These changes are partly influenced by the actions of chemical messengers, called neurotransmitters. Different types of neurotransmitters function to stimulate specific areas of the brain responsible for certain mental states. There are a number of neurotransmitters that can either promote or discourage feeding. For example, seratonin, derived from the amino acid tryptophan, can reduce food intake and this is now the basis of several appetite-suppressing drugs. Ingestion of carbohydrate results in the release of seratonin which inhibits the norther intake of food. Conversely, another neurotransmitter in the brain, neuropeptide Y, stimulates food consumption. There are a number of other chemical messengers that either stimulate or inhibit food intake—the strength of specific signals after a preferred food has been eaten may affect that food’s desirability for further consumption.

Isolation of a ‘satiety’ gene, by geneticists working at Rockefeller University in 1994, suggests that genetics may play an important part in hunger. Research carried out over several years has suggested there may be a mechanism coded for by a gene or genes, which ‘switches off hunger signals in the hypothalamus. Scientists have searched for, found, and now synthesised a protein hormone which they have called ‘teptin’ Qeptos is Greek for ‘thin’ which may result in major advances for drug therapy for obesity—if it lives up to its early promises.

In addition to dealing with neurotransmitter signals and proteins, the hypothalamus integrates a wide variety of messages, from the first smell of food to its metabolic fate as stored energy, by a series of neurotransmitters, hormones and signals from circulating nutrients.

Physiological signals—Stomach and intestinal distension are mechanisms for terminating feeding by negative feedback via the nervous system. The release of hormones such as cholecystokimn and the stirnulation of special receptors in the gut also provide signals to reduce feeding.

Nutrient -Circulating glucose, amino adds and may also signify that food has entered the body’s system and reduce the desire to eat. Low blood sugar levels promote hunger and it is possible that lesser degrees of changes in blood sugar may also influence appetite mechanisms.

Hormonal signals—A variety of hormonal changes occur in response to ingested and absorbed nutrients and some of these may influence appetite mechanisms. Insulin is one of the main hormones involved in nutrient metabolism but its role in appetite mechanisms has not been clearly identified.

Metabolic signals—The conversion of nutrients into storage tissues may influence appetite mechanisms. For example, the amount of carbohydrate and glycogen stores or fat in adipose tissue may feed back signals to the hypothalamus, giving it important information about the status of the body’s energy reserves.

From this wealth of feedback the brain must sort out relevant signals and make decisions about food intake. When hunger is high, an individual’s ability to inhibit inappropriate food choices is reduced. Many food companies, especially snack food manufacturers, exploit this by advertising their products on television around meal-times.

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There are certain factors that can modify the set point weight to some degree. Exercise has been shown to lower set point. In other words, regular exercise doesn’t just burn calories; it actually seems to shift the regulation of body weight to a lower level. Similarly, certain drugs can lower set point. Anyone who has stopped smoking cigarettes and subsequently gained weight can attest to the effects of nicotine in keeping set point weight down. What’s more, evidence suggests that long-term response to a high-fat diet can raise set point. Thus, lowering the percentage of fat in your diet may help you lower set point.

The set point model has much to tell us, not just about obesity, but about the eating disorders as well. For the anorexic, self-starvation and severe weight loss cause the metabolism to slow to a crawl. The greater the loss, the more the body fights to return to its preprogrammed level. This explains why a person with this illness feels she must maintain such vigilance against hunger. Her body is fighting for its very life, and will muster all of the available resources to defend its existence.

Although they may have lost as much weight as an anorexic, bulimic women may be at a statistically “normal” weight or above. But the set point model suggests that “normal” can’t be defined by referring to some chart, such as the Metropolitan Life tables of height and weight. Normal weight can be defined only for a particular individual.

In fact, I would throw out the word normal altogether and substitute natural instead. To illustrate: Woman A may be five feet four with a small frame and a set point range of 114 to 120 pounds. Some insurance-company chart somewhere probably says this particular woman is “average.” But woman Â-same height, same frame-may have a set point range of 130 to 136 pounds. She’s above the statistical average, but she is at a good and healthy weight for her. Each of these women has a set point range that reflects her natural weight.

But now Woman  reads an article that says her weight is “above average.” She feels compelled to diet and loses twenty pounds. She now weighs about the same as Woman A, around 116 pounds. No one would consider her emaciated, yet she has lost 15 percent of her body weight-the same percentage required for a diagnosis of anorexia! Although statistically “normal,” her body may be in a state of semistarvation. Because she needs more food than she is eating, she is at risk of developing uncontrollable binge urges, thus trigg ering the vicious cycle of bulimia.

To break the cycle, people may need help. They need a teacher who will show them the way to regain a healthy balance between the mind and the body.

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For Stephanie, exercise was nothing new. She had tried it several times in the past as a way of getting in shape. “I had been gaining weight ever since I was in college,” she recalls. “I wanted to look better and feel better. But every time I started an exercise program, I’d lose interest. Eventually, I’d abandon my workouts.”

By 1998, Stephanie weighed 173 pounds. “I’m 5 foot 9, so I wasn’t really obese,” she says. “But I was having problems with my heart—it raced and sometimes skipped beats. My doctor attributed those irregularities to the fact that I was in such poor condition aer-obically.”

At last, Stephanie found her motivation to lose weight and get fit. She pursued a variety of activities—step aerobics, aqua-aerobics, running, even salsa dancing. She made some dietary changes, too, eating more fruits and vegetables, watching her fat intake, measuring portions, and drinking lots of water.

Her efforts paid off: Her heart health improved, and as a bonus, her body looked trimmed and toned. She marveled at how the pounds disappeared so quickly, but worried about whether she could continue losing. More and more, exercise seemed like a chore. “Even though I was doing a lot of different things, I felt myself losing interest,” she says. “But I didn’t want to sabotage the progress that I had made.”

Convinced that others must be facing the same problem, Stephanie pondered the idea of forming an exercise support group.

“There’s strength in numbers,” she says. “Staying motivated is a lot i “* easier when you’re working with a group rather than on your own.”

Stephanie decided to post a message on Diet Talk, a Web site that she had been frequenting for information and support since starting her weight-loss program. “I had gotten to know a number of people through the message boards and chat rooms, and I suspected that some of them were struggling with exercise, as I was,” she explains. She was right: About-15 people responded to her message.

In January 1999, Stephanie and her online buddies kicked off their Exercise Challenge. Each person has a goal of exercising at least five times a week. “Everyone’s workout is a little different, based on individual abilities and objectives,” Stephanie explains. “But that doesn’t matter, as long as we’re doing something.” The group members e-mail Stephanie at least every 3 days, and often daily, to report on their activities. Stephanie posts the results online on a monthly basis.

“Every month, 80 to 90 percent of us meet the challenge,” she says. “That’s been really encouraging.”

Even more encouraging is the support that participants give one another. “The group changes in size from month to month, from the core membership of 15 to as many as 40,” Stephanie says. “We’ve become almost like a family. We talk about our weight struggles, but we talk about other areas of our lives as well. And when one of us succeeds, all of us succeed.”

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The answer is simpler than you might think. Take a lesson from the Biblical story of Daniel. The king told his steward to feed Daniel and his three friends-the richest food and the finest wine, but Daniel declined. He wanted only grains, vegetables, and water. After 10 days on this regime, Daniel appeared much healthier and better fed than his friends who had been feasting on heavier fare.

I like to remind my patients to eat like Daniel did. The bulk of the diet should be made up of grains (whole-grain breads, cereals, and pastas). To that, add plenty of vegetables (raw or lightly steamed are best) and several pieces of fruit. Then, add small amounts of meat, fish, poultry, peas, beans, or lentils for protein, plus modest amounts of dairy products for calcium Fatty foods like salad dressing, oil, butter, margarine, and mayonnaise should be used sparingly, just for flavor. Sweets should also be eaten only occasionally, as a treat.

I tell my patients that we should aim for ideal cholesterol and fat numbers, not average. It may not be possible for all of us to have ideal numbers, but we should know what we’re striving for.

The fat blocker diet-Here is the ideals:

♦ Total cholesterol—150, or no more than 100 plus your age

♦ LDL “bad” cholesterol”—100 or less

♦ HDL “good” cholesterol—55 plus

♦ VLDL cholesterol—20 or less

♦ Triglycerides—less than 100

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“Look at this, Dr. Fox,” she said proudly, pointing to the computer screen. “Here’s a list of the diets I’ve been on, arranged alphabetically.” It looked like there were 30 or 40 diets on the screen, from Atkins down to Zone.

New words and numbers appeared on the screen moments after she tapped a few keys on the keyboard. “Now they’re arranged by pounds lost. See?” She pointed to the first item on the list.

“I lost 50 pounds on liquid protein, that’s the most, then 42 pounds when my jaw was wired and 28 pounds on this fruit only diet. And look at this.”

The display changed as she tapped a few more keys. “Now I’ve got them listed by amounts of weight regained after going off the diet. And the list in this column shows the side effects of each diet.” She sat back in her chair, smiling proudly. “This is the most complete record of dieting ever compiled. By name, by dates that I was on the diet, by pounds lost, pounds gained, side effects, and cost; I’ve got it all.” Her smile faded as she continued. “Unfortunately, I’ve also still got all the fat I started with.” Claire is not alone. One out of every three American adults is obese¹ and millions more are carrying around too much fat and becoming obese. Despite the fitness craze that arose in the 1970s and still continues, America is not a slim and healthy nation. But we certainly want to be (and quickly), so we turn to fad diets.

In the early years of my practice of internal medicine and cardiology, I put many people on weight-loss diets in an attempt to improve their health. But things did not go nearly as well as I had hoped. In fact, I once joked to a colleague, “I think I’m running a weight gain practice.” Many of my patients were actually getting heavier on the unimpressive diets we doctors used to recommend back in the 1950s and 1960s.

In the 40 years I’ve practiced medicine, I’ve seen every kind of diet you can imagine: water diets, grapefruit diets, the Drinking Man’s Diet, the Stillman and Atkins diets, pineapple diets, starvation diets, no-carbohydrate diets, starch-blocking diets, diets with pills, diets without pills, “scientific” diets, “common sense” diets, army diets, air force diets, American diets, foreign diets, liquid diets, and liquid protein diets. I learned about these diets from my colleagues, from the medical literature, from my patients, from my secretary, from my wife, even from Reader’s Digest and The Ladies’ Home Journal.

My patients have always asked me which diet was the best, which one they should be on. I knew you could lose a lot of
weight quickly on almost any of the diets, but I always hesitated to recommend one. Once I was approached by a manufacturer of the supplement used in the

Starch-Blocker Diet, who asked me to say something positive about the pill. As I spoke with the manufacturer, I realized that he didn’t know how much trouble this starch-blocking supplement could create as it blocked the ability of the pancreas to make an enzyme called amylase. Sure enough, many people who went on this diet suffered from nausea, vomiting, and other problems. The moral of the story is you must learn everything you can about a diet or supplement before you take it, and avoid it if the answers are not positive.

The problem with most all the fad diets is they are ill conceived, ineffective in the long run, and often dangerous. The originators and purveyors of these diets do
not understand (or have chosen to ignore) the underlying meaning and rationale of diets. Most of us think of a diet as a quick way to lose weight. We see it as a temporary device, a way to control ourselves or juggle food around. And once we’ve lost the desired amount of weight, we quickly and happily discard it.

The word “diet” comes from the Greek word “diaita,” which means a mode of life or a regimen. A diet, then, is not a temporary aid to be dropped and forgotten when the weight-loss goal is met. Instead, it is a lifelong plan, a blueprint for your life and health.

You can lose weight (at least temporarily) on just about any diet. But before you do, ask yourself 2 very important questions: How are you losing the weight? And how will the process affect your health?

There are three ways to lose weight: 1) By getting rid of water in your tissues; 2) By forcing your body to consume lean body tissue such as the heart, lungs, kidneys, or muscles; or 3) By burning fatty tissue.

Losing water weight, as you do with the high-protein diets and diuretics, is absolutely worthless because you will quickly replace the lost water and find yourself right back where you started. Losing and regaining water is not only a big waste of time and money, but it can also cause you to lose vital minerals, which can prompt serious medical problems.

Cutting into your lean body tissue is also a dangerous, possibly deadly, approach. Vital organs can become undermined, leading to organ damage and even organ failure. The only safe, sound, and permanent weight-loss method is burning off excess fat. Doing so takes time and patience, but fad diet promoters would rather promise quick and easy weight loss. Unfortunately, their promises are usually just hot air. Numerous studies have shown that 95 percent of those who lose 30 to 40 pounds or more on fad diets will gain it all back (often with interest) within 1 year. And 99 percent will have gained back all the lost weight within 3 years.

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