Abstract: Persistent, chronic overweight and obesity are usually caused not by one, but multiple factors that are uniquely interconnected within each person's brain reward pathways. Over-eating involves attitudes, habits, and other emotional and sociological components that have to be dealt with, which the AMA's medical model fails to address. Lasting, effective weight management occurs when people are taught to become Proactors who can replace their primary reward source -- food and drink -- with other reward sources.

       Here is how, back in 2002, Dr. Phil Fontanarosa, Executive Deputy Editor of JAMA, admitted, with extraordinary candor, just how badly we have been losing the war on the overweight and obesity:

“Ironically, during a time when the amount of research activity, knowledge, and interest in obesity among the medical community as well as the level of public attention to issues of overweight, diet, and exercise have never been greater, the epidemic of obesity continues virtually unabated with no sign of reversal. What could be wrong?” ¹

       Today, six years later, the situation has become even more critical.^2,3 More young people are becoming fat.⁴ And overweight/obesity is no longer an epidemic; it has become a full-fledged pandemic, with one billion people overweight and 300 million obese, worldwide.

        Now as to Dr. Fontanarosa’s “What could be wrong?” question – what is wrong is that the traditional medical research and dietary model that the AMA has been espousing for the past 30 years has been a dismal failure. What more proof do we need than the fact that 2 out of 3 adult Americans are now overweight, and 1 in 3 obese?² In the past two decades alone obesity has exploded by more than 100 per cent.²

       It's long overdue for AMA to shift paradigms and advance a comprehensive, interdisciplinary approach to weight management. People could learn to manage their weight successfully on their own, if they were given the appropriate tools, and if the American Medical Association and the pharmaceutical companies didn't try to mislead them or hold up false hopes.

        Our bodies, notably our brains, with their 100 billion neurons and up to a quadrillion interconnections between them, are such an incredibly complex array of interactive systems and modules, as to stagger the imagination.

       Yet too many weight experts and researchers have confined themselves to extremely narrow turfs related to finding a “magic pill” that would further enrich the pharmaceutical companies, rather than promote the overall well-being of Americans. And like the six blind men of Indostan describing an elephant, they are trying to come up with cures for overweight primarily through the narrow portholes of genetics, diet and pharmacology. This tunnel vision has locked them in their areas of specialization and turf protection.

        Just as wars are too important to be left to the generals, we can’t depend on experts with such narrow focus to lead us out of the overweight quagmire. The self-discipline/deprivation, medical model with its accompanying “exercise more/eat less, especially fat and cholesterol” mantra — never worked and has led us to the present conundrum.

        Theories abound to explain the overweight pandemic. One popular theory is that we are descendants of hunter-gatherers who didn't know when and where their next meals were coming from. And only those who were genetically predisposed to build up large fat reserves in times of plenty survived, and in turn passed those genes to us.

       The extended version of that theory goes something like this. Americans are helpless victims of their genetic history and the present, calorie-rich/exercise-poor environment: the prevalence of tasty, ever-increasing portion size, high-calorie fast foods makes it easy to consume a day's worth of calories in a single super-sized meal, while requiring no physical exercise. They are waiting for weight experts to rescue them from their overindulgence and laziness by way of a magic pill, before they eat themselves to death.

       But when people are cast in the role of victims it tends to breed helplessness and provides tacit permission to overindulge. This is a classic case of a self-fulfilling prophecy, leaving 138 million Americans overweight, with 72 million of them obese.³

        The so-called weight experts are part of the problem not the solution. By promoting the idea that the answer is pharmaceutical in the form of a magic pill, they are obfuscating and delaying the effective dealing with the pandemic.

        Even if weight researchers were to come up with an effective appetite/hunger suppressant that had no serious side effects, that would not solve the overweight crisis. Eating and drinking are integral parts of our social fabric and our brains’ hard-wired reward pathways, that evolved over millions of years to assure our survival. No pill is going to override million of years of human evolution and social conditioning.

        Let me advance a much more immediate explanation for resolving the overweight pandemic, based on my 23 years of lifestyle research and experience in counseling, among others, obese and overweight individuals.

        During the past two decades when obesity more than doubled, life in the U.S. has become ever more stressful, insecure and unpredictable as over 57 million⁵ Americans lost their jobs since 1979, and over 900,00 more are being separated each year.⁵ The perpetual downsizings, September 11 and world-wide terrorism, record-setting number of personal bankruptcies and home foreclosures, along with the ever-widening pension and health benefit takebacks are just a few of the events that are putting people under extreme stress.

        When a baby is distressed, what’s the first thing a mother does to comfort the child? The answer, of course, is that she offers her breast or bottle! As adults, when we are disappointed, frustrated or have something to celebrate, what’s the first thing we’re likely to do? Usually have a drink and/or eat our favorite food. Food and liquor comfort and soothe, are inexpensive, readily available and provide immediate gratification.

        The point is that since overweight is due to many causes, the solution requires a broad, interdisciplinary approach that goes beyond narrow biological/genetic/pharmaceutical research in the quest for the ever-elusive magic bullets and diets. Beyond these factors our weight is affected by a multitude of individual habits, attitudes and preferences, and includes a crucial existential component -- being a Proactor -- that has not even appeared on our obesity radar screen.

       Here are some key factors that have to be taken into account in customize our lives for healthy weight management:

       o Neuroscience reveals that our brains are modular,⁶ containing extremely powerful reward pathways that require daily “quotas of pleasure,"⁷ via serotonin, dopamine and other neurotransmitters. For the overweight, food tends to be the major source of that pleasure and emotional gratification. Self-deprivation, diets and “no-pain, no-gain” exercise regimens deprive the reward pathways even further and are counterproductive. Enriching lives and finding healthier sources of pleasure⁷ outside of food and drink are much more viable options.

       o Repeated surveys show that over sixty percent of Americans don’t get enough exercise -- and this was before the Institute of Medicine raised its recommendation from 30 to 60 minutes of daily activity. We have to accept the reality that a majority of Americans just aren’t into exercise. So instead we need to arrange getting exercise through play,⁹ without torturing ourselves with those potentially harmful “no-pain, no-gain,” exercise regimens.

       o Since our brains are modular, the psychological Cortical Integration¹⁰ technique is invaluable for resolving life's conflicts, that may or may not involve food consumption.

       o Adopting healthy eating habits, quit playing the "Fat Game," doing smart calorie math, demystifying weight loss and managing stress effectively¹¹ are some of the ways for enriching our lives rather than depriving ourselves.¹²

       o Staying clear off extreme diets that require either deep reduction or loading up on one of the major classes of foods such as carbohydrates, proteins or fats. Take the current fad -- the low carb diets. For up to the first 14 days that people are on it, weight loss may be rapid. But it turns out to be fool's gold: the rapid weight loss soon comes to a screeching halt because it is primarily due to fluid loss.¹³

       o Since chronic overweight and obesity are usually caused by a combination of conflicting factors that manifest themselves differently in each person, it is absolutely essential to teach people to become Proactors;⁸so that they can, with the aid of their own physicians, resolve the incongruent factors.

Finally, determine to what extent food is being used to make up for general reward deficits, amelioration of stress and self-medication of depression. And as Proactors use the Pleasure Inventory¹⁴ as a guide for substituting activities that are autotelic (enjoyed for their own sake such as team sports, dancing, jogging) in place of the negative ones, such as overeating, smoking¹⁵ and alcohol abuse.¹⁶

       Effective weight management is really enjoyable lifestyle management. Maintaining a healthy weight is not about self-deprivation. It’s about getting more pleasure in life through other means than food and turning what once might have been ordeals into positive experiences — by using the new discoveries in neuroscience and psychology to break old habits and lose those archaic attitudes about willpower, dieting, and the “no-pain, no-gain” mind-set that get in the way of happier, more enjoyable living.

Al Louis Ripskis
Editor
Impact Journal
____

¹Phil B. Fontanarosa, The Journal of American Medical Association, "Obesity Research - A Call for Papers," Oct. 9, 2002, Vol. 288, No. 14, p. 1772.
²Reported in the Oct. 9, 2002, issue of The Journal of American Medical Association. “Prevalence and Trends in Obesity Among US Adults, 1999-2000,” Katherine M. Flegal, et al., Vol. 288, No. 14, p. 1723. NHANES survey: 64.5% of U.S. adults overweight, 30.5% obese.
³"Obesity Among Adults in the United States," Cynthia L. Ogden, et. al. NCHS Data Briefs: "More than one third of U.S. adults, or over 72 million people were obese in 2005-2006."
⁴Surgeon General's Childhood Obesity Prevention.
⁵ For sources of statistics see the last paragraph of Combined News Release.
⁶Chapter 3, "The Modular Brain," Unlock the Life You Want, (ibid.) by Al Louis Ripskis, Boyd Printing Online Store
⁷Chapter 2, "Pleasure Deficit," ibid.
⁸Chapter 11, "Becoming a Proactor," ibid.
⁹Chapter 10, "Play & Fitness," ibid.
¹⁰Chapter 7, "Cortical Integration," ibid.
¹¹Jon Kabat-Zinn's Full Catastrophe Living, Delta, 1990.
¹²Chapter 15, "Weight, Fun & Fitness," ibid.
¹³"Low-Carbohydrate Diets and Realities of Weight Loss," George A. Bray, MD., JAMA, April 9, 2003, Vol. 289, No.14, p.1843
¹⁴Chapter 6, “Your Pleasure Inventory,” ibid.
¹⁵Chapter 16, “Replacing the Nicotine Addiction,” ibid.
¹⁶Chapter 17, “The Drinking Conundrum,” ibid.
                                                        Copyright © 2008 Al Louis Ripskis
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