FAT LOSS – BEHAVIOURAL INFLUENCES: OTHER APPROACHES
The late 1970s saw a shift towards portraying fat as a symbol in a person’s life, particularly in the Jives of women, and a re-examination of the psychodynamic aspects of being overfat. Susie Orbach saw fat as a kind of defensive psychological smoke screen, an unconscious rebellion for a woman against her sense of powerlessness in society. Compulsive eating, then, not only serves the deeper purpose of maintaining the distance between her real self and the rest of the world, but also acts to ‘blot out’ unacceptable feelings and thoughts. The problems of fatness become a reflection of a woman’s cultural position of inferiority; her compulsion to control her eating as a displacement of her inability to deal with other more profound aspects of her life. This theme was then taken up and expanded by Naomi Wolfe who sees the apparent epidemic in eating disorders as symbolic of society’s need to keep increasingly educated young women in a state of semi-starvation, rendering them ‘no trouble’.
Obviously this approach requires a different response to the behavioural strategies discussed above; if eating problems are caused by an existential and societal inequality, addressing the issue of powerlessness becomes the theme of both group and individual therapy. However, it is unclear from the feminist perspective how to account for the large numbers of men who acquire excessive fat. Presumably it is not for the same reasons of frustration and powerlessness, nor that they need to be assisted to come to terms with their ‘real’ selves. Perhaps males more easily tall into the trap of the ‘unconscious’ habits which more readily respond to the behaviour modification approaches. It seems highly likely that strategies need to be tailored to suit the individual.
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THE ROLE OF FAT IN ENERGY BALANCE: DE NOVO LIPOGENESIS
The lipogenic enzymes needed to make new fat are present in humans but in far smaller concentrations than in other animals. The rate of de novo lipogenesis in the liver can be estimated in normal humans and has been uniformly found in the order of only a few grams per day. In other words, even on a high-carbohydrate, low-fat diet, the body would not be expected to turn more than a few grams of the excess carbohydrate into fat.
While the liver may synthesise a small amount of fat from non-fat precursors, other tissues, such as skeletal muscle, may simultaneously be burning fat for fuel. Therefore, net whole body fat synthesis will only be present if the former is greater than the latter, which is rarely the case. Examples of conditions which result in net lipogenesis are forced overfeeding of carbohydrate (i.e. up to 5000kcal of carbohydrate per day in the resting state), some disease states such as cirrhosis or HTV infection, states of malnutrition, direct infusions of simple sugars intravenously (such as during intravenous nutrition) or into the abdominal cavity (such as during peritoneal dialysis). These can swamp the body’s ability to use glucose as an energy fuel or store it as glycogen, and under these conditions, some of the glucose is forced to convert into fat. However, this state is very difficult to achieve by eating or drinking the carbohydrate, even in the form of simple sugars.
Clearly, net de novo lipogenesis requires forced overfeeding of carbohydrate and does not occur under the conditions of ad libitum (at liberty or free) eating in normal individuals. Excessive consumption of carbohydrate (to the level of 50 per cent more than normal), has been shown to lead to increased fat deposition if maintained over the long term (14 days or more), but the indications are that this is because of fat sparing through increased carbohydrate use as an energy substrate, rather than conversion of excess carbohydrate to fat.
Myth-information. Contrary to popular opinion, carbohydrate-rich foods are not as fattening as those high in fat. This is not only because carbohydrates (sugars) contain less energy, and require more energy for storage, but because carbohydrate is not converted to fat in humans under normal physiological conditions.
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FEED YOUR BODY RIGHT: SHE SLIMMED DOWN BY SITTING DOWN
When it comes to eating, Kathy Wilson was a stand-up kind of person. She would stand at the cupboard and snack. She would stand at the refrigerator and snack. “I can honestly say that I never sat down and ate a meal,” says the 48-year-old DeWitt, Michigan, resident.
By the time she reached her mid-forties, Kathy weighed 262 pounds. Her blood pressure was way above normal. And she no longer wanted to go out with her husband, because she was embarrassed by her size.
All of these factors drove Kathy to confront her weight problem. She knew that she had to slim down, but how?
After looking into several weight-loss programs, Kathy decided to enroll in Jenny Craig. In the program, clients eat prepackaged meals until they’re halfway to their goal weights. Then they switch to preparing their own food, using menus provided by Jenny Craig.
“Typically, when you think of a diet, you think of what you can’t eat,” Kathy says. “But I learned that I can eat what I want, as long as I control my portions.”
She also learned to stop sabotaging her weight-loss program by eating in front of the fridge. “When I started adding up the calories, I realized that I was taking in a lot more than I should have been, mostly because of my stand-up meals and snacks,” Kathy ‘ “* says. “Sitting down«t the kitchen or dining room table each time I ate forced me to be more aware of the food that I was putting in my mouth.”
Within a year of starting the Jenny Craig program, Kathy had lost 100 pounds. She has maintained her goal weight of 162 pounds since April 1994.
Now that she’s slimmer, Kathy is more active than she used to be. She loves to run, ice-skate, and play softball. She was so impressed with how the Jenny Craig program changed her life that she became the director of a Jenny Craig center in Lansing, Michigan. “I want to help others achieve their weight-loss goals, as I have,” she says.
WINNING ACTION
Leave stand-up to the comedians. Research shows that nearly all of us, whether we’re heavy or slim, underestimate by 20 to 50 percent how much we eat. Like Kathy, we forget about the snacking in front of the refrigerator, the taste-testing during meal preparation, the nibbling during meetings at work. And those calories can add up fast. To keep tabs on absentminded eating, get in the habit of sitting at the table for every meal and snack. This simple action will help remind you that what you’re putting in your mouth counts toward your daily calorie intake. You may realize that you’re not as hungry as you thought!
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