Wednesday, September 18, 2013

Obesity: From Aestheticism to Disease

Obesity: From Aestheticism to Disease

By

Maria Teresa De Donato, PhD, RDN, CNC, CMH, CHom



Obesity from an aesthetic, cultural, and psychological perspective


               For a quite long time our Western world has identified obesity primarily as an aesthetic issue.  Hence, it was quite revealing several years ago to watch a documentary that PBS broadcasted on KLRU, which, while focusing on the concept of female beauty, mentioned how the latter is differently perceived and, consequently, defined depending on culture and ethnicity.  One of the main aspects that emerged from that video was the consideration that seeing beauty as synonym of being slim is a phenomenon that characterizes predominantly our white Western society.

            As a matter of fact, according to the information PBS presented on that occasion, African-Americans and Africans in general are usually more prone to associate beauty with harmonious forms rather than with being thin.  This means, for instance, that no matter if a woman is overweight or even obese – at least to a certain extent – as long as she has her ‘right curves’ and is well proportioned, that is her waist and hips are clearly defined, she would still have the potential to be considered as beautiful.

            We all, however, may agree that the concept of beauty has undergone some drastic changes over time.  As a result, what was considered ideal body image, and, therefore, ideal weight in the 50s was already obsolete in the 70s.  During those last forty years, the fashion world, whose goal does not encompasse taking into account one’s own slower or faster metabolism and musculoskeletal structure and dimensions, nor the consequences and implications of malnourishment, and unhealthy eating and lifestyle habits, has determined, and educated the public accordingly, that the ideal body image is supposed to be very slim, sometimes even questionably close to anorexic.  This has led millions of people, primarily women, to become very concerned about, if not even obsessed with the way they look and led them to attempt and match as close as they can an ideal figure that for the majority of us would simply be an unrealistic expectation.  It goes without saying, however, that feeling right and at peace with and within our body image and size favorably impacts our self-esteem.  In fact, people who struggle with their body weight and self-image are usually under a much higher stress than the average person who doesn’t, for a number of reasons ranging from not looking as good as they suppose they should, to the fear of being criticized or even mocked by others due to their oversized physical appearances, especially if in their teen years when the need to feel accepted by the group is, usually, at its climax.  All these issues may worsen the situation for many people who became overweight or even obese due to emotional, excessive eating, and contribute to the problem to a much greater extent, trapping them in a catch-22, which in many cases appears as impossible to escape from.  
  
            Though the previously mentioned PBS documentary was pretty inspirational in revealing its approach to beauty from different cultural perspectives and in examining the dimensions of the human body strictly from an aesthetic point of view, all of which contributes to better understand socio-cultural aspects, when we, however, consider obesity from a medical perspective and analyze its impact on human health, we may end up with a completely different evaluation and conclusion.  In fact, as Jeremy Kaslow, MD – a Board Certified Internal Medicine Physician and Surgeon who has been practicing for more than twenty five years in Orange County, California – correctly stated when referring to diet and self image, while losing weight “at any price” in order to “fit into a particular dress or feel comfortable in a swimsuit, is about image…” weight management, to the contrary, is related to “the pursuit of lifelong health.” (Trivieri, L. & Anderson, J. W., 2002, p. 826)

Obesity: What it is and what causes it

            A recent article titled “A.M.A. Recognizes Obesity as a Disease”, and published online by The New York Times, attempted to make a summary of the main issues that obesity brings with it.  Interestingly enough, the article stated that “the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease… .”  (Retrieved July 1st, 2013 from http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html?_r=0)

            As a matter of fact, navigate among the various schools of thought in the attempt to determine what a proper definition of health and disease might be would take much time and endless efforts and lead us astray from our current discussion, at least for now.  Huge is, in fact, the difference between mainstream medicine – which is fundamentally based only on what is physically provable through clinical analysis – and the holistic approach of alternative/complementary medicine, which, by taking into account the complexity of human life and, consequently, of health from a physical, spiritual and emotional perspective includes also all the invisible and, from the conventional medical point of view, ‘improvable’ aspects all of which, nonetheless, still contribute to our health and well-being.  That said, we are going to examine right away what obesity is and how and when a person is classified as obese.        

            The Free Online Medical Dictionary defines obesity as “an abnormal accumulation of body fat, usually 20 percent or more over an individual’s ideal body weight” and distinguishes as mild obesity being between 20 to 40% over one’s ideal body weight; as moderate obesity being between 40 to 100% overweight; and as severe or morbid obesity being 100% over one’s ideal weight.  The body mass index (BMI) is considered to be the unit of measurement to calculate whether a person should be classified as obese, with BMI of 25.9-29 indicating being overweight and BMI over 30 the state of obesity. (Retrieved July 10, 2013 from http://medical-dictionary.thefreedictionary.com/obesity)

            Despite their differences on what may constitute health and disease and how to deal with them, today both mainstream and alternative medicine seem to agree that the two main factors which cause a person to become overweight or even obese are an incorrect, imbalanced diet and unhealthy lifestyle habits.  Genetic hereditary factors, in fact, though may in some cases increase the chances to have to struggle with weight management and loss, do not necessarily determine the final result, for, as a matter of fact, predisposition does not mean that people are condemned to succumb and become fat, but only that they might be more inclined than others to accumulate weight if they do not pay extra attention and educate themselves about what foods to eat, in what quantity and combination, and stay away from conducting a sedentary lifestyle.

            Leaving aside the aesthetic factor previously mentioned, obesity is a serious condition which has proven to lead to a great variety of health issues including “degenerative diseases, heart problems, certain cancers, diabetes, arthritis and more… .” Furthermore “high blood pressure, varicose veins, kidney problems, infertility, gallstones, and liver disease” (Balch J. F. & Stengler M., 2004, p. 390) also have a higher probability to occur if the individual is overweight.  Had not been that enough, the consequence of obesity, which is in fact a highly toxic state, is a depressed immune system, which makes people overweight more prone than others to become sick for all sorts of reasons.  But why can we define obesity as a highly toxic state?   What originates obesity?  And is obesity more spread in some countries rather than in others?  The following subtitle will try to answer these questions.

Our modern, industrialized world and obesity

            Though some people born and raised in our developed Western countries might not know or even have hard time to believe it, over the centuries there have been several civilizations – such as the Okinawa in Japan, the Hunzas, who were discovered only around the 1920s by the British Army and the Karakorum, who both lived in the Himalayan-northeastern Pakistan region; the Russian Georgians, Abkasian and Ajerbaijanis; the Titicacas and Vilcabambans in South America; and the Hopis, Thlinglets and Labradors in North America (Day, 2007, pp. 8-12) – who have become famous for their amazing health and longevity, with many of them reaching 120 years and more and looking half of their age, being still fit and conducting plenty of physical activities, sports included.  Among these people health issues so widely spread in our Western world, such as obesity, stroke, diabetes and cancer, to name a few, were completely unknown.  Some common features, which emerged from the reports made by the Western observers who got in touch with and lived among them, were identified with a healthy diet primarily based on vegetables, fruits, grain, a pretty low consume of animal proteins, a quite active lifestyle through physical labor and sports and/or games, and a strong sense of family and community relationships.  The kind of nutrition these civilizations used has also characterized for millennia other Asian populations whose diet highly reflects the teaching and philosophy of the two main Eastern medical systems, that is the Indian Ayurveda and TCM (Traditional Chinese Medicine) both of which encourage the use of whole foods and vegetables and discourage the high consume of animal proteins.

            If we look today at the state of health of the worldwide population we might reach the conclusion that obesity is primarily and widely spread in the most industrialized countries and in those on their way to become as such,  or – simply stated – that is the result of wealth and abundance.  As a matter of fact, people living in third world countries, especially those in the countryside who sustain themselves with a more vegetarian, when not even complete vegan diet and conduct a simple, yet quite active existence are almost never overweight, let alone obese.

            The result of our industrialized world and its impact on people’s diet and sedentary lifestyle, both of which contribute to the epidemic of obesity and other degenerative diseases which follow it, are under our very eyes.  According to the information Phillip Day provided in his book Health Wars  (2007), there were “one in five people in the UK” considered “medically obese” by the British government’s National Audit Office (NAO) in 2001, while the number of people overweight had tripled during the last 20 years, leading to some 58% of the British population being classified as overweight, this causing “more than 30,000 premature deaths in the UK in 1998” and some “£ 2.6 billion in treatment.” (p. 55)

            The UK data, however, were not very different from those of the U.S. that author Patrick Holford mentioned in his work The New Optimum Nutrition Bible, with the U.S. sadly detaining the worldwide obesity record with its 60% of Americans being overweight, 30% being obese, and the numbers still on the rise.  The same source also stressed how obesity increases “the risk for diabetes by seventy-seven times” and with it the chance of “heart disease by eight times”, along with costing the US $117 billions and claiming some 400,000 lives per year. (2004, p. 316).

            Furthermore, though till some 15-20 years ago it was almost impossible to see an Asian person being overweight or obese, the Globalization and the export of our Western world with its quite unhealthy typical American diet to those countries have seriously compromised their balanced dietary habits.  In his article China’s alarming increase in obesity blamed on more affluent lifestyle, published on The Guardian on August 18, 2006, science correspondent James Randerson denounced the “alarming” rate at which obesity has been increasing in China during those last several years, “with nearly 15% of the population overweight and a 28-fold increase in the problem in children in 15 years” as the British Medical Journal reported.  According to his article the reasons for all this were a much higher consume of meat and an increase in sedentary lifestyle.  Obesity, and along with it diabetes and heart disease, started rising at an epidemic level in this ancient civilization where for millennia such health related issues were very rare, when not even completely unknown.  Professor Yangfeng Wu – Director of The George Institute, China, Executive Associate Director at the University Clinical Research Institute in Peking, Honorary Professor at The Georgia Institute for Global Health, Sidney Medical SchoolAustralia, and also a member of the Chinese Academy of Medical Sciences in Beijing – who is responsible for the country’s obesity control program admitted that according to the China’s 2002 statistics there were already 14.5% of Chinese, that is 184 million people, overweight and 2.6%, or 31 millions, already obese.  The most dramatic aspect emerging from these data was, consequently, the rate at which overweight and obesity were growing, that is “28 times between 1985 and 2000 in children aged seven to 18”, this leading “one fifth of the overweight or obese people in the world” to be Chinese.  As Professor Barnett, Head of the diabetes and obesity group at Birmingham Universitysynthesized “westernization” and “urbanization” had been contributing to the striking change in diet and lifestyle determining the epidemic of obesity and other related degenerative diseases.  As a result, the Chinese millennial civilization, whose diet was mainly based on rice and vegetables, now sees the “excess body fat…[as] …health and prosperity” – as Professor Wu put it. (2006) (Retrieved July 18, 2013 from http://www.guardian.co.uk/world/2006/aug/18/china.mainsection).   Had not been obesity enough, as Janet Larsen reported in her Earth Policy Institute ReleasePlan B Update May 25, 2011 “cancer is now the leading cause of death in China” claiming, according to the Chinese Ministry of Health, almost a quarter of all deaths in the nation. (Retrieved July 18, 2013 from www.earth-policy.org/plan_b_updates/2011/update96)
           
            These data seem to confirm our previous statement that obesity is the result of wealth and abundance.  However, though obesity is, in fact, related to more food consumption, so often unfortunately encouraged by the ‘all you can eat’ advertising policy amply spread in our western world, USA in primis, the reality is more complex than that.  When we do not feed our body with all the nutrients it needs to stay healthy and in balance, our body keeps asking for more food till it feels satisfied.  Processed and refined foods, which have been deprived from most of their nutrients through their respective industrialized processes, play a specific role: they make the products look white, a color that according to market analysis renders them more appealing to the public and, consequently, leads to more sales and higher profits.  These processes, however, strongly contribute to the productions of foods which have from very low to no nutritional value at all.  These factors explain the need for most people who consume simple, white carbohydrates to increase their intake over time in order to satisfy the need for the nutrients their bodies so desperately have been longing for and deprived of. 

            The first consequence of these kinds of low to no nutritional value foods is a state of high minerals deficiency which leads to degenerative diseases.  An example of fundamental food considered by both the already mentioned Ayurveda, which is the oldest medical system we know of, dating back to some 5,000 years, and TMC as a mean “to strengthen the body and nurture the mind and the heart” is the wheat berry which, by undergoing “the industrialized production methods” of refinement and processing “is stripped of its essential values” (Pitchford, 2002, p. 8) and, consequently, loses all its historical efficacy. 

            Among the major deficiencies caused by the use of refined foods are those related to selenium and magnesium.  Deficiency in selenium leads to hypothyroidism, also called low thyroid, a problem affecting in the US five times more women than men.  Furthermore, obesity and hypothyroidism are strictly connected to each other due to the fact that since selenium impacts “the transmission of thyroxine (T4) and triiodothyronine” (T3), which facilitates the absorption of nutrients, its deficiency slows this process and leads to overweight or even to obesity.  An insufficient quantity of selenium intake also allows for the accumulation of heavy metals due to the fact that selenium bounds up with them counteracting their toxicity as well as the activity of different kinds of viruses, HIV included.  To the contrary, a balanced diet containing a sufficient quantity of selenium prevents “premature aging, heart disease, arthritis, and multiple sclerosis.” (Pitchford, 2002, pp. 8, 9)

            Deficiency in magnesium, also caused by high consume of refined food,  characterizes almost “70% of the United States population” and according to TCM, is responsible for “stagnation, erratic changes in the body, emotions, or mind” and highlights the “liver/gallbladder imbalance.” On the other hand, the highly beneficial and even healing properties of magnesium can prevent and/or counteract “irritability, depression, bipolar disorder, sleep disorder, and PMS (premenstrual syndrome):…migraine, sudden infant death syndrome, cramps, and spasm anywhere in the body…, constipation and the fast-cycling blood sugar imbalance in alcoholism and diabetes.” (p. 9)
           
            Though this may surprise someone, people living in underdeveloped countries whose diet is plant based and, consequently, consume a higher quantity of legumes – like beans, soy, peas, lentils, chickpeas and many others – along with whole grains and seeds, do not suffer from magnesium deficiency due to the fact that plants are much richer of this nutrient than animal proteins are.  To the contrary, magnesium deficiency is among the main aspects characterizing the poor quality of the average American’s diet which, by consisting primarily of high-fat, low-fiber, refined junk foods, including white flour processed meat, fat sugar, alcohol, canned and processed foods, preservatives, and toxins not only causes malnourishment but, by not including the necessary amount of fibers the body needs daily to prevent and eliminate the accumulation of toxins, precludes the maintenance of a healthy colon and compromises the immune system to an even greater extent.  The result of this is autointoxication, that is, a serious state of self-poisoning generated within the body and caused by toxic substances, such as microorganisms, parasites or pathogen flora, metabolic wastes and other toxins ingested through either foods or the use of chemicals for both our personal care and other cleaning activities.

            Another important aspect which contributes to obesity is the high amount of sugar consumed and its poor quality.  The term sugar embraces a wide umbrella of different kinds of products running from dextrose, originated from starches, to fructose, contained in fruits, to lactose, from milk, to maltose, from malt, to sucrose, which is the refined product derived from cane and beet which people generally use in their tea, coffee, cakes and is contained in soft drinks, and from which its “salts, fibers, enzymes, proteins, vitamins, and minerals have been removed”. (Day, 2007, p. 98)

            Alarming is also the fact that the sugar-sweetened foods that people usually buy and consume have reached some 8.68 million tons of sugar each year, which equal to 73 pounds per person per year and represent the 25 percent of total calories consumed only in the US versus the no more than 10 percent that the WHO (World Health Organization) suggests to use per person. (Holford, 2004, p. 44)  Besides, according to the NCHS (National Center for Health Statistics) Data Brief published by the CDC (Center for Disease Control and Prevention) on May 2013 under the title Consumption of Added Sugars Among U.S. Adults, 2005-2010 non-Hispanic black men and women consumed a larger percentage of their total calories from added sugars than non-Hispanic white and Mexican-American men and women with an increased consumption of added sugars, which included sweeteners added to processed and prepared foods, being linked to a decrease in intake of essential micronutrients [1, 2] and an increase in body weight [3]. Though according to this source the statistic showed that the majority of added sugars was obtained from foods rather than beverages, the article pointed out that previous research has proven that when foods and beverages are separated into specific food and beverage items regular sodas are the leading food source of added sugar, at least for adults aged 18-54 [6], with one-third of calories from added sugars being consumed among adults, 40% of calories from added sugars consumed among children and adolescents as beverages [5] and regardless of whether the added sugars are from food or beverages, the majority of the calories from added sugars as well as total calories are consumed at home by both adults and youth. (Retrieved July 29, 2013 from http://www.cdc.gov/nchs/data/databriefs/db122.htm)

            Sugar is fundamental to our lives for by burning it converts itself into the energy our body needs to function properly.  Its activity and main purpose very much resemble the one that the oil (petrol or gasoline) provides to our vehicle: it makes the engine run and enables people to drive where they need to.  However, while a moderate amount of natural sugar is needed for a correct intake of energy, an excess quantity of refined sugar is highly detrimental to our health for it “passes quickly into the bloodstream in large amount, giving the stomach and pancreas a shock.” (Pitchford, 2002, p. 189)  This produces an acid condition that negatively impacts our body through the loss of minerals and calcium, with the latter causing bone problems, and a weakened digestive system that does not allow the food to be effectively digested.  Blood sugar imbalance and craving for more sugar are the results of this process. 

            However, it’s important to keep in mind that more than the amount of calories intake per se, the real issue when we talk about obesity relates to our metabolism, that is the ability of and speed with which our body transforms the food we eat into fat and keeps our blood sugar level even.  Once our body can no longer keep our blood sugar level even, a state of imbalance, that is of insulin resistance occurs.  In this case the blood sugar level undergoes a real rollercoaster: when it’s too high, it turns sugar into fat; when it’s too low, the body lacks the energy it needs to perform efficiently and the person feels lethargic.  During these ups and downs, when the blood sugar level is high the body produces insulin, through which the sugar transitions from the blood into the cells and converts any excess sugar into fat.  As consequence, the higher the blood sugar level, the more insulin is produced, and the more insulin is produced the more sugar is transformed into fat till the body’s cells become less responsive, that is insulin resistant, this increasing the production of insulin to an even greater extent.  Eventually, when the cells become completely unresponsive, diabetes appears. (Holford, 2004, pp. 316, 317)

Obesity as Disease: What to do next

            In 1948 WHO (World Health Organization) defined health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.”  In so doing, and despite the strong impact that our Western, Newtonian materialistic concept of medicine might have exercised, through this definition WHO proved to have taken into account the invisible, intangible, and sometimes improvable factors – being emotions, beliefs, and psyche – all of which also contribute to health, or the lack of it, as Ayurveda, TMC, and Homeopathy have recognized through the centuries thanks to their holistic approach to life and health. 

            While referring to the definition of disease according to TCM, Dr. Andrew Weil explained in his work Guide To Optimum Health that a physical illness is the consequence of a non-material one, that is, the result of energy imbalance or blockage, which if not liberated and allowed to freely flow within and without the body, materializes itself in the form of physical illness. (Weil, 2002, CD 1).  That said, and considering all the devastating consequences that obesity brings with it, we cannot but agree with the American Medical Association and its recent admission that obesity is, in fact, a disease.  In so doing, we may be glad to see that not only obesity has been in the end correctly classified, but also to realize that the gap between mainstream and alternative medicine has become a little thinner this making them closer to each other at least on this important aspect of human health.    

            During those last thirty years and in the attempt to fight obesity, we have been assisting to the raise and fall of hundreds of weight loss diets and programs – from low-carbohydrate to low-fat and low-sugar – each one claiming to have the capacity to enable people to lose weight, in some cases almost ‘in the blink of an eye’.  Although a few people might have reached that goal, the truth is that in the majority of the cases all these programs seem to have miserably failed.  The main reason determining their failure has been a simple one: no matter how trendy they were, those programs did not take into account the individual’s specific needs in terms of nutrition and led to a state of imbalance and, consequently, to a positive result in terms of weight loss only in the short run and for few of them. As consequence, in the attempt to recover from their long time deprivation, once the weight loss diet ended in order to satisfy their body’s needs they went back to their old eating and lifestyle habits.  In so doing, hundreds of thousands of people, if not millions, not only regained their previous weight, but they ended up weighing even more than they did at the time they started the program.

            In conclusion, now that we have finally agreed that obesity is, in fact, a disease and should be treated as such, our main focus as individuals, community and nation should be working together in terms of education and prevention.  “Prevent is better than cure” the old saying goes.  Though this is true, prevention, however, cannot occur without a proper education about healthy eating and lifestyle habits.  All of this should start at a very young age, when we are in preschool, in order to educate both children and their families about foods properties, everyday nutritional requirements, and balanced lifestyle and proper exercise.  As a matter of fact, becoming aware of the proper way to eat while still enjoying the greatest variety of foods and the nutrients our body needs on a regular basis is absolutely paramount to our health.  No need to say that being active, doing some sort of regular physical exercise beginning with walking each and every single day while avoiding a lazy attitude which is the cause of a detrimental sedentary lifestyle that hurts us by preventing our body to burn the calories in excess and contributes, in the long run, not only to obesity but, as we have considered so far, to an endless number of health issues including degenerative disease, is the correct way to go.

            In the end, therefore, education and prevention are absolutely a must, though the real challenge for many people might be taking responsibility for their own life and, consequently, their health.  This is only possible, however, through the joint effort of will, determination and awareness about what to do next starting with stopping old ways of thinking and justifying bad habits which have led so many individuals in particular, and our nation in general, to detain the unfortunate worldwide record as for the number of obese people and diseases related and caused by obesity, resetting their minds in order to understand and accept the reality of the matter, that is, that obesity is not a merely aesthetic issue but a real disease which can and should be avoided and whose final manifestation is usually not the result of an adverse fate, but rather of our unhealthy choices and behaviors. 

Maria Teresa De Donato©2013-2016. All Rights Reserved.

Photo: Paolo Trotta©2013-2016. All Rights Reserved.

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