Fighting Fat : Obesity Is a Serious Threat to Health, But It’s a Struggle to Lose
Some men eat to live. Other men live to eat. -- Song of Solomon
Diets have been in the news recently. For example:
- Feb. 14, news item: Obesity is termed “a killer” (in the same sense as smoking) by a federal panel. The warning says 34 million Americans are so overweight they have placed themselves at “significantly higher risk” for a graveyard full of deadly disease.
“We want the average American to know obesity is a disease--it is not a state, like loneliness,” said Dr. Jules Hirsch, professor at Rockefeller University in New York and chairman of the 14-member National Institutes of Health panel. Hirsch has developed a theory on fat cells, claiming that each individual has a certain number, some higher than others (in some cases, dramatically so). The total, he theorizes, mandates whether you’ll be thin or fat--until the moment you die. Depressing? Consider the success rate of weight loss nationwide--an abysmal 2%.
Obesity “is a disease that carries an increased risk of mortality,” Hirsch added. “It deserves to be treated and considered just as seriously as any other illness.”
Hirsch’s panel concluded that “the evidence is overwhelming” that being overweight contributes to serious health problems, shortened lives and general ennui.
- March 7, Los Angeles Times: “Three government agencies, including the California attorney general, filed suit Wednesday against Herbalife International, claiming that the fast-growing Los Angeles-based marketer of nutrition and weight-loss products made false health claims about its products and employed an illegal ‘endless chain’ scheme to market them . . .
“Herbalife, which is privately owned, has boasted that its annual gross sales are now almost $500 million. The company has 700,000 people who independently distribute its nutritional and skin-care products throughout the United States, Canada, Australia and England.”
A local spokesman for Herbalife refused to be interviewed and refused comment on allegations that Herbalife’s claims are false.
His refusal came well before the court action.
- March 5, news item: U.S. Postal Service authorities seized all money and product orders mailed to a Carlsbad firm that markets “Grapefruit 45,” a nationally advertised item that authorities say doesn’t work.
World Communications Inc., which markets Grapefruit 45 as “the fat burner pills,” was accused by postal inspectors of violating two 1984 consent agreements that sought to minimize its boasts.
The pills, some of which come from grapefruit concentrate, contain “no appetite suppressant effect,” in the damning opinion of the Food and Drug Administration (FDA).
If motivated to lose weight, people often do it out of vanity, studies show. (Hence the popularity of quick-fix programs.) Ours is a culture that prizes the Robert Redfords and Chers (and the way they look) second only to culinary adventures. (Hence the popularity of celebrity diet and exercise books.)
Only after a near-fatal catastrophe--heart attack, runaway blood pressure, diabetes, shattered marriage, etc.--do overweight people act on The Problem That Won’t Go Away. That is, really act. Most doctors, most studies, confirm this.
Many turn first of all to diets. Many of these promise magic in the way that snake oil once appealed to denizens of the Wild West. How many times have newspaper ads blared in Second Coming-size type: “I Lost 80 Pounds in Three Months! You Can Too!”?
(Jo Ellen Kitchen, a spokeswoman for The Times, said company medical director Wayne Buck checks weight-loss ads “to see if promised results are achievable by the methods the ad claims they are. We don’t check every ad,” she added. “Only if they look suspicious.”)
Many try pills, injections, even creams to shed weight. They surrender to crackpot philosophies and spend thousands on just about anything promising hope.
Many, perhaps weary of the magic that isn’t, turn to exercise. Authorities by the gymful say this is the only way to get it off and really keep it off--that it’s a lifelong measure, a daily habit as necessary as brushing your teeth or bathing.
Many, perhaps weary of the turmoil, turn to such groups as Overeaters Anonymous, which offer hope in peer-group acceptance and soul cleansing.
Weight weighs heavily on the mind and body.
Dr. James Ferguson is a psychiatrist and the medical director of the La Jolla Eating Disorders Clinic. He is regarded by many as one of the foremost authorities in the country on weight loss and the dangers of being obese.
Ferguson has seen numerous “scams” come and go, taking with them dozens of poor victims who get thin only in the pocketbook. Grapefruit 45 is, in his mind, part of a long-running litany of abuse and fraud.
“The bust in Carlsbad typifies the whole diet industry,” he said. “It’s a useless product.”
Ferguson also deplored the rise of the Beverly Hills Diet, fearing that the book from which it sprang would become a best seller.
It did.
“It was absolutely horrendous,” he said. “Metabolically atrocious.”
Ferguson has no use for any plan shortcutting balanced, nutritious eating in favor of a get-thin-quick scheme.
“The physical danger (of fad diets) is you’ll die,” he said. “You lose a ton of potassium (a vital trace element). If the diet is too low in calcium, you suffer muscle weakness. The biggest failures by far are psychological. Patients lose weight, gain, then blame themselves for failing again. The program never fails.”
Insurance Ripoffs
Ferguson said most programs are ripoffs. Many avoid drug enforcement laws by peddling wares as “food supplements,” the laws governing those being far more lenient. Many, he said, are “insurance ripoffs.” If endorsed by a doctor, chances are a bogus program could be covered by insurance, but a good commercial program such as The Diet Center would not be considered, Ferguson said, for a lack of medical input.
Faddists often fail to see themselves as the con artists they are, he added. On the contrary, many preach commitment with almost religious fervor--they believe the nonsense they spout. One such theory is food combining.
“That’s the theory that if you combine certain kinds of food orders, say, papaya and milk, and eat them in the morning rather than the evening, you’ll weigh less at bedtime,” Ferguson said.
“It doesn’t make one bit of metabolic difference. It has the same effect if you’re eating it in the morning as it does in the evening. It has, however, an aura of mysticism that some people crave.
“Some people like complex rituals. What it really does is trick them into avoiding extra food. It makes them ultra-aware of what they’re eating, so they lose weight anyway.”
But not, Ferguson said, permanently--the way that counts.
He has seen what he calls unbelievable con jobs. One was “the starch blocker,” a pill taken from the husk of beans that supposedly activated the enzyme amylase to break down starch deposits. For two years--before an FDA crackdown--starch blockers were a smash success.
Giant Plastic Bags
He has heard of one plan, just hitting the market, that calls for zipping yourself into a giant plastic bag.
“The theory is, you’ll walk around and keep the heat in,” he said, “which would cause you to lose weight.”
Otherwise intelligent beings succumb to such foolishness, he said--they, too, get desperate.
“So many want the quick fix,” he said. “And the ethical programs have no sex appeal. None at all. A good program means work. It isn’t shortcuts.”
Dr. Jeffrey Sandler is an endocrinologist based in Hillcrest and the host of “House Call” on Channel 8. Sandler says 80% of the diabetics in the United States are overweight. He lists hypertension, high cholesterol, degenerative arthritis, back and vascular problems as a few of obesity’s side effects.
“An overweight person is at a higher risk for surgery,” he said. “They have breathing problems, and it’s tough to cut through fat. It carries a tremendous medical impact--across the country, a multi billion -dollar impact.”
Sandler finds a disturbing tendency on the part of society to deny obesity, in the face of so much hype about curing it. He pointed to the deaths of celebrities--singer Mama Cass Elliott, comedians Totie Fields and Allan Sherman--from fat-related causes, though the real reasons were always labeled otherwise.
Degrees of obesity vary. A person needing to lose 30 pounds or less is considered “moderately overweight.” Someone weighing more than height dictates they should is, in medical terminology, “overweight.” A person with an excess of body fat is “obese,” and someone weighing more than 100% of ideal body weight is “morbidly obese.”
For the person who weighs too much, regardless of labeling, the psychological trauma may be the worst. Children don’t notice obesity in a peer, Ferguson said, until roughly the third grade. After that they begin to isolate overweight chums, making the problem “10 times” worse. Isolated children eat more, he said, as a protest and an act of refuge.
Overweight children become overweight adults 60% to 70% of the time. Problems for them cover the scales, Ferguson said, from unhappiness at work to being heckled by children (often their own).
“There’s tremendous job bias against fat people,” he said. “They can’t wear the same clothes as others, and, of course, there’s the cultural stereotype of the lazy fat person, which in most cases is just wrong. Most of the overweight people I’ve known are among the hardest-driving, most ambitious people I’ve met. They work harder to overcome the stigma.”
Part of the stigma is, however, purely an image problem. Ferguson concedes that in a culture like Southern California’s, too much emphasis is placed on appearance, on the way things look and project. Qualified (overweight) people are often passed up for the image of one who looks better.
Why are people overweight?
Part of it has to do with an excess of food. America eats more than any country on earth. Another clue may be found in fat cells, the object of Hirsch’s study. People with a large number of them were probably overweight children. People who become overweight, in adolescence or early adulthood, are believed to have a set number that balloon in size during weight gain. (Weight loss is, in Sandler’s opinion, easier for the latter group.)
Set point is another theory. The idea is that everyone has a certain “set point” of weight. Experiments show that people who lose weight, then return to normal eating, also return to a pre-defined point. The same for those who gain. Exercise is thought to be one way of “tricking” the point, by speeding metabolism and redefining body chemistry. Set point may be the most conclusive evidence of why fad diets don’t work. After the initial loss, normal patterns restore the body to its original condition.
Sandler wonders about the brain’s role in shaping obesity. Certain studies indicate “there may be hormonal feedback to the brain,” he said. “The brain of an obese person may not receive the same signals (as a thin person’s)--i.e., satiety.”
Because of these and other factors, Ferguson said weight loss is one depressing subject--and that is why it’s so easy for charlatans to exploit it. For a hustler, it may be the best gravy train going.
A clinical psychologist based in San Diego, who asked not to be quoted by name, sees the subject as darkly depressing, almost nihilistically hopeless.
“I feel very pessimistic about weight loss,” she said. “I feel much better, say, about changing personality--in almost anybody.”
She laughed.
“I sometimes think it would be easier to rehabilitate a mass murderer than to manage permanent weight loss in someone obese.”
Of course, the sometimes forgotten truth is, people do lose weight. Success stories of (permanent) weight loss exist as evidence that, if man can make it to the moon, he can also prove King Solomon wrong--he doesn’t have to live to eat.
Tuesday: Commercial programs that tackle eating problems.
