[Muffie's Mom]

Obesity. Is it an eating disorder?

Like most things, obesity is a complex phenomenon about which it is dangerous to generalize. What is true for one person is not necessarily true for the next. Nevertheless, we shall try to make sense out of conflicting theories and give answers to people who struggle to maintain self-esteem in a world that seems to be obsessed with youth, thinness, and the perfect body -- whatever that may be.

What is obesity?

A person with anorexia nervosa may define obesity as a weight gain of five pounds, from 89 to 94. A grandmother past menopause may call herself obese because she carries 165 pounds on her large-boned, muscular body. A modeling agency may talk about obesity when one of the women on the payroll puts 135 pounds on her 5'10" body.

None of these women is clinically obese. The anorexic and the model are underweight.

Men are split in their personal definitions of obesity. Many are just as concerned about overweight as women are, while others, frankly rotund, believe they are just fine, perfectly healthy, and universally attractive to potential romantic partners.

Clinically, obesity is described in terms of Body Mass Index, a more accurate measure than weight alone. A healthy BMI is 19-24. Simple overweight is a BMI of 25-29. Obesity begins at a BMI of 30. Morbid obesity begins at a BMI of 40. Super morbid obesity begins at a BMI of 50, and super-super morbid obesity begins at a BMI above 60.

(To learn your Body Mass Index, use the simple calculator provided by the Obesity Education Initiative.)

How many Americans are obese?

A 1999 study reported by the Centers for Disease Control and Prevention indicates that sixty-one percent of adults in the U.S. are overweight. A breakdown of that figure shows that thirty-five percent are slightly or moderately overweight, and that twenty-six percent are obese or super obese. In addition, about thirteen percent of U.S. children are overweight or obese.

Another government study published in October, 2002 indicates that thirty-one percent of the American public is obese. It further suggested that fifteen percent of young people between 6 and 19 are seriously overweight. Even ten percent of toddlers between 2 and 5 are seriously overweight. The study appeared in the Journal of the American Medical Association (10/9/02).

A more recent study indicates that about 31 percent of American teenage girls and 28 percent of boys are somewhat overweight. An additional 15 percent of American teen girls and nearly 14 percent of teen boys are obese. (Archives of Pediatrics and Adolescent Medicine, January 2004) Causes include fast food, snacks with high sugar and fat content, use of automobiles, increased time spent in front of TV sets and computers, and a generally more sedentary lifestyles than slimmer peers.

The prevalence of overweight and obesity is increasing in all major socioeconomic and ethnic groups, including children and younger adults between 25 and 44. (David Sacher, U.S. Surgeon General, December 2001)


What are the causes of obesity?

Too many calories.

Consumption of more calories than are burned through work, exercise, and other activities will lead to overweight and obesity.

In the late 1990s, Americans ate about 340 more calories per day than they did in the mid-1980s, and about 500 more calories per day than in the 1950s.

The extra food was often some kind of refined carbohydrate (white flour or sugar) combined with fat, saturated fat in the unhealthiest cases. (University of California Wellness Letter, January 2002)

Too much good food, too little activity.

A major factor leading to obesity is the ready availability in developed countries of inexpensive, tasty, food in combination with a sedentary lifestyle, including desk jobs and time spent watching TV, using a computer, and other "activities" that require little or no physical effort.

Restaurant food and fast food.

People who can afford to do so are eating out more often than ever before. Restaurants and fast food outlets offer much larger portions than they used to. The amount of home cooked food eaten with family around the dining room table has decreased, but portion size has increased. Food prepared at home offers the easiest way to make healthy choices about fat, sugar, salt, and so forth, but in today's world, convenience often wins out over a home cooked meal.

Food used as medicine.

Some people attempt to numb or escape emotional pain and distress by eating.

For various emotional reasons, including loneliness, boredom and depression, some people eat when their bodies do not need food, but the "fix" is only temporary so they continue to consume food.

Look elsewhere on our Web site for more information about compulsive eating or binge eating disorder.

Diets and prolonged caloric restriction.

When people try to make the body thinner than it is genetically programmed to be, it retaliates by becoming ravenous and vulnerable to binge eating.

Ninety-eight percent of dieters regain all the weight they manage to lose, plus about 10 extra pounds, within five years.

Yo-yo dieting repeats the cycle of weight loss followed by ever-increasing weight gain when hunger ultimately wins.

Medical problems.

Some individuals are obese because of biological problems such as malfunctioning thyroid or pituitary glands.

Others may have physical problems or disabilities that severely limit or prohibit exercise, strenuous work, and other physical activity.

Genes.

Studies published in the New England Journal of Medicine (March 2003) indicate that certain genetic factors are important and powerful underlying contributors to the development of obesity and binge eating.

Too much stress.

New research suggests that there is a biological link between stress and the drive to eat.

Comfort foods -- high in sugar, fat, and calories -- seem to calm the body's response to chronic stress.

In addition, hormones produced when one is under stress encourage the formation of fat cells.

In developed countries, life tends to be competitive, fast paced, demanding, and stressful.

There may be a link between so-called modern life and increasing rates of overeating, overweight, and obesity.

(Study to be published in Proceedings of the National Academy of Sciences. Author is Mary Dallman, professor of physiology, University of California at San Francisco [2003].)

Too little sleep.

Recent studies suggest that sleep deprivation (anything less than 7-9 hours per night) can contribute to obesity.

Bodies that aren't rested produce less than optimal amounts of leptin, a hormone that regulates appetite, leading to increased cravings for candy, other sweets, and salty carbohydrates like chips and french fries.
(Source: David Rapoport, MD, director of the sleep program at New York University School of Medicine. Reported in Health on Parade; August 28, 2005)

Researchers believe that in most cases obesity represents a complex relationship between genetic, psychological, physiological, metabolic, socioeconomic, lifestyle, and cultural factors.



Miscellaneous factors associated with obesity
The children of overweight parents are more likely to be overweight than the children of thin parents.

If friends and family members offer comfort in the form of food, people will learn to deal with painful feelings by eating instead of using more effective coping strategies.

Poor folks tend to be fatter than the affluent.

People living in groups that frequently celebrate and socialize at get-togethers featuring tempting food tend to be fatter than those who do not.

Even artificial sweeteners are implicated in weight gain and obesity. In a recent study at Purdue University, rats that were given artificial sweeteners ate three times as many calories as rats given real sugar. Researchers hypothesize that the engineered sweeteners interfere with the body's natural ability to regulate food and caloric intake based on the sweetness of different foods. ("A Pavlovian Approach to the Problem of Obesity," International Journal of Obesity, July 2004)

Some individuals eat great quantities of food, exercise moderately or not at all, and never seem to gain weight. Others walk past a bakery and gain ten pounds. No two people are the same, and no two obesity profiles are identical.