PERHAPS YOU'VE HEARD THE NEWS. Perhaps you've caught a glimpse of the staggering statistics on obe- sity among Americans. Perhaps you've simply noticed that, compared to a few years ago, more people at the grocery store are overweight. Perhaps you've been in classrooms, on playgrounds or at day care centers and noticed how many kids are already Crippled with a weight problem and can't run twenty feet without getting winded. Our struggle with weight is hard to miss these days. Open a newspa- per or a magazine, or turn on the radio or TV-you know that America has a weight problem. In fact, two out of three adult Americans are overweight, and one-third of the adult population is obese. Not only are these numbers high, but the rate at which they have been rising is ominous (Chart l.2, page 13).1 But what do the terms "overweight" and "obese" mean? The standard expression of body size is the body mass index (BMI). It represents body weight (in kilograms, kg) relative to body height (in meters squared, 2 m ) . By most official standards, being overweight is having a BMI above twenty-five, and being obese is having a BMI over thirty. The same scale is used for both men and women. You can determine your own BMI using Chart 6.1, which lists the necessary information in pounds and inches for your convenience.
Oops! This image does not follow our content guidelines. To continue publishing, please remove it or upload a different image.
THE CHILDREN Perhaps the most depressing element of our supersize mess is the grow- ing number of overweight and obese children. About 15% of America's youth Cages six to nineteen) are overweight. Another 15% are at risk of becoming overweight.2 Overweight children face a wide range of psychological and social challenges. As you know, children have a knack for being open and blunt; sometimes the playground can be a merciless place. Overweight children find it more difficult to make friends and are often thought of as lazy and sloppy. They are more likely to have behavioral and learning difficulties, and the low self-esteem likely to be formed during adoles- cence can last forever.3 Young people who are overweight also are highly likely to face a host of medical problems. They often have elevated cholesterol levels, which can be a predictor for any number of deadly diseases. They are more likely to have problems with glucose intolerance, and, consequently, diabetes. Type 2 diabetes, formerly seen only in adults, is skyrocketing among adolescents. (See chapters seven and nine for a more thorough discussion of childhood diabetes.) Elevated blood pressure is nine times more likely to occur among obese kids. Sleep apnea, which can cause neuro-cognitive problems, is found in one in ten obese children. A wide variety of bone problems is more common in obese kids. Most impor- tantly, an obese young person is much more likely to be an obese adult,3 greatly increasing the likelihood of lifelong health problems. CONSEQUENCES FOR THE ADULT Ifyou'are obese, you may not be able to do many things that could make your life more enjoyable. You may find that you cannot play vigorously with your grandchildren (or your children), walk long distances, par- ticipate in sports, find a comfortable seat in a movie theatre or airplane or have an active sex life. In fact, even sitting still in a chair may be im- possible without experienCing back or jOint pain. For many, standing is hard on the knees. Carrying around too much weight can dramatically affect physical mobility, work, mental health, self-perception and social life. So you see, this isn't about death; it really is about missing many of the more enjoyable things in life.4 Clearly no one desires to be overweight. So why is it that two out of three adult Americans are overweight? Why is one-third of the popula- tion obese? The problem is not a lack of money. In 1999, medical care costs relat- ing to obesity alone were estimated to be $70 billion.5 In 2002, a mere three years later, the American Obesity Association listed these costs at $100 billion.6 This is not all. Add another $30-40 billion out-of-pocket money that we spend trying to keep off the weight in the first place.5 Going on special weight-loss diet plans and popping pills to cut our ap- petites or rearrange our metabolism have become a national pastime. This is an economic black hole that sucks our money away without offering anything in return. Imagine paying $40 to a service man to fix your leaky kitchen sink, and then two weeks later, the sink pipes explode and flood the kitchen and it costs $500 to repair. I bet you wouldn't ask that guy to fix your sink again! So then why do we end- lessly try those weight-loss plans, books, drinks, energy bars and as- sorted gimmicks when they don't deliver as promised? I applaud people for trying to achieve a healthy weight. I don't ques- tion the worthiness or dignity of overweight people any more than I question cancer victims. My criticism is of a societal system that allows and even encourages this problem. I believe, for example, that we are drowning in an ocean of very bad information, too much of it intended to put money into someone else's pockets. What we really need, then, is a new solution comprised of good information for individual people to use at a price that they can afford. THE SOLUTION The solution to losing Weight is a whole foods, plant-based diet, cou- pled with a reasonable amount of exercise. It is a long-term lifestyle change, rather than a quick-fix fad, and it can provide sustained Weight loss while minimizing risk of chronic disease. Have you ever known anyone who regularly consumes fresh fruits, vegetables and whole grain foods-and rarely, if ever, consumes meats or junk foods like chips, French fries and candy bars? What is his or her weight like? If you know many people like this, you have probably no- ticed that they tend to have a healthy weight. Now think of traditional cultures around the world. Think of traditional Asian cultures (Chinese, Japanese, Indian), where a couple of billion people have been eating a mostly plant-based diet for thousands of years. It's hard to imagine these people-at least until recently-as anything other than slender. Now imagine a guy buying two hot dogs and ordering his second beer at a baseball game, or a woman ordering a cheeseburger and fries at your local fast food joint. The people in these images look different, don't they? Unfortunately, the guy munching his hot dogs and sipping his beer is rap- idly becoming the "all-American" image. I have had visitors from other countries tell me that one of the first things they notice when they arrive in our good land is the exceptional number of fat people. Solving this problem does not require magic tricks or complex equations involving blood types or carbohydrate counting or soul searching. Simply trust your observations on who is slim, vigorous and healthy, and who is not. Or trust the findings of some impres- sive research studies, large and small, showing time and time again that vegetarians and vegans are slimmer than their meat-eating counterparts. People in these studies who are vegetarian or vegan are anywhere from five to thirty pounds slimmer than their fellow citi- zens. 7-J3 In a separate intervention study, overweight subjects were told to eat as much as they wanted of foods that were mostly low-fat, whole- food and plant-based. In three weeks these people lost an average of seventeen pounds.14 At the Pritikin Center, 4,500 patients who had gone through their three-week program got similar results. By feeding a mostly plant-based diet and promoting exercise, the Center found that its clients lost 5.5% of their body weight over three weeks. 15 Published results for still more intervention studies using a low-fat, whole foods, mostly plant-based diet: • About two to five pounds lost after twelve daysl6 • About ten pounds lost in three weeksl7.18 • Sixteen pounds lost over twelve weeksl9 • Twenty-four pounds lost after one year20 All of these results show that consuming a whole foods, plant-based diet will help you to lose weight and, furthermore, it can happen quick- ly. The only question is how much weight you can lose. In most of these studies, the people who shed the most pounds were those who started with the most excess weight.21 After the initial weight loss, the weight can be kept off for the long term by staying on the diet. Most impor- tantly, losing weight this way is consistent with long-term health. Some people, of course, can be on a plant-based diet and still not lose weight. There are a few very good reasons for this. First and foremost, losing body weight on a plant-based diet is much less likely to occur if the diet includes too many refined carbohydrates. Sweets, pastries and pastas won't do it. These foods are high in readily digested sugars and starches and, for the pastries, oftentimes very high in fat as well. As mentioned in chapter four, these highly processed, unnatural foods are not part of a plant-based diet that works to reduce body weight and pro- mote health. This is one of the main reasons that I usually refer to the optimal diet as a whole foods, plant-based diet. Notice that a strict vegetarian diet is not necessarily the same thing as a whole foods , plant-based diet. Some people become vegetarian only to replace meat with dairy foods, added oils and refined carbohydrates, including pasta made with refined grains, sweets and pastries. I refer to these people as "junk-food vegetarians" because they are not consum- ing a nutritious diet. The second reason weight loss may be elusive is if a person never en- gages in any physical activity. A reasonable amount of physical activity, sustained on a regular basis, can pay important dividends. Thirdly, certain people have a family predisposition for overweight bodies that may make their challenge more difficult. If you are one of these people, I can only say that you probably need to be especially rig- orous in your diet and exercise. In rural China, we noticed that obese people simply did not exist, even though Chinese immigrants in West- ern countries do succumb to obesity. Now, as the dietary and lifestyle practices of people in China are becoming more like ours, so too have their bodies become more like ours. For some of these people with ge- netic predispositions, it doesn't take much bad food before their change in diet starts to cause problems. Keeping body weight off is a long-term lifestyle choice. Gimmicks that produce impressively large, quick weight losses don't work in the long term. Short-term gains should not come along with long-term pain, like kidney problems, heart disease, cancer, bone and joint ailments and other problems that may be brought on with popular diet fads. If the weight was gained slowly, over a period of months and years, why would you expect to take it off healthily in a matter of weeks? Treating weight loss as a race doesn't work; it only makes the dieter more eager to quit the diet and go back to the eating habits that put them in need of lOSing weight in the first place. One very large study of 21,105 veg- etarians and vegans13 found that body mass index was"... lower among those who had adhered to their diet for five or more years" compared to people who had been on the diet for less than five years. WHY THIS WILL WORK FOR YOU SO there is a solution to the weight-gain problem. But how can you ap- ply it to your own life? First of all, throwaway ideas about counting calories. Generally speak- ing, you can eat as much as you want and still lose weight-as long you eat the right type offood. (See chapter twelve for details.) Secondly, stop expecting sacrifice, deprivation or blandness; there's no need. Feeling hungry is a sign that something is wrong, and prolonged hunger causes your body to slow the overall rate of metabolism in defense. Moreover, there are mechanisms in our bodies that naturally allow the right kind of plant-based foods to nourish us, without our having to think about every morsel of food we put in our mouths. It is a worry-free way to eat. Give your body the right food and it will do the right thing. In some studies, those who follow a whole foods, low-fat, plant-based diet consume fewer calories. It's not because they're starving themselves. In fact, they will likely spend more time eating and eat a larger volume of food than their meat-eating counterparts.22 That's because fruits, veg- etables and grains-as whole foods-are much less energy-dense than animal foods and added fats. There are fewer calories in each spoonful or cupful of these foods. Remember that fat has nine calories per gram while carbohydrates and protein have only four calories per gram. In addition, whole fruits, vegetables and grains have a lot of fiber, which makes you feel full22, 23 and yet contributes almost no calories to your meal. So by eating a healthy meal, you may reduce the calories that you consume, digest and absorb, even if you eat Significantly more food, This idea on its own, however, is not yet a sufficient explanation for the benefits of a whole foods, plant-based diet. The same criticisms I made against the Atkins diet and the other popular "low-carb" di- ets (chapter four) can also be applied to short-term studies in which subjects consume fewer calories while eating a plant-based diet. Over the long term, these subjects will find it very difficult to continue con- suming an abnormally low level of calories; weight loss due to calorie restriction rarely leads to long-term weight loss. This is why other stud- ies play such a crucial part in explaining the health benefits of a whole foods, plant-based diet, studies that show that the weight-loss effect is due to more than simple calorie restriction. These studies document the fact that vegetarians consume the same amount or even Significantly more calories than their meat-eating counter- parts, and yet are still slimmer.11, 24, 25 The China Study demonstrated that rural Chinese consuming a plant-based diet actually consume signifi- cantly more calories per pound of body weight than Americans, Most people would automatically assume that these rural Chinese would therefore be heavier than their meat-eating counterparts. But here's the kicker: the rural Chinese are still slimmer while consuming a greater volume offood and more calories. Much of this effect is undoubtedly due to greater physical activity ... but this comparison is between average Americans and the least active Chinese, those who do office work. Fur- thermore, studies done in IsraeF4 and the United Kingdom,ll neither of which represent primarily agrarian cultures, also show that vegetarians may consume the same or significantly more calories and still weigh less. What's the secret? One factor that I've mentioned previously is the process of thermogenesis, which refers to our production of body heat during metabolism. Vegetarians have been observed to have a slightly higher rate of metabolism during rest,26 meaning they burn up slightly more of their ingested calories as body heat rather than depositing them as body fat. 27 A relatively small increase in metabolic rate translates to a large number of calories burned over the course of twenty-four hours. Most of the scientific basis for the importance of this phenomenon was presented in chapter four. EXERCISE The slimming effect of physical activity is obvious. Scientific evidence concurs. A recent review of all the credible studies compared the rela- tionship between body Weight and exercise28 and showed that people who were more physically active had less body weight. Another set of studies showed that exercising on a regular basis helped to keep off weight originally lost through exercise programs. No surprise here, either. Starting and stopping an exercise program is not a good idea. It is better to build it into your lifestyle so that you will become and con- tinue to be more fit over all, not just burn off calories. How much exercise is needed to keep the pounds off? A rough es- timate derived from a good review28 suggested that exercising a mere fifteen to forty-five minutes per day, every day, will maintain a body weight that is eleven to eighteen pounds lighter than it would otherwise be. Interestingly, we should not forget our "spontaneous" physical activ- ity, the kind that is associated with chores of daily life. This can account for 100-800 calories per day (kcalJday)?9, 30 People who are regularly "up and about" doing physical things are going to be well ahead of those who get trapped in a sedentary lifestyle, The advantages of combining diet and exercise to control body weight were brought home to me by a very simple study involving our experimental animals. Recall that our experimental animals were fed diets containing either the traditional 20% casein (cow's milk protein) or the much lower 5% casein. The rats consuming the 5% casein diets had strikingly less cancer, lower blood cholesterol levels and longer lives. They also consumed slightly more calories but burned them off as body heat. Some of us had noticed over the course of these experiments that the 5% casein animals seemed to be more active than the 20% casein ani- mals. To test this idea, we housed rats fed either 5% or 20% casein diets in cages equipped with exercise wheels outfitted with meters to record the number of turns of the wheel. Within the very first day, the 5% casein- fed animals voluntarily "exercised" in the wheel about twice as much as the 20% casein-fed animals.31 Exercise remained conSiderably higher for the 5% casein animals throughout the two weeks of the study. Now we can combine some really interesting observations on body weight. A plant-based diet operates on calorie balance to keep body weight under control in two ways. First, it discharges calories as body heat instead of storing them as body fat, and it doesn't take many calo- ries to make a big difference over the course of a year. Second, a plant- based diet encourages more physical activity. And, as body weight goes down, it becomes easier to be phYSically active. Diet and exercise work together to decrease body weight and improve overall health. GOING IN THE RIGHT DIRECTION Obesity is the most ominous harbinger of poor health that Western na- tions currently face. Tens of millions of people will fall prey to disability, putting our health care systems under greater strain than has previously been seen. There are many people and institutions working to reduce this prob- lem, but their point of attack is often illogical and misinformed. First, there are the many quick-fix promises and gimmicks. Obesity is not a condition that can be fixed in a few weeks or even a few months, and you should beware of diets, potions and pills that create rapid weight loss with no promise of good health in the future. The diet that helps to reduce Weight in the short run needs to be the same diet that creates and maintains health in the long run. Second, the tendency to focus on obesity as an independent, isolated disease32.33is misplaced. ConSidering obesity in this manner directs our attention to a search for specific cures while ignoring control of the other diseases to which obeSity is strongly linked. That is, we sacrifice context. Also, I would urge that we ignore the suggestion that knowing its genetic basis might control obeSity. A few years ago,34-36 there was great publicity given to the discovery of "the obesity gene." Then there was the discovery of a second gene related to obesity, and a third gene, and a fourth and on and on. The purpose behind the obesity gene search is to allow researchers to develop a drug capable of knocking out or inac- tivating the underlying cause of obesity. This is extremely shortsighted, as well as unproductive. Believing that specific identifiable genes are the basis of obesity (i.e. , it's all in the family) also allows us to fatalistically blame a cause that we cannot control. We can control the cause. It is right at the end of our fork.
