Everything You Know About Obesity Is Not Wrong

Indeed, weight is an imperfect metric of health. But to suggest it’s always and completely irrelevant to health is overstating things. (iStockPhoto)

Last week, HuffPost published a story called “Everything You Know About Obesity is Wrong.” In it, the author, Michael Hobbes, weaves science and people’s stories together to challenge popular perceptions about obesity. He reports that obesity is not necessarily tied to poor health, and that people with it can’t expect to lose weight through diet and exercise. He encourages readers to “shift [their] focus for the first time from weight to health and from shame to support.”

As a health psychologist who’s been studying body image and health behaviors for two decades, I applaud Hobbes for shining a public spotlight on much of my field’s research, and for giving overweight people a space to be heard and seen as people with personalities, families, interests and careers, and not as vessels of disease, numbers on a scale or participants in an epidemic. And I certainly agree that a focus on health and support is important for well-being.

But unfortunately, that’s pretty much where my applause ends. While the article gets many things right, it also seems to misrepresent some of the complexity in this area of research and its translation to real life.

For one, while one of Hobbes’ central points – that diets don’t work – is, of course, spot on, his assertion that scientists have known this fact but have actively chosen to ignore it discounts the fact that some of us have been desperately trying to share this truth for decades. I even wrote a book called “Smart People Don’t Diet” back in 2014 out of desperation to alert the public to something that was so glaringly obvious to researchers, and yet so seldom discussed publicly. I’m not the only one who’s written (and often donated copies of) books like this, developed entire college classes on the topic and spoken at libraries, schools and community centers (usually for free) in the hopes of informing the public.

But people don’t want to listen. The message that diets don’t work isn’t nearly as appealing to consumers as plans, pills or potions that purport to “cure” the concerns they have (warranted or not) about their weight. It’s sexier to follow a social media influencer’s 30-day detox plan than to read an evidence-based book about the life-lengthening benefits of walking. What messages prevail isn’t just about what doctors put out, it’s also about what consumers pick up.

Hobbes seems to miss another important point: Although he’s correct in that typical treatments (like short-term diets) for obesity and overweight do not tend to work, the situation is not as dire, impenetrable and biologically driven as he claims. According to Joseph Dixon, an associate professor of nutritional sciences at Rutgers University with expertise in metabolic processes, while our metabolisms do seem to work against us as we lose weight, the extent of this complex response varies among people. “Certainly, weight loss is not easy – people need to adapt to the truth that there are no short-term fixes for obesity,” he says. “But a permanent state of hunger is far from inevitable – or even likely, if healthy habits are adopted.”

Plus, we do know that there are people who lose weight and keep it off. In fact, since 1994, the National Weight Control Registry has collected data from over 10,000 people who have successfully lost weight (an average of 66 pounds) and kept it off long term. Although what works for one person may not be the best method for another, this research suggests that people who lose weight and keep it off are likely to reduce their caloric and fat intake permanently (not for merely a week or two), exercise for an average of one hour a day, eat breakfast every day, weigh themselves weekly and watch less than 10 hours of TV per week. Although not everyone wants to or can adopt these behaviors, the evidence suggests they are reasonable, healthy and sustainable ways to lose weight for many people.

Research has also shown that people can lose weight and keep it off via surgery, which was once considered a drastic approach, but is increasingly safe and effective. One Cochrane review of 26 studies on the topic reported that people lost an average of 46 pounds eight years after surgery compared to people in control groups, who gained weight eight years after receiving “conventional” treatments (like dieting).

Not only is it sometimes possible to lose weight and keep it off, but it also can lead to better health and even happiness – links Hobbes seems to deny. One study found that nearly everyone in the National Weight Control Registry, for example, reported that their weight loss had led to improvements in their energy level, physical mobility, general mood, self-confidence and physical health. The surgery patients included in the Cochrane review, meanwhile, reported having a better quality of life and fewer medical problems eight years post-surgery than those who had regained weight due to failed dieting attempts.

[See: 10 Unusual Weight-Loss Tips That Actually Work.]

That’s certainly not to say weight loss is the ticket to happiness and body acceptance, or that you can’t be healthy and happy – or even unhealthy and happy – in a large body. But choosing to pursue weight loss doesn’t inevitably mean choosing a more miserable life. And, when reams of research show that weight loss reduces the risk of developing all of the leading causes of death in the industrialized world, including heart disease, stroke and cancer (never mind its pretty direct association with Type 2 diabetes) – why wouldn’t we encourage healthy weight loss in some people? Sure, individuals are not averages, and statistics on overweight and obesity don’t apply to all higher-weight people. But that’s a poor reason not use statistics like averages as they were intended: To help researchers and public health professionals spot trends and associations, and develop general recommendations accordingly.

Throughout his article, Hobbes blames medical professionals for failing overweight and obese patients, and maybe he is to be commended for calling them out. Indeed, many of the solutions they’ve historically offered patients have done more harm than good, and many of them have perpetuated the very real and damaging stigma against higher-weight people. But the article’s subhead and tone – suggesting that there’s some sort of conspiracy theory in the medical community to keep people on ineffective weight-loss regimens – doesn’t reflect the doctors or physicians-to-be I know. When I give lectures about healthy weight management (and reasons not to prescribe dieting and not evoke shame) to medical students at Rutgers University, I don’t sense animosity toward overweight people as much as I see a new generation willing to do better.

But asking current and future physicians to take on the roles of psychologist and registered dietitian as well is an unfairly tall order in our current health care system. Let’s start by teaching clinicians when and how to refer to other qualified health professionals like RDs, and encourage health insurance companies and hospitals to support that. Hobbes notes – correctly, given the research I’ve seen – that shame is an ineffective motivator, and yet it seems to be the tactic he’s using to encourage the medical community to change.

Finally, Hobbes points out that there are interventions – like those that make fruits and vegetables cheaper and more accessible – that can improve health, which is true. And still he suggests that such interventions are unlikely to make people thinner, only healthier. He and many others seem set on the idea that if you pursue weight loss, you can’t also pursue health or body acceptance.

I think this is an unfortunately simplistic view of the world. There is really no reason people can’t work toward making peace with their bodies and lowering their risk for chronic diseases and losing weight, if they so choose. After all, I think one can argue that a life well lived is a life that includes a willingness to keep trying to get better – whether to you this means becoming more dependable, compassionate, healthier or even thinner.