The word ‘obese’ is derived from Latin word “obedere” which means to devour ( ob + edere means about + eat ). Obesity is the result of excessive eating. Obesity is the commonest effect of continued over consumption of calories. This blog post intends to explore preventive principles that could be applied to curb the behavior that leads to excessive eating. Preventive principles could be different from principles used in the treatment of obesity. Prevention of excessive eating would be of value in the clinical management of obese patients but should not be viewed as a curative regime. Obese patients may need other interventions apart from restriction of dietary intake. In my opinion, the prevention of obesity involves the ability to formulate eating behavior that is consistent with inner cues of hunger and satiety.
Obesity is the most common nutritional disorder of modern times. Obesity can occur at any stage of life. Obesity in childhood and adolescence has become common and is viewed with a sense of alarm. Obesity is defined as a condition in which there is an excesss deposit of fat in ( and on ) the body with an increase in body weight more than 10 percent above normal for the age, sex, height, and stock or clan. Body weight is a valuable screening measure for obesity. The measurement of body weight is the simplest and the least direct method of measuring the fat content in the body. It must be very carefully noted that we have tools to measure body weight and that we have no tools to measure or estimate the sensations called Hunger and Satiety. Hence, the preventive principles are not evidence-based, and are only reason-based. It will not be practical to provide consistent results while we depend upon criteria such as Hunger and Satiety which are not measurable quantities that are stated using a precise, scientifically accurate method. To deal with the problem of obesity, we have to deal with the issues of Hunger and Satiety to regulate feeding behavior and to control caloric intake. Patterns of eating behavior and physical activity are influenced by social, cultural, and economic factors. Hence, obesity is a complex issue but the complexity should not stop us from preventing the problem of excessive eating. Genetic factors may influence total body fat and its distribution. However, the epidemic of obesity is not caused by the prevalence of a defective gene or genes.
The brain mechanisms involved in feeding motivation include a complex network that involves the Limbic System that controls the emotional states and the Hypothalamus located at the base of the brain. Hypothalamus has nerve centers sensitive to changes in blood chemistry, water, products of digestion and temperature. A nerve center called Ventromedial Nucleus is described as the ‘Satiety Center’. It is the clearing house for satiety signals. Lesions in this area cause gross overeating or hyperphagia. The nerve center in the lateral hypothalamic area is described as the ‘Eating Center’ or ‘Hunger Center’. It facilitates feeding responses. Electrical stimulation of this area elicits voracious feeding and lesions in this area cause prolonged noneating or aphagia. Glucose receptors are present in the cells of the above nuclei which monitor the level of the circulating blood glucose in order to produce the appropriate response. Excessive eating can be controlled by direct electrical stimulation of Satiety Center. Internal changes that initiate behavioral changes are commonly termed ‘Drive’ or ‘Motivation’. Hunger is a sensation associated with various physiological changes that stimulate the drive to search for food. Most people are familiar with the sensation described as hunger pangs. The responsiveness of the brain mechanisms for feeding is governed by messages reporting the nutritional state of the body. Responsiveness is higher with increasing lack of food in the body. The contents of these messages are primary determinants of the level of feeding motivation. Hunger and Satiety represent high and low levels of feeding motivation.
PHYSIOLOGICAL MECHANISMS FOR REGULATION OF FOOD AND CALORIC INTAKE :
Life depends upon a virtually uninterrupted supply of materials for its metabolism. For purposes of survival, metabolic expenditure cannot exceed food intake for very long period. In principle, feeding must proceed throughout life at a pace equal to that of metabolism. In many cases, food intake does not closely follow caloric expenditure. It is permissible for food intake to lag when there are reserves in the body. Discrepancies between intake and expenditure leads to distortion of the basic pattern of caloric regulation. The capacity of the digestive system may set a limit on nutrient supply to the body. Such limitations play a role in human feeding behavior. In man, the capacity of food-gathering and of the digestive system exceed the demands of metabolism. Man has the inherent physiological capabilities and anatomical capacity to consume food and calories in excess of his normal metabolic requirements. It should not be a surprise to observe a similar predisposition to obesity among human pet animals like dogs and cats.
Lack of fuel in the body can be corrected by intake of food that provides energy. Ingested food( calories ) passes from 1. the mouth to 2. the digestive tract to 3. the blood stream, and then to 4. storage sites such as liver and fat tissues. These four regions are continuously monitored using a variety of receptors:
1. Organs for taste, smell, and touch in the mouth region. 2. Distension rceptors or mechanoreceptors in the stomach and gastrointestinal tract that monitor the volume. 3. Chemoreceptors that monitor the nature of contents of the blood stream. 4. Receptors in Hypothalamus and Liver for monitoring of fat tissues.
The signals converge on the brain mechanism for the feeding motivation using nervous and humoral or chemical pathways. The signals have two kinds of effects; 1. if signals from the four regions report increased fuel contents, the feeding motivation is lowered and satiety is raised, and 2. if taste, visual, and smell receptors are stimulated by palatable food the feeding motivation is increased. The signals for satiation overide the signals for hunger and feeding stimualtion. Food intake stops when feeding motivation drops below a critical level. When food is catabolized, it causes fuel depletion. Gastric emptying and emptying of Colon and Rectum also stimulate hunger sensation causing resumption of feeding. Once feeding isresumed, intake is enhanced by the positive effects of food stimulus. The interplay of positive and negative feedbacks from food intake tends to maintain a balance between caloric intake and energy output so that body fuel content or body weight in fully grown individuals remains constant. Few people adjust their food intake to meet their needs on a daily basis. The excess Glucose that is not utilized by the body is stored in the Liver as Glycogen which is further converted into fat. The excess amount of fat remains stored in the body fat tissues. The control of the amount of energy reserve in the fat tissue and the nature of control system is not fully understood. The physiological stimuli and changes associated with hunger could be stimuli for coordinating the long term regulation of the reserve energy. However, it must be noted that man can accumulate energy reserves and yet experience hunger sensation that is normally generated by a lack of fuel in the body.
OBESITY AND ENERGY BALANCE :
Exercise consumes carbohydrates and most of the fat. Obesity or excess fat accumulation is the consequence of imbalance between energy intake and energy expenditure. Obesity develops if physical activity or energy expenditure becomes very low and the person is not able to reduce food intake or energy intake. In modern times, people are able to obtain their food with little or no physical effort. New sources of power do the work formerly carried out by human muscles. Large number of people spend time without physical activity. People have appetites and are seldom really hungry. A very small excess of calories if habitual, can lead eventually to a large accumulation of fat. It has been reported that if a person eats a slice( 20 g ) of bread that is not needed each day or goes by car instead of walking for 20 minutes, the daily extra 48 KCal or 200 KJ will build up over 10 years to 20 Kg of fat deposited. In simplest terms, obesity is the outcome of consistent consumption of more calories than are required to meet the energy expenditure of that particular person.
THE CAUSES FOR OBESITY :
The causation of obesity is still difficult to explain. There are differences between obese and nonobese individuals in respect of hormone secretion and metabolism. Endocrine changes at puberty, during pregnancy, and at menopause may contribute to obesity at these stages of life. The effects of obesity are better understood than the causes of obesity. In Medicine, obesity is described as a clinical condition with several probable causes. Some of the organic pathological causes of obesity include endocrinal disorders such as hypopituitarism, hypothyroidism and hypogonadism. Hormonal changes associated with menopause, Anterior Pituitary tumor causing Cushing’s Syndrome, Dercum’s disease( Adiposis dolorosa ), and Frohlich’s Syndrome ( Posterior Pituitary Deficiency ) are causes of obesity. In a few obese individuals, psychiatric mood disorders such as depression and anxiety could be present. Depressed or anxious patients or the emotionally deprived may seek solace in food and such emotional factors play a role in the predisposition towards excessive eating. Overeating could be a symptom of boredom or emotional frustration. In mental diseases, bizzare disturbances of appetite, taste , and food preference may be seen. Some well-known examples are Anorexia nervosa and Bulimia. Self-imposed starvation may develop after bereavement or after disappointment in love. It must be understood that the functions of food include that of obtaining a sense of emotional satisfaction apart from satiation of hunger. The most important and the most universal cause of obesity among otherwise normal people is overeating and lack of exercise.
THE PROBLEM OF FOOD CRAVINGS – DESIRE, GRATIFICATION, SATISFACTION, AND CONTENTMENT :
The word desire or craving involves the feelings to wish, covet, or long for something. Similarly, the word appetite describes a desire to satisfy some craving of the body. The term greed describes excessive desire especially for wealth or food. The term lust describes a passionate sexual desire without idealized or spiritualized feelings. The word glutton describes someone who indulges excessively in eating and drinking. All of these different kinds of passionate desires or appetites have a common feature. The behavior that is attributable to greed, lust, and gluttony could be influenced by man’s sense of contentment. The role of contentment could be explained by ubderstanding the following quote from the Books of The Old Testament, The Book of Ecclesiastes, Chapter 5, verse 18:
“Then I realized that is good and proper for a man to eat and drink, and to find satisfaction in his toilsome labor under the sun during the few days of his life God has given him – for this is his lot.”
While it is good and proper for a man to eat and drink, the acts of gratification; eating, and drinking may not provide a sense of satisfaction that is complete and that overcomes the craving for food and drink. Contentment is the factor which determines as to the degree of gratification that is needed for producing the effect called satisfaction. Man can choose to set the bar called contentment at a high or a low level and experience the effect called satisfaction while seeking gratification of his desires. To conquer the insatiable enemy called desire, to achieve the result called satisfaction, one must overcome the senses, the mind, and intelligence which are the sitting places of desire. To accomplish the purpose of restraining the senses, the mind, and intelligence, we need to know man as the Whole Organism. I divide man into two categories; 1. The Self that represents man as a physical, mental, and social being, and 2. The Knowing-Self that represents man as the moral, and spiritual being. The Knowing- Self is the Higher-Self and hence it can exercise control and restraint over the Lower-Self which includes the physical body, the sense organs, the mind and intellect, which are the seats of all passionate desires.
In obese people, eating is less often determined by internal cues like hunger and satiety. For many obese people, the craving to eat is very strong and is similar to the craving for alcohol in the alcoholic and for a cigarette in a person addicted to tobacco smoke. The problem of food cravings is a significant factor in the management of obesity. The failure to respond to a dietary plan that restricts food and caloric intake is often caused by the inability to overcome food cravings which leads to non-compliance. The eating or feeding behavior is influenced by man’s sense of contentment. A person who lives in a state of self-contentment experiences a little less hunger and experiences a sense of satiation or satisfaction more easily after a routine meal. Such a person who is self-contented is not prone to food cravings. He may not need a dietary plan and may not need to count the calories he consumes. He is more likely to maintain a steady body weight without the requirement of changing the level of physical activities. Man has the ability to set his expectations at a level and experience contentment with what he has. If there is contentment, the desire for food and drink is easily satisfied. A contented man is more likely to meet the daily requirements of calories for optimal physiological functioning without gaining body weight. The prevention of obesity could be helped by a proper understanding of food, its nature, and its functions.
Food is a substance eaten for nourishment. Food serves functions other than nutrition. Food plays a vital role in the development, and the maintenance of social interactions, social relationships, and is the fundamental basis for man’s spiritual relationship with a source of energy and its provider which sustains life and existence.
Food describes any substance which a living organism can convert into energy and new tissue using the process of metabolism. The body fluids surrounding each cell are the immediate source of nutrients. The nutrients supplied by food are either used as building blocks in synthesizing large molecules or they are oxidized producing a form of energy that is further used for powering the activities of the cell. To maintain life, an organism not only repairs or replaces( or both ) its structures by a constant supply of the materials of which it is composed but also keeps its life processes in operation by a steady supply of energy. Living systems must be supplied energy for continual synthesis of new organic molecules and to replace or to repair broken organic molecules. Dr. Oliver Wendell Holmes, Professor of Anatomy and Physiology, Dean of the Harvard Medical School( 1847 to 1882 ) had defined life; “To live is to function; and that is all there is in living.” At cellular level, the living functions include uptake and conversion of nutrients, synthesis of new molecules, production of energy, and regulation and coordination of metabolic sequences.
The processes of synthesis and breakdown of the organic molecules of the cell are termed metabolism. Metabolism is divided into two categories; 1. Anabolism- it describes the processes of maintenance and growth, and 2. Catabolism- it describes the processes of energy production. The Living Cell depends on a virtually uninterrupted supply of materials for its metabolism. The Living Cell is a thermodynamically unstable system. This means that without a continuous input of energy, a Cell will degrade spontaneously into a nonliving collection of molecules. Food supplies organic molecules and other substances as nourishment to sustain life. Life is characterized by the presence of complex transformation of organic molecules and by the organization of such molecules into successively larger units of protoplasm, cells, organs, and tissues.
WHAT IS NUTRITION?
All the tissues and organs of which the human body is composed, consists of building blocks called Cells. Each Living Cell contains soft, gelatinous, semi-fluid, viscous, clear or translucent, colloidal living substance or matter called Protoplasm or Cytoplasm or Cytosol. A most striking characteristic of protoplasm is its vital property of ‘Nutrition’. Nutrition is described as the ‘power’ which protoplasm has of attracting to itself the materials that provide the energy, and the substances for its growth and maintenance from surrounding matter/environment. Nutrition, as a biological function and activity, is the evidence for the operation of Consciousness at cellular level. The Living Cell is conscious or aware of its own existence in its given environment, it is conscious or aware of its energy dependent state of internal condition, and consciously uses its power of nutrition to attract substances from its immediate environment. The Living Cell displays its living functions while it exists as a conscious entity. The Cell Death is characterized by the absence of the power of nutrition, and in the absence of energy input or food intake, the Cell dies. Consciousness and Food are related to each other. Consciousness gives the power of attracting Food and Food provides the ability to live with Consciousness which is the most important characteristic of life. The human organism exists because of the functions of the trillions of cells. The purpose of consciousness is to foster functional unity of the multicellular organism and establish it as an individual. This conscious individual experiences hunger, and thirst which provide the drive or motivation to initiate his feeding behavior. Each individual cell uses its own power of Nutrition to attract the nutrients from the body fluids that are present in its immediate environment. Certain metabolic disorders and conditions like Diabetes are associated with problems of food intake at cellular level. The man may feed himself, and nutrients like glucose accumulate in the blood stream and fail to provide the nourishment needed by the cells. Similarly, there are several mental diseases that are associated with a variety of eating disorders, and bizarre disturbances of appetite, taste, and food preference.
HUMAN NUTRITION :
The Biological Membrane or the Plasma Membrane separates the living cell from its environment and from other cells. It helps to maintain a constant ‘milieu’ in which intracellular reactions occur. The Plasma Membrane allows a highly controlled exchange of matter across the barrier it poses; some compounds are able to pass through the Membrane easily, others are completely blocked. Food must provide adequate amounts of all chemical elements needed by the Cells. Of the approximately 35 elements known to occur in cells, four( Oxygen, Carbon, Hydrogen, and Nitrogen ) make up about 95 percent of the cell weight. Nine elements( Calcium, Phosphorus, Chlorine, Sulfur, Potassium, Sodium, Magnesium, Iodine, and iron ) contribute about 4 percent of the cell weight. The remaining 20+ elements together constitute less than 1 percent of cell weight and are called trace elements because they occur in minute quantities. However, many such as Copper, and Zinc fulfil vital functions. Animal cells do not have the ability to synthesize certain complex organic molecules from simple inorganic compounds. Certain large organic molecules that serve as building blocks that must be supplied by food are known as essential dietary components. They include Vitamins, Essential Amino Acids, and Essential Fatty Acids. Man has restricted synthetic powers as compared to the bacteria and hence needs greater number of essential foodstuffs. Man derives energy solely from the breakdown of complex organic molecules, mainly Carbohydrates and Fats. Fuel for the maintenance of life comes from other living organisms or their products. Human life ultimately depends on the existence of green plants that can use inorganic source of energy such as Solar radiation. Terrestrial life depends upon an extraterrestrial source of Energy. All terrestrial organisms live as energy dependent entities and live by establishing a relationship with a source of energy.
FOOD AND ENERGY – THE ‘GOD-CONNECTION’ :
Man exists because of a “Connection.” In nature, man exists as an energy seeker or heterotroph. Human existence becomes possible only when man is connected to an energy provider. This biological connection to a source of energy is made possible when biological information is implanted in the single cell which begins its journey to grow and develop into a new organism. If Sun is viewed as a source of energy for all life on this planet, man is not directly connected to that source of energy. Man exists as a multicellular organism and each cell derives its energy from powerhouses called mitochondria; the intracellular membrane bound organelles found in all living cells.
The mitochondria have the necessary biological information to transform oxidative energy into a form of chemical energy that the cell could further use for its living functions. In nature, man obtains food from other organisms. Only the green-celled plants known as autotrophs can directly convert light energy into chemical energy that they can further use.
Man is connected to these Chloroplasts of green plant cells that have the ability to trap Sun’s light energy. Sun’s energy is an extraterrestrial source of energy and it is provided to man by the intervention of Chloroplasts and the Mitochondria which man had directly acquired from his mother’s egg cell. These biological mechanisms are put in place and they operate outside the intellectual or physical abilities of man. In my blog post titled, ‘The Divine Mother of Life, Energy, and Knowledge, I have described the mother as the source of life and energy. Kindly read that post using the hyperlink :
FOOD AND SOCIAL BONDING :
Apart from nutrition, man consumes food for psychological satisfaction or to derive a sense of emotional contentment, and for the benefit of other individuals. A pregnant woman consumes food to provide a direct benefit to the baby growing in her womb. This placental connection between mother and her fetus establishes an anatomical relationship and a social relationship and social bonding between the two both during the duration of pregnancy and after the delivery of the baby. Man’s feeding behavior and feeding activities are influenced by social, and external environmental factors. Both, the timing of feeding, and the choice of food are affected by social facilitation. Food-directed activities in social situations demonstrate the ability of food to establish connection between food provider and the food consumer. Hunger and Satiety operate the physiological mechanisms related to food intake. The psychological, and emotional contentment derived from food is related to Social Bonding and Social Relationships that are fostered by Food. I describe spirituality as a relationship based upon sympathy, understanding, affection, feelings of care and Love. Food has the intrinsic ability to nurture a spiritual relationship between the provider of the food and its consumer. There is also a direct emotional relationship between man and the food he consumes. The causes for excessive or overeating are not yet fully understood. The physiological mechanisms of hunger and thirst cannot fully account for the feeding behavior of man. Just like lust, and greed, man has psychological desire or craving for food and develops an intimate relationship with the food and drink he consumes. However, man can always express his craving for food in a spiritual context and seek the satisfaction provided by knowing the nature of God-Connection.
FOOD AND THE COVENANT OF SALT FOREVER :
Salt is universally used as a seasoning and as a preservative of food. Salt enjoys a special status among all food substances that man consumes. The status of salt as a life-giving and life-sustaining substance is well-founded. The intimate connection of salt with the idea of a “COVENANT” or binding relationship between man and God, and between man and man is recognized in all human cultures. The idea of “a covenant of salt forever” is found in The Fourth Book of Moses, The Old Testament Book of Numbers, Chapter 18, verse 19: “It is an everlasting covenant of salt before the Lord for both you and your offspring.” Similarly, The Third Book of Moses, The Old Testament Book of Leviticus, Chapter 2, verse 13 reads: “Season all your grain offerings with salt. Do not leave the salt of the covenant of your God out of your grain offerings, add salt to all your offerings.” The special status enjoyed by salt is reflected in the phrases popularly used in the languages of different people; “Untrue to Salt”( Persian ), “Trespass not against the Salt”( Greek ), “There is Salt between Us”( Arabic ), “Injury or Harm to Salt”( “Namaq or Namak Haraam” – Indian ). Jesus had very effectively communicated the relationship between the status of salt and the nature of man. The nature of man is understood in terms of his behavior, character, and conduct. It is expected of man to display respect, faithfulness, and loyalty in his relationship with other persons where the relationship is established by the covenant of salt. Jesus had directly instructed people to reject any person who has lost the fundamental characteristics of character and integrity and had stated His view by comparing man to salt. By accepting food, by consuming food, and by deriving nourishment and sustenance from food, man has established a binding relationship forever with his food provider.
FOOD AND GOD :
Jesus Christ has described Himself as the Spiritual Food of man. In the Gospel according to Saint John, Chapter 6, verse 35, Jesus declared, “I am the bread of life. He who comes to me will never go hungry, and he who believes in me will never be thirsty.” Further, the Book of John, Chapter 6, verse 48 also reveals the purpose of Jesus, “I am the bread of life. I am the living bread that came down from heaven.” Virtually all Christian Churches celebrate the practice of Communion such as Mass, Eucharist, or Lord’s Supper in some form or the other. The First Epistle of Apostle Paul to the Corinthians, Chapter 10, verse 31 instructs, “so whether you eat or drink or whatever you do, do it all for the glory of God.” Apart from the satisfaction of hunger and thirst, man uses food and drink to derive a psychological satisfaction by establishing a spiritual connection with God who is the ultimate Food Provider.
In all religious traditions and cultures of this world, food is associated with God. Food is used in the ritualistic worship of God, food is offered to God, and food is consumed in the name of God. Most religious festivals involve the use of food in celebration of God’s Mercy, Grace and Compassion. Food is traditionally used as the medium for fomenting a spiritual relationship with God.
FOOD AND GOD IN INDIAN TRADITION :
The Indian tradition describes Food and Drink as God and man the consumer of Food and Drink is also God. Man must view food as a spiritual substance; spiritual nourishment provided by the LORD God, the Creator and that attitude towards food would provide nutrition, psychological satisfaction, and social bonding which is complete and wholesome. The creation of Earth, and the Status of Man in nature are fundamental attributes of the Divine Being and His Divine Powers. The physical, mental, and social well-being of man is nourished by food that establishes man’s spiritual relationship with food and the food provider.
THE PRINCIPLES OF PREVENTION OF OBESITY :
1. Man has to eat and drink all his life. 2. Man has a predisposition to obesity as his anatomical structure and physiological functions may not prevent excessive consumption of calories even when the body has satisfactory energy reserve. 3. Man derives nutrients, psychological satisfaction, and develops social bonding by using food. 4. Food when used as a spiritual medium, it provides a complete sense of satisfaction and leads to contentment in life. 5. Man has the ability to control his senses, his feelings, and his intellect by acquiring knowledge about food. 6. Man can choose and set limits to his experience of contentment in life. He can set the level of expectation in a manner that the gratification of his desires produces the effect called satiation or satisfaction to defend his physical, mental, social, moral, and spiritual well-being.
Dr. R. Rudra Narasimham, B.Sc., M.B.B.S.,
Kurnool Medical College, Kurnool, Andhra Pradesh, India,
M.B.B.S. Class of April, 1970.
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