Obesity: not a simple issue

Obesity is not a simple issue. Why do people gain weight? Why do they succeed or fail when they try to lose it?

A simplistic approach to obesity simply doesn't work. This was one of the main messages in a thought-provoking lecture titled "Obesity: A Kaleidoscope of Determinants", delivered by Dr Wenhold.

The lecture certainly caused one to reconsider one's approach to obesity. It is so easy to just think of obesity as the result of too much energy ingested and not sufficient energy used for physical activity. But Dr Wenhold's talk made it clear that this was a simplistic approach and that there was a veritable kaleidoscope of other factors that influence why people gain weight, why they want to lose it and why they either succeed or fail in losing it.

The psychobiological core
Dr Wenhold pointed out that every human being has a basic psychobiological core consisting of a wide spectrum of factors such as genetic makeup, physiology, susceptibility to diseases, exercise tolerance (some individuals can just not do as much exercise as others), gender, hormones, age, state of health, need for pleasure, need to eat (this is one of the most basic human needs that drives us to seek out food and satisfy hunger), and the individual's self-identification (our attempts to define who we are and what we should be).

Each one of these factors can influence why we gain weight and why we struggle to lose it. To give one example, namely genetic makeup - some people have a tendency to gain weight much more easily and rapidly than others. The latter may have a high basic metabolic rate and be able to eat as much food as they like without gaining a gram, while those with a tendency to pile on the kilos, may have so-called 'thrifty genes' which are programmed to convert food to fat.

It is important to determine which of these psychobiological factors are playing a role in your life and to tailor your weight loss programme to make provision for your innate physiology and needs.

Cultural Factors
Dr Wenhold then described the second major contributors to obesity, namely cultural factors, which include our inherited beliefs and values.

Beliefs include:

• Attitudes - some people regard food as essential, but uninteresting, while to others food is the be-all and end-all of their lives
• Faith - food is often an important aspect of faith with certain foods being regarded as 'holy' and others as 'unclean'
• Self-efficacy - some individuals just have greater control of their lives than others. Those who are in control can embark on diets and exercise programmes and will probably succeed, while people who are not in control of their lives will fail
• Perceptions of health - many obese people regard themselves as healthy and do not believe that their overweight can cause serious complications such as diabetes or high blood pressure
• Perceptions of the truth of information - this is a serious problem when it comes to losing weight. If you are gullible and believe everything you hear about fad diets, magic slimming pills and instant solutions, you will be a target for every advertisement that every set out to part you and your money, without delivering the goods.

Human values that influence our reaction to obesity, include:

• Individual or community orientations - some communities revere obesity and regard fat individuals as healthy, free of Aids and beautiful, as is often the case in African societies. Trying to persuade a member of such a community that weight loss is essential, is a losing battle.
• Speed of gratification - modern people are addicted to 'instant fixes'. Whereas our ancestors were patient and prepared to work and wait for result or changes, modern man expects solutions in a wink and many people are not prepared to take time and care to lose weight. I have endless comments from Readers who bewail the fact that they have been on a diet for a week 'and not lost a kg!'. Weight loss takes time and effort, two concepts that are at odds with the modern need for instant gratification.
• Perceived benefits - this value can make any weight loss programme fail, because it is practically impossible to motivate someone to lose weight if they cannot perceive the benefit of doing so. If you are not deeply convinced that losing weight will improve your health and lifestyle, then don't even start a diet, it will be doomed to failure.
• Locus of control - the question of who controls your life is also important. Do you feel that you are in control of your life and all its aspects, or do you feel like a helpless baby torn in different directions by forces beyond your control? If you belong to the latter group, you will also fail when trying to lose weight, because it take control to stick to a diet and an exercise programme.
• Aspirations - these values define your goals. If you are determined to reach your gaol of weight loss then chances are you will get there with flying colours, but if you don't even have any aspirations and just vaguely think you should be doing something about being obese because someone else thinks so, your chances are poor.

Life Experiences
This fascinating aspect of weight loss is also often overlooked. The experiences an individual has had in his or her life can determine how he or she will react to being obese, to taking steps to lose weight and to sustaining weight loss. If you have learnt to associate food with approval or love, then it will be hard to change your mind set to viewing food as 'the enemy'.

Then there are the significant 'trigger points' in life. Some people start to gain weight after a crisis or a great loss. If you have suffered emotional trauma like the loss of a loved one, or a job, or a divorce or any other event that can cause great grief, then you may well turn to food for comfort and find that you are gaining weight dramatically. Before you can lose this trigger-induced weight, you will have to come to grips with the event that set this train of consequences into motion. You need to confront the reality of the death of a loved one and learn new coping skills before you can successfully attempt a weight loss programme.

Habits
Habits are also crucial when it comes to fighting obesity. If you have been taught to lick your plate clean or have always been threatened by the starving millions who would appreciate your food, then you will have become programmed to eat every scrap of food that is presented to you. Or if your family has the habit of overeating or of not participating in sport or any other physical activity, then you will have to break these habits before you can succeed with weight loss. And ingrained habits are extremely difficult to change, so you will have to consciously replace them with healthy habits that will help you to stick to your diet and your exercise.

If you have identified one or more of the above mentioned psychobiological factors that are hampering your attempts at weight loss, then do something about them. Consult a clinical psychologist to help you rethink imprinted beliefs, values, and habits and to remove the chains of trigger events before you attempt to lose weight.

Next week we will consider other factors in the kaleidoscope of obesity.

( Dr IV van Heerden, DietDoc)

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