Occasionally my blog deviates from humor and I write about medicine instead. Today I’d like to dip into the public health well. It won’t be funny, but it will hopefully be enlightening.
Many of you know I have a professional interest in obesity. It’s no secret the issue is a worldwide problem, and it’s no secret weight loss is the best goal.
Or is it?
A session at the American Public Health Association’s national meeting in New Orleans last month forced me to think about the topic in a whole new paradigm. Or at least try to. We all view the world in a systematic fashion. Anything that challenges our established way of thinking chafes like a wet swimsuit. But closed minds get us nowhere. One look at the world shows us that. So for a few hours, I tried to open mine.
Healthy At Every Size®
The HAES® principles include:
- Weight Inclusivity
- Health Enhancement
- Respectful Care
- Eating for Well-being
- Life-Enhancing Movement
The HAES® model “endorses size acceptance and health practices pursued for well-being rather than weight loss.” They believe putting the emphasis on numbers and scales only leads to stigmatization and fat-shaming.
Therefore, when tackling obesity and its numerous complications, our goal should be acceptance not weight loss.
But that seems counterintuitive, doesn’t it? High BMIs* put people at risk for diabetes, hypertension, stroke, heart disease, sleep apnea, and a host of other medical problems. Weight loss improves many of these issues. So while I abhor stigmatization—in fact, my latest novel explores the issues of bullying and fat-shaming, neither of which help my protagonist get healthy—isn’t weight loss the best way to treat these complications? Shouldn’t weight loss be our goal?
That’s always been the paradigm that guided my readings, research, and clinical practice. It’s also the paradigm that guides most clinicians, researchers, and public health professionals.
Which is exactly what ASDAH is trying to change.
Here is what I learned from their fascinating sessions:
1. Before we can shed the stigma of obesity, we need to remove the goal of weight loss. Only when people feel accepted can they truly alter their behaviors.
2. In a study of obese women, those whose treatment was guided by HAES® principles instead of conventional weight loss measures maintained improved eating behaviors better than the control group (for whom restraint and weight loss were the goals). In other words, the control group’s excessive dietary restraint resulted in a return to binge eating. They simply couldn’t maintain the deprivation.
3. Research has shown stigmatization leads to chronic stress and high cortisol levels, which in turn leads to chronic medical problems such as heart disease and high blood pressure. So it’s kind of like the chicken and the egg. Does obesity alone lead to chronic health problems or does the stress incurred from societal stigmatization contribute to them, too?
So what now?
Of course, the best way to manage obesity is to prevent it in the first place. This requires multi-level interventions, not just individual behavior changes. But for the two-thirds of American adults and the one-third of American children who are already overweight or obese, weight loss has always been the goal, and in my mind, it still is. After all, we can’t change our established paradigms in one sitting.
But that doesn’t mean I’m closed to new ways of thinking, and I agree, we absolutely must end stigmatization and fat-shaming. But should we also stop pursuing weight loss as the best way for millions of people to get healthy?
Hmm, I’ll need some time to chew on it.
*BMI is not the best indicator of overweight/obesity, but it’s often the easiest measured and the most often studied for research purposes. But that’s a whole other blog topic…
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