The old view of weight control was simple: People get fat because they eat too much, and they eat too much because they have a psychological problem with food. They overeat when they’re depressed, excited, anxious, distracted or simply bored. If they could only learn new eating habits–take smaller portions, eat more slowly, stop their mindless munching–they’d lose weight. It’s a neat, strainforward concept with just one flaw: It isn’t true.
Over the last several years, physicians, psychologists and physiologists have teamed up to develop a new understanding of what makes people fat or thin. They’ve found, for starters, that an individual’s weight has more to do with biology than with psychology. If you’ve had a long-term problem, it’s probably not because you have a deep, neurotic need to stuff yourself. More likely, you simply have a built-in tendency to be fatter than you’d like.
This doesn’t mean it’s futile to try to reduce. In this case, anatomy isn’t destiny; in fact, mind over matter, or more to the point, mind over body, is very much within the realm of possibility. By setting realistic goals and modifying your views about food and exercise, you may well be able to reach a weight you’re more comfortable with. But the standard brute-force approach — simply making yourself eat fewer calories — is probably the least effective thing you can do.
For one thing, when you lose weight by eating less, more than a third of the loss can reflect reduction of muscle, not fat. You’ll be lighter, but you won’t be equivalently less flabby. For this reason, many experts now reject the concept of weight control entirely. Fat control is the new model: Add exercise to your diet regimen, and you’ll become leaner as you replace fat iwth muscle tissue. Your body will be sleeker and more toned. You won’t necessarily be lighter, because the muscle you’ll add weighs more than the fat you’ll lose. But you will lose inches and may well be able to trade in your current wardrobe for one in a smaller size. Improved appearance and health, you’ll find, don’t always correlate with a reading on a scale.
Separating Fat from Fiction
Speaking of scales, if you’ve always assumed the number of calories you eat dictates the numbers on the dial, consider this: Two recent studies show absolutely no connection between caloric intake and body weight. One, from Harvard University Medical School, surveyed the weight and eating habits of 141 middle-aged women; the other, done at Standord University, monitored 155 middle-aged men.
Both investigations involved sedentary, overweight people, so they were measuring differences in degrees of fatness. But other studies have shown that even people of vastly different weights don’t necessarily consume different numbers of calories. the apparently obvious fact that fat people eat more than thin ones is simply not true.
Dieters who’ve starved themselves for years with cottage cheese and grapefruit for dinner will find the notion that calories don’t make you fat as remarkable as the idea that money won’t make you rich. How can it be true?
For one thing, it’s not just the calories you take in but the calories you burn away that count. A marathon runner on 3,000 calories a day will obviously be skinnier than a couch potato on the same diet. In fact, some experiments have shown that lean people, as a group, tend to eat more than fat people — but stay slim because they’re more active.
There’s increasing evidence, too, that the kinds of calories you eat, more than the sheer number, may have a big impact. Calories consumed as fat are converted into fat on the body more readily than the same number of calories consumed as carbohydrate or protein. In other words, 100 calories of butter (a tablespoon) are more likely to go to your hips than 100 calories of whole-wheat bread (about 2 slices). Both the Harvard and Stanford studies show that people who eat a large proportion of their calories as fat tend to be heavier than those who eat relatively less fat.
But it’s also become clear that two people can have virtually identical diets and exercise habits — eat the same number of calories and the same amount of fat, log the same number of hours jogging or watching TV — and one may still be much fatter than the other. The difference is in the genes.
No one, of course, has genes that command “152 pounds” as precisely as other genes code for “blue eyes” or “long fingers.” But heredity does seem to dictate the way our bodies respond to food and exercise. This biological view has gained increasing acceptance in the last few years. Indeed, it has forced psychologists to change their whole concept of weight control.
Fat as Psychic Conflict, Fat as Bad Habits
Back in the ’50s, in the heyday of psychoanalysis, being overweight was viewed as a problem that began in the head. Many therapists believed that people overate (and got fat) out of deep-seated chronic anxiety, insecurity or repressed sexual needs. (One theory even held that eating, as a substitute for sex, represented a search for the “alimentary orgasm” — whatever that was.) But the “my-id-made-me-eat-it” theme began to lose favor in the ’60s. By then, several studies had made it clear that fat people are no more neurotic than thin ones and, in fact, may even be better adjusted.
As Freudian theories waned, the behavioral approach to weight control was coming on strong. Assuming that people gain weight by eating in response to the wrong stimuli — for example, eating when they’re watching TV, or bored, or worried — Richard Stuart and other behavior therapists trained their clients to break these associations and eat only in response to true hunger. At least, that was the idea, and it seemed to work. In 1967 Stuart reported that people on his program shed an average of 40 pounds apiece in one year, making it about the most effective weight-loss treatment around.
Just as Stuart’s star was rising, a new theory came along that bolstered his approach even more. A series of clever and well-publicized experiments at Columbia University, done by social psychologist Stanley Schachter and his colleagues, gave birth to what was called the externality hypothesis. Their research showed that overweight people are more likely to eat in response to “external” cues — a clock that says it’s dinnertime, a plate piled with food — rather than their bodies’ own hunger signals.
The message was clear: If people can learn to change their response to external cues and let themselves be guided by their internal hunger, then they should lose weight. A number of behavior-therapy techniques, which have become familiar to a whole generation of dieters, are designed to help people do just that. “Put food on a smaller plate, so it looks like a larger portion.” “Eat in one room of the house only.” Plus, of course, “Learn to eat more slowly” (although the link between eating fast and gaining weight is speculative at best).
Behaviorism on Trial
But this sensible-sounding advice hasn’t worked very well. Stuart’s early, dramatic results were not duplicated by other therapists using identical techniques. People have lost weight using purely behavioral approaches, of course, but rarely 40 pounds — and just like people who lose weight with liquid diets, jaw-wiring or other techniques, they tend to gain it back.
So staying thin is not just a matter of linking the right response to the right stimulus. University of Pennsylvania psychiatrist Albert Stunkard, a major weight-control theorist who’s been studying the subject for more than 30 years, says the trouble isn’t with the behavior therapy but with the problem it’s supposed to solve. “If you look at the behavioral treatment of problems like phobias, it’s very effective,” he says. “The hope was that it would be the same with obesity. The original idea was that you got fat because you eat wrong; we’ll teach you to eat right, and you won’t be fat. But that’s clearly not true.”
Stunkard now recognizes that “there must be a very powerful biological pressure against losing weight.” It’s especially clear in people who have a serious weight problem and resort to a very-low-calorie (VLC) diet (well under 1,000 calories a day), like Oprah Winfrey’s Optifast regimen.
People who rely solely on a VLC diet, says Stunkard, generally gain back about two-thirds of their pounds within a year. Intense behavior therapy can help people cut that in half — a moderately encouraging result. “The bad news,” he says, “is that we now have a three-year follow-up, and things really fall apart at three years. By that time, 40% have regained all their weight and therefore reenter treatment programs.” Even those who do not return for treatment gain back, on average, all but 10 pounds of the weight they’ve lost.
The Rise of the Setpoint Theory
Clearly, such psychological approaches to weight loss are flawed because they make universal assumptions about the causes of obesity and people’s responsiveness to learning and maintaining a new eating style. Today, many researchers believe each of us has an individual “setpoint” for fatness. According to this theory, a combination of largely genetic factors — including the number of fat cells in your body and your metabolic responses — conspire to “set” a level of fatness that’s natural for you. (To figure your setpoint, think of the weight you maintain when eating normally — or the weight to which you spontaneously return after a diet attempt.) The setting isn’t absolute; you may be able to lose 10 or 20 pounds without too much trouble.
But if your setpoint is around 180 pounds and you diet yourself down to 140, your body will fight to get back to 180, regardless of whether your’ve reduced by using behavior therapy, a diet book or simple willpower. You’ll become hungier, not because you have a neurotic need to eat more, but because your body can’t tell the difference between a diet and starvation and is making you hungry for the calories you’ve been missing. At the same time, your body changes metabolically: To outlast the famine, your body attempts to conserve fuel by burning fewer calories, thus making it easier to regain weight.
The biology of weight control helps explain another problem facing behavior therapists: The externality hypothesis, which seemed like the perfect rationale for their treatment, has evaporated. By the mid-’70s, psychologists were finding that fat and thin people eat pretty much the same way: They’re equally likely to eat food they don’t really need (like that second piece of chocolate cake) when it’s put in front of them. Chronic dieters, however, whether fat or thin, do eat differently from people who don’t go on diets habitually: They’re less sensitive to true hunger pangs, more sensitive to external cues, and more likely to lose control of their eating.
The setpoint theory explains why. Going on a diet is a way of denying the body, of consciously fighting your own instincts to eat. When you cut calories, you’re making yourself ignore your body’s hunger signals and laying yourself open to temptations that can break your resolve. Paradoxically, a diet is the surest way to set yourself up for a binge.
How Dieting Can Make You Fatter
Clearly, diets often fail to work. But the problem is worse than that. Recently researches have been focusing on the “yoyo syndrome,” where weight goes down, up, down, up . . . as people alternate between losing pounds and gaining them back. This pattern, it turns out, may permanently alter metabolism, making it increasingly difficult to lose with each successive diet. What’s more, repeatedly shifting your metabolic gears can have dangerous effects, ranging from high blood pressure to a rise in your ratio of fat to muscle.
The yo-yo threat has one clear implication: If you’re thinking of losing weight, you’d better be serious about it — because if you regain what you’ve lost, you may be worse off than before. So you have to approach weight control in a realistic, pragmatic way.
For the vast majority of us who are not dangerously obese, drugs and special crash diets aren’t really necessary. The standard treatment — as it’s practiced, for example, at many university-based weight-loss clinics — is behavior oriented but very different from the former methods of behavior therapy. New-style weight-control therapists recognize that although psychology doesn’t explain why a person gets fat, it can be used to help him or her lose weight and stick to a goal. Rather than just learning a few standard techniques, like taking small servings and chewing slowly, people in these programs learn varied, comprehensive tools for changing their way of life.
The Winning Combination
The surest approach to weight control, it should be clear by now, is to combine fat and calorie reduction with exercise. This many even help people with significant obesity.
At Laval University in Quebec, Claude Bouchard and his colleagues put 50 obese women on a strenuous exercise program for 14 months. Although they became fitter, they lost very little weight. But when Bouchard then put some of the women on a low-fat diet at the same time, they lost weight “dramatically.”
This was not a crash diet by any definition. The women still got about 20% of their calories from fat, but that’s roughly half the Canadian and U.S. national average. “Most people,” says Bouchard, “can do that.” The women had cut their total caloric intake by only 100 to 150 calories a day.
Most successful weight-loss programs stress the importance of exercise and teach clients how to incorporate fat-burning aerobic workouts into their daily activities. These programs preach reducing calorie intake, too (calories may not make you fat, but eating fewer, combined with exercise, can make you thinner), with a special emphasis placed on cutting back on fat.
You needn’t become an amateur nutritionist to reduce the fat in your diet. Reading food labels is helpful, of course. The important thing to know is that each gram of fat (the measure it’s listed in) contains 9 calories. And as you become aware of the problem, you may be able to recognize fat just by taste and texture.
Adam Drewnowski, a University of Michigan nutritionist and director of the school’s Human Nutrition Program, has studied taste preferences in people of different weights. He says that “there is no doubt in people’s minds” when they’re given a fatty food to taste: “They know it’s fattening.” The main exceptions may be foods that are somehow perceived as “health foods” despite their high fat content, such as cheese and nuts. It’s not hard to find acceptable substitutes for much of the fat in your diet (for more on this, see “The Triumphant Dieter,” page 48).
Do you Really Need to Lose Weight?
While the women in Bouchard’s experiment needed to lose weight because their health was att risk, we’ve all been conditioned to think that thinner is better. For men as well as women, our society’s standards of beauty, while by no means universal, decree that slim individuals are more attractive. We also think being thin is healthier.
But the hazards of overweight, as they apply to most of us, are overblown. And the American preoccupation with thinness, which began in the 1920s, actually started several decades before doctors sounded the warning against being overweight.
Whatever the cultural causes, it’s clear that millions of people — especially women — are dieting for reason that have nothing to do with health. Statistics show that dieters tend to be relatively young and college-educated, precisely the people who are least likely to be overweight.
According to generally accepted medical standards, people who are less than 20% over the standard height/weight charts are at relatively little medical risk from their poundage. People who are just moderately overweight may still have medical reasons to reduce, but only in certain cases. There’s increasing evidence, for instance, that fat on the abdomen (where men are more likely to gain) is probably riskier to your health than fat on the thighs or hips (where women tend to develop deposits), regardless of overall weight.
To check on your risk level, measure your waist and your hips and divide the first measurement by the second. A waist-to-hip ratio greater than about 0.5 for a woman, or 1.0 for a man, raises the risk of diabetes and heart disease and may be an important reason to start reducing.
You may also need to lose weight if you have a physical problem that’s clearly linked to fatness — mainly high blood pressure, high blood cholesterol, diabetes or an abnormal insulin response. But even in these cases, just losing 10 to 20 pounds may be enough to improve your health considerably; you don’t have to force yourself to match the standard charts. As Stunkard says, “We’ve had an incredible obsession with getting down to ideal weight. Most people don’t, and the good news is, that’s probably OK.”
Therefore, people who aren’t at risk from fatness — in other words, most of us — have the option of doing nothing about our weight at all. For those with a natural tendency to be a little heavy, this option may be especially tempting. The critical thing, whether you try to lose a little weight, a lot of weight, or no weight at all, is to realize the choice is yours.