TCS Daily

A Simple Plan

By Sandy Szwarc - August 8, 2003 12:00 AM

The goal of this series was to encourage all of us to critically question the vernacular precepts about obesity and (weight loss) dieting....and to reveal the facts we never hear. The current war on obesity has caused more harm than good. The simplistic myths and answers it promotes are not supported by the evidence. Obesity is complex and the result of multiple interrelating factors that scientists may never completely figure out.


The Truth About Obesity
The Skinny on Fat
The Diet Problem
Dying to Be Thin
The War on Fat's Casualties
To Your Health
Where's the Epidemic?
To Do List
A Simple Plan
Mikey Doesn't Like It

Thinness has been a cultural fad, growing increasingly extreme, for more than forty years now. With other fashion trends, such as smoking and tanning, our government and healthcare providers make sure the health dangers are well-known. When it comes to the obsession with thinness, however, its very real dangers are never spoken. There are no splashy headlines: "If your dress size is under four, you have the highest risk of dying young!"


Even more alarming, the government -- as well as many healthcare providers, insurance companies, the diet industry, media and others -- have been selling us on the need to be thin and advocating weight loss solutions that endanger our health. Some propose treating obesity like a disease with chronic use of diet drugs, although safe and effective ones don't yet exist. Most promoted is dieting, usually for all of us over recommended weights. Dieting and the even riskier weight loss methods being advanced, largely do not work (if they did, their proponents would have put themselves out of business long ago). Worse, they routinely take otherwise healthy people and put them at risk for grave health problems. Yet, those dangers are never spoken. There are no splashy headlines: "Dieting quadruples your risk of dying early!"


The justification for the war on obesity is, of course, the claim "fat is deadly!" However, sound scientific research shows that fatness is not a disease, not all body fat is the same, and that just being fat doesn't make us unhealthy. Risks inappropriately attributed to fatness also aren't differentiated from those due to dieting, sedentary lifestyles, eating poorly and other factors. The majority of Americans who've been labeled "fat" are typically mischaracterized in the media as all being extremely obese. While attempting to magnify the obesity crisis and frighten us by implying all fat people have similar risks, the extremely obese represent a mere 4.7 percent of us. Little research has been done on this rare group, leaving their health risks largely speculative and possibly overstated, certainly not a fitting basis for public policy. In fact, it's notable that extremely obese women still have longer life expectancies than normal-weight men. And, for most of us? A considerable amount of research as shown that being overweight has healthful benefits. But, good news about fat is never spoken. There are no splashy headlines: "Being overweight as you age quadruples your chances of living longer!"


Now, the government, employers and health insurance companies are looking at discriminatory policies based on weight and compelling weight loss among those deemed fat. While most Americans oppose having their weight become the business of their employer or government, most worrisome is that there is simply no evidence to justify using weight as a measure for anything, not even health. Nor does the research conclusively support their "recommended weights" as being the healthiest or that losing weight will make everyone healthier. What such measures will do is endorse, even encourage, more desperate measures to achieve thinness. Scientific research shows that fatness is largely determined by things outside people's control and that nothing known today can safely change that. Doing everything right for good health won't make fat people thin or even appreciably change their body weights. Promoting healthful lifestyles may be helpful preventatively -- although programs to date have had little or no success reducing obesity rates in their test populations. Perhaps, as some researchers suggest, effective preventative measures will require yet undiscovered prenatal interventions. But, even preventative efforts will never squeeze everyone into one-size-fits-all garments. 


Ideally the incentives behind public health policy should be about ensuring good health for all Americans, not legislating a fashion trend.


As we learned in this series, good health is determined by what we do not what we weigh. Plenty of thin people drop dead of heart attacks, get cancer or have high blood pressure. Genetically slender people who lay around on the couch all day and eat potato chips aren't any healthier just because they look like we think healthy people should look like. This series doesn't "excuse" fat people, nor does it "excuse" skinny ones. None of us has a free pass when it comes to taking responsibility for our health -- but the decision is a personal one. And when making those lifestyle choices, having all the facts count.


We can't all be athletes, as there's a genetic component to those things we used to measure "being in shape" by. But, the evidence is clear that being sedentary isn't healthful for any of us. Being fit today refers to metabolic fitness and that's something we can all achieve. Simply adding 30 minutes of moderate physical activity, doing whatever we enjoy, to each day can benefit us all.


An important ingredient for a long, healthy life is nourishing our bodies with the greatest variety of foods possible and in sufficient calories to get all the nutrients we need for their health benefits. That's often denied fat people because of the mythology that's been perpetuated about them. It's believed that fatness is a choice and that fat people are simply gluttons. Those believing fat people can easily and safely diet away pounds fail to recognize the complexity behind weight physiology and metabolism. In reality, the lifetime of starvation-level diets most genetically plump people have to maintain (and which must become increasingly restrictive) to meet current "ideal" weights, sacrifices their health and shortens their lives. Sure, anyone can starve themselves thin. That's no secret. But, starving is not healthful, for anyone.


So, where do we go from here?


Experts antithetical to the current war on obesity advocate one thing, and one thing only: using sound evidence to identify real health problems and ascertain the most efficacious ways to promote good health.


"Considering what is currently known about obesity and its treatment, we believe it remarkable that there have been so few calls for reexamination of the fundamental premises that form basic health care policy regarding weight loss," David Garner, Ph.D. and Susan Wooley, Ph.D, concluded. "We believe that it is legitimate to question when further dietary treatment of adult obesity should be put to rest both as a subject of investigation and as a clinical technique. ... [W]e can enhance the possibilities of meaningful scientific progress in other areas by reallocating resources currently invested in developing, applying, and studying dietary treatment that have little rational hope of success."


One of the country's most esteemed obesity researchers, Paul Ernsberger, Ph.D., associate professor of Medicine, Pharmacology and Neuroscience, Case Western Reserve School of Medicine, has said that "while it is true that eating the wrong diet and not getting enough exercise is unhealthy...extra body fat itself does not cause diseases."


Attempting to medicalize what we don't approve of doesn't make obesity a disease. Lynn McAfee, medical advocacy director of the Council on Size & Weight Discrimination [], sees obesity as a made-up word. Her organization and other advocacy groups began critically looking at the evidence on obesity decades ago and writing position papers that have been proven out in research time and again. "In the Fat Underground," McAfee said, "we used to say: 'Dieting is the cure that doesn't work for the disease that doesn't exist.'"


"I can never support any reward for weight loss, ZERO. It's ludicrous, there's no evidence to support it," said Glenn Gaesser, Ph.D., associate professor of exercise physiology at the University of Virginia, a Fellow of the American College of Sports Medicine, and author of Big Fat Lies: The Truth About Your Weight and Your Health (Gurze Books, 2002). "The medical viewpoint of exercise and healthy eating is as means to an end -- to control weight. I would view it as an end in its own right. That's an intrinsically better approach."


"I am totally opposed to giving people incentives to participate in weight loss programs, as I believe weight loss is not an appropriate health goal for the vast majority of people who pursue it," said Paul Campos, a law professor at the University of Colorado and author of the upcoming book, "The Last American Diet." "What we should be doing is finding ways to encourage people to become more active, and to improve their nutritional choices -- but NOT for the purpose of encouraging weight loss."


Overwhelmingly, these experts want to put an end to the frenzy over body weights. We should be as blind to weight as we ideally are to ethnicity, gender or age.


"Healthy bodies come in all shapes," Steven Blair, P.E.D., president of the Cooper Institute [], wrote as senior scientific editor in the Surgeon General's Report on Physical Activity and Health. "We need to stop hounding people about their weight and encourage them to eat a healthful diet and exercise."


Ernsberger concluded: "Emphasizing health at current weight is the safest and most effective plan. ... The emphasis on body weight in the old paradigm should be replaced by a new one."


For several years, a new evidence-based movement has been emerging among science and health care professionals to deal with weight and eating issues. Its focus is on promoting health no matter what one's size. It shares sensible positive messages. It frees us to pursue living rich, full lives, rather than wasting them obsessed with weight and foods. The Health at Any Size Paradigm endorsed by Frances M. Berg, M.S., L.N. and the Healthy Weight Network [] states: "It's about wellness and wholeness, eating in normal, healthy ways and living actively. It's about acceptance, self-respect and appreciation of diversity."


It, like this series, is bound to not be popular with everyone. The solutions are too simple and not the stuff of splashy headlines:


            • Add some physical activity you enjoy to each day, a simple brisk walk will do.

            • Throw away the bathroom scale and feel good about who you are.

• Eat normally and enjoy a colorful variety of foods, in moderation without eliminating any food groups, and allow a reasonable balance of indulges.


By removing weight as an issue, recognizing the benefit of all foods and letting Americans take responsibility for their own health, there won't be anyone or anything to blame anymore. There will be no new taxes to impose, no one to sue, no legislation to enact, no new weight loss method to sell...and no one to get rich. That's the real reason these ideas won't be embraced.


But, after decades of misguided policies, negative messages and bad advice, Americans are ready for old-fashion common sense and sound knowledge. We'll all be a lot healthier for it.


© 2003 Sandy Szwarc. All rights reserved.


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