Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Overweight: What's the Problem? despite the Growing Awareness of Growing Waistlines in the United States, the Solution Seems to Go beyond Eat Less, Exercise More. Hbo's "Weight of the Nation" Miniseries Made the Case for the Dangers of Overweight and Obesity, but Many Experts Say Shaming and Blaming People Carrying Extra Pounds Isn't the Answer. They Say Good Health Habits Get the Best Results

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Overweight: What's the Problem? despite the Growing Awareness of Growing Waistlines in the United States, the Solution Seems to Go beyond Eat Less, Exercise More. Hbo's "Weight of the Nation" Miniseries Made the Case for the Dangers of Overweight and Obesity, but Many Experts Say Shaming and Blaming People Carrying Extra Pounds Isn't the Answer. They Say Good Health Habits Get the Best Results

Article excerpt

The United States is well into its fourth decade of the "obesity epidemic," and no matter how loudly we repeat the refrain "eat less and exercise more," the numbers on our collective scale keep creeping upward.

Is weight gain caused by individuals' poor diet and lack of exercise? Or is it an unavoidable effect of an abundant food supply, out-of-control marketing and unlucky genetics? And if most of the evidence points to the latter, why do government agencies continue to use tax dollars to promote solutions that have no hope of working?

In May, HBO aired "Weight of the Nation," a miniseries produced with the Institute of Medicine, the Centers for Disease Control and Prevention, and the National Institutes of Health. The four-part series made an impassioned case for the dangers of overweight and obesity, and the need to act now before it is too late for a generation of Americans.

The campaign was intended to start a national discussion about weight and health, but the responses have been mixed, as many nutritionists and public health activists have called the miniseries out for its "fat-shaming" rhetoric and emphasis on individual responsibility.

A weighty history

In "Calories and Corsets: A History of Dieting over 2,000 Years" (Profile Books, 2011), Louise Foxcroft surveys human beings' relationship with weight and body shape. While there is a long and rich history of fascination with body shape and the relationship between diet and health, only in the past 100 years has it turned into an unwieldy obsession.

The book is a British publication, but Ms. Foxcroft draws extensively on American studies, trends and policies. She traces the history of popular diets, from Fletcherism in the Edwardian era to Atkins in the '70s and then again in the early 2000s. "At the height of its popularity," writes Ms. Foxcroft, "it was estimated that 1 in 11 North American adults was on the diet."

Unfortunately, even diets that successfully promote weight loss seem to have little long-term success. Ms. Foxcroft cites a report by the American Psychological Association that examined 31 diet studies and "found that, after two years of dieting, up to two- thirds of dieters weighed more than they did before they began their regimen."

The National Weight Control Registry tracks approximately 10,000 people who have lost weight and kept it off. Established in 1994 by Rena Wing when she was at Western Psychiatric Institute and Clinic (she's now at Brown University's medical school) and James O. Hill of the University of Colorado, it "is the largest prospective investigation of long-term successful weight-loss maintenance," according to the registry website.

In a 2011 story in the New York Times Magazine, Kelly Brownell, director of the Rudd Center for Food Policy & Obesity at Yale University, pointed out that "while the 10,000 people tracked in the registry are a useful resource, they also represent a tiny percentage of the tens of millions of people who have tried unsuccessfully to lose weight."

Currently, two-thirds of Americans 20 and over are overweight -- approximately 150 million people -- and a third are obese. The United States weight-loss market was worth more than $60 billion in 2010, showing that Americans have spent a lot of money trying to slim down.

Although it seems we know little about how to successfully diet, the medical and scientific community tend to agree on the basics: Take in fewer calories than you expend, and you will lose weight.

But, as Ms. Foxcroft points out, we knew that 2,000 years ago: Hippocrates, the ancient Greek physician, "understood ... that high food intake meant that a lot of hard work was needed for it to be properly assimilated. A failure to balance an excess of either [food or exercise] would upset the body's metabolism and disease would surely follow."

In "Why Calories Count: From Science to Politics" (University of California Press, 2012, $30), Marion Nestle, a professor in the nutrition, food studies and public health department at New York University, and Malden Nesheim, professor emeritus and former director of the division of nutritional sciences at Cornell University, write, "Body weight is the net result of the balance between the calories you eat and those you use, store, put out, burn off or, more formally, 'expend' . …

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