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America's No. 1 Health Problem: Overweight but Undernourished
© Interview With Dr. Anthony Conte Interviewed By Richard A. Passwater Ph.D.
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. [3] 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
implement." [6]
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
advice.
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
wrong?
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"
or "plateaus,
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;
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Richard A. Passwater, Ph.D. has been a research biochemist since 1959. His first areas of research was in the development of pharmaceuticals and analytical chemistry. His laboratory research led to his discovery of 
