Some Things You Know About Obesity Are Wrong…
But So Were Some Things in This Article
I have been seeing this article – “Everything You Know About Obesity Is Wrong” – fly around on Facebook. Even though I don’t think the internet expects of me an editorial comment on every blog post about obesity, I do feel compelled to speak to this one, partly because it is so emotionally loaded and has resonated with so many readers.
On the one hand, this is an excellent, excellent article on obesity and weight loss. It gets many things exactly right, and may be a hard pill to swallow for those who are especially committed to the “obesity = laziness” or “obesity = lack of self-control” tropes.
So before I get into the details of what I think this Huffpost article gets crucially correct, I want to encourage everyone I know to read the article. Whether you struggle with your weight or not, this article’s best points were the ones that spoke to implicit bias, and how we make assumptions about ourselves and others that limit us all.
Secondly, and inevitably (as a health and fitness professional), I did not agree with everything in this article. As is typical of readable and shareable journalism, not all the facts are presented quiiiiiiiite in focus. Some of the pop-out quotes that I have seen on Facebook posts may actually be the most spurious bits of reporting in the whole article, while some of the true gold is buried in the post.
So let’s look first at what this article gets amazingly right:
Doctors are not dietitians or counselors
Don’t get me wrong – some doctors, like Dr. Spencer Nadolsky, are amazingly gifted and skilled weight loss coaches as well as medical professionals. But your average general practitioner is not educated like a registered dietitian. Doctors are not weight loss specialists or nutrition counselors. Their weight loss instructions (or stamp of approval on your weight loss regimen) may not be accurate or helpful, unless you are working with a doctor who is particularly good at nutrition counseling. Plus, if you combine this lack of specialty with an insensitive or fat-phobic bedside manner… the net result is often discouraged and avoidant patients.
If you want medical advice for weight loss and you’re not pleased with your doctor’s feedback, I would recommend working with an RD, or an MD who is known for a successful and evidence-based weight loss program.
Weight and Health are Often Over-Associated
While they’re not unrelated, they also don’t have the tight, linear relationship that many people assume. Yes, being obese elevates your risk of heart disease and stroke and cancer, but for many people who are overweight, even losing a little bit of body fat and keeping it off can dramatically improve health markers. It doesn’t have to be an all-or-nothing transformation. Sweat it out at the gym, get stronger, keep working on your eating habits, and focus on health. Even losing 10% of your bodyweight will reduce weight-related health risks.
Eating Disorders Go Under-Diagnosed in Overweight People
This was the part of the article that I think is crucial for people to understand and accept. Just because someone is overweight doesn’t mean they haven’t tried dieting in all of its forms. Unfortunately, these diets, which can become extreme in the desperation to get the scale to move faster (or at all), often move out of the range of “healthful eating” and into disordered eating territory.
The problem is that – unlike in lean people – disordered eating can be easily overlooked in overweight people. But because eating disorders are mental illnesses, they are just as disastrous for someone who is overweight as they are to a lean person.
Be cautious of complimenting someone’s weight loss – you may not know the “why” or the “how” behind it.
Continuous Therapeutic Support is Essential
I was happy that the article touched on this. The stigmas around mental health in our country make it difficult for may people – overweight or not – to feel comfortable getting the counseling and support they need to implement consistent and meaningful change. This is compounded by the fact that overweight people have often internalized fat-phobia, and tend to direct the “I just need to try harder” message at themselves, as well. This attitude, which is learned from years of enculturation, does not speed along the process of getting help. It often causes people to stay stuck and isolated.
Therapeutic intervention can make a dramatic difference in your weight loss efforts. Don’t hesitate to ask for help.
Food Culture is a Huge Issue
This was one of those buried gems in the article, but I think one of the most important points. Our food environment in the U.S. has become dramatically more conducive to weight gain over the last two or three generations, and – in my opinion – our food industry is largely to blame for the “obesity epidemic.”
Does this remove responsibility from the individual? Unfortunately, no – regardless of ideals, we still have to live and work in offices that leave donuts out, grocery stores that are bursting with convenience food, and confusing “health halo” messaging that disguises processed food as a healthy option. But we can empower ourselves to interact with our food environments (especially our homes) in smart and strategic ways that minimize mindless eating and help us achieve our health goals.
Fat-Phobia is Real
This article really does a great job of illustrating the emotional struggle that people with overweight and obesity experience at the hand of implicit bias. We make assumptions and infer character traits (i.e. laziness or lack of willpower) that are truly unfair.
Here’s an example: when Tess Holliday made the cover of Cosmpolitan UK, I read Facebook commenters point out that they would be okay with her on the cover if there had been pictures of her exercising or trying to “better herself.” When I read comments like this, my jaw dropped. We would never expect the same thing of a thinner woman, or demand that every cover model demonstrate what steps she is taking to “better herself.”
Furthermore, I think what many people do not understand about obesity is that this societal hatred of fatness isn’t just from thin people toward fat people – it’s also a feeling that people experience toward themselves. Insensitive comments only serve to add to the shame and make the public conversation about weight more polarized.
We must take responsibility for implicit bias and the way we think, talk, and write about weight, so that we do not add to the problem when we think we’re creating the solution.
However, despite the incredible positives of this article, there are several reasons that I don’t share it or promote it outside of this blog post. There were some journalistic liberties taken with facts that I think verged on irresponsible.
Here are some important corrections:
Your metabolism does not crash to a halt with modest weight loss
Losing 3% of your bodyweight does NOT result in a linear 17% slow-down of your metabolism, as this article overtly claims. Moreover, the wording menacingly implies that the 3% is only the beginning, as if your body will shut down your metabolism if you keep losing weight.
In reality, the endocrine system helps to regulate weight loss (mostly to prevent it, for many people), but if you are not dieting either at a calorie level that is below your personal energy availability needs or ultimately dieting down to sub-optimal leanness, your metabolic adaptation to weight loss should only be about 10-15%, and will probably straighten itself out over time as your body gets used to being regularly well-nourished at a lower bodyweight.
I don’t like using myself as example (because n=1), but here’s a case study: I went from about 165 to about 115 in 2010-2011, and if this were true, losing 30% of my bodyweight would have resulted in an astronomical slow-down of metabolic function – like an “only able to eat a yogurt per day without gaining weight” kind of slow-down. In reality, I probably experienced the 10%-15% reduction in metabolic rate that is normal for weight loss, and even if this is still the case for me eight years later, it only means I should eat 200-ish calories less per day than another person of my bodyweight in order to maintain my weight. In other words, one less snack. The misrepresentation of these kinds of facts is irresponsible, and it takes the focus off of solutions.
You can lose weight and keep it off
Presenting the chance of an obese woman reaching a normal weight as “0.08%” is not accurate or helpful, and disappointing in an article that is otherwise compelling.
Many people lose weight and keep it off permanently, but it’s important that we redefine “weight loss success.” The problem is that many people do not categorize weight loss as “success” unless it satisfies a predetermined goal amount. For example, let’s say someone wants to lose 50 pounds but only loses 15 before hitting a plateau. What often happens is that even though what they experienced was a medical and life-changing success, it’s easy to be discouraged by hitting a wall. People in this situation – unfortunately – often revert back to old habits, because the results weren’t impressive enough to build momentum. The problem is compounded by the fact that the diets and exercise plans that people use to achieve the initial loss are often not sustainable – once discouragement sets in, it’s almost impossible to keep energy invested in something so unpleasant and difficult.
This is what causes weight re-gain – not something metabolic. When we interpret numbers, we need to be cautious about inferring “can’t” vs. “don’t.” It’s not that people can’t lose weight and keep it off – it’s that people often don’t.
However, people often do.
Check out the National Weight Control Registry, of which I am a member. When you read the success stories at the statistics, you’ll see that many of the members explicitly say that they did not crash diet – they often did simple things, like walking daily, counting calories, drinking more water, cutting junk food, and switching snack foods to a choice like almonds. Many of them also mention the continuous help that they received from online support groups or an exercise class. In other words, you do not have to starve yourself to lose weight, and weight loss (and maintenance) in the double and triple digits is possible for many, many people.
The first step is to break weight loss goals into small increments that start not with 15-30% of body weight (which is often what I see with clients), but just 10%, because a maintenance of even a 10% loss can have huge health benefits. Is it necessarily sexy to go from 180 to 162? Maybe you wanted to go to 140 right away. But a careful re-framing of “success” can help you stay on the path long enough to buffer disappointment, keep experimenting with lifestyle solutions, and possibly reach the number you initially wanted, all while keeping the emphasis on habits and behaviors rather than the scale itself.
Doctors were over-demonized while the food industry was a footnote
While the article generally eviscerated doctors, claiming that “the medical community has ignored mountains of evidence” for decades, I felt that the discussion largely skated over the food industry. This is disappointing, because food production, subsidies, supply, and culture are easily the biggest factors that affect public health.
The reason people have become more overweight in the last 50 years isn’t because Americans have become more weak-willed or because doctors are not nutritionists – it’s largely because our food culture has systemically and dramatically changed, and not for the better. Not only what we eat, but the way we eat and relate to food has completely transformed over the last 40-50 years.
Each generation experiences it unknowingly as a “new normal.” We snack more, we eat in front of the TV more, we eat out more, we cook less, we drink incredibly rich coffee beverages that would have been unthinkable to previous generations, and we consume highly-processed foods on a regular basis that are labeled “healthy.”
In other words, it’s very hard to interact with this food environment without gaining weight if food is something that is anxiety-soothing for you, or if you are otherwise vulnerable to food cues. Or, a better way of saying it is that it is very easy to be overweight in today’s food culture. Understanding that fact is the first step to exercising self-compassion and making meaningful lifestyle change.
If you want to understand better how our food culture is impacted by advertising, Capitol Hill, and funding, read Marion Nestle’s excellent book, Food Politics.
Should People Try to Lose Weight?
In the end, I think this is the real question the original Huffpost article is asking, and I’m not sure I like their implied answer. The message comes across as this: considering the generally poor success rates and the difficulty involved, is it even worth the effort and the possible compromise of your mental health?
My perspective? If I could boil down the whole article to a positive and meaningful soundbite, it would be this quote from the article, pulled from an interview with a weight loss specialist: “Habits, no matter what your size, are what really matter.”
That’s really the crux of the article, and it somehow got lost. As I often discuss with clients, if you’re exercising regularly (“almost every day”) and modifying your eating to cook more, eat out less, eat mindfully, and eat more vegetables and less sugar, the great likelihood is that you do not have to worry about weight loss. In the end, the habits are what really matter.
Is weight loss a motivating goal? Absolutely. I think this is why the 10% loss can feel like such a defeat for some – it may not give you the external transformation you were looking for. But if you can shift your goal-setting so that the weight is just one measure of success, and the habits themselves become the driving force of change, then you have a shot at sustaining something for a lifetime.
In summary – please read then article to fully explore a well-written portrait of the difficulties and nuances of obesity. Please open your heart to seeing this world through a new point of view, and to be more compassionate and to think twice before you say or write something about body image or weight. Always play something through your head twice, and ask yourself if you would say the same thing about a thinner person.
On the other hand, if you are struggling with your weight, please don’t read the article and lose hope. The prognosis is better than Huffpost would suggest. Take much of the “research” presented with a generous grain of salt, and remember that obesity is such a multi-factorial issue that it can’t be reduced down to one article or one study. People, like me, who have successfully lost weight and kept it off know that there are many things that need to change for weight loss to be successful, healthy, and balanced, and you can do it without rigid diets or unrealistic workout regimens.
Want help focusing on your healthy habits? Join my closed Facebook community, Habits First, for daily encouragement, ideas, tips, and sharing.