The single most prevalent metabolic disorder in countries where food supplies are abundant is obesity. A person is considered over weight if his weight exceeds the upper range of ideal weight for his body frame. He is considered obese if his weight exceeds by 15-20% his ideal weight.

Obesity occurs when the caloric intake exceeds the energy requirement of the body for physical activity and growth, with resultant accumulation of fat. This excessive adipose tissue may be distributed generally over the body or may be localized. Hormones from the pituitary, thyroid, adrenal, and sex glands all play important roles in fat distribution.

For the most part, obesity is preventable. Unfortunately, however, the follow-through of treatment for prolonged periods is usually difficult. Relapse becomes extremely common. The amount of body fat can be estimated from the measurement of skin fold thickness with calipers.

Most commonly employed, however, are bathroom scales, and the commonly available tables for estimation of desirable weight with relative guidelines for determining obesity. Some physiologists claim that certain persons are more efficient than others in their ability to digest, absorb, and utilize food.

Although this theory is not completely substantiated it has been observed many times that some obese patients lose weight much easier than others, on a given caloric intake. Direct study of fat cell size by biopsy and the subsequent measurement of the isolated calls permits calculation of the total number of fat cells in the body.

The average non-obese adult has approximately 40 trillion fat cells. Individuals who develop obesity in the middle years of life develop larger fat cells. Those who develop obesity during their growing years increase fat cell numbers, as well as size. This potential of forming new fat cells, with excessive food intake during growth, enhances our emphasis on prevention in childhood.

Most studies demonstrate weight loss in both types of obesity to be associated with reduction in cell size, but seldom are there actual loss of fat cells. Psychological and cultural factors influence our tendency toward obesity. Certain persons may have abnormal appetites, using food as a substitute for satisfaction that ordinarily would be supplied in other ways.

In this respect, these persons resemble somewhat the alcoholic, hence are often termed ‘foodaholics.” Increased food intake may also result from depression or anxiety. The resulting obesity may increase a persons tendency toward isolation. Merely reducing food intake without understanding the underlying emotional problems is usually unsuccessful.

Some cultural groups place great emphasis on food, developing habits of overeating at an early age. In fact, in some societies obesity is associated with success and even health. Education of individuals, families, and all ethnic groups in society is important to achieve proper understanding of fantastic health benefits obtained in weight reduction, also enabling the provision of emotional support during the transition.

The dietary treatment of obesity constitutes our mainstay for successful therapy. It is crucial to maintain good nutritional balance with any diet chosen, especially limiting the calories sufficiently to lose weight. Crash diets should be discouraged, as a weight loss of 2-3 pounds weekly is quite sufficient for most obese patients to regain their healthful profile without looking like a “dried prune.”

I always emphasize the use of natural foods, such as fresh fruits, whole grain cereals, and vegetables. Modest limitations of salt intake helps prevent fluid retention. Avoid as much as possible all rich foods, such as gravies, sauces, salad dressings, and desserts containing much sugar.

Be sure to reduce fried foods, as fat contains 9 calories per gram compared with 4cal./gm, for most carbohydrates and proteins. For individuals finding it difficult to maintain a low calorie diet continuously, a fast one day a week using limited amounts of clear liquids is encouraging.

Some find it more satisfactory to restrict their food intake to two meals a day, usually with a hearty breakfast and lunch and little or no supper. I teach my patients that being hungry one-third of the time is better than being hungry all of the time. Thus, these people can accept a two-meala- day plan and profit thereby.

It is not necessary, however, in most sensible reducing diets to be hungry in a physiologic sense at all. The use of natural foods in abundance will satisfy the appetite, particularly if a few olives or nuts are included for “satiety value.” Snacking should be eliminated. Some commonly used snacks may require a great amount of exercise to burn up the calories taken in this way.

Exercise has also been endorsed as a method to increase caloric loss. Although the stimulus to the circulation, as well as the balancing effect on the emotions are profound, a very minimal caloric effect is obtained with exercise, compared to the reduction in food intake. The metabolic rate, however, increases with exercise, sometimes lasting for hours.

Obese subjects are prone to more sedentary patterns of behavior and often walk and work more slowly than their leaner counterparts. Motivational factors, goals, and an overall emphasis on physical fitness is important to achieve the very real benefits that exercise can make toward a weight reduction regimen.

The use of appetite suppressants, amphetamines, hormones from the thyroid gland and diuretics, are mentioned only to discourage their use. Their indulgence always upsets the balance of body chemistry and places a false emphasis upon “miracle drugs” rather than diet in treating the obese.

More radical surgical procedures include the jejuno-ileal bypass (creating an unnatural shunt between two parts of the small intestines) and gastric stapling (where the stomach size is drastically reduced with a row of staples). Such measures should not even be considered unless a grave medical emergency exists.

In such cases there are usually safer approaches, such as fasting or dental wiring. All of these do not reach the underlying cause, namely dietary reeducation, emotional stabilization, and the promotion of overall physical fitness that are so essential to long-term success in weight control.

This more rational handling of obesity can be a challenging and rewarding discipline to both patients and health counselors. A person’s victory over appetite often proves the key to unlock many dimensions of fulfillment in emotional, as well as spiritual lines.