Dear DOCTOR Owen:
It seems that everywhere I go and in every commercial I see, there is a bit about “low-fat” this and “non-fat” that. Most restaurants have “light” or “heart-healthy” menus. Low-fat dressings and condiments are available everywhere. In spite of this, everything I read suggests that we are still getting fatter as a society. Why is this? Are we eating more?
Low-Fat Lucy
Dear “Lucy”:
Your observations are “right on”! We have known for the last several years that fat intake has decreased substantially. In addition, caloric intake has decreased on average. Yet, we in the Western world are getting fatter. What is going on?
A study published in The American Journal of Medicine, Vol. 102, 259–264, reports on researchers at the University of Alabama, who looked at the National Food Consumption Survey documenting caloric and fat intake. They found that Americans have decreased their average fat intake from 41% to 36% of the daily diet. However, obesity—defined as a Body Mass Index (BMI) of 27 or above— rose from 25% to 33% during the same time period. (Since this study, the Centers for Disease Control has lowered the standard for obesity to a BMI of 25, which means that 53% of Americans are now overweight.)
The study documented that there was an increase in the use of low-calorie food products. However, the continued consumption of non-diet soft drinks and chips remains high. The average intake dropped from 1854 calories/day to 1785 calories/day. If you calculate your Basal Metabolic Rate (BMR) at 11calories/pound/day for women and 12 calories/pound/day for men, and drop a point at age 40 and another at age 65, then you can see how you stack up. A sedentary woman over the age of 40 with an average intake of 1785 calories/day would weigh 178 pounds. Got it?
The researchers also looked at the Behavioral Risk Factor Survey System to evaluate exercise, and found no change in activity levels since 1976. Fully 60% of the population did no programmed physical activity at all. Gyms and home exercise equipment, which were not widely available in 1976, apparently have done little to get us “off our duffs.”
The authors concluded that an aging population—that does nothing and eats less—will continue to gain weight. This correlation with aging baby boomers follows their decreasing metabolisms with age due to loss of hormones. No suggestions were offered on how to motivate Americans into physical activity.
As I say over and over, exercise is not generally fun. I do not wake up every day at 6:00 and say, “Boy, oh boy! I can’t wait to get to the gym!” But then I consider the “good ole’ days,” when life was really hard work. Given the option of then or our current one of luxury now, I wouldn’t trade today’s exercise choices for the world. In the words of a now famous commercial: Just do it!
Weight Cycling—A Problem?
Dear DOCTOR Owen:
I have gained and lost weight many times. I have lost 75 pounds three times. I am afraid to lose weight again, as I have read that cycling weight can cause serious illness and is dangerous. What am I to do? I do not want to stay this heavy, or be heavier, forever.
Yo-yo Phobic
Dear “Phobic”:
Your concern originates from information that made headlines many years ago, suggesting a higher mortality rate among people who “cycle” large amounts of weight. The studies suggesting this were embraced by a media message: “See? Diets don’t work and are dangerous.” The implication was one of “doom” for everyone who is obese: “Damned if you do, damned if you don’t. So, why even try?” In addition, a deeper, subtler message was implied: “You are a failure. You will always be a failure. So, learn to accept the inevitable.”
This message has been incorporated as fact on TV talk shows and in commercial diet programs; this even is a belief of many physicians.
Unfortunately, as is often the case, the information scooped up by the media is incomplete, poorly acquired, preliminary, or “skimpy.” And, when related to controversial or popular subjects, early information is presented as “gospel truth.” Most well-trained scientists, including physicians, resist early data as fact. However, with intense public pressure, the judgments of even good scientists become blurred.
Subsequent data on this subject failed to support the widely publicized “news” but—not being controversial—have never made it into the general media. Hence, you have become “stuck” because you never had an opportunity to see the follow-up information.
Two items promoted as fact were:
- Weight cycling prevents future weight loss.
- Increased risk of death accompanies weight cycling.
The notion that suggests a “lowering” of metabolism by weight cycling has been refuted in many studies since the 1980s. People will lose weight at exactly the same rate by burning up the same number of calories each time. (I have personal experience with a firm of certified public accountant patients, who methodically try to disprove this fact with meticulous record-keeping, only to prove that the weight loss is the same each time.)
An article published by researchers from Pittsburgh in Archives of Internal Medicine, Vol. 155, 1416–1422, looked at cardiovascular risk in weight cyclers. Patients were divided into groups of Gainers, Stable, Large Cyclers, Small Cyclers, Partial Cyclers, Small Successes, and Large Successes. In summary, those who lost weight, and then maintained that loss, had reduced their cardiovascular risk. Every category of cyclers who re-gained weight showed no increased cardiovascular risk.
My suspicion about weight cycling risk relates to what people eat (high-fat diets) as they re-gain weight, concomitant illness such as diabetes, hypertension, high cholesterol, and cigarette addiction. These factors are most associated with risk of heart attack and stroke. With weight loss, there is clearly a reduction in disability and mortality.
The most impressive fact I have learned through the years is that persistence is the key to all success. I encourage you to lose your weight again. This time, however, get the notion out of your mind that the diet will “end”—because it will never “end.” Dieting is a conscious method of eating and exercising. You will never be able to ignore or unconsciously maintain that weight loss. You will need methods, motivation, support, and effort—forever. So, go for it!
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