Fat City

We're fed up. We don't need another magazine ranking telling us we're fat any more than we need another world-famous corned beef sandwich. (Actually, we do need to do something about those corned beef sandwiches.) But instead of letting it get under ou

If I could be any cell in my body, I'd be a fat cell. What a cush life. For one, I live in Cleveland, which is to fat cells what Palm Beach is to wealthy retirees, a delightful place to kick back, relax and meet other fat cells. Also, to be a fat cell in Cleveland is to have job security. On a cellular level, it's easy to keep things warm when it's cold outside, and no one wants to walk anywhere (except maybe to the front of the line at The Cheesecake Factory). Not that anyone could get rid of me anyway ? unless a plastic surgeon actually sucks me out. I might shrink, but in Cleveland, I'll probably just get bigger.

Of course, as a fat cell, I'd have many to thank for my good life: the folks at Slyman's, Malley's and all the nearby Dunkin' Donuts for making it so easy; Drew Carey, Scott Savol and the Cavaliers' "Beefcake on the Lake" male dance team for keeping physical fitness expectations low; the Indians, the Cavs and the Browns for making sure I spend a lot of time snuggled against a couch or a seat in the stands and for all the nacho chips, hot dogs and beer.

Admittedly, as a fat cell, I'd be reviled. Under a microscope, I just look like a oily sphere, squished against other oily spheres. But I'm much more recognizable - and detested - when gathered with millions of my friends. Maybe you've seen the 5-pound replica of fat that health educators like to carry around. It's a soft, bumpy, misshapen thing the color of diluted urine. Globs of real, live fat cells are more yellow than that - at least they look more yellow than that as they're being dislodged from a saddlebag of an otherwise shapely woman.

This is what happens during a liposuction at Dr. Lu-Jean Feng's office in Pepper Pike: The patient's fat cells are sucked into plastic tubing and emptied into two 2-liter containers as Feng works a hollow, stainless steel suction device, moving it in and out the way a cellist might work her bow, purposefully, rhythmically. Its tip, visible under the slipcover of skin, pokes at the fat deposits, filling the containers with the yellow fat tinged orange with blood. The mountain of flesh on the patient's derriere becomes a gently sloping hill under Feng's gloved hand. "It's not what you suck out, it's what you leave behind," she says.

Feng performs the surgery only on people who are likely to preserve the body she leaves them with ? those within 15 pounds of their target weight and with good eating and exercise habits. Because even after liposuction, there will be plenty of fat cells left behind to expand if the patients overeat.

An adult of average weight probably has between 25 billion and 35 billion fat cells, way more than you see hanging over your waistband in the form of a love handle. There are many, many more hiding in places that cannot be seen by anyone outside a surgical suite, including around the eyes and intestines, on the palms of the hands and the soles of the feet, even adhering to the heart.

At the Case Western Reserve University School of Medicine, fat clings to a ventricle of a cadaver being dissected by first-year students. Soon after lifting the avocado-sized heart from the chest cavity, the students cut away at the dark yellow globs with their scalpels. Some of this fat served a good purpose for the small, thin woman when she was alive; it cushioned and insulated. But fat is the enemy of anatomy students, slowing them down in their pursuit of the organs and muscles. Fat is everywhere, and gets in the way constantly, messily, stickily.

Do you know how much time it takes to remove all that dead fat? When you're trying to learn your way through an entire human body, way too much. Students dissecting heavier cadavers work with fat-ensconced hearts as big as cabbages.

You've got to admit, the fat cell is fascinating in its ubiquity. There is no place it fears to venture. When given lemons, the fat cell makes lemon torte.

Take some things that turn people off about Cleveland most: the weather, the inaccessibility to the lake, the self-esteem problem. All that stuff is great for the fat cell. Being the butt of jokes is much harder than being the butt. Saddlebag fat is some of the stubbornest fat around, even if you work out regularly.

And according to the 2006 Men's Fitness rankings, Cleveland has many, many places to work out - we're in the top 10 percent of gyms and health clubs per capita ? and more than eight out of 10 Clevelanders reported some physical activity in the past month, which is far more than the average. But our increased TV-watching and poor nutrition made us the No. 18 fattest city this year.

Even in 2005, when we claimed the No. 24 spot on the FITTEST cities list (up from being No. 9 on the fattest list in 2004), it wasn't such good news for Clevelanders. As the magazine explained on its Web site, the city's ranking improved because Clevelanders had more gyms they could visit and spent less time in front of the TV ? it wasn't because we were any less fat than we were in 2004.

That's backed up by the Centers for Disease Control, whose statistics show the percentage of overweight and obese people in Cuyahoga County didn't change much between 2003 and 2004, says David Bruckman, biostatistician for the Cleveland Department of Public Health. In the county in 2004, just more than 36 percent were overweight (Body Mass Index between 25 and 30) and just less than 26 percent were obese (BMI of 30 or greater). But since 1990, the obesity rate in Ohio ? 24 percent ? has more than doubled, according to a 2005 obesity report by the Health Policy Institute of Ohio. We're the 13th most obese state in the nation.

In short, we know fat, and we're getting to know it even better.

On one day in February, 10 of Amazon.com's 50 top-selling books in the "Health, Mind and Body" category were diet-related. A recent trip to the library solidified the impression that we like to read about our fat more than we like to read about our minds, our children, even our sex lives.

A slew of new diet books along with more interestingly titled works, such as "French Women Don't Get Fat" and "The Hungry Gene: the Science of Fat and the Future of Thin," shared the health section with "Scoot Over, Skinny: the Fat Nonfiction Anthology" and "The Fat Girl's Guide to Life."

What ambiguous times for the fat cell. We seem torn between being disgusted by our fatness and resigned to accept, even celebrate it.

In gyms across America, for instance, treadmill runners are hating it, while in labs, scientists are marveling at it. Is it a foundation of flab or a czar among cells, dictating how energy is stored and used, when the immune system should be engaged and even when we should reproduce?

Evidence shows it may be both. The fat cell is enjoying a celebrity moment. It's overexposed like Jennifer Aniston and misunderstood like Angelina Jolie. We are both attracted to it and weary of hearing its name, but we can't help ourselves from thinking about it in the grocery store checkout line.

Paul Ernsberger, who researches metabolism at Case and wrote the introduction to the book "The Obesity Myth" (called "The Diet Myth" in paperback) says that fat's reputation is much worse than it deserves because of the far reach of the weight-loss industry. His theory: Fat is only a problem when too much of it accumulates in muscles or tissues, raising blood pressure and putting people at risk for heart attacks and strokes.

"You won't see the concept of ideal weight anymore, except with weight-loss surgeons," he says.

"[The idea of] ?You must weigh this' is out."

Hate fat or honor it. Fight it or make peace with it. It's your call.

My fat is abdominal primarily. Our relationship has worsened since I had a baby nearly two years ago. Before baby, I had a stubborn, little pudge in the middle. That pudge made me reach for the one-piece swimsuit more often than the two-piece, but other than that, it didn't bother me much.
After baby, the pudge branched out into love-handle territory. Unlike 60 percent of Americans, I am not technically overweight but now fat stretches like a flotation device around my middle.

Remember the measure of those old Special K commercials? Well, I can definitely pinch more than an inch. The way I see it now, a thinner waistline ? like eight hours of uninterrupted sleep - is just another thing I lost when I gained a daughter.

Pregnancy happens to be one time in adult life when it's possible to develop more fat cells. While it's the flabby stuff there I most detest, I should worry more about the deep fat clustered around organs. That fat can send fatty acids and hormones to the liver and affect its function, which includes making cholesterol. This kind of fat is worse than fat in the butt or thighs, which will just hang out harmlessly for decades. (When fat secretions from those places are released into the body, it goes into the general bloodstream, not directly to the organs.) In addition to heart disease, diabetes is the other big disease with a connection to fatness. Estimates of deaths from overweight and obesity nationwide have ranged widely - from about 26,000 to 400,000 per year, according to The Health Policy Institute of Ohio.

So what's a person with too much tonnage to do? Contrary to what some diet gurus say, you can't starve them (you'll end up losing muscle, which will lower your metabolism and make it even harder to shrink your fat cells). You can't target pockets of them (unless you get liposuctioned). And you can't, you simply can't ignore them. You've got to show your fat cells that you're the only cook in your kitchen.

Ernsberger recommends starting some physical activity that you will have to keep up. Getting a dog who must be walked daily would do the trick.

Cindy Moore, a registered dietitian who is the director of Nutrition Therapy at The Cleveland Clinic, offers these pointers:

- Eat at home more, where you can control what goes into your food.
- If you do eat out, choose the salad instead of the fries.
- Box part of your meal and take it home.
- Be aware of your eating behaviors and try to replace unhealthy ones with healthy ones. Try munching on a bag of carrots instead of a handful of crackers.
- Serve dinner on plates and return the pots to the stove instead of setting them in the center of the table. If you have to get up to get more food, the research says you may eat less.

Small changes can yield big results. Just skipping the tartar sauce on your fish sandwich, for instance, can save you 50 to 100 calories a day. After a while, those calories add up.

"Even if you do nothing else but not order tartar sauce with a sandwich, you could lose up to half a pound a month," Moore says.

Lastly, accept the fact that there is no miracle diet, no one thing that can make you achieve the weight you want permanently. There are many things. If you adopt even a few of them - and keep them up - you'll be the one living large, not your fat cells.

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