Fat: Fighting the Obesity Epidemic [Hardcover]

There is more that we do not know about obesity than we do know. Despite this, obesity is a rapidly increasing problem in the United States. From 1991 to 1998, the U.S. population that is obese (more than 30 percent overweight) grew from 12 percent to 18 percent. Studies suggest that this trend, as alarming as it is, hides the severity of the problem, because many people understate their weight in surveys.

Weight is affected by environment, genes, and behavior. Little is known about how the three interact with each other. The author argues that the current growth in obesity mainly relates to an environment that is getting less and less healthy rather than some sudden negative change in genetic make-up or intentional behavior. He also does not suggest any specific solutions.

Many people do not understand that the process of losing weight often causes the body to burn fewer calories. So you have to feel like you are literally starving to death to lose weight past a certain point. That point is your "set point" and we each have a different one. For many overweight people, that set point is well above the weight that the physicians encourage. So many overweight people aren't "indulging" themselves more than thinner people, they just have a different body chemistry. So remove those value judgments when you see overweight people. Give them a hug instead.

The other flaw in thinking about weight is that that being overweight is the cause of many diseases like heart disease and diabetes. Recent research suggests that the connections are not always linear. Being overweight is sometimes a symptom of some other problem, rather than the cause of the disease.

The main weakness of this book is that it does not include the work described in Sugarbusters! and Live Right for Your Type that suggest a role for the mix of foods you eat as affecting your weight level. Mix of foods is referenced, but mostly in the context of behavioral treatments for overweight that emphasize creating aversions for certain foods.

Hearing about how scientists have worked on this problem makes me feel pretty discouraged. My suggestion is that only obese scientists work on overcoming obesity. At least they will have a bodily experience as a reference point. In picture after picture in this book, the pioneers of obesity research are displayed as extremely trim individuals.

After you read this book, I suggest you think about the problems of discrimination that obese people face. How can those barriers be lowered? How can the emotional pain of being obese be reduced? I suspect that the harm in these two areas is even greater than the health harm associated with obesity. That's the real epidemic!

Live comfortably with your body!

Fat is not a guide to weight loss for individuals. The research is very discouraging for anyone currently obese -- most studies show that weight can be lost, but no one knows how to help people keep it off. However, Pool discusses some of the research that investigates why people cannot keep off weight they lose, including studies demonstrating that those who lose wait not only have slightly slower metabolisms, but they also burn fewer calories through fidgeting, etc.

Pool also discusses obesity from a public health perspective. Given that losing weight and keeping it off is so difficult once one becomes obese, he argues that some effort should be paid to keeping the population from becoming obese in the first place. In this discussion, he looks at studies examining when and how various populations became obese. Such studies -- like that of the obesity difference between Pima groups in the US and Mexico -- provide clues for how the current environment could be modified to prevent some obesity.

Seems reasonable enough.

Reasonable, that is, until you visit a medical library and read what these successful losers are actually doing. They are consuming an average of 850 to 1990 calories daily and burning off, through exercise, an average of 400 to 500 of those calories, seven days a week. Which means these folks are living on anywhere from 450 to 1500 calories a day and burning off the balance with exercise that is the equivalent of a daily 4 mile walk. Given the intensity of this regimen, it's not too surprising that the total enrollment of the Registry is only a few thousand; a few thousand out of a population of hundreds of millions. Whatever else the successful losers are, they are rare.

Though Pool admits that the "eat less, exercise more" programs have not worked, the National Weight Control Registry findings seem to boil down to "eat way less, exercise way more." It is difficult to imagine how society could be transformed to help the potentially overweight to eat way less and exercise way more without hopelessly inconveniencing and/or starving those for whom weight will never be a problem. This difficulty provides the foundation for Pool's call to action. Are we up to the challenge of reshaping our environments to fit us or will we continue to allow the environments we have created to deform us? While this is an admittedly tough call, I think it's a safe bet that we'll continue to allow the environments we've created to deform us.