Overweight And Obesity

THE urge to reduce is most commonly based on the wish to be more attractive, and this is true of men almost as much as of women. The most common reason for reducing is the fact that it is uncomfortable to be fat. These more immediate personal considerations are apt to be more persuasive than talk about possible health problems in the future, but if you are fat, reducing offers three motives: You will look better, feel better, and have a better health prospect.

Overweight is not the primary concern of this book, but the general dietary plan presented here is easily applicable to this problem. A low fat diet is one of the easiest ways of keeping the calories under control. Moreover, the dietary tables and menus in this book allow easy and accurate calorie counting.

Propaganda about the health threat of overweight and about the high frequency of heart disease in the United States has linked these two problems in the public mind, but the character of the diet may be at least as important as its calorie content.

Doctors usually advise their overweight heart patients to reduce and this is wise. A diseased heart that is barely able to take care of the circulatory demand on it can be protected somewhat by merely reducing the weight of the body. Normally, much of the circulatory demand for the heart to work is caused by exercise. With a normal heart this is not harmful; actually there is much reason to believe that work is good for it, strengthening the heart muscle. But when the heart is damaged by disease, the load on it must be controlled. The demand for blood circulation is more or less in proportion to the weight of the body to be moved, and so the heavier you are, the more blood your heart has to pump for a given movement.

Further, fat people are clumsy because their fat gets in the way; arms do not swing freely and legs must move in circles in walking because the thighs are too fat to pass each other naturally. The result is an unduly high energy expenditure for every movement and an extra demand for circulation by the heart. Finally, fat is a heat insulator, so fat people have a hard time getting rid of their body heat. This, too, puts a load on the heart, especially in hot weather.

Does Obesity Cause Heart Disease?

Obesity is bad for the damaged and incompetent heart. But does overweight damage the normal heart? In other words, if you are obese but otherwise normal, will reducing protect you against coronary heart disease in the future?

Life insurance experience indicates that the likelihood of surviving another twenty years after taking out a policy is considerably lessened if you are greatly overweight. But there are some questions. For example, are insurance policyholders who might legitimately be charged extra premiums solely because of overweight really representative of all overweights? Certainly it is still possible to ask whether the kind of people who get fat and stay fat may not tend to be the kind of people who would be prone to have a high mortality even if they were not fat.

Then there is the question of the cause of death that produces the extra mortality among overweight policyholders. Kidney disease, diabetes, appendicitis, "strokes", gallbladder disease, and accidental death are unduly common among people who are greatly overweight. For coronary heart disease, our present main worry, the insurance evidence is not so clear, and studies on patients with this disease show a surprising lack of evidence that overweight plays a preponderant role in causing their trouble. These clinical studies show that the majority of coronary patients are not and never were overweight and that overweight is almost as common among the healthy members of the same age in the community as among the patients. At most, overweight cannot be blamed as being more than a part of the reason for the great amount of coronary disease that occurs today.

Curiously, when coronary heart disease develops, the fat patients tend to do better than the thin ones. The obese coronary patients have a lower mortality during the critical first month after an occlusion and they show better survival when checked by followEAT WELL AND STAY WELL up five and ten years later. Possibly the latter finding reflects the fact that fat coronary patients can be reduced so as to decrease the burden on their damaged hearts and to decrease the serum cholesterol content, whereas the thin patients have no such large possibility of improvement.

It is important to note that overweight and obesity are not necessarily identical, and that all of the researches reported so far on mortality have been concerned with overweight and not with fatness itself. It is possible that the overweight caused by body type, heavy bones and large muscles, is more directly associated with a bad health prognosis than is the result of simple overeating. Several investigators have reported that their coronary patients were not fat but tended to be of the muscular, "mesomorphic", type.

Finally, it must be obvious that when overweight is caused by overeating, the kind of diet involved may have the greatest influence on the health prospects. We remember Jack Sprat, who could eat no fat, and his wife who loved it. Do fat people generally eat a high fat diet? In some population samples, at least, the fat people are found to be those who eat a diet with a higher percentage of fat in it than the average.

We conclude that it is unknown whether plain over-eating, that is, simple calorie excess, causes or promotes heart disease in general or coronary heart disease in particular. Obesity is common in Italy, but coronary heart disease is relatively rare; in England, coronary heart disease is almost as prevalent as in the United States, but obesity is much less frequent here in England than in the United States or in Italy. But in Italy even the fat people eat a diet much lower in fat than what we or the Americans eat.

We have no doubt, however, that obesity is a hazard to health in other directions, and nothing that is said above about heart disease is a defence of fat people. If you are fat, you should reduce.

Are You Obese?