INTRODUCTION
Obesity is a matter of psychology at least as much as it is one of physiology. Changing one's lifestyle is not just a simple and straightforward sequence of technicalities that can be easily implemented. In order to begin a process of change, one must first understand the mindset and emotional challenges involved. One of the most common perceptions that stand in the way of change is that of being powerless; the feeling that any efforts are futile and change is impossible. This kind of fatalism will only lead to despair and inaction. Overcoming it is the first step towards lasting change. However, it is not an easy one. Truly believing that one can live differently (with different habits and routines) is difficult because one's self-perception is linked to old and current habits. Leaving them behind requires redefining oneself to a certain extent. Habits play a central role since they are not only ‘automated actions’ but RITUALS that form part of people's identity. Although these habits may be harmful, they also provide a sense of comfort and security; compensating for negative emotions such as anxiety, for example. Even harmful habits serve a psychological function and cannot simply be changed from one day to the next. Although habits (much like addiction) can be detrimental to oneself, it is frightening to leave them behind because, on an emotional level, it means leaving part of yourself behind and stepping into unknown territory. One's social and family circle also plays an important role and must be considered. Those closest to you know you the way you are and have been for a long time (maybe most of your life). Although they would probably not want to stand in the way of you transforming your life for the better, their perception of you can be quite rigid. Being overweight (however problematic it may be) is part of one's social identity. Letting that aspect of yourself die and redefining yourself requires a drastic change in self-perception as well as the way in which others see you. A supportive and understanding social environment is therefore extremely important and if it is not provided, creating clear boundaries can be helpful. In terms of culture, some current trends and parts of mainstream culture (especially in the media or on social media) blame obese people entirely for their condition and show little to no empathy. Feeling judged, rejected and shamed by other people will probably not help with any positive changes. Other movements (anti fat shaming, body consciousness...) excuse them entirely and blame society, industry, government, capitalism, social norms, etc... thus removing all responsibility and agency from them. Emotionally, this may seem easier in the short term but it is absolutely counterproductive in the long term and detrimental to solving the problem on an individual level.
What a person with obesity may need or look for in order to start their transformation:
● EMPOWERMENT: The belief that you CAN change your current situation and a concrete understanding of how it can be done.
● EXPERTISE: Knowledgeable and experienced professionals who have a tried and tested METHOD that breaks down the long-term goals into smaller, more achievable steps
● PATIENCE: Someone who UNDERSTANDS your situation and how you might feel, and provides an alternative, more hopeful, perspective.
● TRUST: Someone you feel comfortable sharing your true thoughts and feelings with. Someone you can relate to on a human level; not someone who seems so perfect you would feel ashamed to talk freely to about your needs.
● HONESTY: A supporting environment of people who will provide HONEST answers and feedback. Not someone who tells you what you want to hear but someone who will tell you what you need to hear in a positive, non-judgemental way.
● A PLAN: Someone who provides you with viable SOLUTIONS and a well-designed easy-to-follow PLAN instead of unrealistic programs that might throw you into the mental and/or physical abyss
We all know what obesity looks like superficially and those who are overweight themselves know all too well what the psychological and practical implications are. But why do so many people become obese? Some believe that obesity is genetically predetermined. Others insist it is a direct result of lifestyle choices (i.e. obese people are simply sloths and gluttons). As it turns out, both of these common assumptions are over-simplifications; and rather useless in terms of doing anything for people who are overweight. What are the physiological processes, dysfunctions and pathologies related to obesity? and, most importantly, what can be done about it? Knowledge is power, they say and in order to change something, one must first understand it. This article aims to:
A. provide a brief and clear explanation of the fundamental evolutionary, societal and physiological processes that appear to be linked to obesity, and
B. describe in simple, actionable terms what someone who suffers from obesity and metabolic disease can do in order to improve their health, well-being and life expectancy.
WHAT EXACTLY IS OBESITY?
The World Health Organisation (WHO) defines obesity as "abnormal or excessive fat accumulation that presents a risk to health". A Body Mass Index (body weight to height ratio) of over 25 is considered overweight, while a BMI of over 30 is defined as obese". This, however, is a rather crude and superficial definition which mostly fails to convey the underlying causes, physiological implications and consequences of the phenomenon.
GENERAL HEALTH
Being overweight certainly has an array of negative impacts on one's every-day life. Technically, however, obesity (or bodyfat per-se) is not the cause but simply ONE (very visible) symptom of underlying metabolic and hormonal dysfunctions which are closely related to a host of so-called ‘non-communicable’ (non infectious) diseases (NCDs). According to experts, NCDs have become “the leading cause of death worldwide and represent an emerging global health threat.” [Ref.]
Non-communicable diseases related to obesity include:
- Metabolic disease and inhibited functioning of the cells; for example Insulin resistance and Type 2 Diabetes (a key factor which will be explained in more detail further on)
- Hormonal imbalances
- Cardiovascular diseases such as High blood pressure, atherosclerosis, coronary heart disease, arrhythmia & stroke,
- Cancer,
- and even Dementia
In a 2021 publication, the Center for Disease Control and Prevention (CDC) stated that “Deaths from NCDs now exceed deaths from all communicable (infectious) diseases combined. NCDs kill 41 million people each year, equivalent to over 7 out of 10 deaths worldwide”.
Of course, not all of these deaths are directly caused by obesity but based on the latest research, a close causal relation between obesity and NCDs seems undeniable. [Ref.]. According to recent statistics, Type 2 Diabetes alone kills on average one person every six seconds around the world. [Ref.]
STATISTICS
A look at global statistics reveals the extent to which obesity and metabolic diseases are affecting populations around the world. According to the World Health Organisation,
- 36.2 % of all adults in the United States are obese (well over a third of the total adult population!)
- In the UK the number lies at 27.8 %
- In Spain at 23.8 %
- And in germany Germany, 22.3 % of all adults are obese. [Ref.]
Meanwhile, childhood obesity is becoming more and more prevalent as well. Being overweight from an early age significantly increases the risk of developing life-threatening conditions later on. A Swedish study from 2019 showed that “individuals who are obese during childhood have an increased risk of death by early adulthood” [Ref.]. Estimates suggest that in 2017, one in five children globally were overweight [Ref.]
HOW DID WE END UP HERE?
It is, of course, true that some people have a genetic disposition for easily accumulating body fat (as explained from an evolutionary perspective further on). Some people are born with metabolic conditions such as Type 1 Diabetes which increase their likelihood of becoming obese and developing other chronic diseases [Ref.]
Also, certain medications may lead to increased body fat accumulation, water retention and negative metabolic side effects. Cultural, economic, educational, psychological factors also play an important role in relation to physical health and should not be downplayed.
But these factors often lie outside of the control of the individual who is affected by them. The concrete mechanisms that need to be understood in order for anyone who suffers from obesity or related health conditions to begin to change their situation are described below.
ENERGY BALANCE
Technically, gaining or losing weight (body fat), depends on our ‘energy balance’ i.e. calories consumed vs. calories burned. Generally speaking, if we take in more calories through our diet than we are able to burn on a daily basis (resulting in a ‘positive energy balance’), the excess calories will be stored as body fat. If the amount of calories we consume is equal to the amount we burn, we will maintain our body weight and body fat percentage. If we consume less calories than the body requires to cover the energy demands of physical activity, brain activity, tissue repair and maintenance, as well as other physiological and metabolic processes, we enter into a ‘calorie deficit’ and the body will start to mobilise its energy reserves. If we maintain a negative energy balance over an extended period of time, we will therefore lose weight.
This logic is based on physics (the laws of thermodynamics) and while it is fundamentally true, it is not the only cause of over-eating; as an explanation it is not incorrect but it is incomplete. In order to appreciate the true complexity of the topic, we have to delve a little deeper. [Ref.]
EVOLUTION
Throughout human history, food was scarce and had to be hunted, gathered or worked for by means of agriculture. Therefore, the human body (metabolism) has evolved to be as energy-efficient as possible, storing excess calories as fat for surviving periods without food.
Obesity (or the tendency to accumulate body fat) has been genetically selected for throughout evolution because individuals who are good at storing energy, were more likely to survive periods of famine. By the same logic of evolutionary food scarcity, our instincts (‘tastes’) have evolved to favour and seek out calorie rich, ‘nourishing’ food [Ref.].
Combine these evolutionary factors with the ‘modern industrialised diet’ and a global culture of sedentary work and leisure, convenience, consumerism and psychological stress and you have the ideal recipe for what is now referred to as the ‘obesity epidemic’. Let's take a minute to look at the kind of food that millions of people around the world (particularly poorer demographics) consume on a daily basis.
PROCESSED, OVER-ABUNDANT FOOD
In the United States, overweight and obesity soared during the 1980s and 1990s [Ref.], coinciding with the rise of fast food. From a scientific perspective, though, correlation does not necessarily imply causation. To better understand the situation we find ourselves in as a modern society, the following factors must be considered:
In most developed countries today, there is an over-abundance of food. Particularly processed and packaged food products are readily available and all too easily consumed. Whether you go to a fast food restaurant, buy canned or packaged meals at the supermarket and simply heat them up in the microwave or pick up a ‘snack’ at the convenience store; calories are not hard to come by and practically no physical activity is required in order to obtain them.
HYPER-PALATABLE JUNK FOOD
Processed food products are designed for excess consumption by fooling our senses and hijacking our evolutionary tendency to seek out calorie dense foods. It is no exaggeration to say that within every company in the food industry, teams and entire departments of food technicians are continuously working on and refining recipes for products that ‘tickle our senses’ in such a way that we find it almost impossible to resist consuming them. Every aspect of these food products is carefully designed to make us buy more; their appearance, texture, consistency, taste, smell and even the effect of their ingredients on our bio-chemistry.
CALORIC DENSITY
Processed foods are also easily over-consumed because they contain far more calories per gram than natural foods. Their ratio of calories to satiety effect is extremely high meaning that they contain a disproportionately high number of calories relative to how full they make you feel and for how long that feeling of satiety/fullness lasts before the appetite for more kicks in. Natural foods tend to contain less calories per gram and are more satiating. Processed foods generally contain far more calories per gram while the feeling of satiety (or ‘fullness’) we get from them does not last very long. This is, in part, due to the effect that their chemical composition has on our metabolism and endocrine system (more on that later) but also because they contain less dietary fiber and are easily digested.
Most of the calories contained in highly processed foods (in particular sugar and other forms of simple carbohydrates) become available to the body far too quickly because they hardly require digestion. Unless you are extremely physically active, these calories will be stored as body fat since they cannot be used as quickly as they become available to the cells.
LOW NUTRITIONAL VALUE
Ironically, it is rather common for overweight and obese individuals to also suffer from micronutrient deficiency [Ref.]. While processed foods deliver an excess of calories, they contain little to no essential vitamins, minerals and trace elements, all of which are of vital importance to the normal functioning of cells and organs. ‘Empty calories’ truly are a hallmark of the modern industrial diet and the term ‘junk food’ seems to be quite appropriate indeed.
COMMERCIAL INTEREST; SELLING OBESITY
Logically, it is far more profitable to sell food products that are high in processed carbohydrates, salt, fat and sugar, have a longer shelf life and are literally addictive than it is to sell wholesome, natural foods which have an expiry date and are not addictive [Ref.].
The goal of this article is not to digress into political debates about the food industry, its policies and social responsibility (or lack thereof). However, in order to give you a complete and realistic impression of the issue at hand, it is probably worth mentioning that large multi-million dollar food companies represent an interest group with significant political leverage. There can be little doubt that they are investing in legal teams and lobbyists to influence the regulations placed on the industry in their favour.
[If you are interested in a more detailed account of the political and socio-economic aspect of this topic, you might enjoy watching this documentary which offers a rather critical view.]
CONVENIENCE AND SEDENTARISM
Not only are empty calories available to us literally at every corner, but we also live increasingly sedentary lifestyles. More and more people have sedentary jobs which require them to sit down almost all day every day. Most of these people will commute to work in their car, with public transport or with an electric scooter; the latest convenience gadget, allowing us to move from A to B without really moving. If we cannot be bothered to take the stairs, there will probably be an escalator to stand on and when, at the end of a long and psychologically draining workday, we want to ‘unwind’, we are quite likely to do so by getting comfortable on the couch and watching Netflix.
The lives of most people in the developed world are becoming less and less physical. In fact, we have developed to such an extent that we hardly have a use for our physical bodies at all anymore.
Our lives are, however, far from stress free. Workloads, economic pressure, competitiveness, day-to-day frustrations, and worries about the future make for a rather stressful and ‘busy’ lifestyle. Under such circumstances, many people will find it hard (practically or psychologically) to keep up with healthy routines such as cooking fresh, natural meals at home or exercising. Unfortunately, in today's world, it is all too easy to neglect one's own health.
The problem with sitting too much and moving too little is not just that we burn fewer calories and therefore accumulate more body fat. The ugly truth is that our bodies are literally deteriorating on every level if we don't use them in the way they have evolved to be used. Our cells and organs become less capable of performing their vital functions simply because they never have to and we become more and more sluggish.
Imagine a car which is hardly ever taken out for a drive. Even if it was a perfectly functional car to begin with, after standing in the garage for a number of years without being used on a regular basis, it will start to rust. Its electrical wiring will corrode and the rubber seals and valves will become brittle. Parts of the engine will become stuck because they never move although they are designed to move. As soon as you turn on the engine or try to accelerate, some vital part will probably fail and the entire mechanism breaks down.