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Obesity lies at the root of numerous chronic diseases. The ever-expanding collective waistline of citizens of Western nations is frequently blamed for the epidemic proportions of Type 2 diabetes, for the burgeoning rate of heart disease, for aggravating osteoarthritis, and as a risk factor for certain types of cancers.
Sixty-three percent of American men and 55% of American women are overweight. More than 20% of all men and 27% of all women are clinically obese. These figures ring alarm bells in all manners of medical and nutritional circles. But the truth is that only 5% of all people who lose 30 pounds or more keep it off for five years or longer.
The market is being deluged with books and weight-loss aids and plans. We’re looking for the magic pill that will help pounds melt off, but is there a magic pill? Or are we likely to find one in the next five to 10 years? The answer is almost universally "no," with a few qualifications. And are we stuck with the "same old-same old" recommendations for diet and exercise? Not necessarily.
"There are hundreds of diet recommendations out there, and only one thing we know for certain: Diet and exercise don’t work," says Daniel Mowrey, PhD, director of American Phytotherapy Research Laboratories in Provo, UT, and author of Herbal Tonic Therapies (New Canaan, CT: Keats; 1993) and several other books on herbs. "It’s a lot more complicated than simply reducing calories; it’s how calories are metabolized. Cutting calories and increasing exercise simply force the metabolism to start doing loops as the body attempts to maintain its weight," explains Mowrey. "Exercise and diet aren’t bad, but they clearly don’t get at the underlying causes of obesity."
Discovering the genetic foundations of obesity is the direction of the future, says Mowrey. "I think in the next five years or so, we will be able to discover which genes are responsible for obesity and from there find ways to correct those genetic imbalances," he explains. For now, Mowrey recommends mild caloric restriction. "I wouldn’t even call it a diet." He also suggests patients take what he thinks is the best herbal method of addressing obesity — an E-C-A (ephedra-caffeine-aspirin) combination — taken carefully and according to label directions. "That’s the only combination, in my mind, that has solid research behind it," he says. "It’s a triple whammy on the body to prevent formation of new fat cells, rev up the metabolism and thermogenesis in a safe and effective manner."
The U.S. Food and Drug Administration recently issued a warning on the dangers of ephedra use. Mowrey says he thinks these side effects are caused by patients’ failure to follow label instructions and perhaps taking larger quantities than recommended.
John La Puma, MD, director of CHEF Clinic in Chicago (Cooking, Healthy Eating, and Fitness) and professor of nutrition at Kendall College near Chicago, agrees that the answer to obesity probably lies somewhere in the gene map, but disagrees that an answer is soon at hand. "I don’t think there will be a magic pill. In fact, once we find out the genetic basis for obesity, it may take a bucketful of pills because the genes are far more complicated than we realized."
The answer to lifelong leanness doesn’t lie in lectin or in any single gene, La Puma theorizes. "There are probably dozens, if not hundreds of genes involved." That doesn’t mean companies won’t continue to market "magic pills" to address obesity, but their success will be temporary at best and expensive ones at that, La Puma says.
Here’s where La Puma digresses from Mowrey: Diet and exercise can work. La Puma’s CHEF clinic is bringing futuristic attitudes to an old formula. He says obesity is increasing because cheap food is more widely available now than ever. "Most of the food we eat is calorie-rich and nutrient-poor. Plus, we are much more sedentary now than humans have ever been before, and it’s harder to fit exercise and fitness into our busy everyday lives."
In addition, La Puma observes, "A surprisingly large number of obese people can’t feel hunger. We need to help them re-establish the satiety mechanism. Even if that fails, we help people look at the plate and when it’s empty, to know they have had enough food." Most diets are unsuccessful because they attempt to cut out whole food groups, says La Puma, who also is author of The Real Age Diet: Make Yourself Younger Than You Are (New York City: Harper Collins; 2001). "Remember the first three letters of diet are D-I-E. Most people feel like they are deprived on a diet," he points out. "In our program, no food is off-limits. We let people know that little changes make a big difference. We even recommend chocolate for the satiety provided by cocoa fat."
A 21-week CHEF clinic pilot study using 60 hours of culinary, shopping, eating out, mind-body, and fitness programming showed the following encouraging results:1
Six months after the program ended, those who lost weight also continued to exercise regularly and further reduced their body fat and triglyceride levels.
|CHEF Clinic Research to Practice in Obesity|
|Include spouses, partners, and others in the initial basic data gathering.|
|Offer the program directly to participants and do not depend on referrals for enrollment.|
|Do not expect obesity to be on any managed care organization’s radar screen anytime soon.|
|Make it fun and easy.|
|Emphasize planning skills: Self-confidence and personal choice are within most people’s grasp.|
|Source: CHEF Clinic, Chicago.|
|CHEF Clinic Sample Clinical Strategies for Weight Loss|
|Surround: If it’s not in the house, it can’t be eaten.|
|Adapt: Adapt professional culinary techniques.|
|Model: Modeling good behavior carries credibility.|
|Plan: People do not fail. Plans do.|
|Log: Successful patients count and record something other than pounds.|
|Enjoy: Create options that people like.|
|Source: CHEF Clinic, Chicago.|
Mind-body therapies may be at the crest of a future wave of obesity control, theorizes Robert Kushner, MD, professor of medicine at North-western University and medical director of the university’s Wellness Institute. "There is a huge unexplored area of mind-body therapies, such as meditation and yoga to be applied to obesity treatments," says Kushner.
Obese patients frequently tell Kushner and his staff they lack control in their lives. "More than any other concern they express, they tell us they feel out of control of their environment, their families, careers, even their time," Kushner says.
Cognitive behavioral therapy, yoga, breathing, stress management, therapeutic massage for better self-image, and mindfulness meditation all are shown to be effective in addressing control concerns like this, and Kushner’s clinic has taken it into practice and is planning a clinical study to provide qualitative measures. "We know this works from the anecdotal evidence we have collected right here, and we’re offering it already for those seeking it," says Kushner. "No obesity researchers are looking at CAM methods of addressing the problem. I think there’s a huge opportunity here," he adds.
Kushner and La Puma are not convinced that herbal or other phytotherapeutic or supplemental magic pills will emerge, although both expressed interest in 5-HTP (hydroxy-tryptophan) and its apparent ability to produce satiety by raising serotonin levels in the brain. "We need to know a lot more about this one, but it might be interesting," says Kushner.
Among the other highly touted herbal and supplemental measures against obesity, such as chromium, creatine, conjugated linoleic acid, and guarana, Kushner says there isn’t enough good evidence to think those measures are beneficial in treating the obesity epidemic that affects 61% of the population. "Whatever we find needs to be pretty broad-based," he concludes.
The University of Pennsylvania is working along some similar lines to Northwestern, says Bob Berkowitz, MD, medical director of the weight and eating disorders programs in the university’s department of psychiatry in Philadelphia. Finding a solution to stress and stressful lifestyles with all the myriad problems they present is at the core of where Berkowitz says obesity treatment is moving. "We are doing a lot of stress management, relaxation, biofeedback, and mental focus work through the clinic because we think that’s where the key lies to solving this epidemic," he says.
Helping patients find better balance in their lives and including proper sleep, rest, and exercise as well as sensible eating are all key factors to unlocking a solution to obesity in the future, says Berkowitz.
(For more information, contact: John La Puma, MD, Director, CHEF Clinic, Chicago. Web site: chefclinic.com.)
1. La Puma J, Becker J. CHEF Clinic culinary and lifestyle training for treatment of obesity and obesity-related conditions: Report of a pilot study and a practice-based intervention. Alternative Medicine Alert January 2000; S1-S4.