Trouble Losing Weight?

The safest exercise is simply walking.

Dr. Theodore Van Itallie is a professor at Columbia University's medical school who has gained international fame for his work in nutrition.

Reprinted from U.S. News & Worlds Report, July 22, 1974.

Dr. Theodore Van Itallie is a professor at Columbia University's medical school who has gained international fame for his work in nutrition. He is associate director of the university's Institute of Human Nutrition and chairman of the National Academy of Science's committee on clinical nutrition.

In the accompanying interview, Dr. Van Itallie makes it quite clear that it is becoming increasingly apparent that dieting alone is not an adequate approach to weight control. The current focus is on modifying the overweight individual's way of life permanently in order not only to take pounds off but to keep them off.

This same philosophy and approach underlies the recently developed Wa-Rite weight control program produced and distributed by the General Conference Department of Health. The twelve-week Wa-Rite program is followed by a Sta-Rite program consisting of once-a-month follow-up meetings that extend over a three-month period.

The Wa-Rite program combines a 1200-calorie diet, daily exercises, and group action commitment, with an emphasis on physical, mental, social, and spiritual health. Those attending meet each week in small groups in order to reinforce and support one another, making specific commitments as to weight loss. At the next Wa-Rite pro gram they report to the group as to whether or not they have kept their commitment.

Interest in the program is also festered by the use of several slide-tape programs produced by the Loma Linda University School of Health and the "Weighing What You Want to Weigh" films produced by the General Conference Temperance Department. Early in the program a film entitled Fat Fighters is used to build an understanding of the benefit of group action commitment.

The program encourages a weight loss of one to two pounds a week. Those participating in the initial pilot Wa-Rite program held in the Beltsville, Maryland, Seventh-day Adventist church reported weight loss of from ten to thirty-five pounds.

A control booklet similar to the familiar Five-day Plan control booklet is given to all attending, and weekly sections are added throughout the pro gram. The control booklet and instructor's manual are available from the General Conference Health Department. Write for additional information to Ella May Stoneburner, Health Department, 6840 Eastern Avenue NW., Washington, D.C. 20012.

 

Q. Dr. Van Itallie, it seems that new diets are con stantly being proposed to help people lose weight. Is there really anything new and useful on the scene?

A. I don't think obesity is a problem that is going to be solved by diet. Otherwise, it would have been solved long ago. It isn't like many other nutritional problems that can be solved simply, like taking vita min C to cure scurvy.

The answer to obesity lies in focusing on the individual and his environment, rather than simply on dieting. Here, the most exciting new development in treating obesity is in behavior modification.

Q. Just what is that?

A. This method is based on the concept that the obese individual probably does not suffer from some subtle metabolic disorder, but suffers rather from a disorder of eating-and-exercise behavior. His life style and his approach to food favor the accumulation of excess calories in the form of fat. What certain scientists have done is analyze the eating behavior of obese patients very carefully and identify those areas that need correcting. The focus, then, is not on the diet per se but on the patient.

Q. Has a pattern of poor eating behavior emerged from these studies?

A. When we know more about it, there may be such patterns. At the moment, this approach is still in a research stage of development, and the emphasis is on individual patients. Of course, it's an expensive and time-consuming process because changing a person's behavior is very difficult.

Q. How does controlled eating behavior differ from dieting?

A. There are some people, let's say, who eat a normal breakfast and lunch but then come home at night and eat an enormous dinner, after which they sit in front of the television and nibble until midnight. During that time, they've taken in a huge number of calories.

Others will find themselves going on eating binges when they are angry, suffering from anxiety or are depressed. There's excellent evidence that changes in eating behavior are related to emotional states. They're also related to food cues in the environment.

Q. What are food cues?

A. They may be the sight or smell of food, an advertisement for food, a window display or anything of that sort. Some obese people may be exquisitely responsive to these external cues, but be less responsive to internal cues such as hunger pangs or the sensation of fullness that comes after eating. These individuals tend to be manipulated by the cues in their environment. ^They're constantly succumbing to temptation.

Q. How does behavior modification help this problem?

A. Sometimes it helps just to understand yourself. If you know that when you are angry you tend to eat more, you might train yourself to run around the block or do something else other than eat in response to this emotional state.

Experts in behavior modification may teach very fast eaters, who also tend to overeat, to put their fork down after each mouthful and to eat only at the dinner table—not in front of the TV set.

In extreme cases, the obese patient may give the therapist something he values very much. The therapist will not give it back until the individual has fol lowed his new behavior program. In a sense, some thing is given up as a hostage for the patient's good behavior.

Q. Doesn't that smack of "Big Brother" treatment — someone manipulating another person's mind?

A. The difference, I think, is that the patient seeks help, and this seems to be an effective way of helping him. Put it like this:

You don't change the individual by changing his diet; you change his diet by changing him. It has taken a long time for scientists interested in obesity to come to this point, but, looking back, it seems to be a logical development.

Q. How many people in this country are regarded as being overweight?

A. It depends on how you define obesity. If you use life-insurance statistics, which are keyed to life expectancy, an estimated 6.7 million persons, or about 5 per cent of the adult U.S. population, could be called overweight. One out of 3 men ages 50 to 59 is 20 per cent or more above his "best" weight.

Q. How can an individual determine whether he's too fat?

A. A good rule of thumb is figuring how much heavier you are now than you were at the age of 22—assuming you were lean at 22. We also can measure body fat by pinching the skin at certain points. But the usual method is to use standard tables based on height, weight and age.

Is obesity a problem largely confined to middle-aged or older people?

A. Not at all. I don't recall the statistics, but certainly there are far too many young people who are obese.

Perhaps this is the time to mention there is growing evidence that there are two major types of obesity: One is the kind that develops during childhood, called "juvenile-onset obesity," and the other type develops in adulthood and is called "adult-onset obesity."

Q. What causes these two kinds of obesity?

A. Both may be caused by excessive food intake, but the implications may be somewhat different. For ex ample, there is good evidence for a genetic factor in obesity. This may express itself in childhood, so that children of obese parents are much more likely to become obese. Whether this is purely genetic or reflects, in part, eating patterns in the home is not established.

Q. Are fat children more likely to grow into fat adults?

A. Yes. The old notion that a plump child is a healthy child is not one that most pediatricians would sub scribe to now. Children fed excessive amounts of food at certain critical times in their development may grow not only larger fat cells but a larger number of fat cells. This may make it more difficult for them to control their weight later.

Q. What are these critical states in a child's life in which overfeeding should be particularly avoided?

A. Very early in life, apparently—before the age of 2 —and then from the years 10 to 16.

 

Q. So it may not be a good idea for parents to insist that Junior clean his plate ——

A. In some cases, it may be a bad idea, particularly in children who already have a genetic predisposition to obesity.

Q. Do some people put on weight more easily than others, even if they're all on the same diet?

A. They seem to. Evidence indicates the important variable here is energy expenditure—differing levels of physical activity. The concept that some people just can't avoid putting on weight is one that I'm not sympathetic toward at the moment.

Q. Is obesity a disease, or a symptom of something else?

A. It's both. Certainly it's a symptom of chronic caloric imbalance. It also can be a disease, in the sense that there is such a thing as abnormal distribution of fat that seems to exist apart from diet and over weight. Also, marked obesity may be a serious mechanical handicap.

Q. What are the health dangers of prolonged obesity?

A. These are still being debated. I think everyone would agree, however, that the life expectancy of very obese people is significantly reduced. Obesity also may precipitate diabetes in susceptible individuals or aggravate hypertension in people who have high blood pressure.

People who develop obesity in middle life—particularly men—may have a rise in blood triglycerides which may carry with it an increased hazard of heart disease. Fat in the diet and fat stored in the body is almost entirely triglyceride.

There is some association between obesity and heart disease, but it's not entirely clear whether this is because obese people are often more sedentary or because of the increased tendency of obese people to have diabetes, hypertension and so forth.

I'm convinced myself that obesity is undesirable from a health standpoint, but I would acknowledge that there's considerable debate as to how hazardous it is if it's only mild-to-moderate obesity.

Q. Is there a connection between obesity and a high cholesterol or blood-fat level?

A. There is not a strong correlation between obesity and cholesterol concentration. Generally speaking, lean people are as apt to have high cholesterol levels as fat people.

Q. Just what is cholesterol — a fat, similar to triglyceride?

A. No, triglyceride is a fat, but cholesterol is a fatsoluble substance. It's really what is called a "sterol."

Although both cholesterol and triglycerides are members of the "lipid" family, the two do not necessarily behave alike. A person may have elevated triglycerides and normal cholesterol, or the other way around.

Q. There seems to be controversy over whether cholesterol is really related to heart disease ——

A. There's no question that there's an association between high cholesterol levels and an increased risk of heart disease. American males, particularly, should look very carefully at the possible disadvantages of overloading themselves with cholesterol and saturated fats. They should be examined frequently to determine whether they have elevated blood lipids— fatty substances in the bloodstream.

Of course, this is only part of the picture that also includes high blood pressure, heavy cigarette smoking, physical inactivity, undue emotional stress, and so forth.

Q. How does the cholesterol content of the body get too high?

A. There are some people who seem to be genetically predisposed to making more cholesterol. But with most, it is a matter of eating a diet that is high in cholesterol and saturated fats. . . .

Q. Then you recommend a cholesterol-lowering diet?

A. I wouldn't want to recommend a single diet for everybody. Many people do not need cholesterol-lowering diets. I do subscribe to the notion that we should consume less calories, and certainly I don't' think it's desirable to stuff ourselves with saturated fats, in view of what we know about elevated blood cholesterol.

I believe in a moderate approach to diet. The important thing is that the diet provide an adequate sup ply of nutrients as defined by the Food and Nutrition Board of the National Research Council.

Q. Getting back to losing weight. Dr. Van Itallie: Which is more important — diet or exercise?

A. Both are very important, but diet is essential. The problem is to change your life style so that less calories and more physical activity become normal parts of your life and not just something you're going to do for a short period of time.

Losing weight is not just a matter of taking weight off, but maintaining one's lean state. That requires eternal vigilance and a change in your habits.

Q. What sort of exercise do you suggest?

A. I would caution against any self-prescribed, sud den and strenuous exercise for middle-aged men. The safest exercise is simply walking. You can control the speed at which you walk, and you can walk on level ground or uphill. The faster you walk, the more calories you expend.

Bicycle riding is another good exercise because you can go at your own rate of speed.

Q. What about jogging?

A. A middle-aged man thinking of jogging should consult his physician first. I don't believe the evidence that exercise is going to prolong life is so good that people should punish themselves.

Q. Is dieting a question of simply eating less, or of avoiding certain foods?

A. Each person has his own dietary problem. Some people are just inherently unwilling or unable to count calories, so they may have to develop certain techniques to restrict their food intake. They may do this by cutting out certain foods, which makes it unnecessary for them to count calories.

If you are accustomed to taking highly concentrated foods, like milk shakes, obviously that's the kind of thing to cut out. Some may have to avoid cake, and others might have to stay away from bread and butter. . . .

Q. How rapidly should a person try to lose weight?

A. For the average person, about one third of a pound a day or 2 pounds a week is a reasonable rate of weight loss. Here I am really talking about loss of body fat.

Now, you may lose weight more slowly as reduction programs continue. The body begins to resist further loss in weight somewhat. The thing is: People get discouraged. Their expectations frequently are too high.

When you read advertisements of incredible amounts of weight lost in a short period of time, that cannot be loss of fat. It has to be loss of water from the body, and that is not desirable. . . .

Q. Can some popular diets be dangerous?

A. Yes. Some diets will induce weight loss through excessive loss of water or protein.

Good weight loss is the loss of body fat, primarily, with a minimum loss of body protein and without untoward physical or psychological effects. . . .

Q. Why is it that people never seem to tire of trying new diets, new ways of losing weight?

A. There seems to be a public hunger for any easy solution to problems, and weight is one of them. Besides, a new diet is something to talk about; it helps relieve the monotony of existence.

One expert has put it this way: Most obese people don't seek treatment. Of those who do seek treatment, most do not remain in treatment. Of those who lose weight, most do not lose substantial amounts. And of those who lose substantial amounts, most re gain the weight they lose.

Q. Then there is no magic diet to lose weight easily ——

A. No, absolutely not. This is clearly demonstrated by the fact that the world has seen innumerable diets. They've come and gone.

The problem, as I said, is not the diet; it's the person.


Ministry reserves the right to approve, disapprove, and delete comments at our discretion and will not be able to respond to inquiries about these comments. Please ensure that your words are respectful, courteous, and relevant.

comments powered by Disqus

Dr. Theodore Van Itallie is a professor at Columbia University's medical school who has gained international fame for his work in nutrition.

January 1975

Download PDF
Ministry Cover

More Articles In This Issue

The Timely Twelve

On the minor prophets.

Stuck in the Sticks?

Contemplating a call.

Good-by to the Confessional?

Revised Rites for the Roman Catholic Sacrament of Penance

Play the Man!

God and the Church Challenge You

The Saviour and His Sabbath

Jesus condemned legalism. He swept away the senseless casuistic restrictions of the Jews.

"Return, O Israel"

The Timely Twelve——1

Wonders of the Ancient World

A ministerial intern relates his oversees experience.

"Position" or "Responsibility"

The Local Church Elder

Breaking Up the Monotony of Our Services

Involving church members in the life of the church.

View All Issue Contents

Digital delivery

If you're a print subscriber, we'll complement your print copy of Ministry with an electronic version.

Sign up
Advertisement - SermonView - Medium Rect (300x250)

Recent issues

See All
Advertisement - SermonView - WideSkyscraper (160x600)