People who are perceived to be overweight according to the norms set by society have a tough time. We live in a media-saturated world in which thinness is not only treated as a desirable marker of good looks and good health, it is also seen as somehow virtuous and hence people who are above the norms in weight are seen as being somehow morally weak and lacking in will power to control how much they eat. This is despite the fact that it is not at all clear what a person’s optimum weight should be, how much it is affected by distribution and body shape and age, what causes some to be heavier than others, and even whether being overweight is as extremely unhealthy as it is sometimes made out to be.
A couple of years ago I wrote about this phenomenon and how some people are fighting back and “have rejected the idea that the word fat is some kind of slur requiring the use of euphemisms to soften it, and have embraced it and made it their own, the way that the gay community did with the word queer. They are fat and proud of it.”
Their position gains some support from a recent study that finds that there are a lot of misconceptions about obesity. Based on a survey of the research literature, the paper published in the New England Journal of Medicine highlights seven myths about obesity that are just not supported by the evidence.
Myth number 1: Small sustained changes in energy intake or expenditure will produce large, long-term weight changes.
Myth number 2: Setting realistic goals for weight loss is important, because otherwise patients will become frustrated and lose less weight.
Myth number 3: Large, rapid weight loss is associated with poorer long-term weight-loss outcomes, as compared with slow, gradual weight loss.
Myth number 4: It is important to assess the stage of change or diet readiness in order to help patients who request weight-loss treatment.
Myth number 5: Physical-education classes, in their current form, play an important role in reducing or preventing childhood obesity.
Myth number 6: Breast-feeding is protective against obesity.
Myth number 7: A bout of sexual activity burns 100 to 300 kcal for each participant.
The authors also point to six presumptions that are widely held but are either not supported or are contradicted by the evidence.
Presumption number 1: Regularly eating (versus skipping) breakfast is protective against obesity.
Presumption number 2: Early childhood is the period in which we learn exercise and eating habits that influence our weight throughout life.
Presumption number 3: Eating more fruits and vegetables will result in weight loss or less weight gain, regardless of whether any other changes to one’s behavior or environment are made.
Presumption number 4: Weight cycling (i.e., yo-yo dieting) is associated with increased mortality.
Presumption number 5: Snacking contributes to weight gain and obesity.
Presumption number 6: The built environment, in terms of sidewalk and park availability, influences the incidence or prevalence of obesity.
So why are all these things so firmly believed despite the lack of solid evidence? The authors speculate:
Why do we think or claim we know things that we actually do not know? Numerous cognitive biases lead to an unintentional retention of erroneous beliefs. When media coverage about obesity is extensive, many people appear to believe some myths (e.g., rapid weight loss facilitates weight regain) simply because of repeated exposure to the claims. Cognitive dissonance may prevent us from abandoning ideas that are important to us, despite contradictory evidence (e.g., the idea that breast-feeding prevents obesity in children). Similarly, confirmation bias may prevent us from seeking data that might refute propositions we have already intuitively accepted as true because they seem obvious (e.g., the value of realistic weight-loss goals). Moreover, we may be swayed by persuasive yet fallacious arguments (Whately provides a classic catalogue) unless we are prepared to identify them as spurious.
A colleague of mine who is a faculty member in the nutrition department of the medical school argues that instead of focusing on permanent weight loss (which is hard to attain) it is far better to urge all people (not just those who are perceived as overweight) to aim for a healthier lifestyle in terms of what we eat and drink, and to lead more active lives with regular exercise. This is a much more attainable, not to mention enjoyable, goal to aim for and easier to attain than losing weight by adopting exotic or draconian diets, and results in much better health outcomes. In the process, some people may lose weight and others may not but that would be incidental.
He says that what we should not do is give overweight people a hard time. His reading of the relevant research suggests that it is usually a waste of time nagging people to lose weight. It is hard to do so and even harder to keep it off if you succeed. This leads to yo-yo weight fluctuations, resulting in feelings of failure, anger, and even depression. People who repeatedly try and fail to lose weight are often tempted to just say to hell with it and stop doing anything at all and give up on attempts at being healthy.
He says that what we should watch out for are our blood pressure and risk factors for stroke. Being overweight is one of the risk factors for Type II diabetes so it is not something to be taken lightly but it is one of many risk factors and we should not focus on it to the exclusion of others. It is health that is important, not weight.
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 1, 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.)