Fat is not a feminist issue: a man's "middle-aged spread" won't disappear without some effort.

Men long known, intuitively at least, that health and obesity are not compatible. Hippocrates observed that the obese die sooner than those not so inclined, and even Shakespeare recognized that being overweight caried an excess risk. in 11 Henry IV the king berates his fat knight Falstaff

"Make less thy body hence, and more thy grace; Leave gormandizing; know the grave doth gape For thee thrice wider than for other men."

And yet in spite of this knowledge we often watch in a helpless horror a our own shapes extend and droop regardless of our well-intentioned resolutions not to let such a thing happen. We console ourselves with hollow comments about'middle-aged spread,' 'spare tires,' and the worth of girth.' We defensively ridicule the women in our lives for their obsession with weight and appearance, but in our innermost selves we admit we do not like the shape we're in.

Happy Fat Man?

Society attaches a significant stigma to being overweight, and many of us can readily identify with Fatty Arbucle's character Sheriff 'Slim' Hoover, in the play "The Roundup," who complained, "Nobody loves a fat man." One physician recently observed that "the stereotype of the happy fat person must be one of the strongest candidates for the most inaccurate myth in contemporary society. The obese are in despair; they hare the disapproval of themselves that others have of them. To it they add remorse and self-hatred for their inability to stop eating."

Today's average American is more than 20 pounds overweight. Almost as many adult males (3 1.2 percent as females (35 percent) weigh 20 percent or more above their ideal weight (the standard definition of obesity), and more than I million these are almost double their desirable weight. If we include those who, while not meeting the official definition of obesity, are nevertheless above their healthy weight, w find that more than 65 percent of the population is overweight.

Pinch An Inch

Although we often speak in terms of excess weight, the true culprit as as health is concerned is fat. The bathroom scale, the instrument most commonly used to determine overweight, obviously does not distinguish between fat and lean tissue. Hydrostatic weighing or skinfold measurements are required to give a more accurate indication of the actual percentage of body fat. The precise determination of body fat does require appropriate instrumentation, but the old adage still holds that if you can "pinch an inch" there is too much fat.

A number of years ago Senator George McGovern, chair of the 1977 Senate Select Committee on Obesity, observed that "paradoxically enough, obesity is the number one malnutrition problem in the United States." Dr. Albert Stunkard from the Department of Psychiatry at the University of Pennsylvania, one of the leading authorities in the field of obesity, stated that obesity is the greatest preventable cause of death in this country today," While there are some that may argue with that evaluation, no credible medical authority will dismiss it as a trivial problem.

Obesity has been established as a major contributor to five of the 1 0 leading causes of death in the United States, including heart disease, some cancers, stroke, diabetes, and atherosclerosis. In some studies with all other factors controlled, obesity is still an independent mortality risk.

An individual's weight gain or loss must result from one or more of the following situations:

1 .Modification of the rate of energy expenditure;

2. Adjustment of food (energy) intake;

3. Alteration of the efficiency of energy used by the body.

Let's take a look at each of these possibilities.

Recommending increased exercise as a way to lose weight is an ancient strategy Galen, a second-century Greek physicia, allows that "I have made any sufficiently stout patient moderately thin in a short time by compelling him to do rapid running." Exercise is still the weight loss strategy most often employed by men, but the results don't always meet expectations.

Ways We Use Energy

Energy expenditure can be divided into three components: basal metabolic rate, the thermic effect of food, and physical activity. Basal metabolic rate or BMR describes the amount of energy needed just to keep you alive. Of the three, it is by far the most significant, accounting for up to 70 percent of the total energy expenditure. This is, to some extent, determined by genetics, but it is most closely related to the amount of muscle mass. in fact, if lean body mass is used as the variable, obese individuals have, on the average, the same basal metabolic rate as do the lean.

The thermic effect of food involves the energy used and released in the process of the digestion of food. Again, researchers have failed to find any significant differences between the obese and lean.

The final category, that of physical activity, would seem to be where the variability lies, but, again, studies do not bear this out. True, obese individuals do move about less, but since they are moving a greater weight the net energy expenditure is about the same.

Physical activity can be subdivided into two categories; one, referred to as spontaneous physical activity, has to do with the normal movements of life and accounts for approximately half of the total. The remaining portion, the unrestricted or voluntary physical activity in all but professional athletes or compulsive exercisers, accounts for only about 10 percent of the total energy expenditure and thus would need to be markedly increased in order to have a significant impact on total weight.

Factors in Exercise

It only takes a little calculating to understand why this is so. Take, for example, the energy cost of a threemile walk. If you average a mile every 20 minutes, that amounts to an hour's exercise. If you walked three miles every day, you could justifiably feel that you were engaging in significant exercise and would, most likely, expect to lose weight in the process. Unfortunately you would, more oft than not, be disappointed.

Other factors that are often left o of the calculation of the energy cost of exercise must be considered. First if you did not exercise, you would still be alive and your basal metabolic rate would continue to use energy. This amount must be subtracted from the total, since it doesn't represent additional energy expenditure. Second, it is also likely that you would not remain in a total state of rest during the time used in walking, so the energy used in spontaneous activity must also be subtracted. Thus the net extra energy used in this one hour of exercise is much smaller than it would initially seem.

Post-Exercise Benefits

For a time it was thought that, while the exercise itself did calories, there was a post-exercise increase in the metabolic rate lasting for hours that substantially increased the energy usage. While there is a slight increase, it has not been of the magnitude once proposed. Most authorities now estimate the post-exercise energy expenditure at about 15 percent of the cost of the exercise itself. We must thus conclude that even the fastest exercise cannot burn off the calories that the slowest overeater can take in.

Now this information must not be used to discourage an exercise program. There are many other very positive benefits such as improving cardiovascular health and reducing stress that result from regular exercise. But it does indicate that if weight loss is the only goal of exercise, the results will likely be disappointing. This often leads to an abandonment of the exercise altogether.

Watching Food Intake

The other side of the equation involves the control of energy or food intake. Obese individuals often maintain that they eat no more than their lean counterparts, and in fact past diet surveys have seemed to bear this out. They insist that they are just much more efficient in their use of food so that less is needed for and more is available for storage.

However, when researchers have been able to actually measure the amount of food eaten and compare that to what is reported, they find that obese individuals tend to under report the food ingested by as much as 50 percent. The extra food is oft eaten in binge fashion and may not even be remembered.

This brings us to the final control possibility: the differences in the wa food is used as a fuel. Even though do not fully understand all of the components, it is apparent that a feedback control system is in operation moderating and modulating our weight. This seems to function in much the same way that a household thermostat controls the temperature.

The body maintains a dynamic balance for each of the major nutrients--fat, protein, and carbohydrate--and there is only a modest conversion among them. Theoretically it is possible for excess car bohydrate to be stored as fat, but the conversion process is not very efficient. To store 100 extra calorie of carbohydrate as fat requires 23 calories of energy for the conversion, while the same number of extra calories of fat needs only three calories for storage.

In addition to this inefficiency, a process called nutrient-partitioning resists the conversion of carbohydrate to fat. So strongly is this partition maintained that 3,000 to 5,000 extra carbohydrate calories have to be ingested each day for several days before there is an appreciable conversion to fat. This has led many obesity rearchers to conclude that in Western diets the generation of new fat from carbohydrate is of little importance.

Although protein can supply some of the energy needed, most of it comes from either carbohydrates or fast. The energy derived from each sources is largely dependent on the ratio of these two nutrients in the diet. If a large portion of the daily calories comes from fat, then a correspondingly greater portion of the energy needs are supplied by fat. Unrfortunately, a diet high in fat will fill the fat storage to a greater degree than one low in fat.

Obese individuals who have greater stores of fat must thus be eating diets that are higher in fat than those with lower fat stores. Studies of obese individuals have indeed shown that they consume more fat and, interestingly, less sugar than their lean counterparts.

Less Fat for Less Weight

While each individual has a specific genetic makeup that determines the degree of fat storage at a specific carbohydrate-to-fat ratio, it follows that the best way to reduce fat stores in general is to eat less fat. Research has shown that for most of the population a diet with greater than 30 percent of the calories from fat will produce weight gain and that weight loss will require a diet in which fewer than 20 percent of the calories are derived from fat.

It may well be that God had more than ritual in mind in His instruction to Israel, "Ye shall eat no manner of fat, of ox, or of sheep, or of goat. And the fat of the beast that dieth of itself, and the fat of that which is torn with beasts, may be used in any other use: but ye shall in no wise eat of it" (Lev. 7:23, 24).

The health benefits of sensible weight loss and maintenance are well worth it. Don't try to make it happen too rapidly. Remember, you took years to put it there. Weight loss should never be greater than 2 percent of your weight per week. Keep a positive attitude and approach the problem as a change to a new way of life. if your only goal is weight loss without an accompanying lifestyle change, the weight will soon return. After all, it was your lifestyle that put it there in the first place.

Success won't come without effort, but it is possible. Those who struggle with this problem may find new meaning in responding to Christ's invitation. "Come unto me, all ye that labour and are heavy laden, and I will give you rest" (Matt. 11:28).

Glen G. Blix is assistant professor of health promotion and education at the School of Public Health, Loma Linda University.

RELATED ARTICLES: Five steps to lowering your weight

Each individual is unique and will respond differently to modifications in lifestyle, but a number of general weight loss recommendations may be helpful.

1. Set a realistic weight loss goal.

You may never be able to return to your high school weight, but even a little weight loss helps. Dr. George Blackburn of Harvard Medical School maintains that most of the health consequences of obesity can be minimized by losing only 10 percent of your current weight.

2. Reduce the amount of fat in your diet.

Count grams of fat instead of calories, and for weight loss keep fat intake to fewer than 45 to 55 grams per day. If you are looking for rapid weight loss, keeping your fat grams at 20 per day will achieve the maximum results, but fat levels this low should be used for only short periods of time.

3. Begin and maintain an exercise program.

Even though exercise may not add appreciably to the amount of is important for weight maintenance. Numerous studies have shown that a regular exercise program is the best predictor of weight maintenance. It is also important for cardiovascular health and stress management.

4. Don't eat between meals.

Snacks are often high in fat, and in any event, they increase the total calorie intake.

5. Drink a glass of fruit juice 20 to 30 minutes prior to the meal.

Evidence now exists that this practice may indeed 'spoil your appetite' and allow you to eat less at the meal by blunting the appetite.