Health Reasons or Cosmetic Cure? : Difficult Choices of Diet Therapy
Today’s emphasis on dieting has caused much anguish to the body, psyche and pocketbooks of some heavyweights in this country. As a result researchers have begun to look more closely at the link between body fat and disease to determine the real importance of diet therapy: Is the decision to go on a diet a health choice or a cosmetic cure?
At a recent nutrition conference in Newport Beach sponsored by the Dairy Council of California, Dr. C. Wayne Callaway, director of the Center for Clinical Nutrition, Department of Medicine, George Washington University, said location of fat in the body plays a significant role in health risk for some diseases.
Callaway’s research indicates that it may be the distribution of a person’s excess weight--no matter how much or little--and genetic and environmental factors that are really at issue when determining the potential for disease and the need for diet therapy. Physical appearance is the least consideration.
He explained that the male predisposition for coronary heart disease (in addition to genetics and environment), is affected by the fact that men’s excess weight usually is carried in the abdomen and chest, whereas a woman tends to harbor her extra poundage in the hip area.
According to Callaway, many people who have a predetermined body type and metabolism based on family heritage and environmental climate may be unnecessarily starving and aerobicizing their bodies if their weight--because of its distribution--doesn’t pose a potential for disease.
Environmental Factors
To support his claim, Callaway discussed the extent to which environmental and genetic factors influence body type and cited reasons why he feels it is important to re-evaluate our current standards for normal weight and at what point elevations of this figure imply increased risk of disease. He also dwelt on how these points affect dieting patterns and whether dieting is necessary at all.
Today’s accepted norm for obesity is that it usually occurs when a person is 20% to 40% above the ideal weight range for his or her height and age group. Beyond its obvious cosmetic problems, being overweight is a health hazard with a variety of complications. It is implicated in the incidence of hypertension, gallbladder disease, cardiovascular disease and diabetes.
But the occurrence of any or all of these diseases is variable depending upon a host of other factors--environment, genetics and location of fat among them.
People are fat because of a number of factors. The most common one is that they are taking in more energy (calories) than they expend. But all fat people are not overeaters, Callaway contends.
Assumption Hard to Prove
“The usual first step in weight loss is to get people to eat less--the assumption is that people are fat because they are eating too much. But the assumption that fat people are eating more or grossly larger amounts than skinny people is really hard to prove,” he said.
Environment is one reason people are fat, Callaway said. He conducted clinical studies that compared the most common human eating patterns (time, place, circumstances of eating) to see if they had any bearing on the rate of weight gain in individuals. He studied people who ate no breakfast and no lunch, those eating no breakfast, people whose total fat intake represented less than 10% of their day’s total calories, those who ate three meals a day and “people whose major occupation was eating all day long.”
Ten percent of the variation in the way these people’s bodies expend energy could be accounted for by their eating patterns alone, not just by how much food they ate.
Family history is another factor. Callaway cited studies done with adopted children and identical twins. “As adults, adopted children had weights that correlated with the biological parents but not with the adopted parents.” In the twins, identical pairs “were about twice as likely to be of similar weight than the non-identical ones, whether they were small or large or somewhere in between.”
After a variety of studies, he concluded that about 80% of the way the body burned calories related to how much muscle and lean body mass each individual had--according to genetics. The remaining 20% was environmental, Callaway said.
Compound these two factors with a blurred picture of what is normal and the distinction between desirable weight and obesity becomes more distorted.
For the medical profession, what is considered normal is technically based on Metropolitan Life Insurance Co. weight tables, which were developed in 1942 based on the weight associated with the least mortality. (The tables have undergone revision several times, the latest in 1983.)
Weight Tables
According to the authors of “Normal and Therapeutic Nutrition,” Corinne H. Robinson, Marilyn R. Lawler, Wanda L. Chenoweth and Ann E. Garwick (Macmillan: 1986), the weight tables “represented the average weight for each inch of height at age 30 for males and at age 25 for females. . . . The tables were intended to encourage persons to keep their weight below the average for their height.”
Socially, however, desirable weight is determined by something else, according to Callaway. Most women today tend to base their idea of optimal weight on the models, actresses and other prominently displayed females whom they desire to see in their mirrors at home.
Unfortunately, he says, “The average model was about 8% below average weight 25 years ago and now she is about 23% below average weight.” Thus, this idea of optimal weight is perpetuating the notion that one must be abnormally skinny to be attractive or worse, healthy.
“I think we have a cultural biological dissonance. Our cultural standards are way out of sync with the biological standards,” Callaway said.
How then, do we determine who’s at risk of disease with such conflicting information about why and when people are fat?
“The stubborn pursuit of one’s so-called ideal weight is too often associated with appearance instead of health,” Callaway said. But “a researcher observed that abdominal, particularly upper-abdominal, fat was more likely to be associated with high blood pressure, diabetes and other problems. . . . This is truly an important biological difference.”
To prove this point, Callaway described two women under clinical observation who were equal height, weight and age but had a different distribution of fat and varying set of complications.
The first woman had all the complications of obesity--diabetes, high blood pressure, high blood fats and a great potential for heart attack, he said. She carried the bulk of her excess weight in her abdominal area, which means her waistline is bigger than her hips.
The other woman, who has a relatively small waistline but heaviness in her hips and thighs, is different. She has no complications except that she is tired and cold and has a poor body image. This woman is at a lesser risk for disease and therefore would not require strict weight-loss therapy. (Incidentally, this woman with the low “waist-hip ratio” had struggled all her life to get rid of the weight by dieting. She chronically starved herself on 1,000 to 1,200 calories a day.)
Pose the Most Danger
The point is that in this study the woman whose overweight status posed the most danger was the woman with the “gut.” This is also true of those who are normal weight according to the tables but have most of it in their bellies. “These are the males you see with no buns and they have everything hanging out over their belts,” Callaway said. “These are people who are metabolically obese even though they may be normal weight by our current definition.”
“We are born with a certain biological potential,” Callaway points out. “This is obviously affected by environmental factors, especially activity levels and obviously diet and eating patterns. If one is biologically bigger than the average, there is tremendous pressure to diet in our society.
“The most popular diets are the low-calorie diets because they result in an initial weight loss which looks good on the scale. . . . Then this sets up a survival pattern of fluid retention, low metabolic rate and a tendency to binge. The way out of this is to first distinguish if a person needs to lose weight.
“If they have a problem such as the ones listed here, then by all means weight reduction would be helpful. If they have a strong family history of these problems and they are overweight, weight reduction is certainly indicated. . . . If they are like the pear-shaped lady (small waist, big hips), then weight reduction is probably not going to help (medically).”
The commercial diets so popular today, Callaway says, are very low-calorie, usually dropping between 700 and 900 calories from the diet. Three things happen to the body on very low-calorie diets, Callaway said. One is a drastic decrease in metabolic rate. The body slows its pace to make sure it can survive the famine, and eventually it adapts to starvation, requiring fewer calories to function.
The problem with this is that when the dieter comes off this low-calorie diet and goes back to 1,400 calories or so, he or she gains weight. The body will eventually readjust to the new calorie intake, but most people aren’t willing to wait indefinitely.
Fluid Retention
Another problem with low-calorie diets is fluid retention. Most of the initial weight loss is due to water loss. If you take diuretics along with the diet, it’s possibly more dangerous.
The third contraindication is that the undereating causes binges, Callaway said. In one study of undergraduate women who were given a “tasting test” for ice cream, the results were surprising. The women were told to eat as much as they had to to answer questions about the ice cream’s taste, but they weren’t told that the amount they ate would be measured.
Before the test, they had to drink one milkshake, two milkshakes or nothing. The non-dieting students, who had nothing, had a fair amount of ice cream. They cut back if they had a milkshake, way back if they had two.
The dieters who ate nothing before the test had a small taste. But, after one milkshake they ate more, and after two milkshakes “they go whole-hog” on the ice cream Callaway said.
“The explanation is that these are restrained eaters. They have been forced to break their restrained diets; now it is harder to reimpose control,” he said.
The solution: Select a modest diet composed of a variety of foods from the four food groups and get some exercise. That will prevent the body from entering “famine mode” and will keep it burning calories at an efficient level. There is no quick fix, especially for those who have a built-in tendency to be overweight. For them, lifetime vigilance will be required.
