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Are you sick of being told that you can lose weight by managing your diet and exercise habits? Have you tried countless diets without any long-term results? You're not alone. All around the world, more and more people are devoting their resources and income to controlling their weight. In 2018, the global weight management market was worth US$189.8 Billion, and is expected to reach US$269.2 Billion by 2024. The problem of what to do about rising obesity rates is a major preoccupation of the early 21st century, and as a result, reducing obesity rates is a target for global public health action (Penney, 2015).
Obesity has been correlated with a variety of health problems, including “cardiovascular disease, hypertension, diabetes, and some cancers,” statements that have been accepted as fact in society and perpetuated through targeting advertising (Akil, 2011). However, more and more peer-reviewed research claims that the connection of obesity to some of these disorders may not be due to the amount of fat but to its location in the body. Abdominally localized fat has shown to significantly increase the risk of cardiovascular disease, diabetes, hypertension, and cancer whereas peripheral fat (in legs and arms) may have protective factors (Lee, 2016).
The misconception that weight status alone can determine one's health outcome reflects the deeply internalized nature of weight bias in modern society. Anyone who believes that an obese person could become thin by simply following a lifestyle of control fundamentally ignores the power of the energy-balance system centered in the hypothalamus (Aamodt, 2016).
The rhetoric of the diet industry is simple: eat healthy foods and exercise more. If you can do this, the belief is that you can control your weight. However, science simply doesn't support that myth. The reality is that biologic safeguards underlie the body's resistance to maintaining long-term weight loss.
Research over the past few decades has consistently demonstrated that 90% of people, regardless of willpower or diet or exercise, regain the weight they lose in the long-term (Mann, 2007). In fact, research shows that dieting is a strong predictor of future weight gain.
The Health at Every Size approach argues that you can be overweight and still be considered “metabolically healthy” if these other risk factors are normal, such as blood pressure, HDL cholesterol, triglycerides, glucose, and other biological markers (Tomiyama, 2018). For example, Buscemi's 2017 study compared the prevalence of disease among a large pool of participants to demonstrate how health status and lifespan is not indicative of weight alone. In Buscemi and researcher's study of over one thousand participants (range 18-90 years old), 24% of the classified obesity people were metabolically healthy while 37% of the normal-weight participants were metabolically unhealthy (2017).
Given the interaction between genetics and lifestyle behaviors, the extent that obesity is solely responsible for the epidemic of metabolic and cardiovascular comorbidities has not been established, and whether these physiological conditions are the consequence of unfavorable changes that deteriorate people's lifestyle in terms of sedentary habits and poor diet is an ongoing debate (Buscemi, 2017). Contrary to popular belief, Buscemi's study highlights how obesity is not always uniquely responsible for classical comorbidities such as diabetes and atherosclerosis and that cases of uncomplicated obesity are not rare (Buscemi, 2017). UCLA Health Psychology researchers Dr. Janet Tomiyama and Traci Mann also agree that focusing on weight is not the answer to the obesity epidemic, and obesity treatment “often leads to polarizing views” (2008).
The questions that remain unanswered are whether adipose tissue itself is pathological to an individual and, if so, at what point does it transform from extra weight to a “disease”? Additionally, why do studies show a bias towards the association between obesity and mortality ?
A major reason for the wide uncertainty in estimates is that nearly all studies of the association between obesity and mortality are observational and are subject to the typical biases of observational studies (Lee, 2016). Individuals with lower educational attainment and income are subject to a variety of influences beyond obesity that raise mortality risks. These include poorer access to health care, greater exposure to infectious disease, poorer diets, more dangerous neighborhoods, and more stressful occupations (Lee, 2016). When socioeconomic status is not included in the analysis , these associated hazards that are positively correlated with obesity inappropriately inflate the coefficient on obesity (Lee, 2016).Excluding study limitations in existing research findings create an erroneous impression of the hazards of obesity for the population as a whole, and recognizing these potential biases challenge the generalizability of obesity studies and question the validity of their findings on the claimed mortality risk of obesity (Lee , 2016).
All this to say, we are not claiming that obesity is healthy nor is it a myth, rather, it is important to acknowledge the problematic assumptions underlying the “war on obesity” on social and systemic institutions (Campos, 2004). But, it is possible that several decades' worth of “grim prophecies regarding the devastating health consequences of higher-than-average weight have turned out to be spectacularly inaccurate” (Campos, 2004). By encouraging positive health behaviors for people of all sizes, we can address real health concerns, giving both “obese” and “thin” people the support they deserve while avoiding stigmatizing people and worsening the problem (Brown, 2007).
Aamodt, S. (2016). Why diets make us fat: The unintended consequences of our obsession with weight loss. NY, NY: Current, an imprint of Penguin Random House LLC.
Akil, L., & Ahmad, HA (2011). Relationships between obesity and cardiovascular diseases in four southern states and Colorado. Journal of health care for the poor and underserved, 22(4 Suppl), 61–72. https:// doi.org/10.1353/hpu.2011.0166
Buscemi, Silvio et al. (2017). Characterization of Metabolically Healthy Obese People and Metabolically Unhealthy Normal-Weight People in a General Population Cohort of the ABCD Study. Journal of Diabetes Research. 2017. 1-9. 10.1155/2017/9294038.
Campos, PF (2004). The obesity myth: Why America's obsession with weight is hazardous to your health. New York: Gotham Books.
Lee, JJ, Pedley, A., Hoffmann, U., Massaro, JM, & Fox, CS (2016). Association of Changes in Abdominal Fat Quantity and Quality With Incident Cardiovascular Disease Risk Factors. Journal of the American College of Cardiology, 68(14), 1509–1521. https://doi.org/10.1016/j.jacc.2016.06.067
Mann, T., Tomiyama, AJ, Westling, E., Lew, AM, Samuels, B., & Chatman, J. (2007). Medicare's search for effective obesity treatments: diets are not the answer. The American psychologist, 62 (3), 220–233. https://doi.org/10.1037/0003-066X.62.3.220
Penney, TL, & Kirk, SF (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health, 105(5), e38--e42. https: //doi.org/10.2105/AJPH.2015.302552
Tomiyama, AJ, Carr, D., Granberg, EM, Major, B., Robinson, E., Sutin, AR, & Brewis, A. (2018). How and why weight stigma drives the obesity'epidemic' and harms health . BMC Medicine, 16(23). doi:10.1186/s12916-018-1116-5