QUESTION: I heard you mention one time that fat people really don't eat more calories than thin people. If this is true, why do doctors and other health professionals keep emphasizing dieting as the best way to lose?

ANSWER: Several studies have cast doubt on the idea that people are fat only because they eat too much food. One study looked at the food records of 6,219 non-pregnant people whose diet was not influenced by illness or drugs and who stated their intake, estimated by dietary interview, represented their usual pattern of eating. Neither the caloric intake nor the caloric intake adjusted for physical activity level and age was higher in the obese subjects.Another more recent study was done by researchers at the Stanford Center for Research in Disease Prevention. This group analyzed the eating patterns of a group of overweight, middle-aged men. They found a higher correlation between the amount of fat in the diet and total fatness than between the number of calories consumed and fatness. In other words, the more fat they ate, the fatter they were, regardless of the number of calories they ate.

I have previously reported other studies showing this same phenomenon. For instance, two groups of rats were fed the same number of calories over a 60-week period, but the group that ate the amount of fat in the typical American diet got almost twice as fat as the group fed rat chow. These studies seem to indicate that the type of food is at least as important for many people as the number of calories that are eaten.

Why do we continue to emphasize dieting? There are several reasons I can think of.

First, all of us have been taught that the secret of weight control is caloric balance. If you eat more calories than you burn, you get fat; if you eat fewer calories than you need, you lose weight. This concept is correct, at least in the initial stages of weight control. Because we have been taught these principles, and they seem to work well in actual practice, we keep using them when faced with a weight problem.

The problem arises with the response the body makes to dieting. Research shows that dieting actually changes the body metabolically so that after awhile it becomes more and more difficult to lose weight and subsequent weight gain occurs more rapidly.

Second, there are many people who actually do have a problem with eating too much for their body metabolic processes to use. For these people, cutting down on the amount of food is an important step - but never to the point routinely recommended by some diet programs.

Third, even with an understanding of the role of fat and sugar in the diet, many of us are too impatient to allow proper nutritional practices and exercise to work. In our studies, we see an average weight loss of about 1.5 pounds a week. This means only about 6 pounds a month. Sometimes, we even see weight gains for a week or two as the body re-establishes proper glycogen storage levels. This is discouraging to many people who give up and try some restricted intake approach because the results on the scale are more rapid.

I don't believe there are any shortcuts to permanent weight control. Dieting in the traditional sense has not been effective and will probably never be effective.

The key? Change the type of food you eat and begin exercising. Happy New Year!