3 Truths about Obesity and Weight that May Surprise You
Since I work closely with people with obesity, as well as health professionals specializing in obesity, sometimes I take for granted some of the things I know about obesity and weight and assume that they are common knowledge. I was reminded of this recently when a friend shared an article about Tess Holliday (Munster)‘s new campaign, Eff Your Beauty Standards. Holliday was recently signed to MiLK Model Management in London, and at 5’5″ and size 22, she is larger and shorter than most plus-sized models. My friend noted that though self-esteem is important and that “conventional models are indeed far too thin”, Holliday is “just not healthy” and “a little further along the opposite spectrum”. Many of his friends agreed, with some making relatively sensible comments like “too skinny or too fat isn’t healthy” and “I worry that people are starting to think being ‘big and beautiful’ means you don’t have to excercise (sic) or eat healthy.” One even chimed in (after I made a comment that height and weight alone can’t be used to judge health) that “I think it’s disgusting to promote obesity. Why not have a (sic) obese model with diabetes, cholesterol and heart conditions. Because basically that’s what they’re trying to promote. I’m so against it.”
With that in mind, here are three truths about obesity and weight that I just want to put out there for people to consider before they start judging Holliday, the #EffYourBeautyStandards campaign, and others with obesity.
1. Obesity/weight is not a measure of health.
I called my friend out right away for judging Holliday’s health status based on height and weight alone. There are many “normal” weight people out there who engage in unhealthy habits like not eating properly, not being active, smoking, drinking excessively, etc. By the same token, there are many larger people who engage in many healthy habits. According to Buzzfeed, Holliday works out with a trainer four days a week. I can bet you many of the “normal” weight people in our lives don’t do that.
While obesity is associated with an increased risk of numerous health conditions, having excess weight is not a guarantee that you will get all these health conditions, and it is possible to live a lifestyle that can reduce some of those risks even if there is no weight loss.
With that in mind, I am tired of people associating “weight loss” with “improved health”. I see this most often in the marketing of cleanses and detoxes. Sure, some people come out of them feeling more energized, but most of the time, people just get excited about the prospect of losing 10 pounds in 10 days. Unless weight loss is being done intentionally through healthy behaviour change, it can mean lots of unhealthy things, like an unhealthy relationship with food and the body, or in extreme cases, malnutrition, dehydration or cancer.
2. We don’t have as much control over our weight as we may think.
There is some fear that the #EffYourBeautyStandards campaign is about promoting an unhealthy lifestyle just because Holliday is large. I think this comes from a very common misconception about obesity and weight that as long as you live a healthy lifestyle, you will be a healthy weight, and therefore people who are overweight must not be leading healthy lifestyles.
The truth is, if weight loss was just about “eating less” and “moving more”, we would not see the rates of overweight and obesity that we do today. There are so many factors that affect our weight and body size – genetics, fluid status, hormones, whether we’ve gone to the washroom that day, etc… It’s the reason why there is never a guarantee that reducing your intake by X calories will lead to Y weight loss. I can’t even tell you how many times I’ve seen a client who is frustrated because they have made lots of healthy changes, yet are not seeing the results that they want, or the number of times that a client has told me that they would rather try such-and-such extreme thing rather than “die a fat person”. The point is, if most people with obesity had the choice, I’m guessing they would choose not to have the excess weight.
3. Many health professionals do not have the tools to help manage weight or obesity.
A few days ago, the Canadian Task Force on Canadian Health Care published their latest clinical practice guidelines for preventing weight gain and managing overweight and obesity in adults. The guidelines were slammed by bloggers Dr. Arya Sharma, chair of obesity research and management at the University of Alberta and founder/scientific director of the Canadian Obesity Network, and Dr. Yoni Freedhoff, medical director of the Bariatric Medical Institute in Ottawa, for lacking real direction other than telling doctors to weigh their patients regularly. For patients who are “normal” weight, there isn’t strong evidence for a formal program to prevent weight gain, and for patients who have obesity, they should be referred to a specialized program.
Obviously a huge part of the issue comes from truths #1 and #2 above – obesity is not a measure of health and there isn’t a weight loss/obesity treatment that has strong evidence behind it. In fact, most research looking at long-term weight loss is pretty disheartening.
As a best case scenario, hopefully the new guidelines mean this will encourage doctors to refer out to a specialized program (though there are few available), but in a worst case scenario, the recommendation to weigh patients regularly will discourage many from seeing their doctors. I have heard from clients who have doctors who seem to blame all of their health problems on their weight, with one client saying that their doctor told them to “sign a contract promising that [they] will lose 50 lb in the next year”, but not providing any direction as to how to do it.
Obesity and weight are complicating issues. While obesity as defined medically is a health concern, it does not mean that someone who is heavy is necessarily unhealthy, and that someone who is at “normal” weight is healthy. It causes more harm when we judge a person’s health status by their weight or body size alone, and that is something that even health professionals sometimes need to work on too.