At any given time men and women, young and old, and persons of all colors and backgrounds in the United States are trying to lose weight. Whether in response to gorging ourselves on the Thanksgiving turkey and all the fixings, to noticing the “spare tire” or “love handles” on our midsections, or to other events, the attempt to lose a few pounds is a common practice in American society. Given the hundreds of different diets and endless expert advice available, why do we fail most of the time?

Determining What Triggers an Eating Behavior
Before you can change a given behavior, you must first determine what causes it. Why do you suddenly find yourself at the refrigerator door, eating everything in sight? Why do you take that second and third helping of potatoes or dessert when you know that you should be opting for fruit instead?
Many people have discovered that one of the best ways о assessing their eating behavior is to chart exactly when they feel like eating, where they are when they decide to eat, the amount of time they spend eating, other activities they engage in during the meal (watching television or reading), whether they eat alone or with others, what and how much they eat, and how they felt before they took their first bite. If you keep a detailed daily log of the triggers for at least a week, you will discover useful clues about what in your environment or in your emotional makeup causes you to want food. Typically, these dietary “triggers” center on problems in everyday living rather than on real hunger pangs. As you record this information, your reasons for eating will often become apparent. Many people find that they eat compulsively when stressed or when they have problems in their relationships. For other people, the exact same circumstances diminish their appetite, causing them to lose weight.

Changing Your Triggers
Once you recognize the factors that cause you to eat, removing the triggers or substituting other activities for them will help you develop more sensible eating patterns. Here are some examples of substitute behaviors:
1. When eating dinner, turn off all distractions, including the television and radio.
2. Replace snack breaks or coffee breaks with exercise break
3. Instead of gulping your food, force yourself to chew each bite slowly.
4. Vary the time of day when you eat. Instead of eating by the clock, do not eat until you are truly hungry. Allow yourself only a designated amount of time for eating – but do not rush. Try to become more aware of true feelings of hunger.
5. If you find that you generally eat all that you can cram on a plate, use smaller plates. Put your dinner plates away, and use the salad plates instead.
6. If you find that you are continually seeking your favorite high-fat foods in the cupboard, stop buying them or place them in a spot that is very inconvenient to reach. (Having to run upstairs for the sugar bowl will probably force you to think twice before using sugar.)
These are just suggestions. After recording your daily intake for a week, you will be able to devise a list of substitutes that are geared toward your particular eating behaviors.
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Nourishing manipulation (an open, honest contract) in the same circumstance is illustrated in the following dialogue.
MRS. BROWN: Dear, I would like to invite Mother to stay with us for a week.
MR. BROWN: I don’t enjoy your mother’s visits. She disrupts our household with her criticisms, and in the past you and I have had some bitter fights because of her presence. I resent her staying with us.
MRS. BROWN: I know how you feel. I feel a conflict about her visits too. You are the most important person in the world to me and I do like to invite Mother out once every year or so. She’s getting old, and I know she’s lonely, and it means a lot to her. I feel I’m giving her something very important for her at this time in her life. I don’t particularly enjoy spending a great deal of time with her, but I do feel a certain commitment to give what I can to make her life a little more meaningful.
MR. BHOWN: HOW long do you want to invite her for?
MRS. B: I’d like to invite her for about ten days.
MR. B: I know how you feel about your mother, so I’m willing to go along with your invitation. I do wish that she was only going to be here a week, though.
MRS. B: Thank you. I plan to invite some of my girl friends and their mothers to lunch, and maybe Mother will receive some invitations to spend some time with them while she is visiting with us.
A nourishing relationship involves compromise. Each person never wholly has his way. The critical aspect illustrated in the above dialogue is the direct, honest statement of the situation (Mrs. Brown wants her mother to visit, rather than playing the deceptive game that her mother wants to come and Mrs. Brown doesn’t know how to get out of it). Mr. and Mrs. Brown are open and straight in telling each other how they feel about the situation. Mr. Brown decides that he is willing (he doesn’t have to want it) to go along with his wife’s request. She, in turn, directly asks him for what she wants and leaves it to him to decide whether he is willing or not. She does not play any game of enticement or deception or offer some kind of a “deal” to pay him back.
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EXAMINE YOUR LIFE AND REACH BOTH YOUR WEIGHT-LOSS AND LIFELONG GOALS: ARE YOU LOOKING FOR SOMEONE ELSE TO CHANGE THE CIRCUMSTANCES OF YOUR LIFE?
People are naturally drawn to gurus and other charismatic leaders because we are looking for someone to guide us, solve our problems, or protect us. Similarly, when people look for love, often they’re really looking for social acceptance, because being part of a couple is society’s ideal. Half the single people in America hate being single because of how others perceive them. “You’re thirty-five and single?” others ask, implying that there’s something wrong with you. When I grew up in West Virginia, if you were over twenty-five and single, you were pronounced either dysfunctional, incorrigible, or too ugly for anyone to want to be with. No one ever considered that you might not want to be married. We, as a society, have very strict standards about what we will and will not accept.
Sometimes we are terrified of being alone because we equate being alone with loneliness. We assume there’s a void and that the void can be filled by a warm body. We embark on a relationship looking for the other person to absolve us of our loneliness and insecurity. And most of the time, these relationships fail, because only you can change your set of circumstances.
Instead of looking to someone else to improve your self-esteem or infuse your life with purpose, try looking to yourself first. After all, no one knows better than you what you need. Only when you are a whole and satisfied person will you be able to have healthy, fulfilling relationships with those around you.
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RER (respiratory exchange ratio) measures, or the measure of fat and glucose utilisation, need to be looked at for intensity and duration of exercise both for fit and unfit (possibly fat) people, to gain a better appreciation of the appropriate form of exercise for those most likely to be carrying excess fat.

More vigorous exercise obviously burns more total energy in a given time period, but the graph shows that, at least in the unfit, under normal conditions (i.e. no excessively restricted energy intake), higher intensity exercise is likely to be less effective for fat loss. In other words, for an unfit person, the total amount of exercise at this intensity—even if it could be carried out by an unfit person—would not result in substantial fat loss. For a fit person, however, high intensity exercise is associated with fat burning.

Similar difference between the fit and the unfit can be seen, suggesting that the longer the effort—at least at moderate intensity—the greater the proportion of fat used in the energy cycle. In the unfit though, some of the research quoted above suggests that this may be true only up to a point, beyond which there is likely to be a decrease in fat utilisation and an increased reliance on glycogen. As fatigue sets in glycolysis plays a more important part, and glucose is thus likely to become more important as an energy source for the unfit.

These suggestions have been shown in practice in research by Dr David Kelly from the University of Pittsburgh.10 Kelly exercised obese people over a week for either 50 minutes at 70 per cent of their maximum capacity, or for 70 minutes at 50 per cent of their maximum. Both treatments resulted in exactly the same calorie expenditure. But the RER and total fat oxidation were higher for the longer, less intensely exercised group. Their total fat utilisation was estimated to be 24.5 grams for the 70 minutes, compared to 131 grams for the more intensely exercised group. Because fat utilisation is known to decrease in the unfit with duration of exercise, this suggests that for unfit people, fat utilisation would be even greater in the less intense group if the same time period (i.e. 50 minutes) was used for exercise.

All this suggests a change in thinking about the right parameters of exercise for fat loss in unfit (which include most fat) people. The FITT (frequency, intensity, time and type) mnemonic may be appropriate for improvements in fitness, but this needs to be modified for changes in fatness—at least in fat, unfit people.

Even this model has reservations when it comes to prescribing exercise for specific population sub-groups (women, older people, children etc.). Interestingly though, the new FATT factors also agree with the physical activity requirements for wider health gains. Several recent long term studies have shown that high intensity exercise is not necessary for health, or metabolic improvements, such as decreased risk of heart disease. Regular, low intensity, long duration activities can be sufficient to provide these improvements. Recently, it has also been shown that in obese people, short (10-minute) bursts of exercise, four times daily, are more effective in fat loss (and even in fitness gained) than continuous (40-minute) bouts. This is primarily because it is easier for obese people to comply with the demands of shorter bouts.

Myth-information. ‘Digital tummy trimmers’ are designed to force the abdominal muscles to contract against a tight belt. At best, this may increase some isometric muscle strength in the abdominals. It will have no effect on subcutaneous fat.

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The usual definition of overfatness or overweight is up to 20 per cent over a recognised ideal body weight, or a body mass index (BMI) (or height-weight measure) of 25-29.9- BMI is a measure using weight divided by height squared (kg/m2); the normally recognised ‘ideal’ is a BMI of 20-25. Obesity is regarded here as a BMI of 30-39.9; and morbid obesity as BMI over 40.

Summary of main points.

• Almost 1 in 2 people in western countries are now defined as overweight or obese.

• People in some Western countries have been increasing body weight at the average rate of 1g/day over the last decade.

• ‘Overfatness’ is a more appropriate term than ‘overweight’.

• The fitness and nutrition booms have had little impact on levels of fatness throughout the world.

• The environment determines prevalence, and genes determine the presence of obesity.

• The traditional paradigm of ‘weight=energy in (food)— energy out (exercise) is no longer adequate for understanding obesity.

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