Obesity Introduction:How to beat it - don't buy the hype

Chapter 1: Introduction: Obesity: How to beat it - Don’t buy the Hype

When it comes to nutrition and weight loss products, it is a buyer-beware market in America. Stop wasting your time and money and risking potential harm to your health.

“Doctor, I can’t believe my weight today,” exclaimed a recent frustrated female patient of mine. “I’ve gain 17 pounds in the last 2 months and haven’t changed what I’ve eating one bit.” That’s when I usually have to bit my lip to prevent a flood of comments about how ridiculous that statement is. “My doctor sent me to you to see if a hormonal imbalance was the cause of the weight gain.” I release my lip from my lower teeth. Afterall, at least she is trying to get help for her weight issue from experts and not wasting her time with the latest gimmick-diet. She also following through with her doctor’s advice, seems sincere and committed to doing something different. I think I can help this woman.

America is too fat. The statistics are staggering. Over 60 percent of Americans are now considered overweight, nearly 2 of 3. One in three Americans is obese. The adults to be, our kids, aren't looking any better: 15% of American children are obese. The average American is 11 pounds heavier now than in 1990. All of these statistics are obvious to any reader. If you have lived in America, you are aware that the people around you are getting wider and bigger.

This is not just a cosmetic issue. As a physician, I am reminded on a daily basis that obesity is associated with the development of many serious medical conditions, including Type 2 diabetes, hypertension (high blood pressure) and high blood fats (cholesterol and triglycerides). These obesity-related comorbidities can progress to heart conditions, strokes and a host of other life-threatening conditions. The extra medical cost to the nation is estimated to be in $117 billion range. Employers are worried too. Obese workers not only generate higher medical costs for the employer but also experience lower productivity and more days of work lost. Employers lose about $10 billion each year in lost productivity. These facts have prompted many employers to invest in weight management education initiatives in their workplace to stem the losses.

An alarming report was released by the Rand Corporation and published in the journal Health Affairs. It highlighted the increasing disability rates among young Americans. We assume that science and health care in America is advancing and the young people are getting healthier. On the contrary, the rates of disability rose from 118 to 182 per 10,000 people from 1984 to 1996 among 30-39 year olds. The rate rose from 212 to 278 per 10,000 people in the same period for 40-49 year olds. And guess what – musculoskeletal problems such as chronic back pain and diabetes, both linked to obesity, were the problems cited as causing the disability that grew most rapidly in number during the study.

Again, if you are reading this, you are aware of the health and economic hazards of obesity. You may have diabetes or some other health problem related to obesity. More important for some of you than health concerns is the emotional or psychological impact that excessive weight has on you. Most people are not pleased by their excess weight. It can be a source of anxiety, lower self-esteem, contribute to depression, and cause people to avoid thing or events they would otherwise enjoy. In a recent survey of American women conducted by a reliable source, fourteen percent of respondents planned to skip their high school reunion because of their excess pounds. Some people avoid gyms, beaches, and sports activities because of their weight. That is sad! You may be thinking this book can help you get rid of the weight and restore some of your health. That is my desire too.

Given the awareness I know is out there, how come America is fat? We’ve got all kinds of “experts” providing advice about dieting through books and magazines, promoted on infomercials and littering the Internet. We have all kinds of diet and low calorie foods to choose from in our supermarkets and on-line stores. Many of us have exercise equipment at home or belong to the local gym. Plenty of opportunity to eat “light” and burn those calories. We have also experienced great medical advances in the last couple decades. We now understand more about metabolism, and the active role the fat cells play in altering disease expression in our bodies.

So what is the problem? Time to wake up, America! It is time to deal with the facts about food and metabolism and quit buying the hype. Obesity is not a random disease that strikes without warning and indiscriminately. Yes, there may be a genetic tendency but very few Americans were obese in 1900. Has the gene pool changed over the last 100 years? No, it would take a few thousand years to significantly alter the genetic makeup of our species. We are obese because we choose to be obese. Obesity can be managed. It can be prevented.

Not that it is easy in the “toxic” environment that America has become for those trying to stay lean. Billions of dollars are spent each year on advertising to encourage us to make unhealthy food selections. Portion sizes have increased dramatically since the 1970s, and really “grew” in the 1980s. For example, foods such as French fries, hamburgers and soda are now two to five times larger than their original sizes. Some fast food places don’t even sell small sizes anymore, just medium, large and extra large. Let’s face it food is cheap relative to labor and other overhead costs. Give them large portions and they will come. The buffets in Las Vegas are notorious for offering a lavish spread. On a typical weekend day, the buffet at the Rio Casino will serve more than 7000 people. Those 7000 will consume 5000 lbs. of shrimp, 3500 lbs. of meat, 2000 lbs. of pasta, 5000 cakes and pastries. Even our coffee is no longer a low calorie beverage. Starbucks Caffe Mocha is made with expresso, cocoa, steamed milk and whipped cream. The 16-oz drink has 400 calories, same as 2 Dunkin Donuts. Predictions are that sales of snack and nonalcoholic beverage bars, which include coffee shops such as Starbucks and doughnut shops such as Krispy Kreme, are expected to jump another 8.1 % in 2004.

United States Department of Agriculture (USDA) statistics show that American total daily caloric intake has risen from about 1,850 calories to 2,000 calories over the last 20 years. That is a significant increase - 150 calories per day. As you will learn in later postings, if you were that person eating 1850 calories per day and now eat 2000 calories, that calculates to an extra 15 and ½ pounds. If we eat more, and exercise the same or less, we will gain weight.

Men’s Fitness magazine does a survey each year to identify America’s fattest city. Fourteen categories are used in their evaluation system and it includes such items and number of fast food restaurants, ice cream and donut shops per capita and television viewing trends. The winner in 2003 was Detroit, beating out the prior year winner, Houston, because of a jump in television viewing, a worsening commute time, and scarcity of gyms. Certainly, all of these items would contribute to inactivity and promote weight gain.

Over the years, the message I’ve delivered about weight and dieting has been same. Getting to the message has changed as I’ve had to deal with explanations about the latest fad diet in the marketplace. In the early years of my practice, it was the Last Chance Diet, Rotation Diet, Gastric Balloon, the Popcorn Diet, and the Atkin's Diet. Lately, it has been the Zone Diet, South Beach Diet and the Atkin’s Diet again.

Most patients come to me having engaged in several “go-it-alone” weight loss efforts, these efforts often prompted by a new book or celebrity-endorsed diet plan. In fact, even for those individuals with significant obesity-related health problems, more than 80% of weight loss efforts are self-directed – not supervised by a physician or program. It has always been frustrating for me to spend time, over and over again, about why the newest fad diet will, like the last one, lead to yet another failure. The real reason why diets fail is that they are viewed as short-term interventions. I will “diet” now to lose the weight and then quit dieting and go back to whatever I was doing before. It is not the fad-diet per se that is the cause of the failure. It is the notion that a weight problem can be fixed in a few weeks or months.

The secret too staying lean is fairly obvious. One concern I had about finally sitting down to write my thoughts was that the truth about food, weight and dieting will not be very exciting to most people. My kids suggested “The Las Vegas Diet”, with maybe a showgirl on the cover. That would probably sell. Partial truths or unproven theories, often with celebrity endorsement, seem to catch the imagination of the American public more easily than the truth when it comes to food.

But, we simply can’t deal with the truth. We have an ever growing, $30-plus billion consumer-driven market for diets, herbals, homeopathic remedies, nutraceuticals, diet pills and dietary supplements. We buy low-calorie and low-fat foods, many of them prepackaged and expensive, join commercial weight-loss clubs, spend days at "fat farms," take over-the-counter diet pills of one sort or another and beg doctors for a prescription to the latest appetite suppressant. We submit to liposuction and think potentially hazardous and very expensive bariatric (gastric) surgery is an acceptable means of losing weight. Every new remedy or treatment is greeted with hope and a wave of enthusiasm. Everyone is looking for that one ultimate answer.

Most of these so-called new miracle diets and products are fairly harmless but, unfortunately, not all of them. Very low calorie diets can be harmful leading to several medical complications if not well formulated and closely supervised by knowledgeable health professionals. Several popular diets on the market that provide adequate calories do not provide all the nutrients required for health. Olestra can contribute to the loss of essential nutrients. Flenfluramine, part of the Fen-Phen diet was associated with a serious heart value condition. Dexfenfluramine, a close cousin of flenfluramine, can contribute to a potentially fatal pulmonary hypertension. Ma Huang, a supplement found in many herbal weight loss products, can contribute to high blood pressure, strokes, and cardiac irregularities. You hear of the occasional complication and even death from overly aggressive liposuction.

It is alarming to me that America’s struggle with obesity has elevated bariactic surgery to a fairly common and routine consideration in people with obesity. Again, celebrities that have had the procedure appear on TV and appear to doing so well. Don’t get me wrong. I have recommended the procedure to some of my patients over the years. It is necessary for a select few. However, I fear the unusual recent demand is being pushed by marketing and some hospitals looking to establish a lucrative specialty niche with this procedure. Surgery is risky in very obese people. In the best hands, 1 in every 100 patients dies from complication of obesity surgery. Up to 3% die in places with less experience. Non-fatal complications occur in 5 to 20%. Despite the risks, the number of procedures done in America is skyrocketing – from just over 23,000 in 1997 to more than 103,000 in 2003. These procedures are even being hyped as a viable solution for obese kids. Is this the best way to treat obesity?

The issue of nutritional supplements is one that usually gets a heated discussion going, and will be dealt with in this blog. In a country where the majority of us are overfed, we are busily spending and supplementing our nutritional intake with a variety of vitamin and mineral products. We not only are the most overfed people in the world, but probably the most wasteful when it comes to food and nutrition-related products as well. Where do you think all those extra vitamin and minerals end up? Yes, the toilet. No doubt, we also have the best-fed toilets in the world!

Sure, there are some supplements that can represent good medicine and we will point you to them later. But some of them are based on fraudulent claims, or quackery. A quack is “anyone who promotes medical schemes or remedies known to be false, or which are unproven, for a profit”. One in four Americans will be duped again this year, collectively spending another 20 plus billion on junk.

Are you the one in four to be duped this year? Surprisingly, people with a college education are more prone to use quack remedies than people with less formal education. People who are isolated with minimal or no support from family or friends, those with chronic or incurable diseases, people seeking relief from emotional distress caused by conditions difficult to treat such as obesity, baldness and impotence. Also, people with absolute faith in the written or TV word (“if it is in print or on TV, it must be true”) are the most susceptible individuals.

Some purveyors of unproven or worthless treatments are sincere, but nevertheless, mistaken. Most are manipulators, out for profit or fame. Some may have fancy titles. They tend to use the same sales pitch when presenting their products and remedies citing dramatic claims, and explaining how the traditional medical community doesn't understand this “science” or is limiting availability as part of a conspiracy. Holism is often a smokescreen for health fraud and a cult-like following is encouraged.

It really is a “buyer-beware” market out there. There are, at least, 1000 makers of various dietary supplements in the United States alone. The Internet gives us ready access to many others in other countries. Under a 1994 law, supplements can be sold without first proving they’re safe or truly deliver the benefits they advertise. The Food and Drug Administration (FDA) is powerless to control the manufacturers of these products. By law, the agency cannot regulate herbs and other so-called dietary supplements. The FDA can only step in when one of the supplements has been proven to be harmful, literally after the fact. Wait a minute! Yes, that is what I said; you can sell a supplement without proving any benefit and only get it pulled after it has been shown to be dangerous and already hurt a bunch of people. Currently, there is no way to ensure a bottle contains the promised amount of pure ingredients you intend to buy or consume.

To further emphasize the danger, the New England Journal of Medicine reported in an article in October 2003 about the hazards associated with a herbal weight-loss product containing aristolochic acid. This substance, aristolochic acid, is a potent chemical that can cause cancer and kidney failure. This association has been known for several years. Despite the well-documented risk associated with this substance, over 100 Web sites continued to sell 115 products that contain it after the publication of the article.

What is surprising to me as a physician is the number of very bright people who will ingest a herb and then debate the need for a new prescription drug that is clearly needed. “Doc, I’d rather do this the natural way.” Now the prescription drug as gone through 7-10 years of rigorous study to see if it works and is safe, and is carefully scrutinized by the FDA prior to release or approval. Even after approval, surveillance studies are put in place to monitor for unexpected side effects or problems that might occur once the drug is used in the “real world” of clinical practice. Yes, and a few hazardous drugs get pulled after approval but generally the process works pretty well to keep the public safe. Yet, that same person will take a herb, not knowing what the herb contains (many contain many different active substances) and unaware of any testing or rigorous study the herb has been put through (most haven’t had any). Furthermore, they often get a little “testy” should I become too insistent that they stop using the herb in question. Well, excuse me!

I bring the subject of fraud and quackery up to both alert you of the dangers of pursuing potentially worthless and hazardous remedies and diet plans. But also to point out that this blog doesn’t aim to generate a following. Nobody will be talking about the EndoDoc Diet because there is not a list of good and bad foods that will be provided. No long list of vitamins, minerals or herbs you’ve got to have. Most of you are already eating a reasonable variety of foods and getting most of your essential nutrients. You simply need to know a few truths or rules about how your body works and what it needs and you can be successful. Give the new eating pattern and lifestyle you develop from reading this blog the name of your choosing.

You will come to realize as you read the postings on this blog that the answer is not found in the hype surrounding the weight loss products and diets in the marketplace. The simply truth is they wouldn’t sell anything if they provided the answer because you wouldn’t buy them. You don’t need them.

So where do we start? First, you have to ready to lose weight and keep it off. Take out a piece of paper right now and list the benefits and sacrifices you’ll experience with weight loss. What are the benefits of weight loss for you? Better appearance? Reduced health concerns? Opportunity for advancement on your job? Happier marriage?

There will be sacrifices as well. Foods that need to be limited, time spent exercising, new cooking styles, and other changes in your lifestyle. Can you make these sacrifices over the long-term? If you don’t think so, another diet-cycle or failure is ahead for you – successful weight loss and maintenance isn’t important enough to you yet. The first step in deciding to go on a diet isn’t deciding what diet to go on, but whether you can do it with a reasonable amount of confidence that you will succeed.

Did you make your list? Do you think you are ready? “OK” you say, “Now what do I do?” Well, that is what we are going to try and answer for you. So keep reading.

To help you remember key points, I will end each posting with a “Tips and Tool” chart that you can use for review. It may be helpful to refresh your memory by reviewing these periodically.




Introduction

Tips and Tools

1. Make a commitment to change
2. Get your nutrition and diet information from reliable and credible sources.
3. Stop buying the hype and don’t be duped.
4. Review the tips and tools at the end of each posting to refresh your memory