What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (32 page)

Overweight vs. Dieting: The Health Damage

Being heavy carries some health risk. There is no definitive answer to how much, because there is a swamp of inconsistent findings. Distilling these findings is hazardous, but here is my best guess:
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• Enormous obesity
  (double “ideal” weight or more) may well cause premature death.
  

• Substantial obesity
  (30 to 100 percent above “ideal” weight) possibly causes health damage and may be associated with somewhat increased mortality.
  

• Mild to moderate overweight
  (10 to 30 percent above “ideal” weight) may possibly be associated with a marginal increase in mortality, particularly for those at risk for diabetes.
  

• Underweight
  is clearly associated with substantially greater mortality.
  

If you are overweight, you should ignore scare tactics like Optifast’s desperate “Obesity is a death sentence” ad. Even if you could just wish pounds away, never to return, it is not certain you should. Being somewhat above your “ideal” weight may actually be your healthiest natural condition, best for your particular constitution and your particular metabolism. Of course, you can’t wish pounds away, but you can diet them away with any popular diet, chosen at random. But the odds are overwhelming that most of the weight will return, and that you will have to diet it away again and again. From a health and mortality perspective, should you diet?
There is, probably, a serious health risk from losing weight and regaining it
.

There have been three large-scale studies of weight cycling and death. The first, a study of one million Americans, is often overlooked since it shows increased mortality with increased weight. But it also shows that men and women who lose more than ten pounds in five years have substantially more heart attacks and strokes than expected. This is true of the people who lose weight voluntarily (dieters) as well as the people who lose weight involuntarily because they are ill. In the second study, men who had at least one cycle of loss and regain are at double the risk for death from heart disease than men who progressively gain weight over twenty-five years. In the third study, more than five thousand men and women from Framingham, Massachusetts, were observed for thirty-two years. People whose weight fluctuated over the years had 30 to 100 percent greater risk for death from heart disease than people whose weight was stable. When corrected for smoking, exercise, cholesterol level, and blood pressure, the findings became more convincing, suggesting that weight fluctuation (the primary cause of which is presumably dieting) may itself increase the risk of heart disease.
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Being overweight is risky. But dieting is risky as well. Which risk is bigger? From a health perspective alone, should you diet or not?

I suspect, but I am not yet certain, that the weight-fluctuation hazard may be larger than the hazard of staying overweight. In the only study that directly compared the two risks, the Framingham study, the weight-cycling risk was shown to be markedly bigger than the overweight risk. If this result is replicated, and if dieting is shown to be the primary cause of weight cycling, it will convince me that you should not diet to reduce your risk of heart disease.

If you are coming into middle age and have gradually gained weight since your early twenties, you are probably tempted to diet for health reasons. Resist the temptation. Two exemplary studies show that you may have less health risk than those who have not gained weight. The Framingham people who gradually gained some weight over the years were at lower risk even than people whose weight was stable, and at much less risk than the yo-yoers. In a study of seventeen thousand Harvard alumni, men who gained fifteen pounds or more after graduating were at one-third
less
risk of death than everyone else. No one knows why, but a gradual gain in weight across your middle years seems normal and healthy.
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Depression and Dieting

Depression is yet another cost of dieting, because two root causes of depression are failure and helplessness. Dieting sets you up for failure. Because the goal of slimming down to your “ideal” weight pits your fallible willpower against untiring biological defenses, you will often fail. At first you will lose weight and feel pretty good about it. Any depression you had about your figure will disappear. Ultimately, however, you will probably not reach your goal; and then you will be dismayed as the pounds return. Every time you look in the mirror or vacillate over a white chocolate mousse, you will be reminded of your failure, which in turn brings depression. On the other hand, if you are one of the fortunate few who can keep the weight from coming back, you will probably have to stay on an unsatisfying low-calorie diet for the rest of your life. A side effect of prolonged malnutrition is depression. Either way, you are more vulnerable to it.

If you scan the list of cultures that have a thin ideal for women, you will be struck by something fascinating. All thin-ideal cultures also have eating disorders. They also have roughly twice as much depression in women as in men. (Women diet twice as much as men. The best estimate is that 13 percent of adult men and 25 percent of adult women are now on a diet.) The cultures without the thin ideal have no eating disorders, and the amount of depression in women and men in these cultures is the same. This suggests that around the world, the thin ideal and dieting not only cause eating disorders but also cause women to be more depressed than men.
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The problem of fat consciousness and depression starts shortly before puberty. Earlier, boys have at least as much depression as girls. When puberty starts, boys go from flabby to muscular, but girls, whose weight gain is primarily fat, go from lean to voluptuous. Boys move toward their ideal body, but girls move away from it. Soon after puberty, girls are twice as depressed as boys, and the girls who are most depressed are the ones most upset about their body.
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In a culture that glorifies being thin and young, many of us who are neither are discontents, vulnerable to continual messages that we are failures. It is just a few short steps from constantly feeling like a failure to becoming a depressed patient.

The Bottom Line

I have been dieting off and on for thirty years. I diet because I want to be more attractive, healthier, zestier, and more in control. How do these goals stack up against the facts?

Attractiveness
. Losing weight will make me look more attractive. I am, however, a married man with four children, and I have pretty much gone out of the attracting business. If I were a twenty-five-year-old woman, however, this goal would loom much larger. In this society, the closer a young woman is to her “ideal” weight, the more attractive she is deemed. I do not approve, but these are the facts.

If your attractiveness is a high-enough priority to convince you to diet, keep three drawbacks in mind: First, the attractiveness you gain will be temporary. All the weight you lose and maybe more will likely come back in a few years. This will depress you. Then you will have to lose it again—and it will be harder the second time. Or you will have to resign yourself to being less attractive. Second, when women choose the silhouette figure they want to achieve, it turns out to be thinner than the silhouette that men label most attractive.
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Third, you may well become bulimic, particularly if your natural weight is substantially more than your “ideal” weight.

On balance, if short-term attractiveness is your overriding goal, diet. But be prepared for the costs.

Health
. If I diet, I am probably at increased risk for death. Losing and regaining weight probably increases my mortality risk, perhaps more than staying overweight or even allowing myself to gain more weight gradually. No one has ever shown that losing weight will increase my longevity.
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On balance, the health goal does not warrant dieting.

Zest
. If I diet, I will have less bulk to carry around. I should be able to run and swim faster. But this advantage will vanish when I regain the weight. In addition, my metabolism will slow down in defense of my natural weight, and this is often manifested as lethargy. Worse, I may still be lethargic after the diet ends and the weight is regained. I now wonder if my lack of zest as I have gotten older isn’t the consequence of dieting, not a consequence of the extra pounds. Is it possible that the celebrated “chronic fatigue syndrome” may stem in part from a history of dieting? My desire for more energy will probably not be well served by dieting.

Control
. I want to be in control, but the second dessert tells me I am not. Wrong. I have simply been too quick to condemn myself on this score, because I didn’t know the facts. I thought that my weight was under my control. But now I see that for thirty years my vacillating willpower has been pitted against an unceasing biological defense of my natural weight.

I would get a lot more done if I could sleep only six hours a night. But when I try this and find that I feel exhausted two hours earlier the next evening, I do not feel ashamed or weak of will. I know it is just my body insisting on making up the two hours’ lost sleep. For many people, getting to an “ideal” weight and staying there is just as biologically impossible as going with much less sleep. This fact tells me not to diet, and defuses my feeling of shame. My bottom line is clear: I am not going to diet anymore.

Of course, there is something other than dieting that can help you achieve your goals.

Advice to the Overweight

Fitness vs. fatness
. I just returned from my daily half-mile swim. I am really proud of myself today because I was able to sprint the last fifty yards. I have been swimming laps religiously for about a year. I have not lost any weight (in fact, I’ve gained a few pounds). But my hips are slimmer, my mood is less irritable, I sleep better, and I have more energy. I have also read the scientific literature on exercise. Achieving fitness is clearly more sensible than fighting fatness.

A surprisingly small amount of exercise may lower death risk significantly. In one study of ten thousand men and three thousand women, the least-fit 20 percent were shown to have far and away the highest death risk. Moving out of the least-fit fifth markedly lowered risk. This suggests that even modest exercise, as opposed to becoming fanatical, will produce the biggest reduction in risk. Confirming this, the death rate of the sedentary men in the Harvard alumni group I mentioned earlier is 30 percent higher than that of the men who exercise moderately. Statistically, moderate exercise—burning off 2,000 calories per week—produces two extra years of life. (Perhaps God does not subtract the time spent exercising from your allotted time on earth.) “Moderate exercise” translates into an hour of normal walking or a half hour of slow running or a half hour of swimming each day. Exercise also fights depression and increases self-esteem. Exercise seems to be a much bigger factor in mortality than overweight, and it is probably easier to keep doing over the years than dieting, since it is (almost) fun.
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Exercise alone will probably not take off weight. Coupled with a diet program, it may produce a bit better long-term weight loss. Whatever, exercise has its beneficial effects on health, whether or not you lose weight. But there is a danger that coupling exercise with the discouraging enterprise of dieting may cause you to give up on exercise, too—once the weight starts to come back.
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The makeup of your diet
. It may be useless to try to eat less food, but it is useful to eat less
unhealthy
food: Fat and alcohol are to be watched. In this century, what Americans eat has become about 25 percent fattier, and fat in our food gets converted into fat on our bodies. Fast food, chocolate bars, and ice cream are high in fat. There is little to be said for any but modest drinking of alcohol, and lots to be said against it. Alcohol is very high in calories, addicting, and brain-damaging.
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Changing the composition of your diet may or may not take off weight. It is not known if the body will, in the long run, make up for the calories lost by a low-fat or a low-alcohol diet, but the chances are that cutting back on both is healthful anyway.

Eating only when hungry
. Overeating, consuming more food than you need to sate your hunger, is more of a problem than overweight. Unlike overweight, you can curtail overeating. Most of us are out of touch with hunger. We eat when the clock tells us it is time to, not when we are hungry. We clean our plates, hungry or not. We gorge when things taste especially good, hungry or not.

Overeating may be yet another untoward consequence of dieting. Recall that Pleistocene ancestor after a famine. Eating only when hungry is a luxury he cannot afford. He becomes a hoarder, an overeater. His surviving the next famine might depend on his stuffing himself after a big kill. He eats as much as he can whenever the opportunity presents itself. Former dieters become overeaters for just this reason. All the body knows is that it has once been starved. You change your approach to food, and overeat whenever lots of good food is available, even if you are not hungry. You have learned to ignore hunger in the interest of survival.

The Right Treatment

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