As a Nutrition major, I have always wondered, Why is it that in the last few decades, people around the world have been increasing in weight, especially in America? From 1990 to 2018, American obesity has grown from being 11% of the population to 35% (The State of Obesity). Why do some people have such a hard time losing weight, while others have to work really hard to even gain a few pounds?
So, what exactly is obesity? Obesity is defined as having a BMI (Body Mass Index) over 30, and is considered a chronic disease that increases the risk of a variety of health conditions. This includes, but is not limited to: insulin resistance, diabetes, high blood pressure, gallstones, stroke, heart attack, osteoarthritis, and even cancer (Balentine).
The location of fat on the body can increase these risks; generally, more abdominal fat means a higher risk. Storing fat in the abdomen is known as an apple shape, while storing fat in the hips and legs is a pear shape. The waist to hip ratio, which is found by dividing the measurement of the smallest part of your waist by that of widest part of your hips, is used to assess the increased risk of obesity related diseases. If the ratio is greater than or equal to 0.8 for women or 1.0 for men, their risk for obesity related diseases is elevated (Balentine).
In order to understand this obesity epidemic, we must first understand what causes obesity in the first place. Although there is definitely an influence from people's personal actions, it turns out obesity is not purely a consequence of an individual's choices; there are genetically predetermined factors that impact one's likelihood of gaining weight.
One study used identical twins to test if genetics play a role in one's weight and fat distribution. Twelve pairs of twins were given a one thousand calorie a day surplus over the course of one hundred days for six days per week. It turns out each twin's weight gain and fat distribution was similar within pairs, but varied between the twelve different sets (Bouchard). These findings are very significant, because they demonstrate just how much one's body composition, location of fat distribution, and metabolic rate can vary based on genetics.
One's ethnicity, gender, hormone levels, and childhood weight, all of which are influenced by genetics, play a role in the likelihood of becoming obese. African Americans and Hispanics, women especially, have a tendency to put on more weight earlier in life; this is most likely a result of differences among cultures relating to food. People who are overweight in their 20s have a higher chance of becoming obese in their late 30s. Generally, the earlier the person is overweight in their life, the more likely they will become obese later on. Women are more likely to become obese because of their tendency to put on more weight due to hormones such as estrogen (Balentine).
Although heredity does play a significant role, the foods people eat in America have a great impact on obesity. Lots of sugary, calorie dense, man-made junk foods are marketed to the public, and sometimes they can be very hard to resist. The low nutrient profile in these foods makes people feel full less quickly, often causing them to overeat, filling up on too many calories and not enough protein, fat, or complex carbohydrates (Gunnars). The aggressive marketing of junk food companies does not help either.
Advertising for many junk food items is aimed towards children, who do not yet have enough knowledge to make conscious, informed decisions about what they eat, and they get addicted to sugar at a young age. Countless digital marketing ads are portrayed through phones, games, and social media to children and adolescents. In 2008, the food industry spent about $10 billion per year in marketing to children, according to the Federal Trade Commission (Toxic Food Environment). Certain junk food products are advertised as being healthy, with labeling that claims they are beneficial to the body in some way, when in reality they are not healthy.
Many companies slap labels on their products such as all natural, multigrain, sugar free, fat free, light, among many others (16 Most Misleading Food Labels). These claims can even trick adults into thinking that they are buying a healthy product (Gunnars). For example, cereals such as Honey Nut Cheerios may claim that they are whole grain, low fat, contain all 12 vitamins and minerals, are a good source of iron and calcium, and that they may reduce the risk of heart disease and lower cholesterol (Honey Nut Cheerios | Gluten Free Oat Cereal), but they are still high in sugar and have little protein per serving. Children must be taught at a young age about the importance of fruits and vegetables in the diet, and to limit sugary items.
As a result of consuming so many high sugar, calorie dense foods, people can develop insulin resistance. Insulin is a hormone in the body that regulates the conversion of energy into fat versus being utilized elsewhere in the body. In a person who is insulin resistant, the body does not register when enough of the hormone has been made, and continues making more of it; this causes more energy to be stored as fat instead of used by the body. In order to prevent high insulin levels or insulin resistance, one must not eat an excessive amount of refined carbohydrates and have a good amount of fiber (Gunnars).
People can also become resistant to the hormone leptin, another possible cause of weight gain. Leptin is responsible for reducing appetite when the body has a sufficient amount of fat stored. However, in obese individuals, leptin cannot be registered by the brain because it is unable to cross the blood-brain barrier. This results in an unsatiated appetite, even with plenty of fat storage. Leptin resistance is the most common initiator of fat and weight gain that causes individuals to become obese (Gunnars).
The environment in which people live and work greatly impacts what they eat, and in turn, the likelihood of becoming obese. This includes both physical and social surroundings, such as living as a family, being at work or school, and where a person lives (Toxic Food Environment).
Families influence the way their children eat in several ways. The foods provided at home impact what children will like as adults. Eating together as a family influences a healthier diet for the child if the parents provide fruits and vegetables at the dinner table. However, some low income families cannot afford to buy healthier foods such a fruits, vegetables, and whole grains, and the unhealthier options such as pre-made meals are much cheaper and convenient. Many low income parents are single, working full time, and do not have the time to cook healthy meals (Toxic Food Environment).
The workplace of adults also has an effect on food choices and likeliness to gain weight. Usually, unhealthy options from vending machines, or the huge box of donuts a co-worker brought in, are readily available to be consumed. Stress and fatigue from too much work can also cause people to exercise less and work more, which leads to less calories being burned and potential weight gain (Toxic Food Environment).
While the workplace environment affects the diets of adults, the same goes for children in school. Many schools, albeit having a National School Lunch program, do not have the healthiest choices for kids. Junks foods are sold outside the National School Lunch program, making them known as competitive food. These may include chips, candy, and sugary drinks that many kids are drawn towards (Toxic Food Environment).
The neighborhood where one lives also affects the accessibility of food. Many people, mostly low-income families, are located in food deserts, or areas with limited access to supermarkets. Instead, they have greater access to convenience stores, which usually do not have as much variety as supermarkets and contain mostly processed foods (Toxic Food Environment). This leads to people in food deserts having less nutrient dense diets. There is a great need for healthier options to be accessible to everyone.
Another factor that could be contributing to the obesity epidemic is the way our society treats obese people. There has long been a stigma that people who are obese are lazy, unmotivated, and careless. But this is not always the truth. Putting down obese people only makes them feel badly about themselves and exacerbates the problem. A study done by Brenda Major and others demonstrates the effects of such a weight stigma on women. Women were randomly selected to read an article that was either related to weight stigma or something completely unrelated. Overall, the women who were exposed to the weight stigma article felt worse about themselves and were therefore less motivated to make changes. In particular, it made women who felt they were overweight consume more calories. So, weight stigma is not motivating people to change themselves, but only making them feel more hopeless.
The weight stigma is also evident in the health care system. Many doctors are guilty of not taking their obese patients seriously when they have a problem, assuming they just need to lose weight to feel better. Take for example, Sarah Bramblette's experience with a doctor when she started experiencing hip pain. Sarah was over four hundred pounds, and when the doctor came to assess her hip issue, he said, Let me cut to the chase. You need to lose weight. Without any further examination other than her physical appearance, he wrote down on her list of symptoms obesity pain. Sarah was dumbfounded. She made an appointment with another doctor, one who actually diagnosed her, and discovered she had a scoliosis progression (Kolata, Why Do Obese Get Worse Care?).
A study performed in 2001 at the Texas Medical Center of Houston provided evidence that doctors do not treat overweight and obese individuals the same as patients who are not. 122 physicians were evaluated on how they treated average weight, overweight, or obese patients, all of whom had the same ailment. The results were that the physicians spent less overall time with the overweight and obese patients than the average weight ones (Hebl). With obesity rates continually growing, physicians need to change the way they view obese or overweight individuals, and start taking their needs as seriously as any other patient's.
Additional problems affect the quality of medical treatment obese people receive. One of these problems is that there are no calculated dosages of medication for obese people. All of the dosage guidelines are assumed for people at a healthy weight. Another is that the majority of MRI's are not large enough to contain an obese person, forcing doctors to have to give up the diagnosis. Lastly, many procedures are not done on obese people. For example, surgeons are not willing to perform knee surgeries on people with a BMI over 40. This is because working on heavier individuals increases the chance of a surgical complication, and doctors don't want to risk a negative effect on their surgical success rate. This situation is not ideal when the majority of people with joint problems are overweight or obese. All of these roadblocks to treatment are not fair for obese people, and changes must be made to accommodate their needs (Kolata,Why Do Obese Get Worse Care?).
Despite the bad rap obesity has for increasing the risk of certain health implications, it is actually possible for a person to be classified as obese and still be metabolically healthy. In other words, their metabolism, or the rate the body burns calories through the chemical processes that occur within, is at a normal, healthy rate. These individuals are defined as MHO, or Metabolically Healthy Obese. One possibility of being considered MHO is if your BMI is above 30, but you are muscular and physically fit. Positive lifestyle habits, such as a nutrient rich diet, exercise, not smoking, and a moderate consumption of alcohol can play a role in a person's categorization as metabolically healthy obese. Currently, there are no specific criteria for classifying MHO. Some possible ways to determine MHO could include one's waist circumference, blood pressure, cholesterol, and blood sugar levels, insulin resistance, and physical fitness. Approximately thirty-five percent of obese people are classified as MHO (Nordqvist). This is quite a lot of the obese population, so it would be important to know how to distinguish the difference between the metabolically healthy and the metabolically unhealthy. Such knowledge could result in a better understanding of how to treat obesity.
The way many obese people approach weight loss is another issue with the obesity epidemic. It is common for people to lose weight too quickly, as can be seen on the television show America's Biggest Loser. Kevin Hall, Senior Investigator at the National Institute of Health in Washington, was interested in seeing what happened to the Season 8 contestants post show. Hall monitored their weight and metabolic rate for 6 years after the end of the show, and the results were shocking.
Most of the contestants had gained back much of their original weight, some even more. Not only that, but their metabolisms were slower than when they first started (Kolata, After the Biggest Loser).
Danny Cahill, the winner of Season 8, lost a whopping 239 pounds, going from 430 pounds down to 191. However, in the years after the contest, the pounds came back rather quickly. After the six-year study, Danny had gained back 100 of the pounds he had lost, ending at 295 pounds with a decreased metabolism, burning about 800 calories less than the average person his weight. Why, after all his hard work, did the pounds just pile back on? (Kolata, After the Biggest Loser)
It seems that Danny's body is fighting back against the damage he has done by losing an extreme amount of weight in a short period of time. The more successful you are at losing weight, the slower your metabolism will be, and the more hungry you'll be, says Hall. As Danny lost weight, his metabolism decreased, making it very difficult to maintain the final weight he achieved. Levels of the hormone leptin, responsible for controlling hunger, also decreased, making Danny feel extremely hungry on the low calorie diet that was necessary to maintain his new weight.
To avoid feeling constantly hungry, Danny had to eat more food. But, with such a lowered metabolic rate, his body could not maintain his new weight, so he continued to put on more pounds (Kolata, Biggest Loser). It's like asking someone to hold their breath, you can do it for awhile, but it's very difficult to do it for much longer than a minute or two, Hall explains.
Some scientists believe the body goes through a famine mechanism, in which the body responds to rapid weight loss by reducing metabolic rate and leptin levels in an attempt to hold onto and put back on as much weight as possible to return the body to homeostasis. The body reacts as if it were in an extreme crisis with limited availability of food, lowering the metabolic rate and leptin levels as a mechanism of survival (Kolata, Biggest Loser). The metabolisms of the Biggest Loser contestants had no time to adjust to the extreme caloric deficit they experienced.
Rebecca and Daniel Wright, two other Biggest Loser contestants who also gained weight back post show, have a new plan of action to keep the weight off for good. Instead of dramatically reducing calories right away, they are gradually reducing the number of calories they eat per day. This way, their bodies are adjusting slowly to the change in diet without registering it as as a threat to survival.
Besides a gradual decrease in calories, other advice for successful weight loss recommended by Susan Biali, M.D., is to avoid extreme dieting, enjoy the foods you eat, and make realistic changes you know you can make a part of your lifestyle. Extreme dieting, like what was done on America's Biggest Loser, has a yo-yo effect, and is not sustainable. It only promotes stress and deprivation, and makes the dieter feel as if they failed.