Obesity
As everyone knows, we are in the midst of an epidemic of obesity and, related to that, of type 2 diabetes. We have a good idea of the causes and what to do about the problem, but not enough is being done.
I shall use my own experience as the taking-off point for my discussion. When I was a child during World War II, my parents exhorted me to belong to the “clean plate,” club and to eat all my food out of consideration for the starving children of Europe, although the logic of that point escaped me. (They were good people who meant well.) Anyway, eat I did, and I became overweight. When I became aware of this, I tried to combat it through exercise, but this was only partially successful. I have seesawed in the weight matter throughout my life. (Diet and exercise are both important, but diet more so.)
At 16, I was persuaded to start smoking cigarettes by a college friend who told me that it would give me something to do when waiting on street corners. Somehow, that was a convincing argument, although I seldom waited on street corners. Anyway, I believe that smoking helped me keep my weight down, although I think that it is quite certain that its risks outweigh its benefits. It is said that some French women smoke to stay thin, although they are dying from lung cancer in increasing numbers, according to The Daily Beast: “‘Better dead than fat’ or ‘plutôt mourir qu’être grosse’ could be [their] motto.”
At 26, motivated by the ravages of smoking that I observed as a medical resident on a pulmonary disease ward, I quit cold turkey. Predictably, my weight went up, but that was the lesser of the two evils.
After a while, I visited a very serious doctor, who, facing away from me toward his computer, asked for my height and weight, calculated my body mass index (BMI), and said, “Herb, you’re obese.” How very impersonal! He was right, but that does not negate the arbitrariness of judgments made on the basis of BMI.
The higher one’s weight and the lower one’s height, the higher the BMI. Indeed, if your BMI is higher than 25, you may be considered overweight, and if over 30, obese, if over 40, morbidly obese. However, there are short-comings to this formula. For example, some people may have high BMI’s because of muscle, not fat.
In Donald Trump’s 2016 medical file, his doctor claimed that he was “6'3” tall and weighed 236 pounds, which leads to a calculated BMI of 29.5, or just short of obese. In a photo of him next to a 6’2” athlete, he looks shorter! Indeed, if he was as much as 6’2” tall, his BMI would be 30.3, just over the magic threshold of obesity. Not surprisingly, his doctor was complicit in a Trumpian exaggeration.
That said, one need only look at him to see that he is obese. I have heard it said that to determine if you are obese, you should take off your clothes and look in the mirror. I believe that that bit of advice was attributed to Jean Meyer, a nutritionist and former president of Tufts University, but I have been unable to confirm this.
Obesity is classified as a disease by the World Health Organization in its International Classification of Diseases (ICD11), which is used in billing and for filing with Medicare and other insurance. Both environmental and genetic factors contribute to obesity, but genes are rarely its primary cause. One can become addicted to food similarly to cocaine and heroin. Thus, food (or specific foods) can be irresistible. This raises the question: can one truly exercise self-control in resisting the urge? Can one honestly say, “I can’t help it,” or do we have free will? This is a somewhat philosophical question. We have to respect the idea of irresistible urges, but they can often be overcome by means of incentives with positive or negative consequences, i.e. rewards or punishments, better with the former than the latter. The bad health consequences of obesity notwithstanding, shaming obese people is to be avoided, especially in children, in whom it may cause depression and eating disorders.
Overeaters Anonymous (OA) is a community of people who follow a 12-step program modeled after Alcoholics Anonymous. Weight Watchers is a weight loss program and diet that is helpful to many people.
A sedentary life style contributes to obesity and type 2 diabetes mellitus. In modern times, more people have sedentary jobs and usually transport themselves by means other than walking or bicycling. Pleasures are often sedentary ones like television-watching; hence the concept of the “couch potato”, to which snacking is a frequent corollary.
At times, dietary fat has been seen as a villain, but substituting sugar can also be harmful. In a cynical move, about 55 years ago, the Sugar Research Foundation funded by the sugar industry, under the guise of objective research, purported to refute concerns about sugar’s role in heart disease.
Sugar seems ubiquitous. It is found in packaged breads, condiments, chips, sauces, salad dressings, peanut butter, etc. I have had vegetables with unnecessarily sweet sauces in restaurants. Newman’s Own Salad Dressing has no added sugar and tastes fine. The same holds for peanut butter with no added sugar. Breakfast cereals that are designed to appeal to children are particular culprits. Kellogg’s Honey Smacks, which sports a perky frog on its box, contains a whopping 16 grams of sugar per serving. Quaker Granola, which sounds as though it ought to be healthful, contains 9 grams of added sugar. Bob’s Red Mill Muesli, whose name evokes the wholesomeness of Switzerland, has a similar composition but no added sugar, and would seem to be a sensible alternative.
So what needs to be done? Parents need to set a good example. Sweets should be downplayed in the hope that children will not develop a taste, much less a craving, for them. Perhaps they can be reserved for special events like birthdays and holidays. Items without added sugar should be promoted by vendors including fast-food and other restaurants. Smaller portions should be an option at restaurants. A la carte should be the rule, even as far as the hamburger roll, and including sides like French fries. (“$10 for the hamburger, $1 for the roll, $2 for the fries.”) Unsweetened cole slaw is a delicious cabbage salad!
Then there is the matter of sugar substitutes, like saccharin, cyclamate, aspartame, sucralose and stevia. If you’re trying to lose weight or prevent weight gain, products sweetened with them may be an attractive option, although their effectiveness for long-term weight loss isn’t clear. Use of cyclamate and saccharin was discouraged after studies showed that they caused cancer in rats in amounts much higher (corrected for animal size) than a human being would ever ingest. Ultimately, they were found safe, reason prevailed, and the impediments to their use were removed.
Sucralose (Splenda), a sugar derivative that is about 600 times as sweet as sugar, is now the world’s most commonly used artificial sweetener. Only about 15% of it is absorbed by the body, the rest of it passing out of the body unchanged. While there have been concerns about possible harmful effects of sugar substitutes, like altering the makeup of important bacteria in the gut, it can hardly be doubted that for a child to take in drinks sweetened with sucralose is better than large amounts of sugary drinks.
Sugary drinks have been available from vending machines in schools and this practice has been valued for such purposes as funding scholarships. But the harm likely outweighs the good, and crackdowns have ensued. New York City Mayor Michael Bloomberg famously tried to impose ban on “super-sized” sodas larger than 16 ounces because of the staggering rates of obesity but was unsuccessful.
What about stevia? Unlike the others, it is not synthetic. It seems a plus that it is natural — but then so are ricin, botulinum toxin and hemlock, which was the means of Socrates’ death sentence. However, in its favor, the stevia plant and its leaves have been used for a long time by South American peoples.
Anyway, I have been able to control my weight pretty well with an ovolactovegetarian diet, with no added sugar, but with some cheating (sugar and red meat), and with drinks sweetened with stevia, sucralose or aspartame. When I go to a restaurant, I generally order only appetizers or else take home the leftovers from an entrée. However, once, at that bastion of healthful eating, The Cheesecake Factory, the appetizer proved almost more than I could eat. For a while, I was eating Ezekiel bread, which may be unique among breads in having no added sugar. Its composition is based on the biblical injunction: “Take also unto thee wheat, and barley, and beans, and lentils and millet, and spelt and put them in one vessel…” Ezekiel 4:9. Who could resist such holiness? The trouble is that, as I discovered, bread tastes a lot better with sugar in it, so I have taken to eating bread from, of all places, The Cheesecake Factory, with 3 grams of sugar per serving. Yum. I’m hooked.
Carbohydrates can be classified by glycemic index. One is cautioned to go easy on foods with a high glycemic index like potatoes and sugar itself and to favor those with a low glycemic index like fruits and soybeans (and Ezekiel bread!), because the former, but not the latter, lead to high blood insulin levels, thus predisposing to type 2 diabetes mellitus.
We are also enjoined not to eat fried foods. But this can depend on the kind of oil that is used. They are high in calories — but you can eat less! The foods are often salted — but no one says they have to be! Olive oil used to shallow-fry foods for short periods seems to be a good choice. So, how about some carrots — or even potatoes — fried in that fashion, with no salt added? What’s so hard about that?
In sum, a good catchphrase that I try to follow is from Michael Pollen: “Eat food. Not too much. Mostly plants.”
