Health Options Alan Titchenal  & Joannie Dobbs                    Monday, February 16, 2004

Overall health more critical than body size

Obesity may prove to be the greatest health problem of the 21st century. Our ancestors were protected from becoming obese by an environment that required exercise to catch and gather food. And most of these foods were lower in calories and fat than the foods readily available today.

The option to dip a 100-calorie slice of bread into olive oil and turn it into a 200-calorie morsel did not exist. French fries, high-fat salad dressings, fancy cream sauces and a plethora of other calorie-dense foods have jumped in front of leaner fare in the contemporary U.S. food environment.

In addition, television, extended computer use and long commutes offer ample opportunities to be sedentary. It should not be a surprise that body fat steadily creeps up on many people.

Question: Why can't overweight people just use willpower to lose weight?

Answer: Research shows that many people with ongoing weight problems use significant willpower to diet, but only about 5 percent succeed at keeping lost weight off. Part of the problem is that the heavier a person gets, the more difficult it becomes to be active. Regrettably, however, if increased activity is not part of the weight-loss equation, the odds of keeping lost weight off are severely reduced.

A survival mechanism for all animals, including humans, is to focus on obtaining adequate food. When people lose a significant amount of body fat, this survival mechanism commonly results in strong food cravings and an obsession with food in general. This constant mental drive to eat can become overwhelming. After losing large amounts of weight, some people have even said that they had to choose between being fat or crazy. Given this frustrating choice, most people eventually accept being fat.

Q: If diets don't work for most people, what are the options?

A: For those who face this "fat or crazy" dilemma, some experts suggest a new approach called "Health at Every Size." Dr. Karin Kratina, a registered dietitian, exercise physiologist and cognitive anthropologist, encourages people to forget about body weight and dieting and put their focus on health.

Kratina stresses health in the broadest sense, including emotional, physical and spiritual health, self-acceptance, enjoyment of eating to satisfy hunger and nutrient needs (rather than a diet plan), enjoyment of physical activity and the acceptance that one's body weight has nothing to do with other aspects of character and value.

The focus on health rather than diets and an "ideal" body weight can help prevent food obsessions and an overly self-conscious attitude. By eating an adequate diet, people also feel more like exercising. Being sedentary is more damaging to health and longevity than being overweight.

By enhancing quality of life and overall health, the "Health at Every Size" approach can lead to gradual, healthy weight loss, even when that is not the goal.