Q: If the national obesity rate rises, is it time to stop making excuses about poor diet and sedentary lifestyle?
A: Currently, over 40 percent of American adults are obese (BMI ≥ 30.0). People with obesity are at increased risk of serious diseases and health conditions, including high blood pressure, high cholesterol, type 2 diabetes, coronary artery disease, stroke, osteoarthritis, sleep apnea, and they are at higher risk of death from all reasons.1
The question is what to do about it. There was a move to embrace it. “Weight Diversity Speakers” advocate “Fat Acceptance” for the “Fat Pride” community. “For the two-thirds of Americans who are now overweight or obese, their message is tempting: being heavy doesn’t mean being unhealthy. What is really needed, they argue, is a change in cultural attitudes where we stop taunting obese people as overly indulgent guys, accept the high calorie habit as a tenable lifestyle choice, and expand our aesthetics to view fat as beautiful. “2 For example, the author of “Health in Every Size” campaigns for social justice issues to celebrate “body diversity” and condemn class privilege.3
Celebrating obesity, however, means accepting rising healthcare costs for all of us and losing loved ones before their due dates. While the acceptance of fat is in line with the broader cultural movement of externalizing blame and repressing “aggressiveness,” there can be situations where we become so concerned about not offending someone that we turn their feelings straight into morbid Turning Obesity and an Early Grave.
At the other end of the spectrum is “fat shaming”. By reading this MD column, you will be safe in fitness, including eating and exercising properly. It may be tempting, as this reader’s question suggests, to believe that all people with obesity are lazy or voracious and that all it takes is a simple kick in the ass to drop the box of donuts and head for the treadmill climb. For some, this thinking slips into utter cruelty. “Fat shaming is widespread online, from tricky social media comments on the latest celebrity weight gains to websites sharing ‘funny’ photos and stories of fat people and their voracious behavior,” notes the vice-editor of Harvard Public Health. “Often times, on bold blogs, the comment areas are filled with … unsolicited advice wrapped in a cloak of moral superiority. For example, they say, “She should really exercise and eat better! Your joints need to be beaten! ‘”Are these comments helpful or hurtful? The line between microaggressive impacts and sensible proposals is often in the eye of the beholder.
Research shows that bullying because of his excess weight does nothing to make him thinner.4th In fact, it can stimulate binge eating and the avoidance of physical activity, which ultimately leads to more weight gain. Bothering people about their weight can increase their risk of depression and suicide. Results from one study suggest that the physical effects of weight stigma can be as damaging as poor diet and physical inactivity. Even putting aside the fact that genetic factors play a role in obesity, it is not that easy for many people to commit to the choices it takes to lose weight. For example, in some cases, overeating may be associated with a history of trauma or abuse.5 Don’t judge – you never know what psychological baggage people are carrying.
In my eyes, neither fat acceptance nor fat shame is the answer. As with most things today, we are split into two camps, leaving a barren middle ground of rational response. The American Academy of Pediatrics recommends an alternative approach to speaking to young patients whose weight may be damaging to their health, called the “motivational interview” – “a counseling technique that allows the patient to develop their own goals for beneficial behavior change.”6 The aim is to address the issue of weight directly without people feeling humiliated. Many adults struggling with obesity feel frustrated and self-defeated when they cannot lose weight and feel powerless. This is a bad place to make positive change.
Obviously, there is no “one size fits all” approach to helping someone with an unhealthy weight shed those pounds. What works for one person cannot help another person. But surrendering to an unhealthy body weight is not an approach I can advocate any more than it is acceptable to belittle and shame people for their height. The best path to a healthier America is to use dignity, kindness, patience, and respect to gently guide people to better choices.
4. www.ncbi.nlm.nih.gov/pmc/articles/PMC6565398/; www.ncbi.nlm.nih.gov/pmc/articles/PMC4236245/
5. www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/ptsd-binge-eating#1; www.ncbi.nlm.nih.gov/pmc/articles/PMC5322988/
Fat Shaming or Fat Acceptance?