October 5, 2008
IDEA LAB
Losing the Weight Stigma
By ROBIN MARANTZ HENIG
The public-health crusade of the moment is a no-holds-barred war on
obesity. Those waging it don't have time for subtlety. When Senator
Christopher Dodd introduced the Obesity Prevention Act of 2008 this
summer, he called obesity "a medical emergency of hurricanelike
proportions" that is wreaking havoc "on our families, on our society
and on our health care system."
But some activists and academics, part of a growing social movement
known as fat acceptance, suggest that we rethink this war - as well
as our definition of health itself. Fat-acceptance activists insist
you can't assume someone is unhealthy just because he's fat, any more
than you can assume someone is healthy just because he's slim. (They
deliberately use the word "fat" as a way to reclaim it, much the way
some gay rights activists use the word "queer."
Rather, they say, we
should focus on health measurements that are more meaningful than
numbers on a scale. This viewpoint received a boost in August when
The Archives of Internal Medicine reported that fully half of
overweight adults and one-third of the obese had normal blood
pressure, cholesterol, triglycerides and blood sugar - indicating a
normal risk for heart disease and diabetes, conditions supposedly
caused by being fat.
This is a core argument of fat acceptance: that it's possible to be
healthy no matter how fat you are and that weight loss as a goal is
futile, unnecessary and counterproductive - and that fatness is
nobody's business but your own.
Many fat-acceptance activists prefer a new approach to dieting that
focuses on nutrition, exercise and body image. A new book out this
fall, "Health at Every Size," by Linda Bacon, a nutritionist and
physiologist at the University of California at Davis, outlines this
approach, which is less about dieting than a lifestyle change that
emphasizes "intuitive eating": listening to hunger signals, eating
when you're hungry, choosing nutritious food over junk. It encourages
exercise, but for its emotional and physical benefits, not as a way
to lose weight. It advocates tossing out the bathroom scale and
loving your body no matter what it weighs.
The philosophy is migrating slowly into mainstream programs, like a
spa in Vermont that focuses on "acceptance of ourselves and our
wonderful sizes." But the spas and other programs have trouble with
the bottom line of fat acceptance - rejection of weight loss as a
goal. Weight Watchers, for instance, uses some of the same slogans,
and while it promotes its program as "not a diet," it still tracks
weight loss down to the decimal point.
Several studies suggest that if the aim is getting healthier rather
than slimmer, then in the long run the "Health at Every Size"
approach works better than dieting. In 2005, Bacon led the only
randomized control trial to date that tested this hypothesis
physiologically. She randomly assigned half of the 78 subjects, all
women, to a "Health at Every Size" group; while they lost no weight,
their healthier behavior led to lower blood-pressure and cholesterol
levels, which stayed low even two years later. In the weight-loss
group, more than 40 percent dropped out before the six-month
low-calorie diet ended, and at the two-year follow-up, the average
dieter had regained all her lost weight, and the only measurement
that dropped was one for self-esteem.
Scientists who study obesity at the cellular level say genetics
determines people's natural weight range, right down to the type and
amount of food they crave, how much they move and where they
accumulate fat. Asking how someone got to be so fat is as meaningless
as asking how he got to be so tall. "The severely obese have some
underlying genetic or metabolic difference we're not smart enough to
identify yet," says Dr. Rudolph Leibel of Columbia University Medical
Center. "It's the same way that a 7-foot-tall basketball player is
genetically different from me, at 5-foot-8."
Fat has been blamed for cardiac trouble, diabetes and some forms of
cancer. But fat-acceptance activists argue that the epidemiological
studies that link fatness to disease often fail to adjust for
non-weight-related risk factors found more often in fat populations.
Poverty, minority-group status, too much fast food, a sedentary
lifestyle, lack of access to health insurance or to nonjudgmental
medical care, the stress of self-loathing and being part of a
stigmatized group - all are more common among fat people, and all are
linked to poorer health outcomes at any weight. This makes it harder
to say to what extent an association between obesity and disease is
due to the fatness itself or to the risk factors that tend to go
along with being fat.
It remains an open question, one deserving of further scientific
scrutiny, whether the health risks seen in fat populations are caused
by the fat itself or by something else. Only then can we really know
how to effectively wage the war on obesity - or if such a war even
needs to be waged.
IDEA LAB
Losing the Weight Stigma
By ROBIN MARANTZ HENIG
The public-health crusade of the moment is a no-holds-barred war on
obesity. Those waging it don't have time for subtlety. When Senator
Christopher Dodd introduced the Obesity Prevention Act of 2008 this
summer, he called obesity "a medical emergency of hurricanelike
proportions" that is wreaking havoc "on our families, on our society
and on our health care system."
But some activists and academics, part of a growing social movement
known as fat acceptance, suggest that we rethink this war - as well
as our definition of health itself. Fat-acceptance activists insist
you can't assume someone is unhealthy just because he's fat, any more
than you can assume someone is healthy just because he's slim. (They
deliberately use the word "fat" as a way to reclaim it, much the way
some gay rights activists use the word "queer."
Rather, they say, weshould focus on health measurements that are more meaningful than
numbers on a scale. This viewpoint received a boost in August when
The Archives of Internal Medicine reported that fully half of
overweight adults and one-third of the obese had normal blood
pressure, cholesterol, triglycerides and blood sugar - indicating a
normal risk for heart disease and diabetes, conditions supposedly
caused by being fat.
This is a core argument of fat acceptance: that it's possible to be
healthy no matter how fat you are and that weight loss as a goal is
futile, unnecessary and counterproductive - and that fatness is
nobody's business but your own.
Many fat-acceptance activists prefer a new approach to dieting that
focuses on nutrition, exercise and body image. A new book out this
fall, "Health at Every Size," by Linda Bacon, a nutritionist and
physiologist at the University of California at Davis, outlines this
approach, which is less about dieting than a lifestyle change that
emphasizes "intuitive eating": listening to hunger signals, eating
when you're hungry, choosing nutritious food over junk. It encourages
exercise, but for its emotional and physical benefits, not as a way
to lose weight. It advocates tossing out the bathroom scale and
loving your body no matter what it weighs.
The philosophy is migrating slowly into mainstream programs, like a
spa in Vermont that focuses on "acceptance of ourselves and our
wonderful sizes." But the spas and other programs have trouble with
the bottom line of fat acceptance - rejection of weight loss as a
goal. Weight Watchers, for instance, uses some of the same slogans,
and while it promotes its program as "not a diet," it still tracks
weight loss down to the decimal point.
Several studies suggest that if the aim is getting healthier rather
than slimmer, then in the long run the "Health at Every Size"
approach works better than dieting. In 2005, Bacon led the only
randomized control trial to date that tested this hypothesis
physiologically. She randomly assigned half of the 78 subjects, all
women, to a "Health at Every Size" group; while they lost no weight,
their healthier behavior led to lower blood-pressure and cholesterol
levels, which stayed low even two years later. In the weight-loss
group, more than 40 percent dropped out before the six-month
low-calorie diet ended, and at the two-year follow-up, the average
dieter had regained all her lost weight, and the only measurement
that dropped was one for self-esteem.
Scientists who study obesity at the cellular level say genetics
determines people's natural weight range, right down to the type and
amount of food they crave, how much they move and where they
accumulate fat. Asking how someone got to be so fat is as meaningless
as asking how he got to be so tall. "The severely obese have some
underlying genetic or metabolic difference we're not smart enough to
identify yet," says Dr. Rudolph Leibel of Columbia University Medical
Center. "It's the same way that a 7-foot-tall basketball player is
genetically different from me, at 5-foot-8."
Fat has been blamed for cardiac trouble, diabetes and some forms of
cancer. But fat-acceptance activists argue that the epidemiological
studies that link fatness to disease often fail to adjust for
non-weight-related risk factors found more often in fat populations.
Poverty, minority-group status, too much fast food, a sedentary
lifestyle, lack of access to health insurance or to nonjudgmental
medical care, the stress of self-loathing and being part of a
stigmatized group - all are more common among fat people, and all are
linked to poorer health outcomes at any weight. This makes it harder
to say to what extent an association between obesity and disease is
due to the fatness itself or to the risk factors that tend to go
along with being fat.
It remains an open question, one deserving of further scientific
scrutiny, whether the health risks seen in fat populations are caused
by the fat itself or by something else. Only then can we really know
how to effectively wage the war on obesity - or if such a war even
needs to be waged.
16 years