Q: As the national obesity rate rises, is it time we stop making excuses for people’s bad diet and lack of exercise?
A: Currently, over 40 percent of American adults are obese (BMI of ≥30.0). People with obesity are at an increased risk for serious diseases and health conditions, including high blood pressure, high cholesterol, type 2 diabetes, coronary heart disease, stroke, osteoarthritis, sleep apnea, and they have a greater risk of death from all causes.1
The question is, what to do about it? There’s been a movement to embrace it. “Weight diversity speakers” advocate “fat acceptance” for the “fat pride” community. “For the two-thirds of Americans now overweight or obese, their message is beguiling: being heavy does not equate with being unhealthy. What’s really required, they argue, is a cultural attitude shift, whereby we stop sneering at the obese as overindulgent slobs, accept the high-calorie habit as a defensible lifestyle choice and expand our aesthetic to embrace fat as beautiful.”2 For example, the author of “Health at Every Size” espouses social justice themes to celebrate “body diversity” and condemn class privilege.3
However, celebrating obesity means accepting upwardly spiraling health care costs for all of us, and losing loved ones before their time. While fat acceptance is consistent with the broader cultural movement to externalize blame and stifle “offensiveness,” there can be situations where we worry so much about not offending someone that we coddle their feelings right into morbid obesity and an early grave.
At the other end of the spectrum is “fat shaming.” If you’re reading this column in MD, you’re surely into fitness, including eating right and working out. It may be tempting, as this reader’s question suggests, to think that all individuals with obesity are lazy or gluttonous and that all they need is a simple kick in the ass to drop the box of doughnuts and get on the treadmill. For some, that thinking slips into outright cruelty. “Fat shaming is rife online, from snarky social media comments on the latest celebrity weight gain to websites devoted to sharing ‘funny’ photos and stories of fat people and their gluttonous behavior,” notes the assistant editor of Harvard Public Health. “On fat-acceptance blogs, the comment sections are often filled by … unsolicited advice wrapped in a mantle of moral superiority. They say, for example: ‘She should really be exercising and eating better! Her joints must be taking a beating!’” Are these comments helpful or hurtful? The line between microaggressive jabs and common-sense suggestions are often in the eye of the beholder.
More clearly, research shows that bullying someone about their excess weight doesn’t work to make them thinner.4 In fact, it can spur binge eating and avoidance of physical activity, ultimately leading to more weight gain. Ragging on people about their weight can increase their risk of depression and suicide. The findings of one study suggest that the bodily effects of weight stigma may be even as harmful as poor diet and physical inactivity. Even putting aside the fact that genetic factors play a role in obesity, it’s not so easy for many people to commit to the choices necessary to lose weight. In some cases, for example, overeating can be linked to past trauma or abuse.5 Don’t judge – you never know what psychological baggage people carry.
In my mind, neither fat acceptance nor fat shaming is the answer. As with most things today, we are tribalized into two camps, leaving a barren middle ground of rational response. The American Academy of Pediatrics recommends an alternative approach to speaking with young patients whose weight may be harming their health called “motivational interviewing” – “a counseling technique that engages the patient in developing his or her own goals for beneficial behavior change.”6 The goal is to directly raise the topic of weight without making people feel humiliated. Many adults struggling with obesity are frustrated and self-defeated when they can’t lose weight, and feel powerless. That’s a bad place to be for any positive change to occur.
Obviously, there’s no “one size fits all” approach to helping somebody with an unhealthy weight to lose the pounds. What works for one person may not help another. But surrendering to an unhealthy bodyweight isn’t an approach I can endorse, any more than it’s acceptable to belittle and shame people for their size. Gently guiding people toward better choices, with dignity, kindness, patience and respect, is the best path to a healthier America.
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?