A popular author says that fitness, nutrition and socioeconomic status are far more important than weight in determining health risks.
"Lay off the fat people!" says author and professor Linda Bacon. With a PhD in physiology (specializing in weight regulation) and graduate degrees in psychology (specializing in eating disorders and body image) and kinesiology (specializing in exercise metabolism), Bacon knows more than a little about the impact obesity on health. Bacon's message -- that health is more important than weight -- goes against the grain of our country's current obsession with the "obesity epidemic." Yet her work is extremely popular, and the second edition of her book, Health at Every Size: The Surprising Truth About Your Weight, was recently released.
According to Bacon (who is aware of the irony of her last name), being overweight or obese does not put people at significant health risk. Rather, factors like fitness, activity, nutrient intake, weight cycling, or socioeconomic status are far more important in determining disease risk. Often these same factors increase disease risk and risk of weight gain simultaneously. However, when epidemiological studies control for the aforementioned factors and then examine correlation between weight and disease, increased risk of disease from being overweight or obese is significantly reduced or nonexistent. In other words, while Bacon encourages acceptance of people of all sizes, she's not giving us a free pass to spend our lives in front of the TV eating junk food. A healthy lifestyle is important, even if it's okay that most of us don't have figures resembling the cast of "Bay Watch."
Given these findings, Bacon calls on Americans to join what she calls "the new peace movement" by refusing to fight the "unjust war" against body sizes that are larger than what our culture deems acceptable. Bacon points out that humans have internal systems designed to keep us healthy, and to maintain a healthy weight. These systems include signals of hunger, fullness and appetite. If you can follow your body's signals, your body will in turn find the healthy weight for you. This is, of course, easier said than done. A recent study asked both French and American people how they knew they were done eating; the French said it was when they felt full, while the Americans said they were done when their plates were empty. This is just one of many examples showing how we fail to pay attention to our body's hunger and fullness signals and instead use external cues to determine what, when and how much we eat.
Despite Bacon's impressive resume and her findings -- and the findings of countless studies she cites -- that obesity is not our problem, the war on obesity is only gaining steam with First Lady Michelle Obama's "Let's Move" campaign and celebrity chef Jamie Oliver's "Food Revolution." Obama's campaign specifically states its goal as solving "the epidemic of childhood obesity within a generation." With the program comes a new foundation, Partnership for a Healthier America (with a mission of tackling childhood obesity) and a Task Force on Childhood Obesity. Using this frame, the problem is entirely defined as one of body size and success will be determined by weight loss.
Jamie Oliver's Web site and his petition to start an American food revolution focus more on providing kids with fresh, healthy foods and cooking skills, but his Web site still notes obesity as a problem (for example, offering "facts and figures about how obesity and diet is affecting America's health"). The same can be said of the first few episodes of his show. Mostly they emphasize eating healthy food and preventing problems like type 2 diabetes, but many feel that the show contains a strong fat-shaming element as well. Rather than blaming obesity itself as the main problem, there is an implicit (and sometimes stated) message that obesity is part of the problem. In fact, the city chosen as the site for Oliver's show, Huntington, West Virginia, was selected because it was named the "fattest and unhealthiest" city in America (implying the two terms are synonymous).
Aside from the stark differences in their views on obesity, Linda Bacon, the First Lady and Jamie Oliver agree on quite a lot. Healthy diets are important, and healthy diets consist of fresh, wholesome food, preferably cooked from scratch. School lunches of corn dogs, tater tots and canned fruit in heavy syrup, washed down with flavored milk, are not good. Exercise is an important part of a healthy lifestyle. So, given that efforts like Let's Move and the "Food Revolution" are intended to move America toward healthier diets and less sedentary lifestyles, what's the harm in framing their work in terms of fighting obesity?
Bacon points out a few problems. First of all, research shows that people of all sizes have similar diets, but it only manifests as weight gain in some of us. People today eat more calorie-dense, nutrient-poor convenience foods than Americans did in the past. How we eat also plays a role, as eating while focusing on something else like driving, or eating while in a stressful situation affects our digestive processes. As the average American diet has gone downhill for people of all sizes, weight gain occurred for some -- contributing to the high rate of obesity in America today -- but Bacon says that "assuming fat people are eating worse than thin people is wrong." For this reason, focusing efforts on obesity sends the message to thin people that they do not need to make any changes in their lifestyles when in fact they may also engage in unhealthy behaviors that put them at risk for disease.
Second, focusing on obesity stigmatizes larger people and imbues everyone with a fear of fat. Instead of encouraging people to adopt healthy behaviors, an anti-obesity message encourages the development of eating disorders and the adoption of dangerous, restrictive eating habits. In fact, dieters readily admit they are willing to engage in unhealthy eating patterns in order to lose weight. Bacon encourages focusing on health instead of weight and promoting acceptance of people of all body shapes and sizes. While ending discrimination against fat people is one of her goals, she also notes that people who love their bodies will be more encouraged to take better care of them. "You take good care of things you like," she says. "Self-hatred is not good motivation to make change."
All in all, while inspiring individuals to improve their diet and exercise habits in order to promote public health is laudable, the number one issue we should address on a societal level to decrease the rate of chronic diseases like diabetes is poverty. Lower-income people are more prone to obesity as well as the health problems associated with weight gain. Major risk factors for obesity and disease are in place for each of us before we are born: our parents' income level, educational level and ethnicity, to name a few.
The AP article that declared Huntington, West Virginia the fattest and unhealthiest town in America also says the town's economy "has withered." The piece describes a high poverty rate and an unemployment problem teamed with the problem of low-paying jobs with poor benefits for those who have work. In fact, when the mayor was confronted about his city's health problems, he replied that he was too busy worrying about the economy to think about public health. The best way to accomplish Michelle Obama and Jamie Oliver's goals is to address social injustice and to reduce poverty in America. Why aren't either of them talking about that?
