The skinny on being fat: America's growing problem

The alarm went out a few weeks ago: The FDA warned consumers to stop using 14 Hydroxycut weight loss products immediately. One death and 23 serious illnesses had been attributed to the largely unregulated products, which scientists now believe can cause jaundice and liver failure. Even more startling is the fact that they have not yet been able to identify which specific ingredients are causing the damage. It warned that other so-called weight loss supplements may also have those same ingredients.

Although most weight loss products are not considered particularly dangerous, experts say they are mostly a waste of your money. But people continue to buy the supplements, gadgets, and even undergo drastic surgical procedures in search of a quick fix for obesity.

The more we know, the dumber we get
Obesity in America is out of control and on a lot of people’s minds. If you Google the word “diet,” 160 million search results will pop up. Ads for bariatric surgery, which include the lap band procedure as well as gastric bypass, are so ubiquitous that those terms have become part of the American lexicon. It seems the more we know about weight control, the fatter we get as a society.

According to the Centers for Disease Control, two-thirds of the American adult population is now overweight or obese, as defined by a body mass index of more than 30 and more than 35. And close to one in five children are tipping the scales in the overweight category. The CDC ticked off the possible health consequences of being overweight: heart disease, type 2 diabetes, certain types of cancer, high blood pressure, stroke, liver and gall bladder disease, respiratory problems, osteoarthritis and gynecological problems. Yet we are eating more and exercising less than we did in the 1970s. What is going on?

The hard truth, intimately known to anyone who has tried to lose a significant amount of weight and keep it off, is that weight control is really hard. Everything in our physiology fights it. Experts say 95 percent of diets fail within a year. Others say the whole idea of going on a diet is a bad one. It doesn’t work the way it is supposed to work.

The odd history of dieting
People have been trying to alter their appearance to fit into the latest definition of beauty for a long, long time. And some of the ideas were downright dangerous or stupid. Yet, they were popular. For example, in Edwardian times, the chewing diet was all the rage. It required chewing each bite exactly 32 times, tipping back the head and letting the masticated mass trickle down the throat. Anything still too large to easily slide down was to be spit out. Dinnertime must have been quite entertaining for the skinny people.

The tapeworm diet was a hit around the turn of the century. Pills purported to contain those little critters were sold as a way to trim one’s waistline. The downside? First, there are the side effects of having a live worm inside your stomach, which can cause nausea, headaches, infections, and diarrhea.  Even worse, the tapeworms can lay eggs which can block your organs, possibly resulting in death.

During modern times, we have not become much wiser. Elvis was a big fan of the Sleeping Beauty diet, the idea being that if you sedate yourself enough to sleep for days, you won’t be eating while you already sleeping. Variations of the ear stapling diet have surfaced in recent years, touting the somewhat nutty idea that piercing a specific spot on cartilage of your external ear will suppress your appetite. Yikes.

The cotton ball diet is just what is sounds like. If they couldn’t stomach plain old cotton balls, some people soaked them in gelatin first. No one seems to know the exact number of calories in a cotton ball, but some say they can be quite filling.

And eating enough of them will, obviously, bring on malnutrition and possibly the men in white jackets.

The blood type diet, which dictates which foods you should eat or avoid according to your blood clotting factors, is just silly. Some very popular diets reach back, way back, into history for dietary guidance. The hallelujah diet requires eating only food specifically mentioned in Genesis 1:29. In other words, it is a raw vegan diet that can bring on severe malnutrition. It also ignores Genesis 9:3, wherein God lifts those dietary restrictions.

Some of us may remember the grapefruit diet which, after 70 years, just won’t go away. It works because it is a low carb, high protein diet that can help you eliminate 10 pounds of water in 12 days. But once you eat normally again, the lost weight returns and there you are, never wanting to look at another grapefruit for as long as you live. In the 1960s, there was the drinking man’s diet, which drastically cut calories in order to allow for the evening martini. The 1970s saw the Beverly Hills diet, which claimed that if you ate as much as you wanted of only one recommended food all day long, such as a watermelon day or a grapes day, you would lose weight. Just don’t stray too far from home. The 1990s saw the juice fast diet, which claimed that the juice created in a very expensive juicer machine was nutritionally superior to the whole fruit or vegetable whence it came. The cabbage soup diet is self-explanatory. Obviously, you didn’t eat very many calories on that one.

Some of the recent fad diets make the claim that they will cleanse your body of residual bad stuff that is stuck in your colon. Evercleanse promises to remove from six to 40 pounds of waste stuck in your digestive tract. “If toxins and waste were really retained in the body,” FDA officer Vincent Cordero, M.D., said, “the human race would not have survived.”

Another outrageous claim was the Hollywood Detox Body Wrap. It promised to draw toxins out through the skin with the result of long-term weight loss of four to six inches, all in less than an hour.

Then there are the you-are-what-you-wear claims such as Skineez jeans, which, for $139, are imbued with a chemical that will pull the weight out of your legs just by wearing the jeans. In recent years, we saw Slimming Slippers and the Slimming Soles methods of weight reduction, as well as the Magic ear staple and the Ninzu ear clips.

Surgery is now respectable
There is a serious side to drastic weight loss. Bariatric surgery, which has been around for a long time, has refined its advertising. What had been a procedure of last resort for the morbidly obese, which means someone who is more than 100 pounds overweight, has become the shortcut du jour for extreme weight loss. The clinics that offer procedures such as the lap band technique sometimes act as cheerleaders for the results. The path to such surgery often begins at a seminar that is merely a sales tool. Yes, doctors are involved throughout the process and the preliminary preparation can take a few months, which includes a psychological evaluation. But once you are on that path, patients say it takes on a life of its own as the benefits are highlighted while the risks are minimized. The evidence of efficacy is often provided in the form of testimonials instead of being available as unbiased information.

Dr. Geoffrey Drew, M.D., runs a weight control practice in Thousand Oaks. He is a proponent of the high protein, low calorie regimen along with exercise and common sense. But when it comes to gastric surgery, he is less enthusiastic. “I recognize that at least 10 percent of the population now needs bariatric surgery as a matter of urgency,” Drew said. “In those cases, the only surgery I recommend is the lap band because that can be reversed when they have learned to eat properly.”

Drew added that even the lap band procedure can have serious and dangerous side effects. “After lap band surgery, the patients are so limited in their food choices that they have to think about food every hour,” Drew said. “After about six months, about 60 percent of them are iron-deficiency anemic.”

Although Drew said the procedure usually results in tremendous weight loss during the first year, “what we are worried about is the next year, when they start getting into nutritional deficiencies. So I see the lap band procedure as a temporary solution for most people.”

When good surgery leads to a bad life
Mildred (not her real name), 48, lives in Camarillo, and she has a lot to say about life after surgery. Mildred had the gastric bypass procedure, which is not reversible, performed three years ago. She said her life has been permanently altered and not really for the better, even though she has dropped 285 pounds.

“If you had the 285 pounds sitting on a table in front of me, and the gastric bypass surgery sitting in front of me,” Mildred said, “I would grab the 285 pounds and put it back on.”

Although it sounds as though Mildred’s surgery has been quite successful, she would differ with that conclusion. “I used to be able to tell you that I was a basically healthy person,” she said, “and now I am not a healthy person. At first, I was losing 30 to 50 pounds a month. I am not maintaining my weight; I still have not been able to stop losing weight.”

Mildred said she decided to have the surgery in order to be able to play with her grandchildren. But she did not foresee how seriously the surgery would affect her entire life. “If I eat the wrong things, I don’t have energy,” Mildred said. “I have to watch my blood levels because of anemia. My moods have changed drastically.”

What Mildred said she has learned is that she was in serious need of psychological therapy for compulsive overeating a lot more than she needed the bypass surgery. She is still in therapy and said she is making progress but it is going slowly.

“Even now, when I first glance in the mirror, I still see my heavy self and that is my eating disorder,” Mildred said. “I wish I would have gone into therapy first and not had the surgery. I didn’t know I had other options. I would not recommend the gastric bypass for anyone.”

Diet is a four letter word
Lois Zsarney is a marriage and family therapist as well as a registered dietician in Ventura. She said being extremely overweight is usually all about emotional eating. “Sometimes clients are using food as a coping mechanism,” Zsarney said.

“They use food when they are tired or lonely, upset, happy or sad. They eat in response to emotions rather than physical hunger.”

Zsarney said there are other reasons for gaining so much weight. “Some people use the weight as a psychological barrier to keep other people away from them,” she said. “If a woman feels vulnerable to attention from men, then they will be overweight and they won’t be bothered as much. It is like a physical boundary that they put up.”

Susan Richter is a certified easting disorder specialist as well as a marriage and family therapist in Camarillo. She agrees with Zsarney that the reasons for overeating have little to do with physical hunger. “A lot of people are eating to numb feelings,” she said. Even more complications can set in after bariatric surgery. “If someone is eating in order to become numb and is not able to use food in the way they did before, they are more vulnerable to try to numb themselves in other ways.” Specifically, by acquiring new addictions, such as alcohol or other compulsive behavior.

So why is losing weight and keeping it off so difficult? “The current information, even from many doctors, is to diet; yet we know that dieting doesn’t work,” Richter said. “Ninety-five percent of all diets end in failure; in fact, increased weight gain. Over time, when people go on repeated diets, they actually end up gaining more weight.”

Richter said the obsession with the scale is counterproductive. “When you say you need to lose the weight, the focus is very narrow, and it is all just about the numbers,” Richter said. “That, as opposed to you would like to feel better in your own body.”

As for clients who have had bariatric surgery and have failed to keep the weight off, Zsarney said there is a complicated emotional response. “It is a grief and loss process,” she said. “Grieving the loss of the ability to eat the way they used to eat that caused the weight gain.”

Zsarney said there is another aspect that comes into play. “It can also be about self-esteem,” she said. “If you think you’re a piece of crap, you’re going to treat yourself like a piece of crap.”

For some people, being overweight or obese does not present a problem. Jill (not her real name) is in her late 40s and lives in Simi Valley. After a progression of having four children, she just gave up trying to lose the weight that accumulated after her final two pregnancies. “I don’t have any health issues, and I don’t really care about it,” Jill said. “I don’t have any body image issues. It doesn’t bother me.”

Jill candidly acknowledged that she is seriously overweight but said that losing weight is less important to her than enjoying food. “I love food,” she said. “I love to shop for food. I love to cook food. I love to share food.” Jill said she would never even consider having bariatric surgery because she believes she will never succumb to the looming health issues that accompany obesity. “I don’t deny myself much in the way that I eat.”