RESEARCH SHEDS NEW LIGHT ON OBESITY

Press, Volume CXIV, Issue 33514, 20 April 1974, Page 18

RESEARCH SHEDS NEW LIGHT ON OBESITY

< By

JANE E. BRODY)

Obesity, long the subject of a cruel humour, dangerous crash diets and questionable reducing gimmicks, is beginning to yield its secrets to serious scientific investigators.

Although they have not yet found a magic pill that i will allow people to eat all they want without gaining, these researchers are reaching an understanding that promises more effective ' treatment and prevention of the problem of overweight, ' which plagues 70 million Americans. Many of the new findings were described recently at a symposium on childhood obesity, sponsored by Columbia University's Institute of Human Nutrition, where more than 1000 mostly slender physicians and dietitians heard the latest about the causes of overweight, why permanent weight loss eludes so many, and what can be done to increase the number of formerly fat. Research reported to the symposium shows, for example, that for many people — perhaps 90 per cent of the grossly obese — overweight may be pre- i destined from early childhood, making the battle against excess weight one that they are likely to fight over and over again. However, the findings I offe. a real hope that this form of obesitv, which is most difficult to treat, may at least be preventable. CREEPING OBESITY ( For most other people, the i so-called victims of creeping < obesity who become over- < weight as adults, recent ( •tudies indicate that excess i poundage is largely a con- | sequence of modem living < — a side effect of inactivity, 1 a super abundance of attractive, high-calorie foods, an i emphasis on consumption — | resulting in a caloric surplus, j even from a seemingly rea- i sonable diet. I For these people, < correction of the imbalance i between input and output is easier to achieve, although constant effort must be made to maintain the weight loss. CONVERTED TO FAT Obesity actually is an energy crisis in reverse — its fundamental cause is the consumption of more calories than the body uses up. Whether the excess calories are in the form of, protein, fat or carbohydrate, they are all converted to fat and stored in the body's fat depots. If it were possible to eat 3000 calories of lettuce in a day but only 2500 calories were used for energy, bar- i ring gastro-intestinal upset, i 500 calories would be stored as fat. After a week, those i 500 calories a day would i add up to an extra pound of i fat. < But as Dr Jean Mayer, Harvard University nutri- i tionist and long-time student | of th* causes of obesity, has j said, "Attributing overweight i to overeating is hardly more t illuminating than ascribing alcoholism to alcohol.” The real question, then, is what causes people to con- * sume more calories than they reallv need? HORMONAL ABNORMALITY , Research has shown that i while some people may have t a metabolic or hormonal ab- [ normality that disrupts the body's regulation of input i and output, such an abnor- I mality cannot be found in 1 the vast majority of over- i weight individuals. I More often than not, metabolic irregularities are a consequence, rather than a i cause, of obesity, and they disappear when the obese • reduce. , , l Recentlv. Doctors Jules Hirsch and Jerome Knittie | and their collaborators discovered that people who have been fat since childhood have an abnormally large number of fat cells in their body tissues, and the earlier tn life obesity began, the greater the number of, fat cells. jTAY for life Once these cells are formed, they stay for life, the researchers have found. Weight loss merely reduces , the size of the fat cells, not their numbers. “These people tend to get depressed, physically and psvchicallv. when they lose weight," said Dr Hirsch. senior phvsician at Rockefeller i University. "Everything seems to drive them back to obesity. It's as if their fat cells were sending out a

signa! to the brain saying. •Fill me up’." Dr Knittie. a pediatrician whi > directs an obesity clinic ; li>r children at Mount Sinai Medical Centre in New York tied three periods when fat cells are formed: during the last three months before birth, from birth to the age of two years, and during adolescence. An obese two-v ear-old. Dr Knittie said, may already have half the number of fat cells that are found in a normal-weight adult. By age six, this child may have doubled or tripled the normal adults' fat-cell number INTERPLAY OF FACTORS Underlying the fat-cell boom, Dr Knittie and others believe, is a complicated interplay of such factors as heredity, the kind of mothering the child receives, and psychological and social pressures. Dr Mater's group at Harvard has shown that fatness runs in families, and his s- idies of adopted children have shown that heredity is

more influential than environment. He and Carl C. Seltzer at the Harvard School of Public Health have found that persons with a particular body type — the slender ectomorphs, who have long, narrow hands and feet — are extremely unlikely to become fat. Obese individuals, on the other hand, tend to have the stockier, more muscular build of the mesomorphs or the softer, rounder build of the endomorphs. SOME CAN, SOME CAN’T Dr Hirsch suggests that, "Given the right feeding circumstances, some children can become fat and some cannot. "The ectomorphic infant is relatively protected against obesity. But in our society, given the glut of foods and constant barrage of eating stimuli, a certain percentage of endomorphs and mesomorphs become obese.” Other researchers have noted that modern infant feeding practices — the early introduction of solid foods, early weaning and the preference for bottle feeding over breast feeding — leads to overfeeding of many infants, who in turn produce too many fat cells. "Instead of the infant deciding on the basis of internal cues of hunger and satiety when he has had enough, the mother decides on the basis of how much milk he’s taken from the bottle or how many spoons of food he's eaten,’’ Dr Hirsch observed. British studies have shown that unusually rapid weight gain in the first weeks of iife is related to overweight in later childhood, and that 80 per cent of fat five-year-olds are destined to be fat adults. MOTHER’S RESPONSE Dr Hilde Bruch has found that the mothers of fat children tend to respond to their infants’ distress, regardless of its cause, by feeding. As a result, said Dr Bruch, a psychiatrist at Baylor College of Medicine in Houston, the child fails to learn the relationship between the discomfort he feels and the appropriate response to that discomfort -- his “hunger awareness” is improperly programmed. Later in life, these youngsters tend to react to emotional stress or frustration with the feeling that they need to eat, Dr Bruch reported. Dr Hirsch and others fear that indiscriminate use of the pacifier to relieve infant distress will have similar ill effects. Dr Bruch believes that successful, permanent weight loss for such people must be preceded by a resolution of the . sychological problems that foster their fatness. LITTLE BY LITTLE The other major group of overweight Americans do not begin to put on their extra poundage until after their twenties. Little by little, imperceptibly at first, the scale starts climbing until one day they realise they are 10, 20, 30 or more pounds overweight. As a rule, these people do not have an excessive number of fat cells, Dr Hirsch has found. Rather, their fat cells a.e fatter than normal, he said. Most of these victims of “creeping obesity” say they do not eat very much — in fact, they say they eat less than they used to — yet the pounds keep coming. Dr Mayer blames inactivity for 90 per cent of the problem. NO EXERCISE Although in the last 50 years per capita caloric consumption has decreased slightly, energy expenditure has decreased dramatically, thanks to the automobile and countless labour-saving devices. Today, according to the National Adult Physical Fitness Survey, 45 per cent of Americans engage in no physical activity for exercise Dr Mayer’s studies indicate that throughout a wide range of normal levels of energy expenditure, just enough food is consumed to meet the body’s energy needs, keeping weight stable. But at low' levels of activity, there is a breakdown in the body’s natural mech-

amsm that regulates energyinput and output, resulting in too much on the input side and consequent weight gam. A mere 100 ext; a calories a day — the equivalent of one thin slice of bread, a jigger of whisky or riding instead of taking a 20-min-ute walk — will, in a year add up to 101 b of fat. NOT A GLUTTON In five years, it will mean 50 extra pounds, and marked obesity. Still, the person will argue — with some justification - that he is not a glutton. The obvious solution, according to Dr Mayer, who has demonstrated that obese : youngsters are considerably less active than those of I normal weight, is to move > more. “Walk, don't ride. Take I the stairs: not the elevator," I he recommends. Contrary to what many think, exercise does not make a person so hungry that he eats even more than i he u«ed to. In fact, savs Dr ■ Hirsch. exercise has a ' eu-

phoriant effect” that dimin-j ishes the tendency to turn to food for emotional satisfaction. POOR HEALTH Unfortunately, for many i overweight persons, exercise by itself is not enough to ■ regulate their weight. That such regulation is important is emphasised by the poor:, i health records of the obese. i Overweight persons have an increased risk of developing diabetes, heart disease, I high blood pressure and chronic respiratory dis-;, orders, all of which tend toi foreshorten their lives. They; also suffer to an abnormal degree from such problems , as back and foot aches, vein disorders and skin infections, not to mention emotional trauma and social and occupational discrimination. And most of the $lO billion worth of ill-conceived reducing schemes that the obese latch onto each year only further compromise their health, doctors point out. LIMITED SUCCESS Yet proper medical treatment for obesity has thus far met with very limited ; success. Dr Albert J. Stun-; kard. head of psychiatry at Stanford University, reported that "only 25 per cent of those who enter treatment, lose as much as 20 lb, only five per cent lose 40 lb or more, and most regain the weight soon after.” j i Such dismal statistics have meant that weight re-!, duction is a particularly, ungratifying and enormously time-consuming practice for: most physicians. Therefore,! many are unwilling to make, a real effort with overweight patients, thus almost guaranteeing failure. According to one man who has lost 150 of his 320 lb, motivation makes all the difference. "No diet does any good if you are not in [ the frame of mind to lose weight,” he says, "and if you are in the proper frame . of mind, almost anything will work.” But Dr Myron Winick. director of the Columbia In- ' stitute of Human Nutrition. ’ warns against crash and fad diets that are nutritionally unsound or unbalanced. ’ While many such diets result in rapid weight loss, at , least at the outset, nearly all ’ of this loss is water, not fat. In fact, some crash diets produce a loss of essential , body protein — the core of our muscles and vital organs. — in preference to the unwanted stored fat. Besides, said Dr Winick, 1 "a good weight reduction diet should fit into a person’s life style and be the kind of scheme he can fol- , low with minor modi-*, fications for the rest of his! ilife. Otherwise, he’s likely to I gain back all he’s lost as soon as he goes off the , diet.” To achieve permanent , weight loss, the experts j agree, the dieter must for- , ever change those aspects of j his behaviour that made him fat in the first place. Using a treatment regimen , called modification, Dr • Henry A. Jordan and Dr Leonard Levitz of the psy- ■ chiatry department at the University of Pennsylvania have shown that they can get pounds off even without j directly attempting to change diet. EATING BEHAVIOUR "First we have the patient keep a detailed record of his eating and activity pat-: terns.” Dr Jordan told the; symposium. The record includes such factors as how. fast he eats; his mood, hunger state and physical ' circumstances when eating; time, place and persons i present; type and caloric ' content of the food, and ■ time and place of all physi- • cal activity. For many patients, Dr 1 Jordan said, this record, 'demonstrates that they are eating much more than they ( 1 had thought, and keeping the record alone changes be- , haviour. But the therapists also work on behaviour patterns that are fostering the patient’s weight problem, ' teaching him to take smaller bites, chew more slowly, wait between bites and between courses, eat only in one part of the house, and so forth. EXERCISE ENCOURAGED "Despite the quantities they eat. many obese persons miss the enjoyable aspects of eating.” Dr Jordan noted. His patients are also encouraged to expend more energy — "to park their cars further away from their destination and walk whenever possible." Behaviour modification has had the most promising success to date in treating I obesity — during a threemonth treatment period. 54 ■ per cent had lost more than i 201 b and all of these people continued to lose or main- • tained their loss one year > later. Thus far, however, the » method has not been tested • long and widely enough to f determine its ultimate suci cess. The use of drugs — hor- » mones or appetite suppressants — is one of the least desirable ways to treat over- •• weight, symposium particit pants said. Dr Richard S Rivlm of i the Columbia College of r Phv«icians and Surgeons re- ■ ported that hormones do

little good and some may be frankly dangerous. He singled out thyroid hormone as one of the most commonly misused drugs in obesity. DIET CLL'BS The psychological support and dietary guidance from groups like Weight Watchers and T.O.P.S. (Take Off Pounds Sensibly) has been shown to be helpful to many dieters. Several symposium participants said they rou- : tinely recommend such groups to their patients. Before beginning any weight reduction effort, the doctors recommended a thorough physical examination to be sure there is no organic cause for the overweight and no underlying disease that would be exacerbated by diet. And Dr Mayer warns against what he calls “the rhythm method of girth control” — diet and weight loss, followed by weight regain, and then another diet, and so on. “The second time around the fat cells seem to fill up more easily — just like a balloon that has once been inflated,” he said. Many experts believe that the emotional, psychological and physical stresses of a see-sawing weight create a greater hazard than just staying fat. To patients who are not hell-bent on losing, they often recommend not trying. Indeed, a few physicians — among them, Dr Paul Scholten, a San Francisco obstetrician — have recently ■pronounced the view that for otherwise healthy, modi erately overweight persons, “the time has come to stop .the war against fat and admit that people can be fat and healthy. We can allow ourselves to be plump and contented, rather than neurotic over a few extra pounds.” — (Copyright, "New York Times” news service).