Huffington Post recently published an article titled, “Everything you know about obesity is wrong” by Michael Hobbes.
The article outlines the many ways in which we misunderstand obesity and how our approach to addressing obesity is failing.
It explores subjects related to our medical system, food production systems, public policy, and public stigma.
While I’d love to address every point in the article, for the sake of brevity I’ll offer some comments on a few key points that stood out to me.
At the end of the point-by-point, I’ll provide a summary of my thoughts and concluding statements.
“The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets.”
I’ve never liked the phrase “diets do not work”.
This phrase is often interpreted to mean that we shouldn’t make any changes to our eating habits, that food quality doesn’t matter, or that we shouldn’t restrict in any way, shape or form.
This is the worst advice to give somebody struggling with their weight or their health.
Diets – changes to our eating habits – do work, but the trick is finding one we can stick to.
This isn’t just about the food, either.
Often, it’s not the diet that’s the issue, but the thoughts, feelings, and emotions behind “dieting”.
If we look at our eating habits as something we have to do to see some number on a piece of plastic on the floor change, there’s a good chance we’ll fail.
If, however, we look at our eating habits as a gift to ourselves because we are wonderful, we are worthy, and we deserve nothing but the best, we’ll have a better chance of long term success.
Those of us who approach our eating habits with a victim mentality – drilled into our heads with this “don’t deprive yourself” bullsh*t that conditions us to remain slaves to our taste buds – will be more likely to continuously struggle.
Those of us who approach our eating habits from a position of power – making positive change because we are strong, capable, and in control – will be more likely to make consistent progress towards our health and fitness goals.
“Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.”
If you are eating like a kindergartner, but working against your appetite signals to consciously create an energy deficit, then, yes, there’s a good chance you’ll feel this way.
If, however, you eat plenty of protein and veggies, find the right fat/carb intake for your needs and preferences, and minimize highly refined, hyper-palatable, and potentially inflammatory/immunogenic foods, there’s a good chance your appetite signals will steer you towards an ideal weight automatically.
Oh, and factors like sunlight, sleep, stress management, and time with people you love will help a lot here, too.
Addressing these factors will make weight regulation much easier, whereas attempting to manage weight without addressing them is more challenging.
I’m not saying these steps are easy, but I am saying that all of these factors play a role in our drive to eat.
“…weight and health are not perfect synonyms”
This is true.
However, we’re not just talking about few extra pounds here.
We’re talking about obesity, which has been shown time and time again to be a major risk factor for disease and early death.
While non-obese people aren’t always healthier than obese people, an obese person will nearly always be healthier if they correct the factors contributing to their excess weight.
“Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.”
Of course, we can’t look at an individual and tell if they are healthy or not.
Again, though, we’re not just talking about a few extra pounds.
We’re talking about obesity.
I’m curious if any of these other indicators on their own are stronger predictors of health than obesity, as this statement suggests.
While I agree with the general sentiment that body weight doesn’t tell us everything, I disagree with the implication that it can’t tell us a whole lot.
“The terrible irony is that for 60 years, we’ve approached the obesity epidemic like a fad dieter: If we just try the exact same thing one more time, we’ll get a different result.”
I do not disagree at all.
Cut more calories.
Eat more heart healthy whole grains.
Stay away from saturated fat and cholesterol.
Everything in moderation.
Just use willpower.
Obesity is complex, yet we keep promoting these overly simplistic measures without taking a step back and asking, “how’s that working for ya?”
“Plus, rather obviously, smoking is a behavior; being fat is not. Jody Dushay, an endocrinologist and obesity specialist at Beth Israel Deaconess Medical Center in Boston, says most of her patients have tried dozens of diets and have lost and regained hundreds of pounds before they come to her. Telling them to try again, but in harsher terms, only sets them up to fail and then blame themselves.”
Certainly, factors like genetics, epigenetics, birth method, antibiotic use, and a host of other factors outside of our control play a role in how and where we store body fat.
However, there are always behavioral aspects that we do control that contribute to obesity.
That being said, I do agree with the conclusion of this paragraph, in that repeating failed advice with stronger tone won’t get us anywhere.
I also agree that the behavioral aspects of obesity do not mean it is a moral failure.
On a related note, I feel the same way about smoking and other addictive behaviors.
It’s not always be easy, not everybody has the same success, and there are nearly always emotional and mental hurdles that need to be addressed, but we can control our behavior.
Information alone doesn’t create behavior change, and we need to work on the “hows” and the “whys” of behavior change if we ever hope to put the “whats” into practice.
“Another issue, says Kimberly Gudzune, an obesity specialist at Johns Hopkins, is that many doctors, no matter their specialty, think weight falls under their authority.”
The way that this is phrased implies that this is somehow the fault of physicians.
Authority is given, however, not taken.
Weight only falls under doctors’ authority because we, as a society, let it fall under their authority – just as we have nearly everything else as relates to our health.
Should we blame physicians that we’ve burdened them with this responsibility?
Should we blame physicians for wanting the burden of this responsibility (for those that do)?
The subject of whether weight management be the responsibility of doctors or not is an incredibly complex subject that would warrant its own discussion.
There’s no doubt in my mind there are plenty of physicians who are well qualified to help with weight management, as well as plenty of physicians who aren’t.
We should be hesitant to make a blanket statement one way or the other about all physicians.
“And so, working within a system that neither trains nor encourages them to meaningfully engage with their higher-weight patients, doctors fall back on recommending fad diets and delivering bland motivational platitudes.”
I’ve never been obese and I’ve never been a physician, so I can’t comment from personal experience whether this is true or not.
I’ve heard, however, plenty of anecdotes of folks receiving horribly ineffective and outdated dietary advice from their physicians.
This is no fault of the physicians, however, as they are largely sharing what they understand through their education to be the proper advice.
Also, it’s my understanding that this is changing, as more and more physicians are becoming aware of and advocates for dietary strategies like ketogenic and paleo diets.
Regardless, I do not deny that this is unfortunate.
“This is how fat-shaming works: It is visible and invisible, public and private, hidden and everywhere at the same time. Research consistently finds that larger Americans (especially larger women) earn lower salaries and are less likely to be hired and promoted.”
Fat shaming is a horrible thing, and I don’t doubt that it comes in many forms.
However, I’d be curious if the connections between body weight and salary or body weight and professional status are correlation or causation.
I ‘m curious if there are confounding variables such as lack of confidence or assertiveness that are associated with obesity and have an impact on earnings and professional status.
“The problem is that in America, like everywhere else, our institutions of public health have become so obsessed with body weight that they have overlooked what is really killing us: our food supply. Diet is the leading cause of death in the United States, responsible for more than five times the fatalities of gun violence and car accidents combined.”
Between the “diets do not work” statement earlier in the article and a couple of other statements later in the article, I didn’t expect for the author to bring up diet as a major factor.
This caught me a bit off guard, but made me think that perhaps the article would start moving into more practical, actionable steps we might take to address obesity at both individual and societal levels.
“For more than a decade now, researchers have found that the quality of our food affects disease risk independently of its effect on weight.”
True as this may be, it doesn’t mean that food doesn’t affect our weight, that our weight doesn’t affect our disease risk, or that food doesn’t affect our disease risk through our weight.
This only means that food also affects our disease risk through mechanisms other than weight.
“All of our biological systems for regulating energy, hunger and satiety get thrown off by eating foods that are high in sugar, low in fiber and injected with additives. And which now, shockingly, make up 60 percent of the calories we eat.
Draining this poison from our trillion-dollar food system is not going to happen quickly or easily. Every link in the chain, from factory farms to school lunches, is dominated by a Mars or a Monsanto or a McDonald’s, each working tirelessly to lower its costs and raise its profits.”
I totally agree, and I’m glad to see the author acknowledge this, especially after the statement about how losing weight requires us to be hungry.
The article seems conflicted.
I don’t understand how it can acknowledge the power that our food choices have on our ability to reach and maintain a healthy weight, yet seem to overlook dietary intervention as the obvious choice for making major progress with obesity.
I am not saying that such an approach is easy.
Behavior change – especially with food – is freaking hard.
Hard, however, is not impossible.
“The place to start is at the doctor’s office. The central failure of the medical system when it comes to obesity is that it treats every patient exactly the same: If you’re fat, lose some weight. If you’re skinny, keep up the good work. “
I don’t disagree that there is a major problem with how our medical system generally approaches the issue of obesity.
This article is full of heart-breaking examples of how our medical system is woefully unprepared for the problem of obesity.
However, I don’t think the doctor’s office the place to start.
The place to start is with food policy and home economics.
We need to stop subsidizing crops that make junk food artificially inexpensive to buy.
We need to stop promoting the ineffective, “one size fits all” dietary advice we’ve been getting for decades.
We need to stop creating a culture that prioritizes nearly everything – career, social life, entertainment – over health and well-being.
We need to stop pretending that pills are the only way to address diseases of lifestyle.
We need to completely change our food and health culture.
“Acknowledging the infinite complexity of each person’s relationship to food, exercise and body image is at the center of her treatment, not a footnote to it…
…Telling someone, ‘Lay off the cheeseburgers’ is never going to work if you don’t know what those cheeseburgers are doing for them.”
Could. Not. Agree. More.
We need to do much better in terms of finding individual approaches for each person.
We need to look at our emotional connections to food.
We need to look at our cultural connections to food.
We need to look at what role food is playing in our lives and what holes it might be filling.
Creating change through our eating habits goes far beyond carbs, fats, protein, and willpower.
“Hearing about Emily’s progress reminds me of a conversation I had with Ginette Lenham, the diet counselor. Her patients, she says, often live in the past or the future with their weight. They tell her they are waiting until they are smaller to go back to school or apply for a new job. They beg her to return them to their high school or wedding or first triathlon weight, the one that will bring back their former life.
And then Lenham must explain that these dreams are a trap. Because there is no magical cure. There is no time machine. There is only the revolutionary act of being fat and happy in a world that tells you that’s impossible.
“We all have to do our best with the body that we have,” she says. “And leave everyone else’s alone.”
I thought many of the points in this article were pretty spot-on, but the general tone of surrender – as reflected in this concluding statement – is a disappointment.
On one hand, the article does a killer job describing just how complex and heart-breaking of a problem obesity is, and just how poor of a job we, as a society, are doing at addressing it.
On the other hand, I can’t support the underlying message that the obese should just give up or accept their situation.
This is one of my main qualms with the “Healthy at Every Size” (or “Fat Acceptance”, per this article) movement.
I 100% agree that we shouldn’t shame the obese.
They are moms, dads, sisters, brothers, sons, and daughters – just like you and me.
The stigma against the obese is something that certainly needs correcting.
However, “obesity” and “the obese” are not one in the same.
Obesity is unequivocally associated with poor health, and is not something we should promote or accept.
“Happy at every size”?
I’m all for that (more on this below).
But not “healthy”.
Should we judge, patronize, or discriminate against obese individuals?
Of course not.
But we also shouldn’t accept obesity as completely healthy or even benign.
I get that the “Healthy At Every Size” movement is all about self-love.
Self-love, however, isn’t about saying “I’m fine how I am”.
Self-love is about acknowledging what you might improve, without it affecting your self-worth, and then taking steps to improve those things BECAUSE you love yourself and BECAUSE you are worthy of better.
Everything you know about obesity is wrong, but giving up isn’t the answer.
Until next time, have a most excellent week!