The 'truth' about obesity, weight loss and health?

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How harping about size creates a climate of stigmatization and discrimination

Reports in the media suggest that obesity is a growing danger. Too many people weigh too much and the numbers of such individuals have increased substantially over the last decades. Such excess weight is associated with a variety of diseases and other negative consequences, ranging from high blood pressure to inability to fit into an airline seat, from diabetes to coffins that are too small for obese deceased.

Yet such narratives of obesity are increasingly challenged.

Critics point to evidence suggesting that rates have levelled off and may even be declining. They also question the extent to which obesity causes or is even associated with various diseases. They point to the dismal statistics regarding weight loss: some can lose pounds but very few can keep them off over a five-year period. As a result critics insist that weight should not be, in and of itself, the issue.

By harping on people's size, the health professionals and the media create a climate of stigmatization that creates enormous stress for, and discrimination against, fat people.

These debates are the result of genuine policy differences and scientific and medical uncertainties that may or may not be clarified over time.

However, there are also strong financial interests in play. The food-and-drink industry and others have powerful economic motivations to downplay and, in any event, distance themselves from concerns about excess weight. Conversely, the pharmaceutical and weight loss industries and health professionals associated with bariatric surgery and other interventions can have significant monetary incentives to fuel anxieties about obesity and its consequences.

These various and contending interests dedicate substantial resources to publicity campaigns, lobbying efforts, and research to advance whatever may be their positions in the intense and shifting debates in this area.

Enter Harriet Brown and her Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight -- And What We Can Do About It. That's a long title. But no one can accuse Brown of not coming to the point.

For her the "truth," as the book jacket indicates, is that:

"…research has been manipulated; …the medical profession is complicit in keeping us in the dark; …big pharma and big, empty promises equal big, big dollars; …much of what we know -- or think we know -- about health and weight is wrong."

Body of Truth is a take no prisoners broadside in an area full of complexities and unanswered questions with, increasingly, more health researchers, policy makers and others ready to say they don't have all the answers and to agree that people with obesity are often treated miserably.

Still, Brown makes lots of good points about our individual and collective obsession with weight and about the insistence of many that thinner means healthier and fatter means sicker. While she does all this she writes candidly of her own struggles with her size. And she is not alone. There have been a spate of books in recent years taking similar positions on many of these issues; Anna Kirkland's Fat Rights, Deborah L. Rhode's The Beauty Bias, and Abigail C. Saguy's What's Wrong With Fat? to list but three.

We all need to embrace size diversity, acknowledge that there are many complicated reasons why a person may be obese and realize that once a person is very large it is extraordinarily difficult for them to achieve sustainable weight loss. Emphasizing nutritious eating and more physical activity to improve well being, whatever our size, is also critical. Brown is forceful and eloquent on these points.

Yet, while concerns about the health implications of obesity may sometimes be misstated, they are not nonexistent. Research acknowledging criticisms, such as Brown's, and with empathetic analysis could point the way to a better understanding of obesity and those experiencing this condition. That is also the "truth."


Bill Bogart is a Toronto-based international expert on reducing the harm of risky behavior, society and Canadian law. He is the published author/editor of seven books including Permit but Discourage: Regulating Excessive Consumption (New York: Oxford University Press, 2011,) Regulating Obesity? Government, Society, and Questions of Public Health (New York: Oxford University Press, 2013,) and is at work on his next book on the decriminalization of recreational drugs. A regular contributor to Huffington Post, Bill is often called on to comment on, and give background to current events regarding the regulation of consumption. and @wbogart2

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