1. that obesity is a complex disorder, the culmination of physiological, psychological, social and situational factors;

2. that as a lifestyle disorder, it can only be remedied through a lifetime of effort;

3. that this kind of profound change requires the development of positive alternatives to problem behaviours;

4. that weight loss candidates must address four major stages of weight control: first the decision to commit oneself to action; second, the management of hunger and eating behaviour itself; third, the management of relapse and last, strategies for coping with long term maintenance.

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The reasons that fat was thought to be a major contributor to obesity were twofold: its high energy density of 9 kcal/g, and its relatively inexpensive conversion to fat storage (about 3-5 per

cent of its energy) compared to carbohydrate at 4 kcal/g and about 25 per cent of its energy needed to convert it into fat for storage. A better understanding of the physiology of macronutrient (carbohydrate, protein, fat, alcohol) balance has now added a more powerful reason: macronutrients are largely handled separately by the body and, under modem living conditions, dietary fat is essentially the only macronutrient which ends up in fat stores. Indeed, obesity can be seen as the ‘price’ paid for eating a high-fat diet and burning little fat through exercise since it is the gain in fat mass and fat-free mass which brings the body back into energy and fat balance.

Physiologically, therefore, all calories are not equal and fulfil quite different roles in energy balance. The role of fat is to provide energy reserves and fat in the diet has little impact on the active maintenance of energy balance through appetite mechanisms or stimulating fat burning. But does this mean that fat calories are more important in the cause or treatment of obesity? Changing diet composition while maintaining the same total calories does not result in weight changes over the long term, and increasing the calorie intake, irrespective of its composition, does cause some weight gain in the long term. However, we don’t live in a calorie controlled environment. Under conditions of ad libitum (free) eating, where foods are selected from a wide variety of choices and eating is at liberty in generally unrestricted amounts, the composition of the diet does have a substantial and important effect.

Increasing the dietary fat content results in a slow fat gain in all but the very active and decreasing the dietary fat content results in slow fat loss in people who are overfat. Therefore, the quality of the diet (i.e. fat: carbohydrate ratio) affects the quantity of the diet (i.e. the total calories). In the development of obesity, high fat content and high total calories are both important because they occur together, but the critical insight is that fat is, to a large extent, responsible for total calories anyway.

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The 23-year-old Miami resident had never been seriously overweight, “just a bit chunky,” she says. But when she got engaged in 1997, she decided that she wanted to look just right for her wedding. That meant slimming down—the right way. “I didn’t want to fall for any of those fad diets,” she recalls.

Barbara began reading books on nutrition and weight. She soon realized that certain seemingly innocuous foods such as mayonnaise, butter, cheese, salad dressing, and sour cream were adding a boatload of fat and calories to her meals. So she dropped them.

Now, instead of putting sour cream on her baked potato, she sprinkles a little salt. She flavors her salads with vinegar rather than dressing, her sandwiches with mustard rather than mayonnaise. And she bulks up her sandwiches with lettuce and tomato, not cheese.

Since she started making her simple substitutions, Barbara has lost and kept off 15 pounds. And she doesn’t even miss her high-fat, high-calorie flavor enhancers. “I would never deprive myself of my favorite foods,” she adds. “I just eat them in moderation.”

Best of all, she no longer considers herself chunky. Losing those 15 pounds put her in a slim size-5 wedding dress.

WINNING ACTION

Flavor your foods with calorie burners. Like Barbara, you can whittle away at your fat and calorie intakes just by replacing high-fat, high-calorie condiments

with healthier alternatives. In fact, certain spicy condiments such as horseradish and chili powder actually speed your body’s metabolic rate, so you burn more calories. Try mixing a small amount of chili powder, cumin, chopped cucumbers, and green onions into nonfat sour cream or nonfat plain yogurt. Use this calorie-burning Mexican topping to flavor grilled chicken breasts.

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