|Americas No. 1 Health Problem: Overweight but Undernourished |
|Interview with © Dr. Anthony Conte|
as Interviewed By© Richard A. Passwater PhD
You know it for a fact -- Americans are overweight but undernourished.
Obesity is a major health problem increasing the risk in almost one out
of every three Americans for heart disease, cancer, diabetes mellitus, high
blood pressure, stroke, gout, gall bladder disease, osteoarthritis, some
forms of cancer, sleep apnea, etc. [1,2] There is even good evidence that
"calorie restriction" can lead to better health and longer life
in laboratory animals.  The health care costs to this country of the
morbidity related to obesity were estimated at $39 billion in 1986, and
about $30 billion a year is spent in the U. S. in efforts to lose or control
body weight. [4,5]
Countless educators have tried to convince Americans that all they have
to do is to eat a "balanced diet" (pray tell what that might be)
and reduce their calories. But these educators don't live in the real world.
They ignore the fact that the average American eats too much junk and not
enough whole foods. They ignore the fact that the average American eats
too much fat and calories, and can't stop eating at the suggested limit.
Every time an "expert" comes out with a new theory, another "expert"
proves it wrong. As Dr. F. Xavier Pi-Sunyer editorialized in the Journal
of the American Medical Society, "Decreasing food intake and increasing
activity seems an easy formula, yet it is proving extremely difficult to
What is needed is to have an experienced educator -- one who has successfully
worked with overweight, underfed Americans and understands what is needed
to help them reach their desired weight in the real everyday world -- tell
us what works. So, I have called upon Anthony Conte M.D., a leading bariatric
physician, to give us good practical time-tested and real-person-tested
Passwater: Every one "knows" how to control their weight.
Every day "experts" tell us to avoid fats and exercise more, and
we will have no weight problem. However, studies show that a greater percentage
of Americans are obese. Are Americans ignoring the advice, or is the advice
Conte: The answer is "YES" to both questions. For the past
30 years, every patient of mine has come to the office anxious to go on
a diet to lose weight. To all of them, I have said: "I
don't want you to do either." Although most people talk about losing
weight, they are not really interested in losing muscles, bones, and vital
organ tissues.--the components of lean body mass (LBM); they are interested
in losing body fat only. After all, it is the excess fat that jeopardizes
our health and detracts from our appearance. Have you ever heard anybody
complain that their muscles were too heavy? Fewer and fewer Americans will
ignore our advice if our message is loud and clear: "Dieting without
exercise can result in the loss of a substantial amount of LBM as well as
body fat resulting in detrimental changes in body composition. Don't be
a slave to the scale! Loss of inches means a loss of fat and a gain of valuable
LBM. The bathroom scale carries little weight when it comes to assessing
your fitness level.
Passwater: Just how serious is the problem? Is the percentage really
increasing and what harm is it to be obese or overweight?
Conte: Obesity has ranked high on the list of national health problems
and personal health concerns for most of the 20th century. Today, more than
a third of all adults are obese, 32 million women and 26 million men and
the numbers are increasing dramatically, up 31 percent in the last decade.
On any given day, half of all American women and a quarter of the men are
dieting. A report in the Journal of American Medical Association
called obesity an "orphan disease." Despite obesity being responsible
for so much suffering and socioeconomic damage, neither the medical establishment
nor the pharmaceutical industry have been willing to adopt it. An unfortunate
and unjustified snobbery toward obesity and its treatment exists in many
places out there in the American jungle. Some State medical boards allow
physicians to prescribe appetite depressants for a maximum of 12 weeks out
of the year regardless of successful management and benefits to the obese
patient. Physicians need effective and safe medications for obesity. While
developing these new drugs, pharmaceutical firms, scientists and health
professionals must recognize that herbal medicine should be considered as
an equal partner and not an adversary.
The harm to good health--our most precious possession--is so great that
the Center for Science in the Public Interest has started a National Campaign
to Reduce Obesity and has called for the administration to convene an obesity
summit to focus on treatment and prevention of obesity through good nutrition,
physical activity and more research.
C. Everett Koop, M.D., a former surgeon general, is working with Hillary
Clinton on an obesity prevention program, "Shape Up America."
Of course, the American Society of Bariatric Physicians (ASBP) through research,
continuing education and exchange of information has encouraged excellence
in the practice of Bariatrics for 45 years.
Passwater: Well, you have been concerned with this for over 30 years.
You have been a bariatrics physician, you have published in The Bariatrician
and other obesity-related journals, you have tested drugs and diets, and
have been a pioneer in Bariatrics. What kindled your interest in this field?
Conte: As an Anesthesiologist from 1954-1963, I was keenly aware
of the greater risk presented by the obese patient to me , the surgical,
and the recovery teams. But, I also recognized that controlling obesity
was clearly a physician's responsibility--a medical specialty worthy of
any physician's interest and challenge.
At that time, I definitely agreed with a New Jersey physician, Dr. Henry
A Davidson, who in 1962 predicted correctly that "If we doctors don't
do the job, everybody and his brother (diet faddists, physical culturists,
cosmetologists, gymnasts , dance instructors, masseurs, non-medical nutritionists,
and a spectrum of crackpots) is going to get in on the act of controlling
obesity promoting a variety of fancies."
Right now, I want to say that my quest for a better alternative weight loss
enhancer started over 15 years ago when my wife Jo, a Registered Nurse and
nutritionist, "forced" me (a physician) to read some of your books
and booklets on Chromium Picolinate and selenium to name but two.
Passwater: Another study has added support to the concept that we
have a "set point" for our body weight. What are your observations?
Can we alter this "set point?"
Conte: The "set point" theory, developed in the past 12
years or so, suggests that each of us has a natural tendency to acquire
and hold a certain quantity of fat, you can think of your own SET POINT
as the weight you maintain, give or take a few pounds; when you aren't thinking
about it, the weight you return to after an unsuccessful diet. The set point,
according to some experts, appears to be determined by the brain and the
hypothalamus; how it works is still a mystery, but it fights our efforts
to lose significant amount of fat. When we cut calories by going on a diet,
the body cuts down on the number of calories burned after a few days of
adaptation. This can ruin all our attempts to lose weight. My belief is
that we can bypass the set point mechanism and lose body fat by increasing
our physical activity above a certain level through different aerobic
exercises (the way athletes do) daily.
In highly resistant cases of set points or "previous weight levels"
I have successfully recommended one or two "Unifood" days a week;
either the fruit or the protein method: examples, one apple every two hours
until six apples are eaten; or two ounces (after it has been cooked) chicken
breasts, every 2 hours until six portions are consumed. Remember: "unifood"
means only one food that day, not a combination of different fruits and
or different proteins. Of course a minimum of 64 ounces of water (two quarts
or about eight glasses -- "typical" drinking glasses hold eight-to-ten
plus ounces) per day is also recommended.
Passwater: Why is water so important in a fat-reduction program?
Conte: There is a vital connection between drinking water and fat
loss. Eight glasses or more of water daily keeps fat away! Incredible as
it may seem, water is quite possibly the single-most important factor in
losing weight and keeping it off. I call water the only true "magic
potion" for permanent weight loss. Here is why;
1. It is believed that when we metabolize or "burn" 16 ounces
of fat, our body generates 22 ounces of water which -- surprisingly -- must
be flushed out by drinking water -- a minimum of 64 ounces daily. By drinking
less than this amount, the body feels threatened, and in self protection,
will hang on to every molecule of water in the body, resulting in fluid
retention and no "weight loss" on the scale..
2. Water can suppress the appetite naturally and helps the body metabolize
stored fat. By drinking water and correcting fluid retention, more fat is
used as fuel because the liver is free to metabolize fat at top speed.
3. The kidneys cannot function properly without enough water. When they
don't work to capacity, some of their load is dumped on the liver forcing
it to metabolize less fat.
4. Water helps to wash out by-products of metabolism; prevents accumulation
of body (and drug) toxins; helps in maintaining all normal body functions
such as temperature control and electrolyte balance, and prevents constipation.
Ample water is also important in preventing sagging skin during fat loss.
5. An overweight person needs more water than a thin person. Larger persons
have larger metabolic loads. Since we know that water is the key to fat
metabolism drinking, drinking water is essential to weight loss and
maintaining good health during the stress of dieting..
Passwater: Dieters should keep in mind, that they normally receive
a large portion of their daily water needs through their food, which can
be seventy-to-ninety percent water. During dieting, the food intake is reduced
and thus, the person is not getting their normal supply of water let alone
the extra water they need to flush out the metabolic by-products. This results
in a "hidden hunger" in dieters as the body is craving food, not
for its calorie content, but for its water content.
The water is especially needed to keep the skin healthy. If the body can't
get rid of the by-products from metabolizing stored body fat via kidney
excretion, the skin is called upon to help excrete these by-products. People
often overlook the role of the skin in excreting toxins. Water is not only
a "magic potion" for fat-loss, it is a "magic-cosmetic"
for the skin.
Why does each additional pound of fat lose become harder to achieve?
Conte: For many years we have been told that 3,500 calories is the
equivalent of one pound of body fat. And, if we reduce our daily calorie
intake by 500 calories, in a week we would lose a pound. Of course, this
is a simplification and hardly takes in consideration any of the multiple
factors responsible for obesity. But even if it were true, it would mean
to me that a person would have to constantly be reducing his or her calorie
intake as his or her body weight is reduced. A 180 pound person cannot simply
reduce their daily caloric intake by 500 calories and expect to constantly
lose a pound a week.
First of all, that person may have been gaining two or three pounds a week,
and a reduction in food intake might only slow the rate of fat gain. But
even if the person were in weight-calorie equilibrium, a 180 pound person
could not simply cut their present calorie intake by 500 calories a day
and continue to lose a pound a week until they weigh only 105 pounds.
A certain portion of our calorie intake goes to support our resting energy
expenditure (also called basal metabolism) -- the needs of every cell in
every tissue. The resting energy expenditure (REE) correlates better to
lean body mass than to total body weight, but there is some correlation
to both. As examples, the RDA lists REE reference values for a 128 pound
person as 1,350 calories and for a 154 pound person as 1,750 calories. These
two figures average about 11 calories per pound just to provide the REE.
When we have more body weight, we need more calories just to maintain this
body weight. If we could lose a pound a week by reducing our daily calorie
intake by 500 calories, eventually we reach a body weight that is just right
for maintaining that weight.
Let's go back to my example with a 180 pound person. Let's say that this
180 pound person needs 11 calories a pound per day to maintain their REE
weight and because this person has a sedentary lifestyle, only 5 calories
per pound is needed for a total of 16 calories per pound every day to maintain
their body weight. (The RDA teaches that a person with very light activity
needs the REE times 1.5) Thus, our 180 pound person needs 2,880 calories
a day to maintain his or her present weight. To lose a pound of body-weight
a week according to conventional wisdom, this person would need to reduce
his or her calorie intake to 2,380 calories per day. Assuming that there
is no decrease in metabolic rate -- that is the calorie level that would
maintain the weight of this person at 149 pounds.
As the person approaches the weight that will be supported by a given calorie
intake, the difference between actual body weight and that weight maintained
by a given caloric intake becomes smaller and thus, the rate of weight loss
When this person eventually reaches 149 pounds -- the weight supported by
the 2,380 calorie diet -- the person must then cut his or her diet by another
500 calories to get back to the theoretical one pound per week rate that
would again hold only for the first few pounds of weight loss. At 1,880
calories per day, the person, according to theory, could eventually expect
to reach 118 pounds, if the person could remain on the 1,880 calorie a day
diet long enough -- which is a 35 percent reduction in calories from the
original 2,880 calorie intake.
But there is also evidence that as we lose weight, our body involves a starvation
protective measure and slows our metabolic rate! There are other things
that we can do that can increase our metabolic rate in spite of the fact
that we are losing fat. This is part of the "set point" theory.
Yes, fat-loss, especially those last few pounds, becomes harder. However,
with a successful plan that takes these factors into account, you can be
successful too without counting calories. With good habits, good nutrition
and a good attitude, you can lose the fat you want, without counting calories.
We can turn today's good habits into tomorrow's rewards.
Passwater: "Yo-yo" dieting -- Is this harmful or not? Some
people feel as if they are losing and gaining the same ten or twenty pounds
over and over again. First we were told to diet as necessary to keep our
weight down. Then we were warned to avoid constant ups and downs in body
weight. Recently a report suggested that it might be better to keep taking
the weight gains off to try to stay near our desirable weight. It seems
that if someone were to lose twenty-five pounds and not fully regain them
for two years, then that would be two years in which that person would be
at lower risk for high blood pressure, etc. Should we avoid dieting because
we might gain it back in yo-yo fashion, or should we diet and try to keep
Conte: In my opinion, the jury is still out on the harmful effects
of yo-yo dieting. Unfortunately, patients and doctors alike don't seem to
be able to get away from the word "dieting." I prefer "planned
nutrition" or "smart choice eating."
Selection of an appropriate "Nutri-plan" should consider the individual's
lifestyle, eating patterns, and health needs.
The most effective and nutritionally sound nutri-plan combines the following