Obesity: The “New Normal” Part Three

Losing It

 

Sheena Burnell, M.D.

Sheena Burnell, M.D.

If losing weight and keeping it off was easy everyone would be thin and there would be no such thing as the weight loss industry.

As many women and men will attest however long-term weight loss can be fiendishly difficult and for some people seemingly nearly impossible. Why this is so is a conundrum which is still only partially understood, although research in this area is one of the hottest topics in science. What we do know is that patterns of food consumption and exercise have changed dramatically in the developed world over the last few decades, resulting in levels of obesity and obesity-related disease on a scale never seen before in human history. What we don’t fully understand however is why there are such big differences between individuals in terms of how much weight they gain and the ease or otherwise of losing this weight on a long-term basis.

Currently 65% of the population in countries such as the US and Australia are classed as overweight or obese and recently a new category for extremely obese children has been defined, with 6% of children already fitting the definition. Weight loss programs including shaming (and shameful) TV shows such as Big Brother boast similarly depressing statistics and typically have a failure rate of 80-90%. If nothing else this alarming figure says everything about an industry whose inbuilt failure means it can promise so much but in reality, deliver very little in terms of meaningful results.

So why is it so hard to lose weight and keep it off? As we’ve seen previously weight gain is a complex process with several aspects. If we think of it as having three components: factors which can’t be changed (genetics), factors which may be modified (epigenetic changes as a result of maternal or other influences) and factors which are eminently changeable (diet and exercise) it becomes a little easier to understand why simply tackling one piece of the puzzle – usually the last factor – means failure for many people will be inevitable and even worse, set in train the dieting cycle which only leads to further weight gain.

As we’ve seen many of the foods we eat are themselves the cause of abnormal eating patterns with fructose and to a lesser extent sucrose now being shown to alter our normal body response to the brain’s satiety signals, meaning these foods create their own craving and overconsumption, a truly terrifying prospect. Unfortunately despite the mounting evidence the official guidelines in many developed countries are slow to catch up and the ‘food pyramid’ still has carbohydrates as its platform. Although the recommendation is for wholegrain bread and pasta, brown rice and unprocessed foods, in reality most people don’t enjoy these foods and preparing them may be time-consuming and unfamiliar to many people. Additionally the low-fat message has meant vastly increased consumption of sugars in their place and many consumers simply don’t realize the calorie load of a simple tub of yoghurt, not to mention ‘health’ bars and cereals.

Most weight loss programs have as their platform decreased food intake and increased levels of exercise, a reasonable enough approach and yet one which doesn’t seem to work for many people. There are many reasons for this including our often stress-filled lifestyles, the easier availability of calorie-dense food compared to preparing nutritionally-sound food, lack of food preparation skills, disappearance of communal eating and sharing food at table,  increasing portion sizes and perhaps oddest of all the notion of ‘indulging’ or ‘treating’ oneself with something unhealthy. This must be one of the great paradoxes of Western society compared with a country like Japan, where a treat would be a beautiful imported piece of fruit exquisitely presented rather than a plate of chili-cheese fries or a tube of raw cookie dough.

And herein lies perhaps the heart of the problem, and that is the disconnect many of us now have in Western society between eating for the pleasure of the senses as opposed to eating for the sake of eating. Although countries traditionally regarded as having slender populations such as China or France are now starting to catch up in the overweight stakes, generally societies with a more holistic overall approach to eating and physical activity have the leanest populations. This makes our approach all wrong as we see weight loss as punishment or torture rather than nurturing our bodies; and rather than make pleasurable eating and enjoyable physical activity a daily habit, we intersperse gorging on unsatisfying calorie-laden food with restrictive eating and periods of guilty sloth with unrealistic exercise regimens which are impossible to maintain and make us miserable.

While not everyone is going to be thin and there will always be a wide variety of ‘normal’ weights based on genetic and racial backgrounds, it is safe to say that being grossly overweight or morbidly obese is not a normal or healthy state for most humans and almost always results in ill-health and reduced longevity.

The answer lies not in unrealistic expectations, punishing or shaming, or even worse the misguided attempt to ‘normalize’ overweight which serves nobody at all. Rather the change needs to be a very large shift on the part of our society to one of intelligent choices based on correct information, a sense of care and responsibility for oneself and a reconnection with what and how we eat. Obviously with the vested interests of big business and the food production industry this is a very tall order, however at an individual level we as women can take charge again and refuse to accept mediocre, empty food and the lie that being fat and immobile is an inevitable part of life.

As simple a starting point as thinking hard about what goes into our mouths, really thinking about what food means to us, educating ourselves about what we eat and how we could be eating differently and above all making sure we give our bodies the exercise they need every day is already a blueprint for a healthier, happier life. The crucial point here is that these are changes for life, not a quick rescue and you start as you mean to go on. Simply put the secret that you’re getting it right is that it feels right.

As a doctor I daily marvel at the extraordinarily intricate creation that is the human body – at the same time that I ponder our extraordinary capacity to punish our precious creations with some of the most bewildering lifestyle ‘choices’ ever seen. The issue of overweight goes to the core of our society as a whole and defines who we are as a civilization; the question we now have to squarely face is – do we want to be remembered as the era in human history that had the most food choices and exercise options, but steadily became the fattest most unfit civilization ever seen on earth?

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Dr Sheena Burnell is an Australian-trained doctor currently living and working in Shanghai, China. Her primary training is in anaesthesiology however she is also trained in cosmetic medicine which she has mainly practised since coming to China. Her latest role is Director of Asia Healthcare Consultants, a boutique consultancy specialising in introducing Australian healthcare companies to the China market. She is also a wine educator and a noted specialist on Chinese textiles.

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