Health Options Alan Titchenal  & Joannie Dobbs                    Wednesday, July 9, 1997

Many factors contribute to overweight

Saddened by the death of the great local musician Israel Kamakawiwo'ole, we felt an urgency to address the complexity of obesity. In Israel 's death, he leaves behind an important lesson - solutions for many health problems are not “black” and “white” or “simple.”

This becomes obvious with the problems of overweight, obesity, and morbid obesity. There are no simple definitions for these condi­tions. A weight-range table is given as an example. Individual ideal weight depends on height, frame size and body muscle.

For a 5-feet 5-inch woman:

Normal weight: 110-160 pounds

Marginal overweight: 161-170

Overweight: 171-210

Severe overweight: 211-310

Morbid obesity: 310 pounds

In many individuals, multiple health risks increase with weight gain. And weight gain occurs when more calories are consumed regularly than are used. Consum­ing excess calories can be triggered by many things and aggravated by others. You can see the complexity from the following partial list of known factors that affect weight gain.

1. Genetic factors affect many functions related to obesity. These factors include how we use and store calories, how many calories are needed to make a person feel full, and how fat cells increase in an individual.

2. Physical activity and lack of exercise certainly increase the risk of becoming obese. Genetic factors may affect our inclination to exercise. However, many other factors can be involved in decreasing physical activity such as lack of free time, an injury and chronic illness. Even increased body fat itself requires much more effort to exercise, compounding the problem.

3. Psychological factors can be or become elements in overweight and obesity. These include stress, depression, learned eating behav­iors, frustration, loneliness and re-directed aggression.

4. Environmental changes also can increase caloric intake or de­crease physical activity. In today's busy world, eating out and fast foods are chosen more often. This generally means eating larger portions of food higher in fat and with less nutritional value for the calories. Modern conveniences of TV and computers are replacing the physical activity of our grandparents.

5. Medical problems and aging often decrease activity. Some medications may increase appetite or even increase fat cell number.

People generally handle simple problems easily and quickly, but complex problems require gather­ing information to make good deci­sions. When we approach over­weight or obesity as a simple problem, we are likely to make poor decisions.

Often people view their excess weight as a simple problem with a simple solution. Quick weight-loss diets cause water and muscle to be lost as well as fat. Regained weight can be proportionately higher in fat.

Weight gain becomes a vicious cycle. As fat cell numbers in­crease, so does our appetite. This increase in appetite is thought to be an effort by the body to keep fat cells full. An increase in appetite usually increases food intake, which in turn increases fat cells. At some point, weight gain will make it more difficult to exercise and therefore our need for calories decreases.

The first step in weight control is acceptance of the complexity of the problem. This acceptance is necessary to search for the cause or causes of the initial weight gain followed by aggravating factors. Treatment of life-threatening obesity requires a comprehensive team approach. In future columns, we will identify resources in Hawaii for dealing with weight treatment