Diets: Battle of the bulge beckons many

By Lidia Wasowicz, UPI Senior Science Writer

Published 5/17/2004 11:23 AM

http://www.upi.com/view.cfm?StoryID...17-082503-2255r

United Press International surveyed 84 specialists for a 15-part series weighing in on the causes, consequences and costs of a global gain in girth and measures to curtail the corpulence. Part 1 sizes up the shape we're in.

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Diet fads may come and go but the obesity epidemic swells behind.

"It seems the more we get obsessed with weight, the more we gain," Gail Woodward-Lopez, associate director of the Center for Weight and Health at the University of California, Berkeley, said in a telephone interview.

Despite the estimated $33 billion to $50 billion Americans spend each year on pills, programs, products and potions, all promising a more svelte silhouette, the population's collective girth continues to expand in proportions many health experts find alarming.

Cited causes -- from evolution to economics -- are so ingrained into the daily way of life, some specialists are convinced it will take nothing short of a major societal shift to claim victory in the battle of the bulge. Yet, unfazed by the odds, millions continue to engage the fat demons in a fight, hoping for a speedy, and hopefully painless, resolution.

"A quick fix has a certain appeal, and many of us are good at denial," said Dr. Lawrence Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

If previous trends continue, long-term weight loss will elude the great bulk of the 60 million Americans who, a recent nationwide survey reveals, have vowed to start peeling off pounds this spring.

Numerous studies have dished out some disheartening statistics, showing 85 percent to 95 percent of those who succeed in slimming down will not only beef up to their starting girth within five years but also top it off with an extra 8 pounds, on average.

"When we get fat, we plump up our fat cells and sometimes grow more fat cells," said biochemist Nancy Amy, associate professor of nutritional sciences and toxicology at the University of California, Berkeley, where she teaches a popular class on fad diets.

Once in place, the ravenous cells become a permanently hungry fixture, deflating, but not disappearing, as their food supplies diminish.

"The fat cells, however, always send out messages that they want more fat in them," Amy said. "It is hard to ignore the 'Feed me!' messages from our fat cells."

Hence, the constant tug of war that, over time, can wear thin with the would-be slim.

The secret to successful downsizing is to find a recipe that will remain palatable over the long haul, weight-management experts advise.

"Any sound diet that you adhere to forever can help you keep the weight off forever," Cheskin said.

Consumers seeking scientific solutions to selecting sustainable options for managing weight will find slim pickings in science publications.

"Popular literature about fad diets fails to answer one question: Was weight loss sustained over a long period of time?" Amy noted. "In virtually all studies, that is not mentioned -- which is a warning sign."

Whether the wildly popular, carbohydrate-cutting course circling the globe will feed into a story of sustained success remains to be seen, diet specialists say.

The approach, originated in 1972 by the late Dr. Robert Atkins -- founder and medical chair of The Atkins Center for Complementary Medicine in New York City -- got a big boost from research, published in the New England Journal of Medicine last year. The article described how very overweight patients on low-carb diets lost more weight and fared better on certain cardiovascular and diabetes measures than patients on the more traditional low-fat, calorie-restricted regimen.

The strategy defies traditional admonitions to limit fat intake to 30 percent of total calories and opt instead for such carbohydrate-rich foods as pasta, breads, cereals and rice, which build the base of the U.S. Department of Agriculture's "Food Guide Pyramid." Instead, it calls for curtailing carbs, the building blocks of plant matter, and promoting protein-packed foods, such as lean red meat, poultry, fish and oils.

Industry analysts project an estimated 59 million aficionados of the unorthodox approach will spend as much as $30 billion in 2004 -- twice last year's total -- on snacks, bunless burgers, beer, books and other fare that fit the low-carb bill.

Though the plan can lead to weight loss in the short run, the research cupboard on its enduring effects on weight and health remains relatively bare, leaving unanswered some of the most important questions.

"We need more information about the long-term effectiveness and safety of the Atkins diet before it can be generally recommended," said Dr. Frederick Samaha, chief of the Cardiovascular Section at the Pennsylvania Veterans Administration Medical Center, who headed the NEJM study.

"There is surprisingly little data on the long-term, protective effects of any diet on heart disease," he added.

To help slice through some of the uncertainty, many experts advocate charting a customized course to curbing corpulence.

"Plans that are specifically tailored to an individual's needs and schedule would probably be the best method," said Linda Dong, a UC Berkeley graduate in epidemiology, now at the University of Washington in Seattle. "I don't believe there is one solution to guarantee weight loss," she said. "Otherwise, everyone would probably be on it!"

Indeed, despite the expensive efforts of its detractors, excessive weight is starting to squeeze out tobacco as America's No. 1 avoidable killer, contributing to 400,000 preventable deaths in 2000, just 35,000 shy of the number of lives cut short by smoking.

Nearly two-thirds of the nation's adults -- 129.6 million men and women -- qualify as overweight or obese. The former is defined as having a Body Mass Index -- a weight-height ratio -- of between 25 and 29.9, the latter as measuring 30 or more on the BMI scale. As a point of reference, a BMI of 30 -- some 30 pounds overweight -- translates to 221 pounds in a 6-foot-tall person and 186 pounds in one who stands at 5 feet, 6 inches.

That dubious distinction, applicable to a mere 13.3 percent of the population in 1960, now defines a whopping 30.5 percent, or 61.3 million Americans 20 and older. The spiraling inflation in the prevalence of severe overweight, especially over the past 20 years, exacts a heavy cost in lives -- 300,000 each year -- and expenditures -- some $117 billion annually, according to the American Obesity Association and the U.S. Surgeon General's office.

Stewing since the second half of the last century, the chronic problem has boiled over into a worldwide health threat. Globally, an estimated 1.2 billion people carry more weight than they should, increasing their risk of developing heart disease, hypertension, stroke, diabetes, gallbladder problems, osteoarthritis and other inflammatory conditions, respiratory disorders and certain types of cancer.

The World Health Organization in Geneva, Switzerland, and U.S. Centers for Disease Control and Prevention in Atlanta estimate the incidence of obesity -- which currently tops 300 million globally -- doubles every five years. For the first time in history, the overweight form a plurality in some societies, including Russia, Germany, Australia and the United Kingdom, where the number of cases has shot up 100 percent since the 1980s.

In what many see as the most troublesome development, children, formerly immune to the condition once confined to middle age, are filling the ranks of the overfilled. In the United States, 15 percent of elementary school youngsters carry excess weight. In Egypt and Mexico, the rate has bulged to 25 percent. Now, 20 percent of the world's little ones have put on some big pounds.

"Clearly what's happened in American culture in the last 40 years -- and what we're now passing on to others -- is we are eating gargantuan portions of food that is cheap and energy-dense, that tastes good and smells good, and we spend billions of dollars to advertise it and market it," said internist Dr. Linda Stern, assistant professor of medicine at the University of Pennsylvania in Philadelphia and Samaha's co-author on the low-carb study.

"It's impossible for us to make reasonable food choices in this kind of climate," Stern added.

Even more so when one considers the sugar-coating applied to everything from hamburger to cereal, some scientists suspect. Others consider the greater culprit to be fat, for which humans have a natural affinity.

"We have been 'programmed' by evolution/natural selection (to like fat); fat enhances chances of survival in famine conditions and serves as a storehouse of energy," said Leon Rappoport, emeritus professor of psychology at Kansas State University in Manhattan.

Nature did not intend to abet humans in their overindulgence, said Rappoport, author of "How We Eat: Appetite, Culture, and the Psychology of Food" (2003, ECW Press). "But it equipped us with appetites that promote survival."

Those appetites are more than satisfied in a society gone obesogenic, a term coined in 1996 to connote an environment brimming with weight-bloating traps. Such facts of daily life as urban sprawl that favors drivers and passengers over pedestrians, video games and other entertainment technologies that promote sitting over standing, and modern conveniences that outmode motion, all make modern life more conducive to chewing the fat than burning it.

"Some would say that we need society changes, and changes in the way that we live at the community level before we will see changes in obesity prevalence," said epidemiologist Peter Katzmarzyk of Queen's University in Kingston, Ontario. "The best intentions may not result in actual changes when the entire society is working against you."

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Next: Finding food that's fit to eat for the weight-conscious.

UPI Science News welcomes comments on this series. E-mail sciencemail~upi.com