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Dieters and Views on Dieting Have Evolved Over the Last Two Decades : Science Has Greatly Increased the Understanding of Obesity

April 25, 1985|CAROLE SUGARMAN | The Washington Post

Dieters could not live on hamburger-and-cottage-cheese plates alone. Science wouldn't let them.

Not in today's dieting age of behavior modification and biochemical breakthroughs. Not when eating Lean Cuisine and jogging are national pastimes.

But we tend to forget the days when being fat meant simply that you were an uncontrollable glutton, that to lose weight all you had to do was to eat less. Back then, those high-protein, high-fat hamburger-and-cottage-cheese plates were as stylish as surf 'n' turf.

Pound for pound, dieting has become more complex. And we have become more sophisticated.

'More Health-Conscious'

"Patients have changed," says Dr. Arthur Frank, clinical assistant professor of medicine at George Washington University and an internist who supervises an obesity-management program. "They're more food-conscious, more health-conscious, more literal in nutritional terms."

The problem is still the same; the way we look at it is different. What seems like common sense to many of us, what we now take for granted as the axioms of dieting, wasn't always so.

It's time to take a look back a decade or two, to remember where we came from and to rehash where we are. A "then and now" of dieting, let's call it--at least until the next wave, at least until the "nows" become the "thens."

THEN: You are fat because you have no willpower. You are fat because you have low self-esteem, because you're inadequate.

Doctors used to reinforce that belief, says Suzanne Goddard, 33, who recently lost 133 pounds under the care of Frank. But Goddard remembers the diet specialists of the past with their "blaming attitudes" and "guilt trips." It just compounded the problem, she says.

NOW: Diet specialists recognize that obesity is a very complex interaction between culture, psychology and physiology, says Kelly Brownell, co-director of the University of Pennsylvania Obesity Research Clinic.

Getting Fat Is Easy

There has been an acknowledgement that getting fat in our society is easy, that food makes people feel better and that there are strong physical reasons why some people don't lose weight as quickly as others, Brownell says. The problem is looked at more as a disease.

Specialists now explore why people eat, how they eat and how they use food as part of their lives, Frank adds.

THEN: You are fat because you eat too much. Follow this low-calorie diet and you will lose weight.

NOW: In better identifying the causes of being overweight, experts now know that its treatment has to be more complicated. Food intake alone is not the answer.

Exercise, behavior modification, social support and proper nutrition are all used jointly to tackle the problem, Brownell says.

In addition, experts agree, there has been the growing recognition that because the reasons people are fat differ, each person must be treated with an individualized approach.

Selective Calories

While it remains true that you need to consume fewer calories as part of a weight-loss plan, Dr. Aaron Altschul, director of the Georgetown University Diet Management and Eating Disorders Program, says those calories are looked at more selectively nowadays.

The important thing is not just to reduce calories, but to reduce those things that are caloric-dense, such as fats, Altschul says.

THEN: Taking the weight off is the tough part. Once you lose the weight, the problem goes away.

NOW: Dieting is more of a way of permanent eating rather than a meal plan to be followed for a short period. It is a complete alteration in food choices, eating habits and behavior. It never ends.

People are into long-term weight loss, says local nutritionist Anne Molofsky. People used to be willing to go on a diet for a month. Now, Molofsky says, they realize the importance of follow-up.

THEN: If you don't lose weight on this diet, it's surely because you cheated.

NOW: Those people who were "shunned" as being closet nibblers were probably telling the truth when they said they didn't cheat, Frank says. It is "clear medically" that some people have different metabolic rates, that some people's bodies fail to generate heat and dispose of calories, says Frank.

THEN: Exercise is good for your health, but if you're trying to diet, it will increase your appetite. Anyway, the diet should take care of it. Besides, being athletic isn't for fat people, it's for athletes.

A National Fetish

NOW: Exercise has become not only a national fetish, but also is stressed on practically every kind of weight-loss program. Goddard says she used to laugh about exercising. "Not me" was her attitude. Not anymore; Goddard now makes sure she jogs regularly.

Brownell says that previously it was thought that the only advantage to exercising was that it would burn off fat. Now scientific evidence shows that exercise can help to raise your metabolic rate even when you're not exercising. In addition, he said, at lower levels of activity, it has been shown to decrease appetite, not heighten it.

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