The Missing Element in the Obesity Conversation
08 Jan, 2013
It didn’t take long for the year’s first controversial health study to go viral. A new systematic review and meta-analysis published in the Journal of the American Medical Association (JAMA) concluded that carrying extra weight decreases the risk of death (those in the “overweight” category were six percent less likely to die than individuals at a “normal weight”). This is a stark contrast to the usual weight-related headlines, which identify excess weight as the root cause of various chronic diseases. Cue confusion and heated debates.
As expected, responses from the nutrition and public health community fell into one of two camps. Those who believe obesity is a socially constructed myth stemming from moral panic pointed to the study as proof that obesity is not a problem. Those who work within a frame of obesity reduction or prevention came up with several reasons why the study’s conclusion was erroneous (many of which make sense and are backed by science).
I consider myself in the middle of both of those camps and also outside, standing at a completely different vantage point. Labeling increased rates of overweight and obesity in the United States as a “myth” is inaccurate and dangerous. When a highly visible public health issue is dismissed as a fairy tale, conversation is stifled. Concurrently, the health field’s obsession with obesity has reached a fanatical fever pitch, with troubling consequences. You may remember last year’s “obesity is the enemy and it’s going to kill us all!” headlines after the Robert Wood Johnson Foundation released the statistic that by 2030, adult obesity rates could be as high as 60 percent in 13 U.S. states. Much like the JAMA study, that grim prediction went viral within minutes. Tellingly, though, this wasn’t viewed as a controversial headline, but rather accepted as reality (and, sadly, the “Americans just need to get off their couches!” comments soon followed).
Here is where my vantage point differs, and what I believe to be a crucial point missing from this debate. When our discussions on health center around weight (whether by stressing or minimizing the dangers of gaining it), it is too easy to leave other important factors out of the conversation. In the case of the JAMA study, for instance, little was stated about the quality of life of these heavier individuals who live longer than people with lower Body Mass Index (BMIs). Roughly one-third of Americans aged between the ages of 57 and 85 take at least five prescription medications a day (many of those for diet-related conditions like hypertension and high cholesterol). Is living longer worth it if it means holding our bodies and wallets hostage to Big Pharma?
Studies that only consider excess weight as a health risk also don’t reflect my years of experience as a dietitian in various settings (from hospitals and long-term care facilities to corporate wellness and schools). I have worked with hundreds of patients, and have encountered plenty of “normal weight” individuals with poor diets who had high blood pressure and high triglycerides, as well as several overweight individuals who ate healthfully, had perfect numbers and felt healthy.
There is also the issue of using the BMI as a tool to determine who is healthy and who is not (a tool which has been rightfully criticized for not being an accurate measurement of health).
My biggest concern is that solely focusing on weight (regardless of how positive or negative that focus is) impedes the health movement’s progress. Such a clinical and quantitative frame gives very little thought to—and leaves no room for a conversation about—socio-political and environmental factors that pose a threat to our health (including, but not limited to industry lobbying, Big Food predatory marketing, and misguided agricultural subsidies). Even if the message is “being overweight isn’t bad for your health,” we do know that a highly processed diet (let’s face it, the Standard American Diet) is. There is no doubt that, above all else, the way we eat has tremendous effects on our health.
This point of view matters because it is precisely the neutral and apolitical focus on weight that has contributed to our current public health mess. When health is only discussed through a lens of weight, it is easy for the food industry to consider itself part of the dutiful troops, whether it’s with “commitments to physical activity” or reduced-calorie, minimally nutritious processed foods that feature artificial sweeteners and “fat replacers” made from genetically modified corn. After all, if the goal is simply to get someone to lose 15 pounds, then a 100-calorie snack pack of Cheetos should “do the trick,” as should a diet soda.
I urge my fellow colleagues—especially those in public health and nutrition—to not get trapped in the “obesity is the problem” mold. The framework of obesity can be useful to talk about other issues, such as the fact that obesity maps in the United States are a mirror image of maps of concentrated poverty and food deserts. Obesity is as much a socioeconomic and political issue as it is a public health one, and that is important piece of the puzzle that is often forgotten about. And, above all, regardless of whether it turns out that a BMI of 26 is “healthier” than a BMI of 24 or not, let’s remember that weight is not necessarily a reflection of health.
To those who criticize the JAMA study and insist that obesity is the problem to solve—I pose this question: If obesity is “the problem,” then what is the solution? A population that is of normal weight? I won’t deny that some medical and health risks increase with obesity, but it is possible to be at a “healthy weight,” while subsisting on minimally nutritious foods. Let’s also remember the growing body of evidence which demonstrates that one’s fitness level is much more important than weight alone. And, furthermore, if the ultimate goal is a population that is not overweight or obese, then let’s use that as an opportunity to have a meaningful conversation about, for instance, how to fix the food environment.Until we can have a national conversation about health—specifically how it is affected by our food systems, environment, and politics—instead of weight, it will be hard to make the case for sound policy that promotes our well-being, regardless of our numbers on the scale.
Andy Bellatti is a registered dietitian who believes nutrition is much more than just the science of nutrients and the human body.