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Hello, I am Debra Neiman, RN BSN.
I have worked in Neonatal Care,
at Beauregard Memorial Hospital, DeRidder for over four years. My college
experience at Louisiana State University at Alexandria, resulted in a great
deal of research papers, which are gathering dust in my office. My curriculum
at Northwestern State University also added to this wealth of information.
I hereby begin this series to
provide a way to get this information to those in the nursing field and
any other person with a passing interest in these subjects.
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Food Faddism and Nutrition
A Weight Control Dilemma
Divided into several pages
Debra Neiman, RN, BSN, Spring 1992
Prepared for Home Economics 2010
Louisiana State University
Abstract
As America battles with increasing health costs the association
of disease to obesity has not been overlooked. There are many theories
as to what causes this condition and public awareness has prompted a
new industry to meet growing demands. Diet Centers, therapists,
specialized foods, books, authorities, and theories abound.
Understanding the physiological, societal, and psychological forces
that govern the aspects of eating and eating disorders will change
the way many are approaching this problem. The dangers of Yo-Yo
dieting are becoming well known as are the threats to health caused
by loosing weight without regard to nutritional status. Also gaining
attention is the fact that going on a diet is not the only problem.
Most persons can be successful in loosing weight, but keeping it off
requires a change in behavior that will last not only while loosing
weight but throughout life. A multifaceted approach of education,
support, behavior survey and modification with goals of good
nutrition, moderate exercise, and positive self image is proving to
be the best choice.
I. Concepts of Weight Control
Public Perceptions
Since the end of WWII there has been an ongoing concern in this
country to avoid the effects associated with weight gain. According
to the National Center for Health Statistics, Americans are loosing
not pounds, but the battle instead. About 26% of persons between the
ages 20 to 75 are overweight and the trend is growing
(Williams, 1991). The
public, motivated to improve health and loose weight, has been
overwhelmed by a battery of expert advise, new methods and modern
techniques. Trendy new diets appear each day with celebrities ready
to endorse the success of each. However, the solution may have more
to do with understanding the forces involved than with motivation or
dieting.
Comedian George Burns put it simply, "Everyone in America is on a
diet. Dieting has become a more popular sport than baseball, and it's
played all year round." (1983)
Ironically, even with the increasing participation in weight
reduction programs, the number of Americans overweight is also
increasing. Public education as to the dangers of cancer,
cardio-vascular and heart disease associated with weights
significantly above ideal weight has not slowed the problem.
Many believe that people are fat because they are not trying to be
otherwise. Public opinion has added to the burden of being overweight
by associating being 'fat' with laziness, gluttony, or worthlessness.
Fat bias has been attributed to many missed promotions or hirings,
and have even been the grounds for laying off a good worker
(Williams, 1989).
Pathophysiology
Despite the beliefs of the general public, the cause of obesity is
attributed to one factor: consuming more calories than are needed to
maintain normal functioning of the body. The excess calories are
stored as fat. However, equity is not the rule for the manner of
storage. A normal weight person can gain pounds by depositing fat in
existing fat cells. The response to weight reduction regimes for such
persons is good as the hypertrophy of these cells is easily reversed.
For other persons weight gain is accompanied by increase in the number
of fat cells. This hyperplasia is irreversible and predisposes these
persons to dealing with tendencies to be overweight throughout their
lives. The condition of fat cell hyperplasia is seen in age groups
birth to 2 years, ages 7 to 11, and during adolescence. Examples of
adulthood hyperplasia are also common and are associated with
excessive food intake (Long, 1991).
The location of stored fat on the body also differs according to
genetics and sex. Women have a tendency to carry their stored reserves
on the hips and upper legs, while men are plagued by the proverbial
"spare tire" around the waist. Genetically, women have evolved to
carry a larger percentage of body fat than males, primarily for the
purpose of childbearing. Some body fat is necessary. Men require 3%
body fat and women require 12% for minimum survival. In times of
starvation it is loss of fat below these levels, not protein loss,
that causes death (Williams,
1989).
Ideal Weights
The normal "ideal weights" as currently defined
(Appendix A)
use the three frame sizes with weight ranges. However, there is no
definitive rule for what constitutes a small, medium or large frame.
When body weight exceeds ideal weight by 10% a person is defined as
overweight. When the body weight exceeds ideal weight by 20% the
person is obese and anything exceeding body weight by 100% is
morbidly obese (Kozier, 1991).
Another indicator for weight range is the (BMI) Body Mass Index.
The individual's nude weight is taken in kilograms and divided by
their height in meters-squared to obtain an index. A male of normal
weight will have a range of BMI 20-25. A female of normal weight will
have a range of BMI 19-24. Persons whose BMI is >30 have increased
risk of morbidity and mortality. A BMI >40 has risks for
cardio-vascular disease comparable with smokers, hypertension or
hypercholesterolemia (
Long, 1991).
National Cholesterol Education Program
Recommendations
However it is measured, excess body fat is not the only number
on the minds of Americans. Serum cholesterol levels have gained
notice in the recent years and in 1987 the Federal government's
National Cholesterol Education Program (NCEP) issued the following
recommendations:
"All adults over 20 years have their serum cholesterol levels
checked. A level <200 mg/dl is desirable. Persons with levels >200 to
239 should see their physician within two months if they have a
history of two or more risk factors: male, smoking, diabetes, high
blood pressure, obesity, or family history of heart disease or
stroke. Otherwise they are recommended to repeat the test in a year.
Any person with a level >240 are considered to be at risk for
coronary heart disease and recommended to see their doctor within
2 months for dietary instructions and prescription for
cholesterol-lowering medication if appropriate
(Cohen, 1991).
American Cancer Society
Recommendations
In 1985 the American Cancer Society issued the following
recommendations to reduce risks to health. Under the category of
Protective Factors:
- 1. Eat more cabbage family vegetables: broccoli,cauliflower,
brussel sprouts, cabbage and kale.
- 2. Add more high-fiber foods. Fiber induced peristalsis has been
shown to remove toxins from the colon which are associated with
cancer.
- 3. Choose foods with Vitamin A.
- 4. Choose foods with Vitamin C.
- 5. Control weight to near ideal.
Under the category of reducing risk factors:
- 6. Trim fat from diet.
- 7. Subtract salt-cured, smoked, nitrate-cured foods.
- 8. Stop cigarette smoking.
- 9. Drink alcohol moderately.
- 10. Respect the sun's rays.
Heart Smart Recommendations
In 1987 the NCEP issued their "heart smart" recommendations.
The diet should only contain <10% of calories from saturated fats
with 30% or less of total calories from all fats; <300 mg of
cholesterol intake per day; and no more calories than necessary for
desired body weight (
Cohen, 1991).
Consumer Alert
With so much attention in the media given to the risks associated
with being overweight, it is small wonder that there has been a
virtually flood of special diets, programs, books and experts surface
to help the public to achieve the ideal vision of health and beauty.
Most of these programs have little basis in sound nutritional
guidelines and some are actually hazardous or even life threatening.
Many are supported by studies that seem to justify their regimes.
However as stated by Greg Gormanous, PhD, during lecture on the
LSUA campus "Information collected or observed may
show a correlation, but NEVER does a correlation PROVE causation"
(1991).
This is further exemplified by Thomas Moore, author of Heart
Failure, "The fact that the Japanese have a life expectancy of
79 years and eat the least amount of animal fat doesn't mean that
eating less fat causes them to live longer...the Swiss have a life
expectancy of 78 years and eat roughly the same amount of animal fat
that Americans eat" (
Cohen, 1991).
The public would be wise to balance the reports of studies
supporting these varied health and diet claims with the following
scrutiny: Were people studied, or rodents? How many subjects were
used in the study and how long did the study last? Who funded the
study? Was the research prospective (subjects and conditions
controlled throughout the study) or retrospective (reports of past
behaviors of the subjects)? Was the experimental group truly random
or were they volunteers whose motivation may not reflect the
population at large? What major health groups have commented on the
study? Major groups include: National Institutes of Health, American
Cancer Society, American Heart Association, etc.
(Cohen, 1991).
II. Food Faddisms
Next Page
Appendix A
Ideal Weight For Height Chart
(Weights at Ages 25-59 based on lowest mortality.
Weight in pounds according to frame
(in indoor clothing weighing 5 lbs., shoes with 1 inch heels)
************MEN************** ***********WOMEN**************
Height Small Medium Large Height Small Medium Large
(Feet) Frame Frame Frame (Feet) Frame Frame Frame
5' 2" 128-134 131-141 138-150 4' 10" 102-111 109-121 118-131
5 3 130-136 133-143 140-153 4 11 103-113 111-123 120-134
5 4 132-138 135-145 142-156 5 0 104-115 113-126 122-137
5 5 134-140 137-148 144-160 5 1 106-118 115-129 125-140
5 6 136-142 139-151 146-164 5 2 108-121 118-132 128-143
5 7 138-145 142-154 149-168 5 3 111-124 121-135 131-147
5 8 140-148 145-157 152-172 5 4 114-127 124-138 134-151
5 9 142-151 148-160 155-176 5 5 117-130 127-141 137-155
5 10 144-154 151-163 158-180 5 6 120-133 130-144 140-159
5 11 146-157 154-166 161-184 5 7 123-136 133-147 143-163
6 0 149-160 157-170 164-188 5 8 126-139 136-150 146-167
6 1 152-164 160-174 168-192 5 9 129-142 139-153 149-170
6 2 155-168 164-178 172-197 5 10 132-145 142-156 152-173
6 3 158-172 162-182 176-202 5 11 135-148 145-159 155-176
6 4 162-173 171-187 181-207 6 0 138-151 148-162 158-179
****************************** *******************************
From Metropolitan Life Insurance Co. 1983
(Kozier, 1991)
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Copyright, ©1997 Debra Kay Neiman,
RN BSN
E-Mail me at: crystalblue@usa.net