Are weight loss reality shows perpetuating weight stigma?

I’m having another dilemma. Last week I wrote about how medical care should be less focused on weight, mainly because weight stigma is really damaging and because there are far more important indicators of health than weight. But as I sat down last night to watch this week’s episode of ABC’s Extreme Weight Loss, I felt extremely hypocritical.

I’ve always really enjoyed watching Extreme Weight Loss and The Biggest Loser, shows where extremely overweight people take time out of their lives to work intensely with trainers and other health professionals to primarily lose a huge amount of weight. The great thing about these shows is that they usually help empower people who have really lost control of their health. The participants in these shows typically start out with horrible diets and don’t exercise, and have huge emotional obstacles that they are able to overcome as they overcome their physical weight. The trainers do attempt to make it clear that internal transformation is as important as external transformation.

At the same time, these shows normalize body shame. They always do a “setting the scene” sort of montage at the beginning to show the “before” life of the person. On Extreme Weight Loss, they have the star of that episode stand in their underwear in front of a mirror and talk about how looking at their body makes them feel. They always get upset and almost always cry. This is cruel and humiliating, for one thing, and for another, it reinforces the idea that overweight people should be ashamed of their bodies. On The Biggest Loser, too, the contestants have to weigh in without shirts until they have lost a significant amount of weight.

And no matter how much the trainers talk about emotional transformation and overall health and wellness, the focus and drama of the show is completely centered on the number on the scale, which implies that one’s value as a person is derived from one’s weight.

These are not ideas the media should be perpetuating, people! Yet I still find it so entertaining and inspiring to see these people overcome physical and emotional obstacles and emerge happier, healthier, and exponentially more confident at the end of their transformations. I can’t deny that weight loss may be a desirable part of one’s journey towards wellness — it was certainly part of mine — but I can’t reconcile with my values the idea of making such a spectacle of it.

Please share your thoughts!

Apparently Telling People They’re Overweight Is Counterproductive — What Now?

I recently read an article about an intriguing study that showed that overweight people who are aware that they are classified as overweight or obese are more likely to gain more weight than overweight people who are unaware of their weight status. These results are totally counter to public health philosophy up until now that suggested that overweight people need to acknowledge their unhealthy weight in order to do something about it. And as you might imagine, the finding creates a problem for health professionals — how do you encourage and assist a patient in losing weight without telling the patient that they’re overweight to begin with?

You’re probably curious as to why individuals who identify themselves as overweight are more likely to gain weight. The researchers suggest, as I would have guessed, that feeling and being perceived as overweight is associated with overeating to relieve stress. This is hardly a surprise, given how stressful it is in our society to be perceived as “fat.” Indeed, it is well established in obesity research that weight stigma and discrimination is associated with worse mental health and further weight gain.

So how do we address this conundrum? The way I see it, this is just another reason to add to the list of a zillion reasons why public health and food policy resources should be focused on prevention of obesity and chronic disease rather than treatment. It would be much, much, much easier and much, much, much more cost-effective to societally prevent weight gain than to cause successful and permanent weight loss. If our food system were re-engineered to make healthy choices (and for that matter sound ecology, social justice, and humane treatment of animals) the default, we would have far fewer overweight and sick people to worry about treating.

But as of right now, the fact is that there are millions of overweight and chronically ill folks in this country, and health professionals need to be equipped to treat. So to get around the whole weight stigma issue, I propose that treatment need not involve emphasizing weight — and I do realize how ironic this is, given the name of my blog. But being overweight in itself doesn’t actually guarantee ill health. There are plenty of overweight people who have no other risk factors or symptoms of chronic disease (although being overweight is itself a risk factor for many chronic diseases). There are overweight people who exercise frequently and who eat healthfully. Furthermore, overweight and obese individuals usually do not have to lose all of or even most of their excess weight to experience all of the health benefits associated with weight loss.

With this mindset, prevention and treatment can be approached similarly, because the same diet and behaviors that prevent chronic diseases also usually mitigate them. Doctors should ask patients what they’re eating on a regular basis whether they’re overweight or not, and emphasize to all patients the essentiality of a healthy diet for a long and healthy life. If a patient does have diabetes or heart disease or cancer, let’s coach them in diet and exercise to restore their health, which will probably lead to weight loss if there is excess weight, but that doesn’t have to be and in my opinion shouldn’t be the main goal.

Now if only I could get myself to think about food in terms of my health rather than my appearance.

What makes a food “natural?”

The other day, my brother’s friend asked me if tofu is natural. I replied, “That depends on your definition of natural.” So he asked me if tofu was natural according to my definition of natural. I opened my mouth to answer, then realized I was utterly stumped. I’m so used to talking and thinking about how the word “natural” means nothing on food package labels that I hadn’t really given any thought to what it should mean. When I did think about it, there was no way I could articulate a binary definition of a natural food; in other words, I cannot, from my point of view, label foods as either absolutely natural or absolutely unnatural. I think you can only determine the relative naturalness of a food compared to other foods.

Take tofu, for example. Tofu is made by fermenting soy milk, which is produced by pressing soybeans, which come from a soy plant. Tofu is a processed form of soy, so I would say it is less natural than fresh edamame (a.k.a soybeans). And tofu is, I would venture, more natural than, say, packaged soy ice cream, to which sweetening, texturizing, and preservative agents are typically added. Thus, the relative terms “natural” and “processed” are inversely related; the more processed a food is, the less natural it is. To promote health, we should try to eat foods that are on the more natural and less processed end of the spectrum, a.k.a. whole foods, like I’ve been telling y’all from the beginning.

There are chemicals in our food?!?!?!?!?

It’s enough already with people freaking about “chemicals” in our food. Granted, there are some “chemicals” that I do worry about, like certain pesticides sprayed on crops that cause birth defects in the babies of tomato pickers (one of the reasons I am behind organic farming). But there are plenty that I don’t worry about, and you know why? Because everything is a chemical. This short video from Asap Science really explains it well, but in short, a banana is made of more “chemicals” than a candy heart. The presence of one or more “chemicals” do not define the health or lack thereof of a food. Take apple seeds. Raw apples are arguably one of the most natural foods you can eat, but their seeds are toxic.

Yeah, maybe some artificial sweetener possibly maybe had an association with cancer in rats at doses so high it would be virtually impossible for any human to absorb that much through any food product. But anything in a high enough dose is toxic, even substances critical to our survival. Too much Vitamin A, your liver fails. You can even be poisoned by too much oxygen. Any substance that is going to be added to the food supply should be thoroughly tested for safety, but have some faith in the scientific consensus, folks (notice I said consensus, not any one cherry-picked study). And don’t even get me started on GMOs.

We could argue about this all day, you could probably convince me that I’m totally wrong, but either way this whole debate about chemicals is missing the point. Whether or not azodicarbonamide is in Subway’s sandwich breads and whether or not it is safe for human consumption, you could nourish your body with much more nutritious foods than highly processed Subway sandwich bread. Whether or not aspartame is a carcinogen in doses 3000 times what anyone actually consumes, diet soda is not food. Neither is regular soda, for that matter (this article makes the case for why diet soda is actually a healthier option than regular soda).

If I advise you from a nutritional standpoint to look for foods with as few ingredients as possible (preferably one ingredient foods) it is not to single out any particular additive or even the group of them as the bad guy — I advise that because the number of ingredients is usually a good proxy for how processed the food is, which is damningly associated with health outcomes. And you know how I know that? SCIENCE. The same science that tells us that whole fruits and vegetables are good for us also tells us that cigarettes are horrible and that vaccines don’t cause autism and that we really do not have to worry about a little bit of azodicarbonamide.

We don’t need to fear science, but the reality is that we don’t need any of these additives in our food regardless of their safety, especially when the healthiest people are the ones that eat the most whole, plant-based foods.