The dangers of dieting

THE DANGERS OF DIETING

Winnipeg firefighter Gerardus Smit says that when he was born, he weighed a hefty 10 lb. – and he feels that he has been struggling to get his weight under control ever since. “I tried every diet under the sun,” said Smit, 43. “I’d lose weight, sure, but then I’d gain it all back.” Three years ago, Smit, who is five feet, 11 inches tall, weighed 240 lb. and needed size 44 trousers for his fireman’s uniform. Aware that his excess weight could endanger his life and that of his fellow firemen, Smit decided to try to lose weight permanently. He joined a Winnipeg chapter of a commercial weight-loss firm and began cycling up to 80 km a day. Now Smit weighs 180 lb. and is proud of his trim physique. Still, he says that his battle against surplus weight will never be over. “If I let myself slip,” said Smit, “I’d be back to 240 in no time.

Obsessed: Smit’s preoccupation with weight control is shared by millions of Canadians. Indeed, a survey released by Health and Welfare Canada last year showed that 45 per cent of Canadians over the age of 20 say that they want to lose weight. Women in particular seem to be obsessed with shedding weight. According to the study, 70 per cent of the women interviewed whose weight was considered normal said that they wanted to become slimmer, while 23 per cent of the women surveyed who were considered underweight for their age and height wanted to weigh even less. Across North America, the desire to be slim has spawned diet-related products and services that range from rapidly proliferating “lite” drinks and foods to private health clubs. Still, there is growing evidence that diets – and particularly fad diets promising quick cures – simply do not work.

Studies carried out in the United States and Canada in the past five years have shown that up to 95 percent of those who lose weight on crash diets regain all the lost weight – and put on more – within three years. Some dieticians and medical researchers now insist that dieting itself may actually be one of the causes of people becoming overweight. Health experts call it “diet-induced obesity.” Some specialists in the field say that, instead of dieting, the solution to obesity may lie in getting more exercise and “normalizing” eating habits. That can be as simple as eating three square meals a day – and abolishing snacks. Others contend that the health problems that have been associated with being overweight – including adult-onset diabetes, heart disease and certain kinds of cancer – have been overemphasized and that only those who are obese should worry about their weight.

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Concern: The concern that many North Americans feel about their weight has led to a sometimes-obsessive interest in the amount and type of food they eat. This is turn has fuelled a mounting debate about the role of cholesterol and other fats (page 55). For some people, an overriding concern with staying trim can have a darker side. Dieting can trigger eating disorders such as anorexia nervosa, an illness that can lead to death by starvation. Victims of bulimia, including, at one time, Canadian model Monika Schnarre, gorge themselves with food and then deliberately induce vomiting or use laxaties to purge themselves of unwanted calories (page 52). At the same time, the desire to have the right kind of body is persuading some people to try liposuction – a surgical procedure in which doctors use specialized vacuum equipment to suck layers of fat out of patients’ bodies (page 58).

Evidence of the fact that dieting has become something of a national pastime is abundant. Bookstores across the continent have shelves loaded with diet books ranging from The Express Lane Diet and The Nutrient-Free Diet to The Mediterranean Diet. According to Helen Babiak, a buyer for 215-store Coles book firm, dozens of new diet books have gone on sale during the past year, while old favorites such as the 1979 best-seller The Scarsdale Diet continue to sell briskly.

Jogging: As well, sales of diet foods have soared. Everett Holmes, Markham, Ont.-based vice-president of corporate affairs for A. C. Nielsen Co. of Canada Ltd., said that five product categories – low-calorie soft drinks, artificial sweeteners, calorie-reduced salad dressings, diet frozen dinners and low-calorie yogurts – accounted for more than $800 million il food stores’ sales between August, 1988, and August, 1989. Holmes said this amounted to a nine-per-cent increase in those same categories over the previous year at a time when retail food sales grew by a sluggish four per cent. At the same time, fitness-minded Canadians are jogging, buying exercise equipment and flocking to private health clubs to work off unwanted calories.

Still, most health experts now agree that some methods of losing weight may be, at best, futile – and, at worst, dangerous. They say that, for is that when a person embarks on a calorie-reduced diet, the body registers the fact that it is receiving less fuel. As a result, the body’s metabolism slows down so that the body can survive even on the reduced intake. The dieter may lose weight, temporarily. But when the diet ends, the person’s metabolism – still striving to protect the body from famine – does not return to its higher, pre-diet level of activity. Instead, the slower metabolism ensures that the body retains as much as it can of each calorie of food consumed.

According to some experts, that means that a weight gain is virtually inevitable when the diet ends. As well, if a dieter attempts other diets, the metabolism slows a little more and the body’s set point – the weight that a person can naturally maintain with moderate exercise – is raised. Said Patricia Perry, director of the Toronto-based Eating Disorders Clinic Inc.: “When you keep going through this yo-yo dieting, you never lose quite as much and you gain just a little bit more.”

Many researchers now believe that lack of exercise may be as much to blame for obesity as overeating, because it is through exercise that the body burns off the calories taken in by eating. Indeed, a recent study of 141 middle-aged women carried out at the Harvard University medical school in Cambridge, Mass., showed no connection between calories eaten and weight. Said Dr. Meir Stampfer, one of the team of physicians who conducted the study: “Videos have been made of kids playing volleyball. The lean kids jump all over the place while the fat ones just watch the ball sail over their heads.”

Pressure: Some health professionals say that there may be psychological, as well as physical, reasons for dieters regaining more weight than they have lost. Peter Herman, a professor of psychology at the University of Toronto and a leading diet researcher, says that chronic dieters eventually lose their ability to determine how much they need to eat. When people diet, said Herman, they impose artificial inhibitions on the impulse to eat. But once the pressure of the diet is relaxed, said Herman, the controls disappear as well. Added Herman: “People who never diet know when they’re full.”

Aided by the new insights into obesity and rapidly expanding weight-reduction programs, overweight Canadians are increasingly winning their battles with fat. Diane Leader of Truro, N.S., first put on weight in the 1960s when she was pregnant with her two children. During the next 20 years, she experimented with the then-fashionable grapefruit diet, high-protein diets and a banana-and-lettuce diet. “Some of them I couldn’t stay on for more than 48 hours,” said Leader, who is five feet, one inch tall and – at her heaviest in 1962 – weighed 225 lb. Finally, in 1976, she joined a local chapter of the successful New York City-based Weight Watchers program and brought her weight down to 115 lb. Now 46, Leader has been able to keep her weight under control with the help of better nutrition, exercise and group support. The trouble with ordinary diets, said Leader, is that “when you say you’re going on a diet, that means you’ll also go off it.”

John Ives, a 46-year-old Charlottetown real estate broker who is six feet tall, decided to lose weight last year after tipping the scales at 245 lb. Ives and his wifd, Gail, who wanted to lose 50 lb., joined a commercial weight-loss program that offered counselling and prepackaged foods. After a year, John Ives lost 45 lb., although his wife would not reveal her weight loss. “Gail and I had bedn eating out as much as food and rich desserts. I felt great and got a charge out of people’s reaction.”

Commitment: Winnipegger Iris Walsh, 47, says that she has struggled with her weight all her life. Growing up in Montreal in a traditional Ukrainian Catholic home, recalled Walsh, “I was fat from the time I was 6. I grew up thinking I was a second-class citizen because I had a weight problem.” When she was 18, Walsh began dieting and lost 40 lb. in about four months. But, she said, “I ended up gaining it all back in two months.” In 1968, Walsh joined Weight Watchers and lost 60 lb. Now, as head of Weight Watchers in Manitoba, Walsh is struggling to lose weight again. Walsh says that she knows now that keeping her weight under control has to be a lifelong commitment.

While theories about obesity and methods of controlling weight have been changing, so have popular notions of just what kind of weight is desirable. The voluptous ideal embodied by Marilyn Monroe during the 1950s gave way to the wraith-like thinness of the British model Twiggy during the 1960s, and then to the slender-but-athletic image represented by models Cheryl Tiegs during the 1970s and Paulina Porizkova in the 1980s. Now, the popularity of television’s tempestuous but fat Roseanne Barr, star of ABC’s Roseanne, may be helping to once again alter popular conceptions of what is attractive.

Indeed, most experts in the field say that the right weight for each individual depends on a complex interplay of factors involving heredity, physique and personality. To help Canadians determine what their weight should be, Health and Welfare Canada last year recommended a Body Mass Index in which weight divided by the square of a person’s height relates to a broad range of acceptable weights for most adult Canadians. Typically, a five-foot seven male or female could weigh from about 130 lb. to 160 lb. Said Nancy Schwartz, president of the Ottawa-based National Institute of Nutrition. “Most health professionals are trying to move the focus away from a single `right’ weight to a range of weights that are consistent with emotional and physical health.”

Risk: At the same time, new research findings suggest that when it comes to health risks, the location of body fat may be more important than a person’s total body weight. Jean-Pierre Despres published in the March/April issue of the journal of the American Heart Association, women who have a high proportion of their body fat concentrated in the abdominal area have a higher risk of contracting diabetes and heart disease than women who carry the bulk of their body fat on their legs and hips. “If the amount of abdominal fat is low,” said Despres, “the women tend to have a normal health profile, even if half their body weight is fat.”

Despres recommends a simple method for determining the distribution of body fat by measuring waist size at the navel and dividing that by the width around the hips at their widest point, including the buttocks. Women begin to be at risk, says Despres, if the resulting ratio is above 0.8, while the ratio for men should not exceed 1. Despres said that he recommends the waist-to-hip ratio as a health indicator because it shows where fat is located. than women to have excess fat in their abdominal region – and as a result are more likely to suffer from heart disease.

There are some men and women who become so enormously overweight that health problems result, regardless of their body shape. Those are the individuals considered to be morbidly obese because they are more than 100 lb. overweight. According to Dr. Nicholas Colapinto, director of the obesity clinic at St. Michael’s Hospital in Toronto, the morbidly obese often face serious social problems, such as not fitting into theatre seats and being ridiculed on the street. Said Colapinto: “Their self-esteem is just about zero. They sit at home and they watch TV and they eat. That’s their existence.”

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Desperate: After years of unsuccessful dieting and other forms of medical treatment, some of them come to Colapinto for an operation of last resort – a surgical procedure known as stomach stapling, which drastically limits the amount of food the morbidly obese person can comfortably eat. During the operation, metal staples are inserted to allow only two ounces of food to enter a reduced part of the stomach per meal. According to Colapinto, stomach stapling has helped 90 per cent of the men and 70 per cent of the women operated on to achieve and maintain a significant weight loss. Added Colapinto: “These people are so desperate, and they’re so unhealthy, that in 1989 there’s nothing else to offer them.”

Benefits: For the vast majority of Canadians who want to lose 10 or 20 lb., such measures are not necessary. Indeed, a growing number have found that by concentrating on exercise that will burn off calories, they can lose weight or maintain their ideal weight. There are other benefits to being active. Prof. Roy Shephard, director of the University of Toronto’s school of physical and health education, says that exercise can temporarily set the body’s metabolism higher, so that even when the activity is over, the body still burns calories at a higher rate. According to Shephard, exercise can even help to counteract the depression caused by low blood sugar levels that many people feel when they are dieting. He said that, during exercise, the body releases a type of hormone known as catecholamine, which binds to fat cells and stimulates their breakdown. Moderate exercise is more important than all-out vigorous exercise, said Shephard, because it draws on the body’s stores of fat rather than depleting the sugar stores. Added Shephard: “You’ve usually put on weight over quite a long period, and so you have to be prepared to see the fat disappear over a similar, fairly long period.”

Despite new knowledge and new techniques in the field of weight loss, the siren song of crash diets continues to beckon. And, of course, there are diets that will work for some people. Toronto dietician Rosie Schwartz suggests that wise dieters should eat small amounts of food often, choosing what they eat

from the four main food groups – milk and milk products; meat, fish and poultry and alternates; breads and cereals; and fruits and vegetables. According to Schwartz, eating regularly provides the body with more energy and helps to stave off the hunger that leads to binges. It also contributes to the thermal effect of food, in which the very act of eating helps to set the body’s metabolism higher. Eating in such a manner and exercising regularly, said Schwartz, can lead to a weight loss of about two pounds a week, the maximum that can be achieved without leading to a cycle of weight loss followed by weight gain. Explained Schwartz: “You should think of weight loss as your mind declaring war on your body. Think of it as subversive warfare.” Clearly, for the thousands of Canadians who say that they want to lose weight, the news that the war can be won is reassuring.

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