Almost half of the adults in the Western World are too fat. Many of them regularly make determined attempts to lose weight, but by no means do they always achieve lasting results. It then gradually becomes clear that slimming is a more complicated business than most people think and that the well-meant advice simply to eat a bit less is not very effec-tive in practice. Numerous theories have been put forward on the cause of this problem, which gives rise to so much frustration and psysical suffering. No totally satisfactory explanation has yet been found, however, let alone an effective method of treatment. In tackling the problem of obesity, the first step is for the ‘victim’ to admit that he or she is overweight, and then to genuinely want to do something about it.
Are you too fat?
Being overweight is a condition which has been found to trouble women in particular. An examination of the available data, however, shows that objectively there is little difference between the number of women and the number of men who are overweight. Evidently men as a group are much less worried by the problem. One of the reasons for this is probably that a less negative view is generally taken of fat men than of fat women: for some unexplained reason, fatness in man is more acceptable. A simple method of finding out whether you really are too fat is to compare your weight with the weight you ought to have. There are tables giving this ‘ideal’ weight, in which account may or may not be taken of factors such as age, sex, height and build – all of which influence body weight. You can also calculate the ideal weight, though less accurately, by subtracting 100 from your height in centimetres. This means that for a height of, for example, 170 cm the ideal weight is roughly 70 kg.
It is generally accepted medically that you are ‘overweight’ if you are more than ten percent above your ideal weight. A person who is twenty per cent above it or more is usually classified as ‘obese’. A simple method of judging whether you are overweight is to jump up and down in front of a mirror. If your flesh wobbles like a jelly, you will have to admit that you have too much fat.
Alternatively, pinch the skin together at the back of your upper arm, halfway between the shoulder and the elbow. If the fold of skin is more than 25 mm (1 inch) thick you are too fat.
Whereas it is true that every pound of extra weight we carry has entered through the mouth, as it were, it is not true that a person could grow fat through drinking water. We become fat when we consume more nutrients containing Calories (proteins, carbohydrates and fats) than the body requires. The surplus is stored in the form of fat under the skin and around the internal organs.
In order to function, your body needs a certain amount of energy, commonly measured in Calories. One gram of fat provides more than twice the number of Calories as does one gram of carbohydrate or protein. By eating foods containing fat, therefore, you satisfy the body’s energy requirements far more economically than by eating carbohydrates and protein. Obese people have a tendency to eat too much fat, found notably in such foods as butter, margarine, cheese, oil and meat. Less obvious sources of fat are nuts, eggs, cakes and biscuits. Obesity can also be caused by an excess of sugar, a carbohydrate that is a very concentrated source of energy. Unfortunately, sugar is a standard ingredient in many foods, such as jams, cakes, pastries, biscuits, syrups of tinned fruits, savoury sauces and many sweetened drinks, and can therefore be extremely difficult to avoid.
Alcohol, if taken in large quantities, can also be very fattening. The energy yield during the ‘burning’ process in the body is 7 Cal (30 kJ) per gram of alcohol. Thus a double gin and tonic contains about 150 Cal. Moreover, many alcoholic drinks contain a lot of carbohydrates and, hence, have a high calorific value. Cider, sweet white wine and beer are particularly high in Calories; a pint of bitter contains 180 Cal. An inactive lifestyle or a sedentary occupation means that your Calorie requirements are less than if you were taking regular exercise or doing hard manual work. Consequently, if you give up a sport or regular walking you must reduce your Calorie intake to compensate, otherwise you will grow fatter. Your body’s energy requirements decrease with age, particularly after the mid-twenties. However, no decrease in appetite occurs to compensate for the reduction in energy requirements. This is why people suffer from ‘middleage spread’ if they have not reduced their Calorie intake.
Although women generally have twice as much body fat as men at their healthy weight, they are not more prone to obesity unless they have had children or ceased menstruation.
Although usually a person can become fat only through eating too much, it is by no means always the case that fat people eat more than thin people. There is evidently inequality in the world even as regards eating. Consuming the same amount of food, one person can grow fat, whereas another has difficulty not falling below his normal weight. In everybody’s circle of acquaintances there is someone who seems to be able to consume virtually unlimited quantities without gaining a single gram. The cause of these differences is at least in part hereditary. Research has shown that a child with one fat parent has a forty per cent chance of becoming overweight, whereas a child with two fat parents has an eighty per cent chance of resembling them in this respect. It is difficult to determine, however, whether the cause lies solely in a hereditary predisposition or whether the family’s eating habits – passed on to the children – also play a role and, if so, to what extent. In many cases a combination of the two factors is probably at work.
Whichever factor weighs the heaviest, it is at any rate true that a fat child will find it very difficult to become and stay a slim adult.
One explanation for this is provided by the fat-cell theory, according to which two forms of obesity can be distinguished: one in which the fat cells contain too much fat and one in which there are too many fat cells.
Fat cells are built up only in early youth and once they are there they never go away. Fat children probably develop too large a number of fat cells through a combination of hereditary predisposition and eating habits, and this form of obesity is difficult to treat. The form of obesity which develops at a later age can be dealt with fairly easily by eating less because it is largely the result of overeating, which has caused the fat cells to become too large. Another possible explanation of the fact that some people grow fat more quickly than others is that their energy requirements differ. Just as one car uses more petrol than another for a given performance, one person needs more ‘fuel’ for his activities than another. Here, too, hereditary factors and eating habits probably play a role. When food is ‘burned’ in the body, heat is released. Some people are able to get rid of the extra Calories they have consumed by generating more body heat, a process known as ther-mogenesis. Have you ever noticed that you feel hot or sweaty after a large meal? This is common, even occurring up to seven hours later, and is a sign that your body is burning off the excess Calories that you have supplied it with. Similar subtle alterations in metabolism would also help to explain many cases in which people put on weight after giving up smoking, even if they do not suck sweets as a substitute. A third physical cause of obesity could be a disorder of the hypothalamus, a part of the diencephalon, or between brain, in which a hunger and satiation centre is located. Obesity has been brought about in laboratory animals through damage to the hypothalamus, and the same may apply to people. Occasionally, obesity may occur through the malfunctioning of the endocrine glands (which produce hor-mones), such as the thyroid, pituitary or sex glands. For example, underactivity of the thyroid gland (hypothyroidism) often leads to an increase in body weight.
Oedema, retention of fluid in the tissues, also causes weight gain. These conditions require treatment.
Eating too much
In our society we usually eat because we enjoy it, not merely because we are hungry. The large variety of food available in the shops, often attractively displayed, tempts many people to buy more than in-tended. Undoubtedly, social factors also play a role. Many people dare not refuse when they are offered food or an extra alcoholic drink; they think that they might get the reputation of being poor company. An excessive consumption of alcohol can also result from the pressures of recurrent business or social occasions, an example being the habit of having a few drinks with colleagues after work.
Some people eat too much because they are depressed, nervous or lonely. Food can act as a substitute for attention and affection. Boredom also frequently causes people to eat more, usually in the form of snacks between meals. This fits in well with the psychoanalytical theory of Sigmund Freud (1856-1939), which still has many adherents. According to Freud fat people were frustrated in the oral stage of development. In this period, which extends from birth to roughly one year of age, pleasure is associated with sucking on the breast or the bottle. When they are feeling out of sorts, Freud argued, fat people still experience a longing for this pleasurable experience and relieve it by eating (or smoking, another means of oral satisfaction).
The German doctor and psychotherapist Ulf Pitthan gives another explanation of why people eat in stress situations. Pitthan argues that the body reacts to stress with a reduction in the blood’s sugar content. This creates a feeling of hunger and the person experiences a desire for carbohydrates. If this is true, a fat person who is dissatisfied and tries to lose weight gets into ever deeper trouble: the attempts to slim give rise to stress, with the result that he or she starts to eat more, which creates a vicious circle.