Obesity by the Numbers: Our Complex Relationship With Eating

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Oversimplified approaches to fixing the obesity problem in America could have unintended -- and dangerous -- consequences for all of us

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Obesity is a world of big dollars and big numbers: big dollars spent in generating it, big dollars trying to prevent it, big dollars treating it, and big dollars dealing with its consequences; big numbers, in that when we speak of overweight and obese as defined by the accepted measure of body-mass index (BMI) we are speaking about two-thirds of the adult U.S. population. The increase in the incidence and prevalence of obesity has mirrored an increase in chronic and debilitating disease states like diabetes.

Should we regulate choices through a method like the institution of a fat tax? On what then? A fast food burger?

Yet when we speak of obesity on a personal level, denial is the default. And when we look closely, it becomes much more complicated than a person simply eating too much, too often. Ultimately, it is the calories in and the calories out that determine our weight. However, the variables in that equation are multiple, varied, and exhibit complex relationships. It is not just that we as a nation have continued to increase our intake of fats. It is not that obese persons eat all the time. (Studies have demonstrated that obese individuals tend to eat less often than those who are not obese, but they tend to consume more at those sittings.) Your weight depends on what, or what is not, added to your plate -- not just in terms of quantity but in terms of quality, as well. Your weight can vary with your metabolism; interestingly, the metabolism of those who are obese tends to be higher than those who are not.

If it is not simply eating a lot all the time combined with a low metabolic rate that causes someone to become obese, what are some of the other variables that have been shown to influence our likelihood of unwanted weight gain? They are legion. They include things like your mother's weight gain while she was pregnant and your birth weight. They include your age, sex, and genetic make-up. They vary with your hormone state. Stress is a powerful influence. Medications can affect weight. We are continuing to learn of the complex relationship between our emotions, our mental state and their impact on our physical bodies. A powerful correlation exists between the amount of quality sleep you get and your weight -- so powerful that it may be a more accurate predictor of weight gain than caloric intake.

Yet despite these obvious complexities, there are approaches that seek to address the obesity problem through brute force of caloric and choice restriction. The folly of this method can be exemplified by carrying this argument to its logical conclusion. If the calorie count is the only important variable, then an artificially constructed zero calorie beverage would be a better choice than a glass of fresh orange juice. Intuitively we know this to be false. How and what we eat is a common-sense process. And common sense is difficult to define, let alone legislate.

There are movements afoot to limit dietary options because clearly we resist making good choices for ourselves. Should we regulate choices through a method like the institution of a fat tax? On what then? A fast-food burger? Then what are you taxing? The entire product. Should all burgers be banned? A particular component? If so, which one? The bread? The vegetable condiments? The meat? Do we tax all meat? Is it some particular meat combination? Who decides, and based on what? Regulating poor food choices can wind up being a lot like regulating choices regarding pornography -- we can't quite define what it is, but we know it when we see it and we all know when we should avoid it. Ultimately, it is our choice and, thus, our responsibility.

Addressing complex relationships requires a thoughtful and coordinated plan. Rapid implementation of oversimplified approaches for the sake of expediency or political purpose is dangerous. It can lead to overarching rules, recommendations, and regulations that can have severe unintended consequences. Albert Einstein noted that we need to make things as simple as possible -- but no simpler. We and our relationship to food are simply not simple.

Image: REUTERS/Amir Cohen.

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Michael S. Fenster is an interventional cardiologist and professional chef. He is currently working on a new television show, Code Delicious, and his book, Eating Well, Living Better, will be published in early 2012. Visit his website.

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