REFRAMING THE OBESITY PARADIGM

Our society is obsessed in a negative way with fat. The news media warn us daily about the dangers of obesity. They proclaim that obesity is on the rise, that obesity will kill us and that we can get fat just by hanging out with people who are fat. Obesity and fat have become the boogeyman today, the receptacle for children’s fears—even though these anxieties may have nothing to do with body size.

The media and the health industry frame obesity as a personal weight issue and as an individual responsibility to reinforce a culture of fear, weight-loss and shame. Despite numerous studies that question and dispute this way of looking at obesity the voice of this paradigm is the loudest one, because it is the one that is most often heard and that most readily influences our beliefs and dictates how we respond to and treat children and adults who are fat.

According to Paul Campos author of The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health, there is no scientific basis for our excessive fear of body fat—except with regard to groups who are at the extreme ends of body weight. Fat in itself is the not the issue, according to Glen Gaesser, author of Big Fat Lies: The Truth about Your Weight and Your Health. Most ‘weight-related’ health problems such as high blood pressure and high cholesterol and triglycerides and glucose tolerance, insulin action can be improved rapidly though exercise and improved quality of food independent of weight-loss—and without restrictive eating. Many people who may be considered ‘overweight’ but are moderately active are actually healthier than their peers who are sedentary but thin.

It is the constant cycle of weight-loss and weight regain as well as the lack of exercise and nutritious food that put people at risk, says Glen Gaesser. Despite the evidence that weight-loss programs are 95% unsuccessful, they are still seen as the ‘cure’ for obesity. Most people who diet embark on a yo-yo cycle of losing and gaining weight over and over again. This weight cycling may elevate their blood pressure, reduce their level of HDL (good) cholesterol and deplete their body reserves of important omega-3 fatty acids. Weight cycling has also been liked to gall bladder disease, kidney cancer, breast cancer and premature death— primarily from cardiovascular disease. Long-term studies on men and women indicate that a history of dieting may increase their chances for subsequent—and significant-weight gain (Gaesser, 2003).

As with adults, when the cure for obesity in children is weight-loss dieting makes them fatter. A three-year study of 8,203 girls and 6,769 boys aged 9-14 showed that frequent and infrequent dieters gained more weight over the course of the study because dieters were significantly more likely to binge, and bingeing was a significant predictor of weight gain. Even though dieters in the study were more physically active than non-dieters, they still ended up with higher weights (Field et al, 2004). Weight control attempts of adolescent girls observed over a 4-year period actually predicted onset of obesity. The risk of obesity was 324% greater for self-labeled dieters than the non-dieters even after controlling for baseline obesity levels (Stice et al, 1999).

Framing obesity as a weight issue reinforces the belief that we should all be striving towards the thin ideal even though not everyone has the physiological, social and cultural resources to be thin.  For some people being thin means constantly living in a condition of semi-starvation. It makes obesity an individual problem instead of a societal phenomena and intensifies the weight prejudice and stigmatization that people who are fat experience—not only by family and peers but also by professionals who play a significant role in their lives.

Shifting the Paradigm

People may be fat for a multitude of reasons. Weight is a complex mix of biological, social, environmental and psychological issues as well as lifestyle practices. While children (like adults) can become fat for a variety of reasons, the main environmental causes of obesity are inactivity and lack of nutritious food. Children today don’t get enough exercise. Inactivity begins right at birth as babies are swaddled and spend most of their waking time strapped into carrying seats. For older children, playing outdoors has been replaced by sitting at the computer and/ or watching TV. Many parents harbour fears about safety and sexual predators that stop them from giving their children free reign to play outdoors and instead limit them to indoor organized activities. Many schools no longer have regular physical education and when they do, it can often be sacrificed for other activities which are deemed to be more important.

For many families being active has not yet become a part of their lives that makes them feel good, but is just regarded as one more add-on to an already busy and demanding life. Children who live in communities where vegetables and fruit are expensive are more likely to gain excessive amounts of weight than kids who live in areas where produce costs less. Many parents don’t know how to prepare a nutritionally balanced meal from scratch or don’t have the time to do so. Because many parents work outside the house it is often faster and easier to put together meals from pre-cooked high caloric, high-fat food or to provide fast food.

The Health At Every Size Approach

If we subscribe to the prevailing views on obesity our focus will be on the evils of weight. Our tendency when working with kids who are fat might be to ‘fix’ them by encouraging them to diet so that they will become  less fat. When we do this we reinforce size as the measure of self-worth which destroys their self-esteem, making our children fatter and eventually making them sick.

We need to shift the paradigm so that fat in and by itself is no longer a measure of health. When we can view fat as just a description of body size then we can focus on the lifestyle choices that make us unhealthy at whatever size we are. Instead of asking what we can do to help our overweight kids lose weight, we can then ask how we can help kids of all shapes and sizes to become and stay healthy.

Health at Every Size (HAES) is an alternative to weight-loss and shape preoccupation. It is based on the belief that although we may not be able to help fat people lose weight permanently, we can help them improve their health and reduce their risk of chronic disease. According to the Council on Weight Discrimination, the HAES philosophy promotes the concept that everyone has an appropriate healthy weight that cannot be determined by the numbers on a scale, or by a height/weight chart, or by calculating body mass index or body fat percentages. HAES defines a "healthy weight" as the weight at which a person settles as they move toward a more fulfilling and meaningful lifestyle.

Health at Every Size promotes the benefits of a healthy way of life for everybody that includes physical activity, healthy eating and life skills for dealing with stress. It promotes body satisfaction and the achievement of realistic and attainable health goals without concern for weight change. Size acceptance means saying that a person is okay at the size she or he is right now, and that one does not have to lose weight in order to be healthy or to become healthier. When people feel good about themselves they are more likely to try new behaviours and make positive changes in their lives.

© Salal Communications Ltd. Adapted from Sandra Susan Friedman’s Just For Boys (2007) and Body Thieves (2002).

Sources:

w      Campos, P. The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health. New York: Gotham/Penguin Books, 2004.

w      Council of Weight Discrimination Inc., 2000.

w      Field, A.E., Manson, J.E., Taylor, C.B., Willett, W.C. & Colditz, G.A. Relation between dieting and weight change among preadolescents and adolescents. Pediatrics 112. 900-  , 2004.

w      Gaesser, G.A. Big Fat Lies: The Truth About Your Weight and Your Health. Carsbad, CA: Gurze Books, 2002.

w      Gaesser, G.A. Is It Necessary to Be Thin to Be Healthy? Harvard Healthy Policy Review. Vol. 4, No. 2, Fall, 2003.

w      Stice, E., Cameron, R.P. & Killen, J.D. Naturalistic weight reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. J Consult Clin Psychol 67: 967, 1999 as reported in Neumark-Sztainer D. Obesity and eating disorder prevention: An integrated approach? Adolescent Medicine. State of the Art Reviews. Vol. 14, No. 1, 150-170, 2003.