Is our attitude on obesity more dangerous than obesity itself

Up until not long ago it was considered a given, proven fact that obesity causes 300,000 deaths a year (this is still believed wholly by a good many people), and that by encouraging obese people to lose weight, exercise and eat healthy that those death rates could be slashed.

I agree that eating healthy and exercising are good for health, and I used to wholly agree that fighting obesity was a laudable goal. However I have been doing a lot of reading as of late and I have come to the conclusion that (in my view) treating fat as a bad thing may be doing more harm than good for our mental and physical health than the fat itself.

Sadly, because I am a minority voice in this debate I fear being insulted repeatedly and being expected to have flawless arguments (which is impossible), please try to keep the debate civil, fair (to me) and intelligent. I am willing to admit that fat can be, and actually is (according to the latest CDC report on obesity) damaging to health, I am just of the opinion that our attitudes towards fat (socially and medically) are far more damaging to us mentally and physically than the fat itself. I admit that obesity could be far more dangerous than I think, and that the attitudes towards obesity could be far less dangerous than I think, but I am right now of the opinion that it is not worth it.

Before I start the debate there are several studies I want you to read

The new, updated CDC report shows only 25,814 deaths a year are due to obesity

Girls obsessed with thinness four times more likely to smoke than girls not concerned with thinness here and here

Non dieters have higher compliance rates for exercise and healthy eating than dieters

Physicians subtly associate being worthless, stupid and lazy with obesity

Regular exercise can save more than 400,000 lives a year

Ok, having read those articles you may be wondering what any of that has to do with obesity. I will tell you. Assume there are two worlds, in one world obesity is considered disgusting, ugly, dangerously unhealthy and a sign of a weak will. In this world people are pressured hard to lose weight and keep it off, and treating obesity in and of itself is considered the smartest intervention when someone has health problems.

In the second world obesity is considered unattractive and somewhat unhealthy, but it is not a big deal in and of itself. Socially speaking obesity (especially morbid obesity) is considered somewhat unattractive, but no more ugly than having crooked teeth or being bald. Women believe that being fat is bad, but they do not base their worth as human beings based on how big their waist is.
In both worlds an individual is worried about developing a disease (cancer, diabetes, heart disease). This person has a BMI of 40 and wants to go to his doctor.

In version 1 this is what seems likely to happen. The person will say to her husband about her desire to get some preventative health advice “I want to see the doctor, but I’m afraid he’ll just insult me for being fat, maybe I shouldn’t go”. Her husband cajoles her into going, and when she does the doctor generally ignores all her complaints and simply tells her to lose weight. So she tries to lose weight. She eats healthy and exercises a bit, but after a month or two gives up. She (reluctantly) goes back to the same doctor after six months and after not losing weight the doctor subtly insults her and says ‘lose weight’ again, implying if she weren’t so weak willed she wouldn’t be fat. The same thing happens every six months for a few years.

In world two the same woman is less reluctant to see her doctor. When she sees her doctor and says ‘I’m worried about disease X’. The doctor may say ‘that’s understandable, but there are a myriad of interventions we can do to cut your risk’. She asks if she should try to lose weight and the doctor says ‘I guess it couldn’t hurt, but losing weight and keeping it off is very hard. We’d be better off focusing on other ways to prevent you from developing X’. So the doctor tells her to find a sport she enjoys playing, to go for walks with her friends, etc to improve her exercise habits. He tells her not to lead an overly restrictive diet, but to try to get in 20-30 grams a day of fiber, to try to eat 5 servings a day of fruits and vegetables and to switch some of her foods around to lower fat alternatives (to switch from ground beef to ground turkey, to switch from whole milk to 1% milk, etc). After he does that he fills her in on various things she can do to cut her risk of developing ‘disease X’. Assume ‘disease X’ is type II diabetes. I don’t know if the studies I’ll list below are proof in and of themselves that these interventions are a good idea, but my point is that in the first scenario these ideas wouldn’t even be considered by the physician, the physician in scenario one would be mainly/only concerned with weight loss.
When I made a post in MPSIMS about wanting to avoid getting type II diabetes much of the advice I got from medical professionals was to keep my BMI low and to eat a healthy diet and exercise. Although I am willing to admit that BMI in and of itself can be/is a predictor of type II diabetes it is one of several.

One study showed that not eating sugary drinks cuts the risk of type II diabetes by 83%. The study says half of the risk could be associated with weight gain, but the other half could be associated with the fact that sugary drinks are more readily absorbed.

One shows that eating a high fiber breakfast cuts insulin resistance by 35-50%

One study shows that several studies show moderate drinking lowers the risk of developing type II diabetes by 30%

Exercise is tied into cutting type II diabetes rates in many studies. Smoking almost doubles type II diabetes risks.

While the medical professionals did tell me to lose weight, eat healthy and exercise (all proven ways to cut the risk of diabetes, and I agree that having a high BMI is tied to type II diabetes, my mistake) the problem is that when eating healthy and exercising are seen as ways to lose weight instead of laudable goals in and of themselves compliance drops dramatically. According to the study I listed above, individuals who are taught that exercise and diet are tools for weight loss had a 42% dropout rate while individuals who were taught that healthy diet & exercise were good ideas in and of themselves only had an 8% dropout rate. By the end of the study (2 years later) exercise rates had quadrupled for the non-dieters but were back to baseline levels for the dieters. Considering the sixth study I listed that shows exercise can cut well over 400,000 deaths a year (it didn’t give total numbers it just said exercise can cut more deaths than smoking and smoking kills 400,000 a year) this is very relevant to the discussion of obesity. Not only that, but nobody really gave me advice other than eat healthy and lose weight. I am not a doctor and I don’t know their reasons (not giving advice based on a few studies may be a good idea for physicians) however, at the end of the day I received no advice other than to lose weight and exercise. All the studies I listed above which can cut risk factors for developing type II diabetes were not given to me as ways to decrease my risk factors, I was just told to lose weight and eat healthier and exercise. With heart disease, there are 246 risk factors and endless interventions to cut risk. However if a fat person goes into a doctors office the doctor will probably treat ‘losing weight’ as the first, best and main intervention he/she wants the patient to follow, ignoring the other 245 risk factors. As I said, the problem is that when eating healthy and exercising are tied into weight loss people associate these activities with restrictive living and the loss of bodyweight, lowering compliance.

Based on the second study, girls who believe that being thin is very important are four times more likely to take up smoking than girls who feel that being thin is unimportant. The link is not really known, but it could be tied into the idea that smoking can encourage weight loss and the idea that girls obsessed with thinness may develop psychological problems (then again, maybe their interest in thinness is a sign of pre-existing problems instead, I do not know). In the nurses study, which is quoted a lot when supporting the fight against obesity, smoking nurses are disqualified. However thin nurses were twice as likely to smoke as obese nurses, this link can’t be totally ignored and should be factored into debates on obesity. You also have to take into account that individuals who feel that being thin are important are probably (I can’t find any studies that test this) less likely to want to quit since quitting smoking is associated with weight gain. In fact, if you look at sites on quitting many list ways to not gain weight early on, which

Back to the two worlds listed above. In world 1 the woman lives in a world where she is much more likely to take up smoking, she is less likely to want to quit, she can’t trust her doctor, her doctor doesn’t listen to her and offers no advice or medical help other than telling her to lose weight, her compliance rates for exercise and healthy diet are very low and she suffers from major psychological problems associated with her obesity. People have their value judged based on their weight, personal accomplishments, devotion to charitable causes or family are not as important as bodyweight.

In world two the woman is less likely to start to smoke, more likely to quit, she trusts her doctor, her doctor offers her various kinds of advice on how to cut her risk factors that have nothing to do with losing weight (meaning they promote interventions with a much higher compliance rate), her compliance with eating a healthy diet and exercising are higher and her psychological states are better than the woman in situation 1. In this world making a persons entire self worth based on their weight is as laughable as making their self worth based on how straight their teeth are or how much hair they have (bad teeth, no hair and obesity are all considered unattractive for biological reasons, so I’m lumping them together).

It is now 15 years in the future, woman 1 has done almost nothing for her health, while woman 2 is more likely to have done a variety of intelligent interventions to improve her health. Drugs are starting to hit the market that can cause people to lose weight without diet and exercise. In world 1 most people do not eat healthy or exercise, and those who do mainly only do it to lose weight either for vanity or health reasons. In world two more people (I have no idea how many more) are likely to try to eat somewhat healthy (not overly restrictive, just a diet with adequate fiber, adequate fruits & vegetables, etc) and more likely to exercise. Being fat is considered bad, but no more than being bald or having crooked teeth. Too much fat is shown to be unhealthy, but since making fat people thin is highly unlikely, physicians focus on other medical interventions instead. Losing weight isn’t frowned upon per se, its just not treated at the smartest or most effective intervention for a medical problem.

In world 1 when the drugs hit the market rates for diet and exercise drop dramatically. Most of the people who were working out and eating right were only doing it in an effort to look good and to maintain a weight loss, and now that motivation is gone for them.

In world 2, since people eat healthy and exercise for mental and physical benefits and not for vanity benefits, the pills are taken but people continue to eat reasonably healthy and exercise in higher amounts than the individuals in world 1. Smoking rates are also still lower in world 2 and the rates of psychological disorders are also lower.
Now back to reality. The latest CDC report shows that 111,909 deaths a year are due to being overweight (a much smaller number than the 300,000 figure, which was immensely flawed). However, of these 111,909 deaths 82,066 were among individuals with a BMI of 35 or higher. Also, individuals in the overweight range (25-30 BMI) received health protections from being overweight, 86,095 people who would’ve died had they had a regular BMI instead survived. When subtracting the 86,905 figure from 111,909 you end up with 25,814.

Consider that only about 10-15% of Americans have a BMI of 35 or higher, and that about 35% are in the 25-30 range. I do not know the exact number of individuals with a BMI of 35, but the percentage of individuals with a BMI of 40 or higher was 4.7% in 2000 so I’m guessing its about 10-15% for a BMI of 35. At the very least, shouldn’t we change the BMI standards so 18-30 is considered normal, 30-35 is overweight and only at a BMI of 35 does obesity start to pose major problems if being overweight actually improves health?

You may be asking what does this all mean. Well I assume I made several assumptions in my post, and I’m sure there are many interpretations of my views and that I’ve made several mistakes. However, if the CDC’s latest report is true and only 25,814 deaths a year are actually due to obesity, is it really worth it? 25,814 lives a year is alot of lives, but is what obsessing over obesity is doing to us as a culture worth it to help those 25,814 lives (actaully we don’t help those 25,814 since compliance for weight loss is about 5-15%, so we barely save a few thousand a year in america due to our obsession with weight) Is it worth this culture that encourages people to hate themselves and each other, a culture that encourages doctors to think of their patients as worthless, lazy and stupid? A culture that discourages exercise and healthy eating (by teaching people that these things are ‘just’ ways to lose weight which can cut compliance rates), a culture that encourages people to start smoking and discourages them from stopping, a culture where medical interventions with a higher compliance rate are ignored in favor of interventions based on controversial studies with a 5-10% compliance rate? A culture that teaches a destructive value system that women’s worth is based on how fat/thin they are? Do women base their worth on how pretty their faces are or how straight their teeth are (if they do, its news to me)?

Many cancer deaths are due to poor decisions on the part of the sufferer (not getting screened, poor diet, lack of exercise, smoking) however cancer patients are treated differently than the obese in the sense that they are treated humanely. AIDS is due in large part to poor lifestyle decisions too but AIDS sufferers get treated well. In fact most diseases and illnesses are due largely or partly due to poor decisions on the part of the sufferer. Not getting regular checkups, poor diet, poor lifestyle, smoking, unprotected sex, living in a high crime area, working a dangerous job, etc. However these people are not treated as stupid, lazy & worthless by doctors & society.

People who live in the ghetto don’t want to be victimized by crime. If a politician said ‘we have the ultimate cure for crime in the ghetto, you’ll never be victimized again’. The people would say ‘what is that’ and the politican would say ‘move. Move out of the ghetto’. This is common sense advice and it would save lives but even though most people in the ghetto want to move, only a small percentage are able to move out. By focusing on telling people to move and dismissing the inhabitants as lazy, stupid or worthless if they don’t leave the ghetto this promotes a very destructive attitude. Luckily police are more concerned with criminal intelligence, community policing and stopping gangs (instead of telling the people there to move and calling them idiots when a year later they still live there) and as a result crime has gone down a bit.

At the very least there needs to be a debate on this subject, and people should look at the situation from all sides. People like Sandy Schwartz (who has articles available at tech central station) Paul Campos and Glenn Gaesser are good writers on the subject.

I am not saying this is an either/or debate that we have to be 100% in world 1 or 100% in world 2, I am saying our attitudes encourage the behaviors listed in world 1. I am not saying doctors are not allowed to factor in other interventions, or they are not allowed to be humane with patients, just that it is less likely to occur with our current views on obesity. Considering that only 25,814 lives are lost due to obesity a year in the US, and that we barely know how to make fat people thin (meaning I bet only a few thousand lives are actually saved by weight loss annually since most people who lose weight gain it back), and that obsessing over obesity is tied into endless medical problems (doctors hating their patients, higher smoking rates, lower exercise rates, lower dietary rates) and psychological problems (people hating themselves, people hating each other) maybe we should rethink this thing.

Another problem is that obesity and being overweight is not really a health concern for 90% of the population. If the new CDC statistics are correct, only 10-15% of the population (those with BMIs of 35 or higher) are at any signifigant health risk due to their weight because 73% of deaths due to obesity occur among those who have a BMI of 35 or higher, even though only the most overweight/obese 25ish percent of overweight/obese have BMIs that high or higher and only 10% or so of the population has a BMI that high. Not only that, but by promoting healthy eating and exercise independent of weight loss more lives could probably be saved than promoting weight loss as the main/best way to decrease their mortality.

Another problem is, as I said, promoting weight loss across the board is destructive in a way. If being overweight saves lives then encouraging the overweight to have ‘healthy’ BMIs (18-25) will end up killing 86,095 people a year. On the other hand, by encouraging those with a BMI of 35+ to get their BMI into the 25-30 range we could be saving lives, assuming it is the bodyfat itself that causes illness or protects, and not some internal physiological difference between teh obese, overweight and normal weighted individuals. By that I mean, someone who has a BMI of 35 and drops to a BMI of 25 still has the same internal physiology that they had when their BMI was 35. Do we even know if its the bodyweight itself or the internal physiology that causes the bodyweight to shoot up so high that is the real danger? Paul Campos uses and example to illustrate this point. Bald men have shorter lives than men with hair because their internal physiology produces more testosterone. Telling bald men to buy toupees and telling them that this will increase their life expectancy is flawed because the internal physiology that made them bald in the first place remains the same. If a person whose internal physiology predisposes them to be 100+ pounds heavier than everyone else loses 100 pounds, their internal physiology remains the same.

One of the criticisms of the new CDC study is the fear that those with wasting diseases (AIDS, cancer, heart disease) were included among the ‘normal weight’ individuals and as a result the benefits of overweight may just be a fluke. I emailed Paul Campos about the new study, asking him what he thought and he says that the study accomidates for that factor.

I should’ve read the CDC article closer, only 8% of people have a BMI of 35 or higher.

So as a culture 8% of people are at risk due to their weight while 35% are being benefitted because they are overweight. Overly thin people who make up about (maybe) 15% of the population are at health risk too, but I won’t include them right now.

And again, we really don’t know how to encourage people to lose weight and keep it off. Be treating an illness with a cure with a 5-15% success rate as the primary treatment method puts lives at risk. With most/all otehr medical interventions, the first interventions are those with the highest success rates. Normally interventions with a low success rate are only tried after more competent interventions are tried and fail. With obesity the exact opposite is true, the most inept interventions (those with a 5-15% success rate) are tried as the smartest and primary medical intervention.

And again, I’m not sure if its the weight itself or the internal physiology of people who are predisposed to gain weight that causes the health benefits of the overweight or the health problems of those who are underweight. Moderately severe obesity (a BMI of 35 or higher) may just be a side effect of a medically dangerous physiology and not a threat in and of itself.

Wow that is a long and well written post…a little self hijack from the title I think but very well done.
to the question about attitude, you are in some ways correct without a doubt. obese people have to deal with the 24/7 stress put on them by the non-obese in the form of outright insults to simple peer pressure. I dont see this part going away anytime soon for reasons that seem to be mine alone.

look at humans from an evolutionary standpoint. we are predators. Predators look for weakness, we look for the slow, the wounded, the easy kill. when we see easy prey we attack, in this case I dont mean we are predisposed to drop insults by evolution, simply that we are geared as animals to respond with aggression againts noticably easy prey.

the overweight are not what we would consider prey but they are what you would consider a liability to the pack, the village, the comunity. one reason there are more obese people today than ever before is simple accesss to food. we live in a country where there are people who are both poor and obese…to most of the world that would be a blatent contradiction.

the obese wear their weakness on the outside, for all to see. I dont think that evolution and our status as predators accounts for ALL of our attitudes but I think it accounts for more than most would give it credit for.

the parts about eating healthy and exersise and the apperant inability to teach these things…to true. and the only way to fix that is to get somone (or a group) who can work out a fool proof (HAH! INCONCIEVABLE!!) method to teach the basics and get that method out to the general public/healthcare profesionals. and believe me that would be hard as hell to do.

Wesley Clark, thank you!

Thank you, thank you, thank you!

I’ve been living this for years, now. I am morbidly obese. However, I’m also suffering chronic clinical depression. Of the two conditions I know which one I consider more deadly - and the common ways to treat the first exacerbate the second. My doctors all agree with my decision to focus on mental health first, then begin slow, steady work on the second. But in public I get total strangers giving me unsolicited advice because being obese is so bad.

Hell, even here on the SDMB the antagonism and the willingness of people to cause emotional harm in the name of ‘helping’ people with obesity is chilling.

Wow, I echo the sentiment that that was an incredibly long and well written post.

I think you’re absolutely right and I doubt you’re going to find much disagreement here.

Although I have no counter-view to present, i’d like to encourage you to fight the good fight. It’s the only way to achieve your world 2.

I rarely consider my “wordsmithing” adequate for GD, but I’ll stick my neck out anyway…

Adding to critical1’s evolutionary observations… Our attitudes to obesity may derive from evolutionary patterns, but I think the obesity itself is a result of millions of generations conditioned to eat whenever food is available. Simply put, the obese folks may be the result of the most successful lines of genetic inheritance (acquire lots of food, store it efficiently). Unfortunately, that ability has become a liability for the first time in our planet’s history.

Unlike other habits, or behaviors we humans try to correct, the problem of losing weight is a battle against our very makeup. Obese people can’t make a “single” decision to change; They have to make thousands of small decisions, all contrary to instinct, and do it continually for years in order to really lose weight. This is a nearly impossible task.

(Since the source of the various posts may be of interest, I’m slim, and have never had to fight against weight.)

I agree 100%. The stress put on overweight people is cruel and unneccssary. Why don’t people get into their own fatheads that overweight people know they are overweight and know about how diet and exercize are supose to be an instant cureall for the condition.

As Peg Bracken once wrote “There are worse things than being fat, and one of them is worrying about it all the time.”

Although I don’t have much problem with your greater premise, I do want to caution you from inferring causation from the link between smoking in girls and the desire to stay thin. Many young people start smoking to look cool and fit in with their peers. In other words, they do it to conform. It’s plausible that conformists are also more likely to aspire towards media images of beauty, which includes having tiny waists and twiggy thighs. Conversely, nonconformists may eschew both smoking and an obsession with thinness. The factors look related on paper, but may be completely independent in actuality.

That is certainly plausible for starting smoking, but one of the main reasons given by both men and woment for reluctance to quit smoking is (a very real) fear of weight gain.

Funny story. I used to post in the diet threads here and I have lost a good amount of weight. I used to be 302 and 38% bodyfat, right now i’m at 250 and 22% bodyfat and i’ve stabalized in the 245-260 range for the last 2 years.

In my experience with this issue most people dismiss anyone who disagrees with modern dogma on obesity by more or less implying ‘yeah well you’re just a fat person who can’t lose weight so you made up a bunch of crap to justify your condition’.

I have done what most people can’t do, I’ve lost weight and kept it off for 2 years. I’ve considered letting myself regain the weight (I don’t want to contribute to this medical and social atmosphere of hate and junk science by being a ‘success story’), but if I do that then people can discredit me knee-jerk as ‘some fat person who can’t lose weight’. So I’ll probably have to let myself stay thinner just to maintain my credibility when I talk to people about this isse face to face (ie when they say ‘youre just some fat person who can’t lose weight’ I’ll say ‘no, unlike you and most people I’ve lost 50 lbs and kept it off for years, and the premises of the war on obesity are still wrong’). I’m not happy about it, but I see no other option.

Re the 2nd paragraph above: Wow, he’s got it! "…thousands of small decisions, all contrary to instinct, and do it continually for years… " That’s exactly it. I would add, “contrary to instinct and habit”.

Re the 1st paragraph above: I think this is correct. But another factor is the kind of food available in today’s supermarkets, convenience stores, etc.

Tomato sauce, ketchup, bread, rolls, buns, crackers – should any of these things be sweet? I would say, no. Some things should be sweet: cake, cookies, syrup, etc. But Tomato sauce, ketchup, bread, rolls, buns, crackers? These are not products that are supposd to be sweet – yet in our supermarkets and convenience stores, it is difficult to find any tomato sauce, ketchup, bread, rolls, buns, or crackers that do not contain sweetener. Many contain several sweeteners. And the most-used sweetener in the US today is high fructose corn syrup. Most used because cheapest. Cheapest only in the US, due to US sugar price supports.

As I understand it, the experts do not agree on this, but some think that high fructose corn syrup is a significant factor in the increase in overweight and obesity. Due to being absorbed faster than other sweeteners? I’m not sure. I’ve been trying to avoid it, but the stuff seems to be in everything!

(This is off topic, but speaking of ingredients, why do they put so much salt in so many things? Does tomato juice, for example, really need to be loaded with salt? The hard to find low salt version tastes, to me, exactly the same as the high salt “regular” version.)

I agree and I said so in my post that I didn’t know how coorelated the two things were. However you can’t totally dismiss the coorelation.

At the very least, even if we clamp down hard on those with a BMI of 35 or higher (ie, those who make up 73% of deaths on obesity) only about 10% will be able to lose weight and keep it off. That means our war on obesity, if fought with intelligents and cutting edge science, will only save 8,206 lives a year. Saving 8,206 lives a year at the expense of all the medical and socially destructive attributes of the war on obesity is not a good idea. This is also assuming there are no negative health effects in the 90% of yo-yo dieters who can’t keep the weight off (studies are contradictory that yo-yo dieting encourages cardiovascular and cancer deaths. Some say yes, some say no) and that the 10% who do keep the weight off actually get health benefits (see the toupee metaphor again).

I echo the statements others have made about your post being well written. However, I disagree with the picture you paint. I decided not to quote your post because of its length so if what I am referring to is unclear, please tell me.

First, doctors often stress increasing physical activity in addition to weight loss. However, not focusing on weight loss would be a dereliction of duty. Type 2 Diabetes is affected more by weight than activity level. Doctors aren’t in the business of being your friend and sugar coating the situation for you. If you can’t take enough interest in whether you live or die, it should not be their responsibility to coax you into doing so.

The distinction you make between dieting and lifestyle change is important. People misinterpret this all the time. Diets are temporary. Any real weight loss is only sustained through lifestyle change. Most doctors will explain this to patients and will not advise obese people to go on crash diets unless the situation is dire.

The smoking thinness connection you make is tenuous at best. I think someone already discussed this so I will move on.

BMI index is only a rough guideline. It doesn’t tell you much about muscular or athletic people. Many healthy football players would be considered overweight or obese according to that chart.

First, I don’t think HIV patients are treated well by any society, and many have the disease through no fault of their own. I have to disagree with your statement that the obese are treated as worthless and stupid by doctors and society. Any good doctors would never do that. Lazy is a different story. Let’s face it, many overweight people are lazy. They don’t get enough exercise and they eat far too much. This impression is often based on observation and not bias. How many obese people do you know that have a good diet and get the proper amount of exercise?

Healthy eating and exercise are not independent of weight loss for overweight people. To separate the two is disingenuous at best. It’s simple, you lose weight if you burn off more calories than you take in. Healthy eating, for people who are overweight, means taking in far fewer calories. This should result in weight loss. You seem to be advocating that doctors should lie to patients by saying losing weight isn’t the main problem when it usually is.

The latest theories I’ve been exposed to are that people predisposed to being overweight don’t have the internal mechanism, that allows them to calculate how much energy they’ve taken in (calorie wise). A study was done on children to see if their appetites fluctuated with the caloric intake of the food they were given. First, the kids were fed hot dogs and fries and told to eat until they felt satisfied. The next day, they were given the same meal, except that the food had more calories. Across the board, the kids, at normal weights, ate less of the high calorie food. They had no way of knowing that one had more calories, but their bodies did. I think most fat people either don’t have a functional version of that gene, or they don’t listen to their internal sensor. In both situations, it’s not your genes making you fat, it’s what you eat. That’s why I think your example of people who were told to listen to their bodies having successful weight loss bolsters this theory. Most people’s bodies know how much food they need to take in. It’s when people begin eating more for pleasure or psychological reasons that weight gain begins to happen.

Your bald analogy is hollow for a number of reasons. Most importantly, there is nothing about a fat persons genes that is inherently unhealthy. Bald genes are actively working toward a goal, fat genes only predispose people to weight gain. In addition, losing weight will have a dramatic physiological effect, a toupee will not.

There is relatively low success rate with any kind of behavior modification. You seem to be advocating ignoring the problem because it makes people feel bad. It’s like telling a chain smoker to run more often and get more aerobic exercise, and then saying, “oh, and you may want to quit smoking too”. Smoking is the main problem, just as being obese is.

No, severe obesity is a threat in and of itself. Of course, you could be a healthy overweight, but it harder to do so.

The shift in attitude you are advocating has already occurred in a number of other areas. Now, most people consider alcoholism and drug addictions a disease. I don’t think that its really had a measurable effect on the number of alcoholics. OTOH, smoking, which has been universally demonized, has become less common. What conclusion can we draw from that? Probably not many valid ones, but it is clear that an attitude shift will not necessarily lead to less people having a problem.

True, they say that, and if breaking the smoking habit was as simple as not buying any more packs, I would rate weight gain as a very likely reason smokers continue to smoke. But smoking is not easy to give up; it is psychologically and physically addictive. So while people may claim they don’t want to part with the habit because of fears of gaining weight, I’m skeptical that is the primary reason they don’t quit.

You constructed a hypothetical world based on the premise that a desire to be thin leads to smoking. I don’t think you’ve substantiated that enough to make yours a convincing scenario. There is probably as much societal pressure heaped on smokers to quit as there is on the overweight to become thin. Just ask any of the Doper smokers. Doesn’t that kind of shoot holes in your theory that our anti-obese society leads to more smokers? Looking at current trends, with the prevalence of smoking steadily decreasing, based on your theory obesity should also be declining. But it isn’t. This discrepancy begs for an explanation, and I’m on the opinion that it because the two things have little to do with each other.

Even if being obese is only dangerous because of its effect on the way people treat you, you have to look at the easiest way for the average obese person to improve his situation. And right now, it’s going to be significantly easier for that guy to lose weight than to change the attitudes of total strangers.

There are several interventions a person can take to decrease their risk of diabetes which have a compliance rate higher than 10% and which dont’ encourage unhealthy behavior or discourage healthy behavior the way our obsession with weight does. What are the chances that a doctor will tell his/her patient to eat a high fiber breakfast, or to drink in small amounts, etc. He will just tell his patient to lose weight and to eat right and exercise in an effort to lose weight. As i’ve shown, this is a bad idea for several reasons.

So by doing this, we are discouraging almost everything a physician can do in order to promote health by bypassing all solutions other than weight loss. Even though bodyweight is tied to obesity, so is exercise, our attitudes (according to the exercise study I posted) tend to discourage exercise when it is seen as a means of weight loss rather than a goal in and of itself. Those who were taught to exercise for health and psychological reasons quadrupled their exercise levels, and those who were taught to do it for weight reasons returned to baseline levels.

And again, our attitudes seem to encourage smoking which is highly tied to type II diabetes.

Even with the obesity epidemic, rates of deaths from diabetes complications are going down and have been for the last 11 years.

The smoking tie is tenous I agree, but if our best obesity interventions can only save 8,206 lives a year then that means only 2% of smokers need to start or refuse to quit out of fear of being fat to nullify those 8,206 deaths a year since 400,000 die of smoking annually. Since the study showed that girls who felt thinness was highly important were 400% more likely to smoke than girls who felt thinness wasn’t important, and as others have said fear of gaining weight is a reason people don’t quit smoking then I think that 2% figure is all but guaranteed.

Me. I have a BMI of 35, I eat about 40-50 grams of fiber a day, I eat ground turkey instead of ground beef, I eat a diet of about 30% fat, I exercise 3-4 hours a week, I drink diet sodas (instead of sugary sodas) and I try to get in enough fruits & vegetables a day. However, I am muscular so my BMI is not a good indication.

Obese people are not lazy per se. I know and see many obese people who are doctors, lawyers, doctoral students, politicians, people who have recovered from serious illnesses, etc. Tommy Thompson is obese and he is a lawyer, governor, and high ranking politician. Even though his credibility on healthy bodyweight relies on him having a BMI of under 25 he doesn’t have that BMI. He can become a lawyer, a governor, and a high ranking insider but even when his credibility for pushing the BMI table is on the line he can’t do it. I remember when he was giving his speech there was a female politican who also gave a speech. She was even fatter, and i’m sure she was extremely accomplished too.

If people who can get doctorates and become governors can’t lose weight and keep it off even when their credibility is on the line on the subject (an obese Tommy Thompson giving a speech on BMI is like a drunken David Crosby giving a speech at AA) why should that kind of intervention be seen as the first/best medical intervention for the general public?

healthy eating and exercise are not guaranteed to lead to weight loss. Even if they do it is probably because the regimins are going to be overly restrictive and overly controlling, which will decrease compliance.

This doesn’t change the fact that treating obesity as a bad thing only saves 8,206 lives a year at best, and discourages an endless array of healthy activities. It also doesn’t change the fact that with our current attitudes on exercise and diet when working anti obesity drugs hit the market in 10 years compliance rates for healthy diet and exercise will go even lower.

What is wrong with the bald analogy?

This is an experimental study on mice, but it was found that the hormone MSH is necessary for obese mice to develop diabetes. Obese mice with MSH develop diabetes, obese mice without it do not develop diabetes. Would making the mice lose weight change their levels of MSH? The article doesn’t say, but there may not be a direct coorelation between MSH levels and obesity. Even if so is encouraging an intervention with a 10% success rate the best way to lower MSH levels?

I don’t know if you’ve heard of the Pima but they are an Indian tribe in Arizona. Their genetics predispose them to obesity and diabetes so that 50% have diabetes and 70% are obese. They also have genetic cousins in mexico who do not eat western diets (they eat high fiber diets which are low in fat) and they do 25 hours of physical activity a week.

"The second issue is the “Enigma” within the “Paradox”. Although the Mexican Pima does not have the health issues of the Arizona Pima, they still have a prevalence rate of diabetes at 6.4% (approximately 1.5x greater that the non Pima Mexicans), and a 13% incidence of obesity among the adult population.

While these numbers are impressive compared to the US population, and stellar compared to the Pima population, the question remains why should an essentially unacculturated population performing on average 23-26 hours of physical labor per week have any incidence of diabetes or obesity."

So even by doing everything right (eating healthy, exercising, losing weight), the mexican Pima still have about the same rate of obesity (13% vs 15%) and twice the diabetes rates as Canada (6.4% vs 3%) even though their lifestyles are much better than the average Canadian. Their rates are much better than the Arizona Pima though. That may be a bad example, its just to show that lifestyle in and of itself can only help, it can’t guarantee a cure. And by treating weight loss as the main/sole intervention other interventions may get passed over.

I am advocating focusing on interventions with a success rate higher than 10% which don’t encourage smoking, don’t encourage psychological problems in hundreds of millions of people, don’t encourage poor doctor/patient relations, don’t discourage exercise and dont discourage healthy diets in an effort to save 8,206 lives a year.

Nonetheless, with current tactics the best we can largely shoot for is making 10% of the population permanent weight loss. Even if we only encourage those with a BMI of 35 or higher to diet this is only 8,206 lives a year we would save. That is also assuming that dieting in and of itself has no negative health effects on the 90% who try and fail (studies are contradictory, some say it is dangerous and some say it isn’t), and that the 10% who do succeed will manage to alleviate the medical problems they experienced when they had a higher BMI.

The exercise study I listed where individuals were taught to feel diet and exercise were good goals in and of themselves showed higher compliance and more physical activity.

Severe obesity is a threat in and of itself (only 8% of the population has a BMI of 35 or higher, but they account for 73% of the deaths). However since the best we can currently do is make about 10% of them thin, why are we obsessing over obesity? This also assumes that chronic dieting isn’t going to have negative health effects on the 90% who can’t stay thin.

I am not saying 80-90% of smokers smoke due to fear of fatness. However you only need 2% of smokers to take up smoking or not quit due to fear of fatness to nullify the health benefits we get from placing pressure on obese people to lose weight,and this ignores all the medical problems and social problems our war on obesity causes and just focuses on smoking (and ignores our war on obesity’s effects on healthy diet, exercise, psychology, medical activities, etc). Do you disagree that 2% of smokers start or refuse to quit either in whole or in part due to pressures to say thin, considering that the study I listed showed girls who felt thinness were important were 400% more likely to smoke and that stopping weight gain is listed as one of the main fears of quitting?

I googled a page on quitting smoking at random and the first question asked in the ‘Common Concerns About Quitting:’ section was

Will I gain weight when I quit?

ultrafilter - true. But a person has a choice, either try to explain to people that the system is wrong or go along with it. A person can do both, but just going along with the system will only perpetuate it.

I’ve ranted about BMI’s elsewhere and will leave that rant here a simple statement that normal has been defined as “overweight” but real obesity (roughly correlating with BMI’s over 30) is still an indepenedent risk factor of significance.

But how to best address it? I’d agree that obsessing on the scale and the number is ineffective at best. You address obesity by adressing lifestyle choices and define success as maintaining those choices, and not by the achievement of some number on a scale. I’d rather see that a teen have a BMI in the 85%ile or above but is eating whole grain, friuts, veggies, fish and other good lean protein with lots of physical activity and is comfortable with their body, than that (s)he is eating junk albeit small amounts, playing PS2 constantly and/or obsesses with how fat they are despite being in the 50%ile.

I don’t think “obesity is a health risk” is the same issue as “our culture is obsessed with being thin,” and combining the two in this manner could cause people to lose sight of the fact that carrying around extra pounds and not eating right really is not healthy.

Losing weight is not the same as starving yourself, taking up smoking, and trying other unhealthy things to stay thin. I think our attitudes about attractiveness can be dangerous when they’re internalized and cause people a great deal of stress. Could that harm more people than obesity? I don’t know. But a doctor who tells a patient to lose weight is not being inhumane or abusive; it can be a solution to a health problem. If doctors told everybody to become super-skinny, yeah, that might be the same issue. Or if weight loss - coupled with better diet, more exercise, etc - had no health benefits. But attractiveness vs. health… even though this is all about weight, somehow I feel it’s apples and oranges.