled through your muscles. Fat—like cream—floats; lean muscle mass and bone, which are heavier than fat or water, sink. The fatter you are, the less you will weigh submerged in water.
This is one of the reasons why a tape measure can be a better tool than a scale for measuring the success of a weight loss program. Since muscle weighs more than fat, your weight may seem to stabilize or even increase as you build muscle mass. Don’t be discouraged. If you’re wearing smaller-sized clothes or you’ve lost inches from your hips, waist, or neck, you are actually leaner and healthier than when you started.
At least as important as total weight is where the fat tends to settle on your body. While fat in the hips, thighs, and buttocks is mainly stored just under the skin, fat in the midsection is stored deeper in the body.
It has now been well established that having an “apple shape,” in which fat collects around the midsection, is more dangerous than having a “pear shape,” in which excess fat gravitates to the hips and thighs.
Experts theorize that abdominal fat releases more fatty acids, leading to a rise in blood cholesterol and triglyceride levels. While this can be a serious health problem in and of itself, it also may interfere with the action of insulin in the body, thus increasing the risk of diabetes. Some researchers also believe that “apple shape” obesity may increase the availability and activity of estrogen, leading to an elevated risk of breast cancer. The good news is that, to some degree, you can modify your shape, whether apple or pear, through exercise and diet modification.
Apple or Pear
|People with apple-shaped figures (heavy around the abdomen) have a higher risk for cardiovascular disease than do pear-shaped people (heavy around the hips and thighs).
To find your waist-to-hip ratio:
1. Use a tape measure to find the circumference of your waist at its narrowest point when your stomach is relaxed.
2. Measure the circumference of your hips at their widest (where your buttocks protrude the most).
3. Divide your waist measurement by your hip measurement.
Waist/hip = Waist-to-hip ratio>
The higher the ratio, the more apple-shaped; and the greater the risk of disease. Women should have a ratio of 0.8 or less. For men, a waist-to-hip ratio of less than 0.95 to 1.0 is recommended.
Most of us realize that our dissatisfaction with our bodies is the result of our society’s love affair with the ultra-slim ideal of beauty personified by underfed “waif” models. We have also bought the myth that our bodies are infinitely adjustable.
Obesity researchers are discovering, however, that our capacity to change our weights is actually quite limited. In addition to our gender, we can partly blame our genes. Even before discovery of the “fat gene” in mice, researchers had decided that genetic factors can be twice as important as lifestyle in determining adult weight.
Although for many centuries obesity was considered simply a result of gluttony, it is now well established that there is a genetic propensity for it in some individuals, families, and larger social groups with a shared heritage. For example, studies have shown that twins with a genetic tendency toward fatness are likely to grow up fat, even if adopted separately by thin families.
Researchers have also found that one person’s basal metabolism (the rate at which he or she expends energy) can differ from another’s by as much as 400 to 500 calories a day. There can also be differences in the ways individuals store or burn off extra calories. One person may need to consume 4,000 calories each day to gain weight, while another may see an increase on just 1,000 calories a day.
And, in particular ethnic groups—for example, the Pima Indians of Arizona—there is an extraordinarily high prevalence of obesity. Genetically equipped to retain fat in times of famine, they respond to today’s ready availability of food and reduced activity with an especially quick and substantial weight gain.
The influence of genes is far from clear-cut. To confuse matters, ethnic, religious, and class factors all seem to play a role in obesity. For instance, researchers don’t know whether it’s a cause, an effect, or a coincidence, but it’s a fact that excess weight tends to accompany low social status. Ironically, people who live below the poverty line are more likely to be fat than those at the top of the economic pyramid.
Regardless of your background or genetic make-up, it is possible to keep your weight in check. Radical and repeated dieting, however, is not the answer—even though physicians routinely recommend dieting for heavy patients. Extreme dieting poses dangers associated with continual food restriction, and statistics show that 80 to 90 percent of all dieters regain the weight they lose.
Prescription and over-the-counter weight-loss drugs are not magic bullets either. The loss tends to be temporary and all drugs carry the risk of side effects. Clinical guidelines released by the National Institutes of Health recommend that weight-loss drugs be reserved for patients with a BMI greater than 30 or a BMI greater than 27 if they also have risk factors for a chronic disease such as hypertension or diabetes.
Most weight-loss drugs work by suppressing the appetite. Options in this category include the prescription medications Adipex-P, Fastin, Ionamin, and the newer diet drug Meridia. All can be habit-forming if they’re abused. There’s also one medication that works by preventing the absorption of fat. Named Xenical, it blocks uptake of up to one-third of dietary fat when used along with a low-fat diet. It can, however, cause unpleasant side effects.
When giving any of these drugs a try, don’t expect results unless you also diet and exercise. And remember that unless you make some permanent changes in your eating habits, the excess pounds are likely to return.
Physician-supervised commercial semi-starvation diet plans, which offer participants just 400 to 600 calories daily for a period of months, are supposed to help the dieter’s body shed excess fat rather than muscle. But there have been many reports of adverse side effects, including at least 67 deaths.
Very low-calorie diets, particularly those that concentrate on one or two foods, often lack adequate nutrients. People on restricted diets don’t have the energy necessary to function at their usual activity levels; metabolism is depressed; and see-sawing weight gains and losses raise the risk of hypertension. People who don’t or can’t stick to their diets begin to see themselves as failures. Perhaps the worst risk is the development of a dangerous preoccupation with food.
Yo-yo dieting is a controversial subject. When you go on a diet, the body’s famine-oriented biochemical changes begin. The fat-storing lipogenic enzymes are activated and multiplied, so that you will be better equipped to store fat after the diet. As we have already seen, women have more storage enzymes than men, and dieting doubles them. Worse yet, a dieting woman becomes less efficient at losing fat. Research has shown that dieting can reduce fat-releasing lipolytic enzymes by 50 percent.
It has been long thought that when you go on and off diets, the effect is cumulative. You supposedly manufacture even more storage enzymes and fewer releasing enzymes after every diet cycle, so that each time you go on a diet, you will lose the weight more slowly and gain it back more quickly. However, the National Institutes of Health have been unable to find any evidence that yo-yo dieting actually does make weight loss more difficult the next time around. Nevertheless, it’s still a good idea to avoid it.
So, if dieting isn’t the answer, what is? It’s how you eat—not just what you eat—and how you live.
Starting Your Children Off Right
In the last trimester before birth, the baby begins to accumulate fat cells. For the first six months of infancy, the number of fat cells continues to increase, then slows through childhood. The total number of fat cells accumulated (generally 30 to 40 billion in the average adult) depends on genetic and lifestyle factors, especially nutritional ones.
Although some researchers believe that obesity in childhood predisposes a person to obesity for life, not all fat babies grow into fat adults.
Obviously, it’s better—and easier—to prevent gain than it is to try to take off excess pounds after they have accumulated. For the best ways of keeping your child’s weight in line, see “What’s Right—and Wrong—for the Kids.”
Keep a food diary. For four days, including one weekend, write down the foods you eat, how much, where, when, and under what circumstances (for example, watching TV at night, when you’re angry, when you are cleaning up the kitchen). This can help you see whether you have an eating pattern that is blocking your efforts to control your weight. (Are you confusing anger, anxiety, or boredom with hunger?)
Stop dieting. Diets are restrictive, boring, and punitive. Eating healthy, however, is a satisfying lifetime proposition. Increase your consumption of nutrient-rich foods like vegetables, fruits, and whole grains, while cutting back on “empty” calories and fatty fare. (But keep your favorite foods on the menu—at least once in a while—so you won’t feel deprived.)
Eat slowly. Smell, taste, and savor your food. If you eat too fast, you’ll be stuffed before you feel full.
Burn the fat. Exercise is critical for healthy weight loss. It doesn’t have to be vigorous exercise: A brisk walk or other form of aerobic exercise for 30 minutes every other day is enough to raise your metabolism and condition your cells to release and burn fat. Building muscle mass helps, too. It increases the number of mitochondria, the fat-burners in your muscle cells. Strength-building exercise for 30 to 60 minutes 4 days or more per week increases muscle mass and doubles the efficiency of the mitochondria in your muscle cells.
Be a daytime eater. While metabolism is highest during your first 12 waking hours, the typical American eats about 70 percent of the day’s calorie allotment after 5:00 p.m., when metabolism is lowest. If you wake at 7:00 a.m. and your body needs 1500 calories a day, it will burn about 75 percent of those calories (or 1,125 calories) from 7:00 a.m. to 7:00 p.m., and only about 25 percent (or 375 calories) after 7:00 p.m. Any additional calories after 7:00 p.m. will stay around to haunt you.
Shrink and multiply your meals. Eat five or six meals a day instead of three, but eat only the amount of food that you would ordinarily have eaten at three meals distributed evenly over the course of the day.
Look for support. Not all of us can go it alone. Turn to friends, family, and the local chapters of organizations like Overeaters Anonymous or Weight Watchers to provide the encouragement you may need when your commitment to a healthy lifestyle falters.
Take it easy. Trying to lose too much too fast by following a diet that is too stringent just won’t work. Target a slow, but steady weight loss not to exceed one-half to 2 pounds a week. (Aim for a loss of more than 1 percent of your body weight per week.) An exercise-induced burn of 300 calories a day plus a daily calorie reduction of only 200 calories is often enough to lose a pound a week.
Be flexible. Don’t set rigid targets; and don’t let your menu dominate your life. Listen to your hunger, and stop when it subsides.
Whatever else you do, be sure to get up and move around. A recent study at the University of Washington among overweight, but otherwise healthy men over age 65 found that trimming off five pounds by walking, jogging, or bike riding raised “good” cholesterol—high-density lipoproteins (HDLs)—even more than did losing 20 pounds by cutting calories alone.
What’s the Right Weight for You?
Standardized height-weight tables should be merely a starting point for an understanding of your healthiest weight. The best weight for many people is simply the lowest they have been able to maintain for a year as an adult without a struggle.
Body shape is another factor you should consider when calculating your ideal weight. Fat concentrated on the hips, thighs, and buttocks (the classic “pear shape”) is less dangerous than fat you carry on your abdomen (the “apple shape”). So, individuals with slender arms, legs and hips, who are thick around the middle, should probably dip below the standard for their height to reduce their risk of developing fat-related illnesses like cardiovascular disease and diabetes.
Most obesity experts prefer the nearby body mass index, or BMI, for determining the recommended weight for optimum health. Remember that less can be more here. In a study of Harvard alumni, researchers found the lowest mortality among individuals who weighed, on average, 20 percent less than the U.S. average for men of comparable age and height.
Recent research suggests that if you repeatedly have trouble reaching—and maintaining—your ideal weight, you may be better off surrendering that elusive goal altogether and focusing instead on what your body really wants to weigh: your natural weight.
Natural weight is the weight your body goes to and maintains when you’re eating reasonably and not drastically cutting calories, exercising vigorously, or otherwise trying to shed pounds. It will never be a fixed number, but, rather, a range of 5 to 8 pounds (since weight normally varies slightly with changes in general health, activity, hormone levels, and the time of day).
Of course, that doesn’t mean that any weight is healthy. If your weight or body shape is associated with significant health risks (see the nearby table), you should consider trimming down to stay healthy.
Determining Your BMI
The body mass index is an estimate that gauges your risk of health problems due to excess weight. It measures weight relative to height and is strongly correlated with total body fat in adults. (Note, however, that some very muscular individuals may have a high BMI without the associated health risks.) The numbers apply to both men and women.
To determine your BMI, find your height in inches in the left-hand column and move to the right until you reach the number that is closest to your weight in pounds. The number at the top of the column is the BMI at that height and weight. BMIs of 19 to 24 are considered the healthiest. A BMI of 25 to 29 signals excessive weight, and a BMI of 30 or above indicates obesity and potentially significant health risks.
Body Mass Index
To determine your current natural weight range, consider the following factors.
Your personal weight history. Try to remember the lowest weight range you have successfully maintained as an adult, without dieting, for a period of a year or more. That is your baseline natural weight range.
Your family. Make a mental picture of your parents, grandparents, aunts, and uncles when they were about the age you are now. Because genetics is a powerful variable in terms of size and shape, family resemblance can help define your natural weight. (Remember, however, that even if you come from a long line of very heavy people, if your weight seems dangerously high, it’s wise to check with your doctor about the need to shed some pounds.)
Your exercise habits. Think back to that period when you maintained your lowest-ever weight. If you exercised regularly then and don’t do it now, you may need to add several pounds to your baseline weight range—or start exercising again.
Your age. As the years pass, metabolism slows and weight tends to creep upward. There is a great deal of controversy about whether or not you can afford to put on a few extra pounds as you get older without risking your health. Nevertheless, while not all of us gain weight with age, few can expect to have as sleek a profile at 40 as at 25. Your target—all things being equal—should be to keep your weight no higher than the current height-weight recommendations.
Once you have determined your natural weight range, what do you do with the information? If your weight is excessive for your height, you should try to lose weight gradually by adopting a low-fat, moderate-calorie, healthful diet and boosting your exercise level. Remember that crash diets and furious bouts of exercise don’t work; moderation and consistency do.
If your natural weight and shape check out healthy, however, your only real task may be to abandon the image of that impossibly svelte ideal and begin the process of becoming comfortable with the body you have.