The fact that some people are able to maintain a normal or healthy
weight while others become obese is almost certainly a result of behavioral
and psychological factors working in concert with genetic and metabolic characteristics.
Increasingly, one.s diet and weight have been implicated in a number of health problems or adult onset diseases, and weight management
and nutritional risk management programs have become a standard part of
wellness or health promotion campaigns (e.g. Wing 1995a, Weiss et al 1991).
Use of vitamin supplements, increasing consumption of fruits, vegetables, and
fiber, and moderation of consumption of animal fat are widely believed to predispose
better health. Healthier diets and proper nutritional balance may also
facilitate weight management and help to prevent obesity. However, dietary
change often requires substantial lifestyle change, and weight control has
proven difficult for many people to maintain (Wing 1995b).
OBESITY AND CARDIOVASCULAR RISK Perhaps the clearest links between diet
and health or disease outcomes are for cardiovascular disease, where fat and
cholesterol intake as well as salt consumption, obesity, and weight gain have
been implicated as major contributors to coronary artery disease, hypertension,
and stroke. Many of the dietary characteristics that affect weight gain and
obesity are also risk factors for cardiovascular disease, and some programs
seek to intervene to address both issues simultaneously. For example, high-fat
meals are less satiating than are high-carbohydrate meals (Golay & Bobbioni
1997), and high-fat diets may be associated with greater overall food consumption
and weight gain than are high-carbohydrate diets. In addition, people
who are or have been obese do not appear to adapt appropriately to dietary fat
and respond to it with increased fat storage (Golay & Bobbioni 1997). Consumption
of fat affects eating behaviors as well as metabolism of food, weight
gain, and cardiovascular risk in several different ways.
Interventions to prevent obesity and help people to lose weight are successful
in achieving short-term benefits, but show more complex and poorer outcomes
over longer periods (Wing 1995b). Some are very successful as long as
the intervention is maintained and participants comply (Metz et al 1997). Interventions
targeting specific ethnic or socioeconomic groups and recognizing
cross-group differences in diet and disease risk have also had some success in
changing dietary behaviors (e.g. Barry & Wassenaar 1996, Fitzgibbon et al
1996, Stolley & Fitzgibbon 1997).
DIET AND CANCER The literature on the impact of diet and overall weight on
the etiology and progression of cancer is more speculative and difficult to
evaluate than is research on diet and heart or vascular disease. Nonetheless, research
suggests that careful dietary management may help to prevent or control
cancers. The literature on the impact of vitamins, foods, and natural products
on cancer is growing rapidly.
Data provide some support for the possibility that what people eat affects
their risk of developing cancer, but findings are mixed. For example, highfat/
low-fiber diets are associated with mammography results indicating high
risk of breast cancer, while lower-fat/high-fiber diets are associated with much lower risk mammography profiles (Nordevang et al 1993). However, research
has also failed to find associations between fat or fiber intake and cancerrelevant
outcomes (Negri et al 1996). Estrogen levels are associated with fat
consumption, and dietary fat has been associated with recurrence of breast
cancer among women with estrogen-receptor.positive tumors (Longcope et al
1987, Holm et al 1993). These findings are provocative, but more definitive
evidence of these relationships must await the results of several ongoing trials.
As with interventions to reduce risk of cardiovascular disease, efforts to
manage cancer risk through diet have achieved significant changes in diet.
Randomized trials seeking to decrease the percentage of caloric intake from fat
have shown that people can modify their diet and achieve recommended or target
levels of fat intake or weight loss (e.g. Heber et al 1992, Meyskens et al
1985, Schapira et al 1991). Similar efforts have been linked to increased consumption
of healthy foods and fiber (Domel et al 1993, Atwood et al 1992). Attitudes,
knowledge, or beliefs about associations between diet and disease can
also be manipulated to help alter patterns of food consumption. People who believe
that diet and cancer are linked, who know what recommendations to follow,
and who believe that others support modification of diet to reduce cancer
risk are more likely to make healthy changes in diet than people who do not
(Patterson et al 1996). Among people considering their risk of cancer, it appears
that many adults are willing and able to modify diet when there is clear
evidence for it.
STRESS AND DIET Stress is thought to affect diet and weight at several different
levels. Negative mood may lead people to eat more and may result in their
seeking .comfort foods. or foods that make them feel better. Most of these
foods are relatively high in fat and salt or sugar, meaning that stress may increase
consumption of less healthy fatty, salty, or sweet foods. These effects
can be traced at any of a number of levels, as in stress-related enhancement of
metabolic rate, stress-related increases in physical activity or in time pressures
and busy schedules that can increase consumption of fast or convenience
foods. Enhanced metabolic demand during stress may increase consumption
of food without necessarily affecting weight.
The literature on stress and eating behavior, weight gain, and obesity is
complicated and focused most intently on acute stress-eating relationships
(e.g. Greeno&Wing 1994). The relationship between stress and eating is complicated
by personality or behavioral factors that qualify stress-related changes
in food consumption, and thoughtful analysis of chronic stress and weight or
diet changes have not been evaluated. Systematic examination of these and
other possibilities will clarify the relationship between stress and diet and
should help to design programs that more effectively manage weight and risk
of disease.
