At least 80 percent of women at risk for cardiovascular problems weigh 20 percent more than they should for their height and age—the technical definition of obese. But when women go to their doctors or nutritionists, they are given meal plans, lists of what and what not to eat, and so on. The problem is much deeper than simply eating too much food. The key to losing weight for many women is to examine why they became obese in the first place. Obesity is the most powerful risk factor regarding building cardiovascular problems and common over-fifty cancers, such as colon or breast, as well as Type 2 diabetes. Basically, the longer you’ve been obese, the more you are at risk. Amazingly, experts have noted that when you lose just 5 pounds, your body actually begins to work more efficiently. Part of the story of Western obesity is understanding where the modern diet came from. After all, you didn’t create the modern diet; you were born into it. In fact, the word diet comes from the Greek diatta, meaning “way of life.” Many European countries experienced a significant drop in a number of obesity-related diseases during the first and second world wars, when meat, dairy foods, and eggs became scarce for a large portion of the population. Wartime rations forced people to survive on brown bread, oats and barley meal, and home-grown produce. Had it not been for the Depression, we may indeed have seen an increase in obesity-related health difficulties much earlier than we did in North America. The seeds of sedentary life were already planted in the 1920s, as consumer comforts, mainly the automobile and radio, led to more driving, less walking, and more sedentary recreation. The Depression interrupted what was supposed to be prosperous times for everyone. It also intercepted obesity and all diseases related to obesity, as people in many industrialized nations barely ate enough to survive. The end of World War II marked another significant change in diet: People wanted to celebrate—they gave parties, drank wine. They smoked. They went to restaurants. More than ever before, our diets began to include more high-fat items, refined carbohydrates, sugar, alcohol, and chemical additives. And as women began to manage large families, easy-fix meals in boxes and cans were manufactured in abundance and sold on television to millions.
The demand for the diet of leisure radically changed agriculture, too. Today, 80 percent of our grain harvest goes to feed livestock. The rest of our arable land is used for other cash crops such as tomatoes, sugar, coffee, and bananas. Ultimately, cash crops have helped to create the modern Western diet: an obscene amount of meat, eggs, dairy products, sugar, and refined flour. Since 1940, chemical additives and preservatives in food have risen by 995 percent. In 1959, the Flavour and Extract Manufacturers Association of the United States (FEMA) established a panel of experts to determine the safety status of food flavourings to deal with the overwhelming number of chemicals that companies wanted to add to our foods. One of the most popular food additives is monosodium glutamate (MSG), the sodium salt of glutamic acidity, an amino acid that occurs naturally in protein-containing foods such as meat, seafood, milk, and many veggies. MSG is a flavour enhancer that researchers believe contributes a “fifth taste” to savoury foods such as meats, stews, tomatoes, and cheese. It was originally extracted from seaweed and other plant sources to function in foods in the same way as other spices or extracts. Today, MSG is made of starch, corn sugar, or even molasses from sugar cane or sugar beets. MSG is produced with a fermentation process similar in order to that used for making products such as beer, vinegar, and yogurt. While MSG is labelled Generally Recommended As Safe (GRAS) by the FDA, questions about the safety of ingesting MSG have been raised because food sensitivities to the substance have been reported. This fact notwithstanding, the main problem with MSG is that it arouses our appetites even more. Widespread in our food supply, MSG makes food taste better. And the better food tastes, the more we eat. Hydrolysed proteins are also used as flavour enhancers. These are made by using enzymes to chemically digest proteins from soymeal, wheat gluten, corn gluten, edible strains of candida, or other food sources. This process, known since hydrolysis, breaks down proteins into their component amino acids. Today, there are several hundred additive substances like these used in our food. The legacy of the Western diet of leisure is that it has become cheaper to eat out of a box or can than off the land. In the developed Western world, where there’s minimum wage, there is also maximum fat. At one time, fat was a sign of prosperity and wealth. Today, wealth is defined by thinness and fitness. Ironically, low-fat foods, diet programs, and fitness clubs attract the segment of our population least affected by obesity. In fact, eating disorders tend to plague women from higher income brackets. The Coalition for Excess Weight Risk Education, a Washington-based organization comprising the American Diabetes Association, the American Association of Diabetes Educators, the American Society for Clinical Nutrition, the North American Association for the Study of Obesity, and four pharmaceutical manufacturers, issued recent statistics on obesity in the United States. The data can be used to interpret obesity patterns throughout the Western world. Based on a thirty-three-city survey, the National Weight Report found that cities with high unemployment rates and low per capita income tended to have higher rates of obesity. Areas with high annual precipitation rates and a high number of food stores also had greater rates of obesity. (More rainy or snowy days lead to more snacking in front of the television set!)
Why We Like Our Fat
Fat tastes good. Fat also feels good in our mouths. Foods that have the particular texture and taste of fat are more acceptable than foods that will don’t. This is exactly why packaged good manufacturers describe their products as “smooth, creamy, moist, tender, and rich.” All the foods that boast these qualities, from ice cream to chocolate to parmesan cheese, give us that unique feeling of satiety and satisfaction that makes us feel good. Eating is a sensual experience. When we enjoy our meals, our brains produce hormones, “feel-good” hormones that are usually, ironically, also produced when we exercise. Eating fat is analogous to having a “mouth orgasm.” To many of us, without the flavour and texture of fat, eating is an empty experience. And when we are in emotional pain or need, the texture and taste of fat become even more important. Bingeing or falling off the diet plan wagon is not because of to losing control yet to regaining lost good feelings. Food, as millions of overeaters will tell you, is our friend. It’s always there; it never lets us down.
The Impact of Low-Fat Products
Since the late 1970s, Americans have been deluged with low-fat products. In 1990, the United States government launched Healthy People 2000, a campaign to urge manufacturers to double their output of low-fat products by the year 2000. Since 1990, more than a thousand new fat-free or low-fat products have been introduced annually into American supermarkets. Current guidelines tell us that we should consume less than 30 percent of our calories from fat, while no more than one-third of fat calories should come from saturated fat. According to U.S. estimates, the average person gets between 34 and 37 percent of calories from fat and roughly 12 percent of all calories from saturated fat. Data shows that in terms of “absolute body fat, ” the intake has grown from 81 grams per day in 1980 to 83 grams per day in the 1990s. Total calorie intake has also increased from 1,989 per day in 1980 to 2,153 calories per day. In fact, the only reason that data shows a drop in the percentage of calories from fat is because of the huge increase in calories per day. The result is that we weigh more today than in 1980, despite the fact that roughly ten thousand more low-fat foods are available to us now than in that year. Most of these low-fat products, however, actually encourage us to eat more. For example, if a bag of regular chips has 9 grams of fat per serving (one serving usually equals about five chips or one handful), you will more likely stick to that one handful. However, if you find a low-fat brand of chips that boasts “50 percent less fat” per serving, you’re more likely to eat the whole bag (feeling good about eating “low-fat” chips), which can easily triple your fat intake. Low-fat or fat-free foods trick our bodies with ingredients that mimic the functions of fat in foods. This is often achieved by using modified fats that are only partially metabolized, if at all, by our bodies. While some foods reduce fat by removing the fat (skim milk, lean cuts of meat), most low fat-foods employ a variety of “fat copycats” to preserve the taste and texture of the food. Water, for example, is often combined with carbohydrates and protein to mimic a particular texture or taste, as is the case with a variety of baked goods or cake mixes. In general, though, the low-fat copycats are carbohydrate based, protein based, or fat based. Carbohydrate-based ingredients are starches and gums that are often used as thickening agents to create the texture of fat. You’ll find these in abundance in low-fat salad dressings, sauces, gravies, frozen desserts, and baked goods. Compared to natural fats, which are about 9 calories per gram, carbohydrate-based ingredients run anywhere from 0 to 4 calories per gram.
Protein-based low-fat ingredients are created by causing the proteins that make them to behave differently. For example, by taking proteins such as whey or egg white, and heating or blending them at high speeds, you can create a creamy texture. Soy and corn proteins are often used in these cases. You’ll find these ingredients in low-fat cheese, butter, mayonnaise, salad dressings, frozen dairy desserts, sour cream, and baked goods. They run from 1 to 4 calories per gram. Low-fat foods that use fat-based ingredients tailor the fat in some way so that we do not absorb or metabolize it fully. These ingredients are found in chocolate, chocolate coatings, margarine, spreads, sour cream, and cheese. You can also use these ingredients as low-fat substitutes for frying foods ( you do this when you fry eggs in margarine, for example). Olestra, the new fat substitute just approved by the United States Food and Drug Administration (FDA) is an example of a fat substitute that is not absorbed by our bodies, providing no calories. Caprenin and Sala trim are examples of partially absorbed fats (they contain more long-chain fatty acids; see glossary): These are the more traditional fat-based low-fat ingredients and contain roughly 5 calories per gram. There’s no question that low-fat foods are designed to give you more freedom of choice with your diet, supposedly allowing you to cut your fat without compromising your taste buds. Studies show that “taste” outperforms “nutrition” in your brain. Yet many experts believe that low-fat products create a barrier to weight loss over the long term. Researchers at the University of Toronto suggest that these products essentially allow us to increase our calories even though we are reducing our overall fat intake. For example, in one study, women who consumed a low-fat breakfast food ate more during the day than women who consumed a higher-fat food at breakfast. The good news about low-fat or fat-free products is that they are, in fact, lower in fat and are created to substitute for the “bad foods” you know you shouldn’t have but cannot live without. The boring phrase “everything in moderation” applies to low-fat products, too. Balancing these products with “good stuff” is the key. A low-fat treat should still be treated like its high-fat original. In other words, don’t have double the amount because it’s low fat. Instead, have the same amount as you would of the original.
Stop Chronic Dieting
The road to obesity is paved with chronic dieting. It is estimated that at least 50 percent of all North American women are dieting at any given time, while one-third of North American dieters initiate a diet at least once a month. The very act of dieting in your teens and twenties can predispose you to obesity later in life. This occurs because most people “crash and burn” instead of eating sensibly. In other words, they’re chronic dieters. The crash-and-burn approach to diet is what we do when we want to lose a specific number of pounds for a particular occasion or outfit. The pattern is to starve for a few days and then eat what we normally do. Or, we eat only certain foods (such as celery and grapefruit) for a number of days and then eat normally after we’ve lost the weight. Most of these diets do not incorporate exercise, which means that we burn up some of our muscle as well as fat. Then, when we eat normally, we gain only fat. And over the years, that fat simply grows fatter. The bottom line is that when there is more fat on your body than muscle, you cannot burn calories as efficiently. It is muscle that makes it possible to burn calories. Diet it away, and you diet away your ability to burn fat. If starvation is involved in our trying to lose weight, our bodies become more efficient at getting fat. Starvation triggers an intelligence in the metabolism; the body suddenly thinks it is living in a war zone and goes into “superefficient nomadic mode,” not realizing that it is living in modern North America. So, when we return to our normal caloric intake, or even a lower-than-normal caloric intake after we’ve starved ourselves, we gain more weight. Our bodies say, “Oh look—food! Better store that as fat for the next famine.” Some researchers believe that starvation diets slow down our metabolic rates far below normal so that weight gain becomes more rapid after each starvation episode. This cycle of crash or starvation dieting is known as the yo-yo diet syndrome, the subject of thousands of articles in women’s magazines throughout the last twenty years. Breaking the pattern sounds simple: Combine exercise with a sensible diet. But it’s not that easy if you’ve led a sedentary life most of your adult years. Ninety-five percent of the people who go on a diet gain back the weight they lost, as well as extra weight, within two years. As discussed further on, the failure often lies in psychological and behavioural factors. We have to understand why we need to eat before we can eat less. The best way to break the yo-yo diet pattern is to educate your children early about food habits and appropriate body weight. Experts say that unless you are significantly overweight to begin with or have a medical condition, don’t diet. There is another part of the weight story that has do with the role of food and fat in women’s lives.
Being fat—and/or the overeating behaviour that causes us to be fat—is perceived by many as a very public rebellion against the role many women are asked to play in this society. So it’s important to explore what being fat means to you, personally, and the issues surrounding food addiction. As women, we are the ones that usually do the purchasing and preparing of food for our families. At the same time, we are continuously being deluged with impossible standards of beauty, fitness, and thinness through media images. How do these conflicting roles affect us? For many women, the effect is a feeling of powerlessness. Depending on the woman, by manipulating the body size to be bigger or smaller by eating food or refusing food, we express unconscious desires to achieve more control over our lives. For the record, compulsive eating is more often a woman’s problem, which tells us that it has much more to do with being a woman than doctors and dietitians generally admit. Psychotherapists who specialize in compulsive eating disorders stress that the only way to help women lose weight is to help them understand what conscious or unconscious needs are being met by the fat. Therapists who work with women about weight loss issues observe that fat isolates a woman, on one hand, and makes her an object of failure, on the other. Women, of course, know this, and sometimes use this for psychological advantage. In other words, to the woman, the fat can protect her from being successful in two specific areas: sexual and financial (career-related) endeavours. Many women who are striving for financial success find that a thin body size immediately interferes with that goal. When they are thin, they fear being perceived on sexual terms by male colleagues (or have been so perceived/noticed in the past). They may even fear their own sexual desires, or fear being rejected as a sexual object. But when they are fat, they can feel liberated from being perceived as a sexual or “decorative” object and reap the financial rewards of their success nonetheless, or simply enjoy being perceived as productive or competent.
By being fat, women can also help to keep their families together by removing themselves from “the market”—avoiding affairs with other men. On the flip side, many women who have never had success in their lives (sexual or financial) use their fat as a way to remain isolated. This allows them to say to themselves, “If I were thin, I’d be successful.” The fatness becomes the reason for failed attempts at personal success, which shields many women from facing their own inner demons and fears, keeping them from the achievements they really want. For many women, especially those who gained their weight after childbirth, fat has nothing to do with sexuality or personal/financial success. It has to do with their relationship with their mothers, and their own feelings of nurturing and being a mother. After all, it is a mother’s breasts that initially nurture us, and it is through our mothers that we learn about food, food behaviours, and so on. Our mothers are also the source of love, comfort, and emotional support. Even when we do not get this from our own personal mothers, we still associate mothering with these emotions. Therapists have observed that body size and eating gets tangled up in mother-daughter relationships and can have varied meanings for the overweight woman. In other words, what your fat says to your mother can mean anything from “I’m a big girl and can look after myself” to “I’m a mess and can’t look after myself.” Some daughters use fat to actually reject the mother’s role, or to express anger at their mothers for inadequate nurturing. In some cases, the fat is an unconscious desire to incorporate your mother into your body because she’s soothing and nurturing. It’s a rather brilliant way of taking your mother with you wherever you go. Many women find their fat expresses anger at the beauty standard and at the repressive sexual role they’re asked to play. The fat is not protection but a deliberate attempt to offend the world. Here, the fat says to the world, “Screw you! If you really want to get to know me, then you’ll take the time to penetrate my layers. Otherwise, I don’t want to know you!” Many women fear being seen. They believe that “the less of me there is, the more people will see;” thus the fat protects the woman from being overexposed emotionally and sexually.
Biological Causes of Obesity
Eating too much high-fat or high-calorie food while remaining sedentary is certainly one biological cause of obesity. Furthermore, a woman’s metabolism slows down by 25 percent after menopause, which means that unless she either decreases her calories by 25 percent or increases her activity level by 25 percent to compensate, she will probably gain weight. There are also other hormonal problems that can contribute to obesity, such as an underactive thyroid gland (called hypothyroidism), which is very common in women over age fifty. Since diet and lifestyle changes are so difficult, there is an interest in finding genetic causes for obesity. If we’ve inherited obesity, that would mean it is beyond our control, which would probably be comforting for many people. Now that the Human Genome Project is underway, the goal of which is to map every gene in the human body, efforts are proceeding to find the “obesity gene” or “fat gene.” Few scientists believe that obesity is simply genetic, however. In other words, there are so many environmental and social factors that can “trip” the obesity “switch,” finding a specific gene for obesity is about as worthwhile as finding the “anger gene” or “crime gene.” An important theory about why we get fat concerns insulin resistance. It’s believed that when the body produces too much insulin, we will eat more to try to maintain a balance. This is why weight gain is often the first symptom of Type 2 diabetes. But then we have to ask, What causes insulin resistance to begin with? Many researchers believe it is triggered by obesity. Additionally, there are many theories surrounding the particular function of fat cells. Are some people genetically programmed to have more, or “fatter,” fat cells than others? There are no answers here, as yet. What about the brain and obesity? Some propose that obesity is all in the head and has something to do with the hypothalamus (a part of the brain that controls messages to other parts of the body) somehow malfunctioning when it comes to sending the body the message “I’m full.” It’s believed that the hypothalamus may control satiation messages. To other researchers, the problem has to do with some sort of defect that prevents the body from recognizing hunger cues or satiation cues; the studies in this area are not conclusive, however. A study reported in a 1997 issue of Nature Medicine showed that people with low levels of the hormone leptin may be prone to weight gain. In this study, people who gained an average of 50 pounds over three years started out with lower leptin levels than people who maintained their weight over the same period. Therefore, this study may form the basis for treating obesity with leptin. Experts speculate that 10 percent of all obesity may be due to leptin resistance. Leptin is made by fat cells and apparently sends messages to the brain about how much fat our bodies are carrying. As with other hormones, it’s thought that leptin has a stimulating action that acts as a thermostat of sorts. In mice, adequate amounts of leptin somehow signalled the mouse to become more active and eat less, while too little leptin signalled the mouse to eat more while becoming less active. Interestingly, Pima Indians in the United States, who are prone to obesity, were shown to have roughly one-third less leptin in blood analyses. Human studies of injecting leptin to treat obesity are in the works right now, but to date have not been shown to be effective.
Drug Treatment for Obesity
Drug treatment for obesity has an awfully shady history. Women have been abused repeatedly by the medical system. Throughout the 1950s, 1960s, and even 1970s, women were prescribed thyroxine, which is thyroid hormone, to speed up their metabolisms. Unless a person has an underactive thyroid gland, or no thyroid gland (which may have been surgically removed), this is a very dangerous medication, which can cause heart failure. Request a thyroid function test before you accept this medication. Amphetamines or “speed” were often widely peddled to women as well by doctors, but they, too, are dangerous and can put your health at risk. The U.S. government recently approved an ant obesity pill that blocks the absorption of almost one-third of the fat people eat. One of the side effects of this new prescription drug, called orlistat (brand name Xenical), causes rather embarrassing diarrhoea each time you eat fatty foods. To avoid the drug’s side effects, simply avoid fat! The pill can also decrease absorption of vitamin D and other important nutrients, however. Orlistat is the first drug to fight obesity through the intestine instead of the brain. Taken with each meal, it binds to certain pancreatic enzymes to block the digestion of 30 percent of the fat you ingest. How it affects the pancreas in the long term is not known. Combined with a sensible diet, people on orlistat lost more weight than those not on it. This drug is not intended for people who need to lose a few pounds; it is designed for medically obese people. (Orlistat was also found to lower cholesterol, blood pressure, and blood sugar levels.) One of the most controversial ant obesity therapies was the use of Fenfluramine and phentermine (Fen/Phen). Both drugs were approved for use individually more than twenty years ago, but since 1992, doctors tended to prescribe them together for long-term management of obesity. In 1996, U.S. doctors wrote a total of 18 million monthly prescriptions for Fen/Phen. And many of the prescriptions were issued to people who were not obese. (This is known as off-label prescribing.) In July 1997, the FDA, researchers at the Mayo Clinic, and the Mayo Foundation made a joint announcement warning doctors that Fen/Phen can cause heart disease. On September 15, 1997, Fen was taken off the market. (More bad news has surfaced about Fen/Phen wreaking havoc on serotonin levels, which only reinforces the message that in light of the safety concerns regarding current ant obesity drugs, diet and lifestyle modification are still considered the best pathways to wellness. A Fen/Phen replacement drug, sibutramine (Meridia), was approved in November 1997 by the FDA. Sibutramine was first developed in the late 1980s as an antidepressant, but like Fen/Phen, it controls appetite by affecting the brain’s interpretation of feeling full. Sibutramine differs from Fen/Phen in that it does not interfere with the heart.
For 2 percent of the female population in America, starving and purging are considered a normal way to control weight. Only a small number of women are obese because of truly hereditary factors. Most women who think they are overweight are, in fact, at an ideal weight for their height and body size. In Western society, the fear of obesity is so crippling that 60 percent of young girls develop distorted body images between grades one and six, believing that they are fat; 70 percent of all women begin dieting between the ages of fourteen and twenty-one. A U.S. study of high school girls found that 53 percent were unhappy with their bodies by age thirteen; and by age eighteen, 78 percent were dissatisfied. The most disturbing fact, revealed in the 1991 critically acclaimed Canadian documentary The Famine Within, is that when given a choice, most women would rather be dead than fat! Eating disorders are so widespread that abnormal patterns of eating are increasingly accepted in the general population. There are parents who are actually starving their young daughters in an effort to keep them thin. The two most common eating disorders involve starvation. They are anorexia nervosa (“loss of appetite due to mental disorder”) and bingeing followed by purging, known as bulimia nervosa. Women suffering from bulimia will purge after a bingeing episode by inducing vomiting and abusing laxatives, diuretics, and thyroid hormone. The most horrifying examples occur in women with Type 1 diabetes, who sometimes deliberately withhold their insulin to control their weight. Perhaps the most accepted weight control behaviour is over exercising. Today, rigorous, strenuous exercise is used as a method of purging, and has become one of the tenets of socially accepted feminine behaviour in the 1990s. A skeleton with biceps is the current ideal. Women with a history of eating disorders are at much greater risk of developing osteoporosis. Women who are carrying a bit of weight have stronger bones than thin women. Osteoporosis is on the rise in anorexic women as young as age twenty. Eating disorders are diseases of control that primarily affect women, although more men have become vulnerable in recent years. Bulimics and anorexics are usually overachievers in other aspects of their lives and view excess weight as an announcement to the world that they are out of control. This view becomes more distorted as time goes on, until the act of eating food in public (in bulimia) or at all (in anorexia) is equivalent to a loss of control. In anorexia, the person’s emotional and sensual desires are perceived through food. These unmet desires are so great that the anorexic fears that once she eats she’ll never stop, since her appetite will know no natural boundaries; the fear of food drives the disease. Most of us find it easier to relate to the bulimic than the anorexic; bulimics express their loss of control through bingeing in the same way that someone else may yell at his or her children. Bulimics then purge to regain their control. There is a feeling of comfort for bulimics in both the binge and the purge. Bulimics are sometimes referred to as “failed anorexics” because they’d starve if they could.
Anorexics, however, are masters of control. They never break. I once asked a recovering anorexic the dumb question, “But didn’t you get hungry?” Her response was that the hunger pangs made her feel powerful. The more intense the hunger, the more powerful she felt; the power actually gave her a high. When we hear “eating disorder,” we usually think about anorexia or bulimia. There are many people, however, who binge without purging. This is known as binge eating disorder (compulsive overeating). In this case, the bingeing is still an announcement to the world that “I’m out of control.” Someone who purges her bingeing behaviour is hiding her lack of control. Someone who binges and never purges is advertising her lack of control. The purger is passively asking for help; the binger who doesn’t purge is aggressively asking for help. It’s the same disease with a different result. But there is one more layer when it comes to compulsive overeating, which is considered to be controversial and is often rejected by the overeater: The desire to get fat is often behind the compulsion. Many people who overeat insist that fat is a consequence of eating food, not a goal. Many therapists who deal with overeating disagree and believe that if a woman admits that she has an emotional interest in actually being large, she may be much closer to stopping her compulsion to eat.