The next development examined the separate nutrient balance equations, i.e. fat, alcohol, carbohydrate and protein equations. In human physiology it became clear that fat imbalance was the main cause of energy imbalance. Hence the formula to describe this became the following:

Rate of change of fat stores = rate of fat intake — rate of fat oxidation.

This developed from important physiological studies in the 1980s which found that in humans, fat stores come largely from dietary fat, and that under most conditions, fat balance equals energy balance. It is only under unusual conditions that humans convert significant amounts of non-fat calories into fat for storage. This model then suggests fat imbalance as the primary cause of an imbalance between energy intake and utilisation. Hence, the approach is a major step forward because it moves away from regarding obesity as a pathological state in a ‘normal’ environment. Because the problem of obesity is so widespread in modem societies, it suggests that the opposite is almost certainly true, i.e. that the spectrum of body sizes from lean to obese represents the normal variations of physiology and, within a ‘pathological’ environment (which favours obesity), many more are at the obese end of the spectrum. However, there are still problems with this approach. The fat balance equation above describes the changes in fat stores that occur within a given individual over time. It is less clear how differences in body fat between individuals arise. Why is it that some people remain relatively lean when they seem to have the same sort of lifestyle as others who are overfat? It also fails to explain the differences in obesity prevalence between populations. To explain this requires an expanded approach.

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For example, gastric dilatation, in which the stomach expands and may rupture, can occur during a binge. Pancreatitis-inflammation of the pancreas-may also develop.

Starvation can lead to abnormal growth of fibrous tissue in the kidneys (interstitial fibrosis). Another risk is diabetes insipidus, which robs the body of its ability to conserve fluids.

Slowed heart rate (bradycardia) is a common effect of starvation. Potentially fatal heart arrhythmias may also develop, usually due to electrolyte imbalance, but sometimes occurring even when electrolytes are normal. Fatal cardiac failure can occur if weight is regained too rapidly.

Starving reduces the ability of bone marrow to produce blood cells. As a result, the white blood cell count may drop. (Surprisingly, this may not always lead to increased infections.) It also disturbs the blood’s ability to form clots, which can lead to bleeding problems.

As the starving body “turns down the thermostat” to conserve energy, the thyroid reduces its functions. Other endocrine abnormalities also develop. Another major problem is osteoporosis, a decrease in bone mass that can lead to fractures of the ribs or spinal vertebrae.

These potentially fatal medical consequences may frighten you. However, sometimes it takes a good scare to break through the wall of denial that accompanies these illnesses.

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It also made her overweight. In 1975, at age 55, Teresa reached her top weight of 205 pounds. “I was at a point where I just didn’t like myself anymore,” she says. “Then I read about Weight Watchers in a magazine, and I decided to give it a try.”

The program taught Teresa how to make smart food choices and how to cook with low-calorie ingredients. “I was amazed at how quickly the pounds began to disappear,” she says. “I lost between 7 and 8 pounds in the very first week.”

But then, Teresa noticed that her weight loss was slowing down. She did an inventory of what she was eating and found one culprit showing up repeatedly—her favorite, apple strudel. She was indulging once or twice a week.

“You keep eating what you grew up with,” Teresa says. “It’s built into you. So I had to figure out a way to eat differently but still get that familiar, old-home feeling.”

Teresa decided to trade her strudel for cereal. She had a bowl every evening, before she went to bed. The sugar in the cereal satis fied her sweet tooth as the strudel once had. And the milk, which she drank while growing up in Hungary, reconnected her with her childhood. She was able to lose weight without feeling deprived.

Teresa, who’s now 80, shed a total of 86 pounds in about a year and has kept off the weight for 24 years. These days, she teaches baking at her local senior citizens’ center, where she occasionally whips up a batch of her apple strudel. She even allows herself a serving, as a treat. But she hasn’t forsaken her bedtime snack of cereal, creating her own concoction of one sugary brand and three nonsugary brands. “I constantly alter the proportions so that the mixture always tastes a little different,” she explains.

WINNING ACTION

Satisfy your sweet tooth with a new favorite. A bowl of cereal with skim milk can satisfy a craving for sweets without blowing a healthy diet. Like Teresa, I satisfy my nighttime cravings for sweets with cereal, but without milk. I just pour some into a bowl and sit down for sweet and crunchy handfuls of Golden Grahams.

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