What can be done about obesity?

All too often, obesity prompts a strenuous diet in the hopes of reaching the "ideal body weight." Some amount of weight loss may be accomplished, but the lost weight usually quickly returns. More than 95% of the people who lose weight regain the weight within five years. It is clear that a more effective, long-lasting treatment for obesity must be found, lest obesity lead to oblivion.

We need to learn more about the causes of obesity, and then we need to change the ways we treat it.

When obesity is accepted as a chronic disease, it will be treated like other chronic diseases such as diabetes and high blood pressure. The treatment of obesity cannot be a short-term "fix," but has to be an ongoing life-long process.

Instead of staring nearsightedly at the goal of attaining an "ideal weight," obesity treatment must acknowledge that even modest weight loss can be beneficial. For example, a modest weight loss of 5 to 10% of the initial weight, and long-term maintenance of that weight loss can bring significant health gains, including:

• Lowered blood pressure
  
• Reduced blood levels of cholesterol
  
• Reduced risk of type 2 (adult-onset) diabetes. In the Nurses Health Study, women who lost 5 kilograms (11 pounds) of weight reduced their risk of diabetes by 50% or more.
  
• Decreased chance of stroke
  
• Decreased complications of heart disease
  
• Decreased overall mortality
  

It is not necessary to achieve an "ideal weight" to derive health benefits from obesity treatment. Instead, the goal of treatment should be to reach and hold to a "healthier weight" (for more, please read the "Aim for a Healthy Weight" article). The emphasis of treatment should be to commit to the process of life-long healthy living including eating more wisely and increasing physical activity.

In sum, the goal in dealing with obesity is to achieve and maintain a "healthier weight."

Does it matter where body fat is located? (Is it worse to be an 'apple' or a 'pear'?)

Concern is directed not only at how much fat a person has but also where that fat is located on the body. The pattern of body fat distribution tends to differ in men and women.

Women typically collect fat in their hips and buttocks, giving their figures a "pear" shape. Men, on the other hand, usually collect fat around the belly, giving them more of an "apple" shape. (This is not a hard and fast rule, some men are pear-shaped and some women become apple-shaped, particularly after menopause).

Apple-shaped people whose fat is concentrated mostly in the abdomen are more likely to develop many of the health problems associated with obesity. They are at increased health risk because of their fat distribution. While obesity of any kind is a health risk- yes, it is better to be a pear than an apple.