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Overweight represents a true condition of illness, not so much because of the prevalence of adipose tissue over other body components (skeleton, muscle) but because it leads to the onset of the nutritional maladjustment that accompanies it and which remains even after the excess weight has been eliminated, not to mention the metabolic, physical and psychological complications it brings in its wake. This maladjustment, conditioned and maintained by the progressive weakening of physiological and nutritional self-control, permanently forces those afflicted by it to concentrate constantly and consciously on the choice of the types and amounts of food necessary to maintain health and fitness.

We have called this incessant psychological and physical effort required to maintain proper and responsible nutritional behaviour CIBOMANIA ( foodwatching, literally 'foodmania'), which calls for sacrifices, moderation and constant vigilance over the choice of foods. Depending on circumstances, it is a disturbance that can be more or less serious, but one that must be accepted as indispensable in properly counteracting the process of gaining weight. Without the presence of the cibomania, the loss of weight caused by a low-calorie diet is quickly regained and weight easily increases to beyond the starting point (the 'yo-yo' syndrome) with an inevitable degeneration of the metabolic maladjustment. Thus dieting, without a good knowledge of the true nature of the illness and the strategies to follow in making the cibomania more tolerable, is not only useless but even damaging. This explains the failure of treatments of obesity based on dieting that has been reported at all levels.

It is tantamount to trusting exclusively to the bailing scoop to keep a boat with a hole in the hull afloat. Together with the scoop we must also try to plug up the leak, or at least patch it somehow. The consequences are even worse if the low-calorie diet does not take into account the requisites of personalization, gratification, completeness, tolerability and nutritional, physical and cognitive re-education.

It is known to all that in any given pathological condition it is possible to arrive at a truly effective therapy only with a good knowledge of its origins. In our case, the term obesity is frankly to be considered reductive for a state characterized by two quite distinct conditions: the increase in fatty tissue and nutritional maladjustment, with the latter clearly prevailing over the former since the correction of excess weight and the maintaining of the results with the passing of time is possible only through control of the nutritional maladjustment which is destined to continue over the long term. The boat can be hauled ashore and repaired to make it completely seaworthy once again, but physiological control over nutrition cannot be repaired, so we have to make do with a patch (cibomania) that must be held in place for a long period of time.

In conclusion, we can continue to call it obesity, but at the same time we must keep in mind that this condition originates and is maintained by nutritional maladjustment, which is neither a vice nor a sign of poor character, as those who do not know about the problem say, but a true illness and certainly not a minor one. Just as in the case of smoking and drinking, where it is certainly not enough to treat the consequences to the lungs, heart or liver, but essential to stop smoking and drinking, in the case of obesity or other illnesses connected with the loss of metabolic equilibrium, the main efforts must address the control over and improvement of the cibomania. Since obesity is the result of a maladjustment, it must be treated as such.

Conditions of maladjustment are typically characterized by permanence and the lack of effectiveness of all kinds of pharmacological treatments. Smokers and drinkers stop their smoking and drinking only if and when they decide to take this step, knowingly and autonomously; the use of drugs is neither here nor there (most give up without taking medicines) or, at the most, may provide a mechanism that strengthens the will if taken with conviction (for example the cost of a medicine represents a favourable factor). There is no drug that works without the convinced and suffered participation of the person involved.

The permanence of the maladjustment, as we shall see later on, explains the large number of relapses.

Compared to smoking and, to a lesser extent, drinking, the control of food is far more difficult since in the case of the former two it is possible to completely avoid smoking and drinking; with food this obviously cannot be done (it would lead to anorexia nervosa), nor is it possible to eat the same foods every day of the year: for humans, unlike animals, food has not only metabolic significance!

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