The obesity conundrum


America seems to be obsessed with the issue of obesity. Hardly a week goes by without this being mentioned as a serious public health crisis and that urgent measures need to be adopted to combat it. One can hardly blame people who do not fit into the perceived body-size norm for feeling beleaguered by society’s pressures and feeling that they have to take all manner of measures, even extreme ones, to try and lose weight. But as I wrote last year, there a lot of myths surrounding weight and weight loss that work against the idea that losing weight and keeping it off is a straightforward matter.

I have a colleague who is a professor in the field of nutrition who has long been arguing that America’s obsession with obesity is misplaced. He is not saying that being overweight is a good thing or that it does not cause some adverse health effects. What he is saying is that the negative health consequences are way overblown, rather than being narrowly focused, and that the idea that everyone should strive for some ideal range based on height and weight (using such measures as the Body Mass Index) is not helpful. Apart from being unrealistic, it leads to stigmatization of people who do not approach the image of the ideal. We should stop nagging them or treating them as if they are somehow lazy or weak-willed or gluttonous simply because they do not fit into an acceptable weight range.

He says that the causes of obesity are complex and have a significant genetic component that makes it easy for some people to maintain a low weight and much harder for others. A report about new study seems to confirm my colleague’s view that achieving permanent weight loss is almost impossible.

There’s a disturbing truth that is emerging from the science of obesity. After years of study, it’s becoming apparent that it’s nearly impossible to permanently lose weight.

As incredible as it sounds, that’s what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. “It couldn’t be easier to see,” she says. “Long-term weight loss happens to only the smallest minority of people.”

We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbour — the ones who really did it.

But if we check back after five or 10 years, there’s a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.

Cory Doctorow says that he has to work really hard all the time to prevent any weight loss he achieves from creeping back up.

Which is to say, it’s a ton of work to stay where I am, and I know from past experience that if I skip swimming for a few days, or let myself go nuts on carbs for more than a day or two, or skip fasting-days (which aren’t really fasting — just very low-calorie days) that my weight creeps up. I pretty much never eat without making a complex (and tediously unwelcome) calculation about what I’m about to consume, and I often experience guilt while eating “bad” food and shame afterwards.

I have a friend of mine who does similar calculations all the time to see how much exercise she should do to compensate for whatever she ate. It is not a pleasant way of spending time. And it must be frustrating for them to see other people enjoying all manner of foods without gaining weight.

The problem, my nutritionist colleague says, is that our focus is wrong. There are a lot of benefits to eating healthily and getting regular exercise and everyone should do them. But the obesity-centered view tends to make people think that these things are a means to an end, the end being to lose weight. And when people find that it does not cause them to lose it or keep the weight off, they get very discouraged and stop doing them, despite the other benefits they lose by abandoning them.

He says we would be better served by shifting from an obesity-centered view to a health-centered view, in which all people are encouraged in healthy eating and exercise habits simply for the enjoyment they give and the improvement in their health and quality of life generally. In the process they may lose weight or they may not, but that should be seen as incidental.

Such an approach would also help reduce the stigma that overweight people face on a daily basis.

The Daily Show back in 2010 had a clip on this topic and some of the overwrought rhetoric that surrounds discussions of weight in the US.

(This clip was aired on June 22, 2010. To get suggestions on how to view clips of The Daily Show and The Colbert Report outside the US, please see this earlier post.)

Comments

  1. says

    “Such an approach would also help reduce the stigma that overweight people face on a daily basis.” But such an approach will never be mainstream for 2 reasons:

    1) The super fit beautiful people are able to motivate themselves to stay that way with the sense of their own virtue/superiority for doing what so many others can’t/won’t. I had more than one professional trainer like that. Even after 8 months of training and dieting, they refused to notice the 30 pound weight gain and severely deteriorated physical health. I pointed out to one trainer that my entire family is huge so I was at a genetic disadvantage. Her reply? “I don’t need DNA. I have God.” My doctor set me straight as soon as he saw my increased weight and blood pressure, and he wasn’t subtle about it. (His final words were “Stop. NOW.”)

    2) Nobody is going to sell millions of dollars of professional training sessions, gym memberships, exercise equipment, workout clothing and gear, books, videos or supplements promising “improvement in their health and quality of life generally”, or using spokespeople who look like normal people who are touting their healthy blood pressure and range of motion. That’s another thing my doctor sternly advised me on (he had to be stern, he knew it was going to be a blow to my pride as a skeptic) – I had been taken in by a billion dollar industry whose claims have no basis in science.

    The greatest understatement in the world may be “Your results may vary”.

  2. says

    And anyway the whole point of seeing thinness/’muscliness’ as ideals is because it’s hard, and especially because it’s costly, to do.
    Remember that when most people didn’t have enough to eat and did hard work out in the fields (and such like) that the ideal was a plump and pale.

  3. jaxkayaker says

    Weight shouldn’t be the issue as much as body fat content, and location. Excess fat contributes to high blood pressure and the onset of Type II diabetes.

    I agree that the problem of obesity is much more complex than it’s often made out to be. An organism isn’t a bomb calorimeter, and the proportion of different types of molecules (simple carbohydrates, complex carbohydrates, protein, lipid) in the diet, the genotype of an individual, and the microbial community in the gut of an individual interact in complex and poorly understood ways to contribute to caloric uptake. There is increasing understanding of the role that the microbiome plays in affecting weight.

    http://www.nature.com/news/2011/110420/full/news.2011.249.html

    http://www.nature.com/news/2008/080528/full/453578a.html

    http://www.nature.com/news/2008/080528/full/453581a.html

    http://www.nature.com/doifinder/10.1038/news061218-6

    Numerous other investigations have been and are being performed to try to tease out the mechanisms involved and the most important microbes affecting weight.

  4. funknjunk says

    I’m not sure i understand the real tone or purpose of the piece OTHER than saying, “In modern society, it’s difficult to lose weight and keep it off” … this verbiage of “nearly impossible” in the piece makes it sound like it’s a mystery or some such. I don’t get it – am I missing something? I understand that the media and pop culture ideals are ridiculous, sure, sure. THOSE are outliers. But keeping a healthy weight for your own body type? Myeah, it’s not a mystery, and it’s not that hard unless you think that almost never eating another Big Mac is some kind of real sacrifice or something. Exercise every day. Don’t eat crappy things that a human being was never ment to eat. For myself, I have heart disease in the family and my last set of labs were not good even though i thought i was eating great. So I basically went nearly all vegan except for treats (just had chicken saag the other night …mmmm), and protein powder for when i go to the gym. We do what we have to do in life … fingers crossed my labs are solid next time… now, if you feel like not eating big macs or bags of potato chips is a huge sacrifice, well…. i dunno what to say. Veggies are delicious?

  5. carbonfox says

    I realized that dieting was bunk when I lost 40 pounds eating a diet that consisted of over 50% fried chicken tenders (when I was an EMT, I literally ate at Bojangles at least twice daily five times a week). I did not increase exercise during this time. Calorie-wise, there wasn’t much change from my overweight days. I do know that my stress levels had plummeted, and with them, the pounds.

  6. MNb says

    “healthy eating and exercise habits simply for the enjoyment they give”
    Unhealthy eating (though especially not McDonalds) gives me a lot of enjoyment too while exercise habits don’t. I only started after a serious and totally avoidable back injury three years ago. The memory of the pain I had back then, now that’s a good motivation.

  7. jaybee says

    Sure, genetics is part of it, but he rate of obesity has climbed so rapidly that genetics can’t be the primary driver.

    My own, gut-level, guess is that the number of restaurant-cooked meals consumed per capita is way higher today than it was 30 years ago, and those tend to be both calorie dense and of large portions. A second factor which has been demonstrated is a norm-setting effect where having overweight friends and family shift personal expectations of what is what is considered “fat.,” kind of like the Overton Window in politics. The third factor is the bad advice handed out for the past 40 years in the form of the standard food pyramid; our diets have gotten lower in fat but higher in sugar and starch.

    Considering the climbing rate of people with diabetes, which is strongly correlated with weight, it is a bit painful to hear that concern weight is overblown.

  8. smrnda says

    On trends – we eat more processed foods and refined sugar than people did in the past (as was mentioned above) and I think that many jobs are not that physically active, and spare time is something that not everybody has that much of to go to a gym or work out.

    Overall, the obsession with numbers is unhealthy and unproductive. I seriously stay off scales just to avoid thinking in terms of weight – I try to measure my fitness by how I feel and what I can do.

  9. Loobiner says

    I think part of the reason for an increase in obesity is simply lack of access to exercise facilities and healthy food. If you have to drive all day and only have the time and the money to go to the drive through, of course you will be unhealthy and, if you’re prone to it, fat. The increase in obesity in America is not a matter of personal responsibility, it’s a matter of American food politics and urban planning. I suspect that the reason we see fatness correlate with diabetes and heart disease is because fat people give up on healthy life style habits that are time consuming and expensive to maintain when they don’t succeed in losing weight. Perhaps if fat people were enabled to eat healthy and exercise without the goal of weight loss the correlation would weaken.

  10. hyphenman says

    Good morning Mano,

    Three years ago I went in for a checkup at the Veterans Administration and never got past the blood pressure check. My doctor sent me to the emergency room where I was given medication to get my blood pressure down to something like a safe level. Eight hours later they sent me home.

    The VA assigned me to a heart specialist who focused on weight reduction (I was 265 pounds) and over the next five months, with his help, I shed 80 pounds mostly by being totally anal about tracking my food intake and avoiding all fast foods and desserts. That’s the good news.

    The bad news is that today my weight is back up to 219 pounds. I attribute that gain mostly to work related stress and a schedule that made fast food the easy, low-stress alternative. I know how to fix this–eat less, exercise more and return to my obsessive devotion to tracking what I eat–but often find myself drained at the end of the day and simply wanting to zone out.

    I’m very aware of the positive health benefits of getting back to 185 pounds (I’m 6-feet tall) and I have vivid recollections of how I felt when I went under 200 pounds and the panic I felt when my weight climbed back over that line.

    When I think about this I turn to Oprah Winfrey. She is one of the richest people in the world, able to hire personal chefs and trainers, and yet she has a lifelong struggle with her weight. If she, with all of her advantages is challenged, how much harder must it be for the rest of us.

    Do all you can to make today a good day,

    Jeff

  11. karmacat says

    I tell patients to focus on endurance gains with exercise rather than weight. I also suggest not making any foods forbidden, because then you will just want them more. A good nutritionist can help you find easy and healthy meals to make. The divided plate of different food groups is so much better than the food pyramid

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