Philip B. Fontanarosa, MD
Executive Deputy Editor
The Journal of the American Medical Association

Dear Dr. Fontanarosa:

Your extraordinary candor in admitting just how badly we are losing the war on the overweight epidemic and asking your readers for help, is refreshing. As you point out so cogently in your editorial, “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

        What is wrong is that the traditional medical research and dietary model that the AMA has been championing has been a dismal failure, as demonstrated by the fact that 2 out of 3 adult Americans are now overweight, and 1 in 3 obese.²

       It's time the AMA broke “out of the box" by advancing an interdisciplinary approach to weight management that would liberate us from the present yoke of perpetual dieting and self-deprivation to live richer, more enjoyable lives.

       The exploding Overweight Epidemic is reversible and Americans can learn to manage their weight comfortably—if the American Medical Association and the pharmaceutical companies stop leading us down the wrong path, and start dealing with the real issues underlying overweight and obesity.

        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, are trying to come up with cures for overweight primarily through the narrow portholes of genetics, diet and pharmacology. The tunnel vision has locked them in their areas of specialization and turf protection.

        Just as war is too important to be left to the generals, we can’t depend on experts with such narrow focus to get us out of the overweight quagmire. The self-discipline/deprivation, medical model and mantra of the past quarter century — exercise more/eat less, especially fat and cholesterol — hasn't worked and has indirectly led us to the present calamity. In the past two decades alone obesity has exploded by more than 100 per cent.²

        Theories abound to explain the overweight epidemic. 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 like this. Americans are helpless victims of their genetic history and the current, 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 the self-fulfilling prophecy in action. And we have the present exploding overweight epidemic with 129 million Americans overweight, 61 million obese.³

        Some of the so-called weight experts, then, are part of the problem rather than 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 epidemic.

        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 an integral part 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 re-wire million of years of human evolution and social conditioning.

        Let me advance a much more immediate explanation and resolution of the overweight epidemic, based on my 17 years of lifestyle research.

        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 53.6 million⁴ Americans lost their jobs since 1979, and over a million more are being downsized each year.⁴ The perpetual downsizings, September 11 and world-wide terrorism, Enron and record-setting number of personal and corporate bankruptcies, and the ever-widening pension and health benefit takebacks are just a few of the events that are unsettling our lives.

        When a baby is upset, 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 short-term gratification.

        What I'm illustrating by the above example 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 that up to now has been ignored.

       In a highly condensed fashion here are the 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,⁵ containing extremely powerful reward pathways that require daily “quotas of pleasure,"⁶ 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 and are counterproductive in the long run. Enriching lives and finding healthier sources of pleasure⁶ outside of food are much more viable options.

       o That requires functioning from the existential position of a Proactor,⁷ while operating from the positions of Reactor or Victim tend to engender a sense of helplessness which perpetuates overweight and obesity.

       o Repeated surveys show that over sixty percent of Americans don’t get enough exercise -- and this was before the Institute of Medicine recently 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,⁸without torturing ourselves with those potentially harmful “no-pain, no-gain,” exercise regimens.

       o Since our brains are modular, Cortical Integration⁹ is the key for resolving conflicts involving eating and finding more fulfilling ways for gratifying our emotional needs, outside of food.

       o Adopting healthy eating habits, quit playing the Fat Game, doing smart calorie math, demystifying weight loss and using a radically modified version of the Food Guide Pyramid are some of the other factors for enriching our lives and keep overweight at bay.¹⁰

       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 people are on it, weight loss may be rapid. But it turns out to be fool's gold: the temporary rapid weight loss comes to a screeching halt because it is primarily due to fluid loss.¹¹

Smart 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 an ordeal into a positive experience — by using the discoveries in neuroscience and psychology to get past resistance, change habits to enrich our lives, while losing those archaic attitudes about willpower, dieting, and the “no-pain, no-gain” mind-set that get in the way of happier, more enjoyable living. The exceptions: the extremely rare cases where there are genuine genetic or deep-seated psychiatric disorders.

Al Louis Ripskis
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¹Philip B. Fontanarosa, Excecutive Deputy Editor, 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 According to the 2000 U.S. Census there were 200,948,641 adult Americans age 20 and over. Hence, 129,611,000 Americans overweight, 61,289,000 obese.
⁴ See bottom of News Releases.
⁵Chapter 3, "The Modular Brain," Unlock Your Life.
⁶Chapter 2, "Pleasure Deficit," UYL
⁷Chapter 11, "Becoming a Proactor," UYL.
⁸Chapter 10, "Play & Fitness," UYL.
⁹Chapter 7, "Cortical Integration," UYL.
¹⁰Chapter 15, "Weight, Fun & Fitness," UYL.
¹¹"Low-Carbohydrate Diets and Realities of Weight Loss," George A. Bray, MD., JAMA, April 9, 2003, Vol. 289, No.14, p.1843
                                                        Copyright © 2003 Al Louis Ripskis
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