Is the War on Obesity Worth Fighting?

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Today’s post is written by Marci Anderson, RD, a registered dietitian in the Boston area who works exclusively with people who struggle with eating disorders, body image and weight concerns, as well as emotional and compulsive eating.  The post details her thoughts after listening to a debate of the same name as this post at the annual meeting of The American Dietetic Association.  I thought readers of A Weight Lifted would find it valuable reading.

A few days after The American Dietetic Association’s annual conference dust has settled, I still find my emotions riled up about the very first session I attended. John Foreyt, renowned obesity research and Linda Bacon, Health At Every Size (HAES) clinical researcher and advocate, debated their views on the “obesity epidemic.” John Foreyt staunchly defended his position that the war on obesity is a war worth fighting and Linda Bacon asserted that this war we are waging is ineffective, misguided, and even harmful.

I cannot escape the fact that I write this post from a very biased point of view. I simply cannot give a neutral, objective review of the debate because my feet stand so strongly in the HAES camp. I use a non-weight focused approach in my nutrition counseling and I am a certified Intuitive Eating (IE) Counselor (which means I teach my clients how to respond to internal cues of hunger/fullness rather than dieting).

So, I questioned whether to write this post at all, knowing I don’t currently have access to a recording of the debate and my memory seems to have only held on to the pieces of Dr. Foreyt’s arguments that I found uniformed, inaccurate, and downright offensive. So despite all of this, I sit here writing my two cents, which are heavily influenced by my flawed memory, passion for a non-weight focused approach to health, and personal experience in my own clinical work (and in my own life).

I cannot adequately re-cap the 90 minute debate. But I will recount my top 5 assertions that Dr. Foreyt made that I whole-heartily disagree with.

1. There are no negative side effects to yo-yo dieting and weight regain (except “some bad feelings like depression for some people”).

If Dr. Foreyt had properly done his homework, he would have known that dieting is the #1 PREDICTOR OF FUTURE WEIGHT GAIN! See here and here for two examples. And I think it’s a bit crazy for him to undermine the negative mental health consequences that are a by-product of weight cycling. Anxiety, depression, and chronic self-esteem issues are serious concerns. He treated them like nothing more than a pesky skin irritation, when in fact mental health problems are like a deadly form of cancer; challenging a person’s ability to live with a quality of life everyone deserves. We cannot minimize the effects of rebound weight gain and mental health challenges.

2. Some of your clients will be failures and some will be successes. That’s no reason to stop trying to diet and lose weight. Just keep trying.

Whoa, hold it right there. I cannot stomach the notion that anyone I work with is a failure. But I suppose if there is only one way to measure success that might be the case. If there was a chemotherapy treatment that created more cancer than it eliminated, would we keep using it? No. So why do we keep using the same methods for weight control when the research shows that a weight-focused approach leads to more weight gain? I have learned something magical in my work. When I take the focus off the scale it allows me and my clients to work on core issues which affect body weight, food choices, and self-esteem.

3. Intuitive eating is a cause of today’s obesity epidemic. Intuitive eating doesn’t work.

I about jumped out of my chair when Dr. Foreyt stated this. How on earth can he say that intuitive eating contributes to obesity when virtually no one in the US practices it?!? Not practicing intuitive eating is THE REASON most people struggle with food and many carry more weight than they naturally would.

The principles of IE are often misconstrued or improperly applied. Dr. Foreyt, have you read the book or the research on IE? It is not eating with reckless abandon. No, quite the opposite. It is eating what you want in response to physical cues for hunger/fullness, while attending to emotional needs without using food. I cannot fathom how this can lead to increased rates of obesity.

Please see the IE website, where there is research showing the effectiveness of IE.

4. Dieting does work.

Unfortunately, every long-term clinical trial aimed at reducing body weight by placing clients on a specific diet that I’m aware of results in the lovely “J-Curve.” The J-Curve illustrates rapid weight loss, followed by creeping weight gain over time. The LOOK AHEAD trial, led by Dr. Foreyt is an interesting example. Like all obesity research, interventions like a healthier/reduced calorie diet and exercise protocols are given. Consequently, weight decreases but a whole slew of other parameters improve (ie blood sugar, fitness levels, cardiovascular health). What’s really fascinating is that the decrease in weight is sometimes quite small, like less than 10 pounds. But the researchers always cite the improved parameters secondary to weight loss, rather than a natural consequence of eating healthier and moving more. Why the focus on weight loss?

Many people love to cite the National Weight Control Registry as an example of permanent/lasting weight loss. Dr. Bacon informed us that weight loss must only be maintained for six months in order to be added to the registry, with no clear way to have your name removed if you have re-gained your weight. Dr. Bacon shared a story of a student whose name is on the registry, but has since gained back more weight than she lost and hasn’t been able to remove her name from the list. The weight loss research we have shows the majority of lost weight gained after two years. So the National Weight Control Registry may not be a reliable measure of successful “losers.”

5. It’s better to be skinny than fat.

Again, Dr. Foreyt needs to check the research because it actually shows that the life expectancy for a person who is categorically overweight but exercises regularly is longer than someone of a “normal weight” and doesn’t exercise. Having dedicated my career to working with eating disorders, I can promise that it is better to be healthy inside and out regardless of your body weight. Being thin is absolutely no guarantee than you are healthier or “better” by any standards.

Please let me make myself clear. I am an advocate for HEALTH. This means I am an advocate of:

  • Eating a balanced, nutritious diet that includes all foods
  • Eating when hungry and stopping when full MOST of the time
  • Learning to cope with emotions without using food
  • Learning to eat in a way that leaves you feeling energized and satisfied
  • Eating by your own rules and no one else’s
  • Incorporating exercise in a way that keeps your body strong (this can only be done if you are eating well first)
  • Eating guilt and stress free
  • Enjoying and finding pleasure in what you eat and how you move your body

And I believe that this is possible at any weight. I stand with Linda Bacon when she says that “fat” is not the problem, it’s the war on fat that is making us sicker and more miserable.

Marci ends her post with these words: This is a controversial topic. What are your thoughts? 

We’d love to hear what you think.

7 Responses (Add Yours)

  • I whole-heartedly agree with Marci. My own experience with emotional eating/bingeing, body image issues, weight gain, and dieting prove her points. It was only when I started embracing the idea that maybe I needed to focus on other things that my body/mind/spirit became lighter and and I started to heal. I weigh a little more now than I did at my lowest weight (and am still considered overweight), but I am healthier and certainly happier. I am also about 40-45 pounds lighter than my heaviest weight.

  • Kari says:

    I was simply left speechless reading the ridiculous assertions this so called expert was making. If he is dreaming of a world full of one size skinny people I’m afraid he will never see it. We are all so different, physically and emotionally. What works for one possibly doesn’t work for the another. We all have to find health by eating well and remaining active. For some of us it means being a bit curvier than others but still being fit. He can’t possibly really believe that I must be skinny in order to be healthy.
    I know for a fact my relationship with food had a lot to do with my mental health. Had I not gotten help for that I would still be on this endless roller coaster with ‘dieting’ in order to fit his ideal healthy body. Dieting affects everything you do and can cause more harm than simple depression. It can lead to serious eating disorders just to give one example. Never mind how demoralized you feel after what he calls a ‘failure.’ I can’t believe there are professionals out there that still have this backwards way of thinking.
    I have been on the ‘overweight’ spectrum since the age of 9 but until recent years when I was very depressed and isolated, had always been fit and active. To this day, even having reached morbid obesity, I have no health problems aside cranky knees. My now ex-doctor even seemed to be upset I was healthy even carrying all this weight. I believe it was the fact that she couldn’t scold me for not being as thin as she was because she had no ammunition to throw at me. She seemed so upset she couldn’t find anything wrong she was dismissive and rude just telling me to go on a diet. I know I will never be thin and I have made my peace with that. I just want to be healthy and fit again even if I stay at a size they deem is wrong.

  • I have read many posts about this conference and Dr. F’s statements. here is my take on the War against Obesity…I think the original sentiment, to help our society with the growing population of obese adults and children….with that being said…..WAR is NOT the appropriate word and as in anything else that is a “state” of being, the focus goes astray and opinions take over.

    I could go on and on and on about this subject, but I believe that it should be a cure for obesity which means learning self-care and self-awareness. I was floored last night at the parents who were fighting for the right to have morning coffee, cookies and pastries as a monthly fundraiser. One teacher voiced her concerns as they are promoting healthy eating at the school, students can only have healthy snacks for parties at school but the parents couldn’t get past the “cookie and pastry” sale.
    The “war” has taken on a life of its own and not a solution.

  • julie says:

    I’ve heard Linda Bacon say some outrageous, uber-biased things as well. I think the truth lies somewhere in the middle. Not everyone who loses weight starves themselves, loses their hair, shivers all the time, and gains it all back. Some of us do it very slowly, even using IE. The Weight Control Registry sends out a detailed questionnaire every year, it seems like they’d take your friend off in a hot minute, unless she’s not filling this out. And while that’s the criteria for registry, most have taken a lot more off, kept it off a long time, on average. I should join, but am too lazy. Maybe after another year of maintenance I’ll get to it.

  • I agree.. everyone has a different way of losing weight that would be best for them. Interesting post.. thanks for sharing!

  • We need to set a good example for our children because they eat and do what we do so eat right and stay active for their sake

  • Yes! Thank you for writing this. I studied eating disorders and public health and it drives me crazy how often people have the facts wrong. Its so sad that people in the healthcare field are spreading these lies and making it harder for people to become healthier because they are getting caught up in gimmicks that don’t work and make them even less healthy. My sister is a dentist in Charlotte and she works a lot with people who have teeth problems due to diabetes so she hears a lot about what they are doing and how their diets never work. We really need to change the way things work.

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