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.