03/18/2010 05:12 am ET Updated Dec 06, 2017

Weight Loss: The Fat Gap, Generation Gap And Appetite Gap

Americans are falling into three gaps that threaten personal health and national solvency. Unless we reverse the trend, 43 percent of Americans will be overweight or obese by 2018, and the nation will spend $344 billion to address health-related problems.

The fat gap, a term coined by British researchers, refers to the discrepancy between how individuals see themselves and the number on the bathroom scale. Evidently, our notion of what constitutes being overweight or obese has been supersized because those around us--friends, family and colleagues--have similarly supersized their bodies.

In a British study reported September 23, 2009, in the Telegraph, only one person in 10 identified themselves as being obese, when in fact one in four was obese (roughly 30 or more pounds overweight). As a result, "Ten million Brits are unaware they are obese because being fat is now seen as the 'norm'." This lack of awareness unwittingly places the individual at risk for medical problems triggered by obesity.

In the United States, two out of three adults are overweight or obese. And since there is no reason to believe that our self-perception skills are more acute than those of our cousins in England, we can assume that millions of Americans are unaware that they are similarly at risk for medical problems associated with surplus weight.

Lest you think I am judging these individuals for their lack of self-awareness, I hasten to add that when, at five feet one inch, I tipped the scales at 183 pounds, I did not see myself as obese. Even though I was 60 pounds overweight, I saw myself as slightly pudgy. Besides, I didn't think I looked any worse than the people around me. I was trapped in the fat gap and was in the 90th percentile for risk of heart disease, cancer, stroke and diabetes. If I hadn't lost weight and got fit, I would likely have become disabled or died.

I'm not alone in my self-deception. Dr. Nick Yphantides, author of My Big Fat Greek Diet, fell into a similar massive fat gap because of an inaccurate self-perception. Just before his own radical, nonsurgical weight-loss adventure of 270 pounds, Nick estimated and told others that he weighed around 350 pounds. Not until he straddled two scales did he discover that he actually weighed 467 pounds. One of Nick's core messages is "you have to change the way you see before you can change the way you look, and this certainly applies to how we see ourselves."



Dr. Nick Yphantides. Photos Courtesy of Dr. Nick Yphantides.

These anecdotes explain why the fat gap is triggering a generation gap that is reversing decades of improvements in the health of seniors. For the first time in decades, Americans currently in their 60s are going to suffer more disabilities and medical problems--leading to a loss of independence--than did the preceding generations.

Researchers report this disturbing trend in a study funded by the National Institute on Aging reported in the November 2009 issue of the American Journal of Public Health. Seniors who grew up in the 1920s and 1930s enjoyed healthier food (junk food had yet to be introduced) and regularly participated in physical exercise in schools. They may also have worked in jobs that required physical effort. These and other factors have tended to protect their health.

In contrast, the biggest factor contributing to the declining health of the next generation of seniors is the expanding rate of obesity. Those who are overweight or obese strain their joints and cardiovascular systems, and they are more susceptible to diabetes and stroke. Consequently, even if the members of this generation survive a heart attack or stroke, they may be left with disabilities.

The decline in health may increase as future generations with even higher rates of obesity reach their senior years. In 2018, researchers predict that 43 percent of Americans will be obese.

Diabetes has already reached epidemic proportions among children, and 70 percent of adults 65 and older are either diabetic or prediabetic, which means they are on their way to being diabetic unless lifestyle changes are undertaken.

The explanation for the rising incidence of obesity may be related to yet another phenomenon--the appetite gap. The appetite gap is the discrepancy between what the body needs to maintain a normal weight and a sense of satiety that triggers an end to eating. If food doesn't trigger a sense of having eaten enough, individuals keep eating even though they may already have consumed more calories than required to maintain their weight.

The results of an experiment with rats, reported in the September 2009 issue of the Journal of Clinical Investigation, attempt to explain the chemistry behind appetite gaps. Rats fed a diet high in saturated fat for only three days--comparable to a human eating cheeseburgers and french fries for three days--showed a reduction in the hormones that trigger a sense of satiety.

Eating a diet high in saturated fats increased the appetites of the rats and these findings raised an interesting question: why would consuming saturated fat trigger a craving for more fat? Logic tells us that the opposite should occur: if the rat ate copious amounts of fat, the rat should feel satisfied. That the biochemical mechanism would trigger a craving for more fat seems counterintuitive. (Interestingly enough, healthy fats, such as those found in olive oil, did not suppress the satiety hormones.)

If a diet high in saturated fats produces weight gain in rats and the body chemistry of rats is similar to that of humans, then the growing epidemic of human obesity would be understandable. Saturated fats are common in many American foods--from fatty cuts of meat, bacon and processed meats to cookies, cakes, ice cream and muffins. Consuming these foods may be triggering a craving for even more fatty food and contributing to the rising level of obesity.

The mystery of the appetite gap remains unsolved pending further investigation. Although pieces of the puzzle are being put in place, it's unlikely that scientists will quickly determine the precise cause (or causes) of obesity and mass-market a simple, safe solution that will help us bridge the gap. It's more likely we'll need to modify our own behavior.

Dr. Yphantides considers behavior modification to be a key issue. "In order to achieve and sustain an ideal weight, people need to rediscover the importance of eating to the point of appropriate satisfaction and satiety rather than packing themselves like a cannon or a Thanksgiving turkey."

Besides moderating portion size, individuals who want to avoid falling into the fat gap may want to replace junk food with the Mediterranean-based diet suggested by the Mayo Clinic. The diet recommends the following:

• Eating a generous amount of fruits and vegetables
• Consuming healthy fats such as olive oil and canola oil
• Using herbs and spices instead of salt to flavor foods
• Eating small portions of nuts
• Drinking red wine, in moderation, for some
• Consuming very little red meat
• Eating fish or shellfish at least twice a week

Besides including the food groups from the Mediterranean diet, individuals can also benefit from regular exercise and meals with family and friends.

We have choices, and we must make them in full knowledge that our future is at stake. If we want to enjoy longer, healthier lives and reduce our burgeoning medical expenses, we'll have to find or create ways to close the gaps.