Most of what we know about obesity is right: A Huffington post rebuttal

Huffington post published an article: “Everything we know about obesity is wrong.” The title is eye catching as obesity is viewed by the health community as an epidemic that doesn’t seem to be slowing down. There is a diet and weight loss industry making billions a year and yet nothing is really changing. Hoping to learn about a breakthrough medical finding, or just a conversation starter on educating people about health, we ended up with a confusing piece that misinterprets its sources, uses outdated and inaccurate claims, and fails to gives us a message on where to stand when it comes to our health.

Here’s the original: https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

The article provides an account of people experiencing discrimination and hate for being obese. Not only is the shaming coming from bullies in school or from strangers on the street, but also from medical professionals. Obese people have reported being name called and humiliated by their doctor. It is documented that rapport between doctor and obese patients is lower than non-obese patients, and doctors would often place blame on the individual for their obesity.

Yet, doctors receive very little diet and nutritional advice training, and are usually too short on time to provide enough education that could help someone. The basic “move more, eat less” is not helpful for someone who’s probably tried dieting and exercise several times before with no success.

One example in the article was about a woman who admitted to her doctor that she was starving herself in order to lose weight. He replied to her “whatever you are doing, it’s working”

The ill advice the medical doctor was giving to his patient is shocking. No one, whether they have a medical degree or not, knows that the patient’s behaviour is dangerous, and a sign of an eating disorder.

Is fat shaming a real thing? Absolutely. Does bullying make a person lose weight? No. Does stigmatization prevent a group from receiving proper care? Hell, yes it does!

What the article showed that this type of behaviour reduces the likelihood of obese patients seeing a doctor or any other health professional. And feeling shame after being ridiculed by the rest of the population, brings damaging depression and less future efforts to improve health.

Here’s what the article left out. The hard truth. Obesity is highly correlated to heart disease, type 2 diabetes, stroke, certain cancers, and osteoarthritis. Obese people have a greater mortality rate than non-obese people, and live 5-20 years less than non-obese.

Reducing body fat is related to a decrease in all of these medical conditions.

So, it’s obvious that the medical community would view obesity as a health concern, and promote a reduction of body fat to reduce risk of…well dying.

The inappropriate behaviour is unacceptable and ineffective, but not addressing the risks of obesity and possible ways to reduce risk of many diseases, does nothing either.

Being obese brings a high risk of medical problems. The article mentions a OB GYN clinic in Florida turning down obese patients. The author uses this example as way to show discrimination but left out why they were turned down. It’s because it is more dangerous for obese women to carry a pregnancy than non-obese women. The clinic’s physicians felt that they were not equipped enough to work with these patients and the chance of complications was too high to be worth the risk.

The article addresses that a certain percentage of obese people are “metabolically healthy.”

What does this mean? Based on one meta-analysis, metabolic health means having a normal blood pressure, high-density lipoprotein cholesterol level, triglycerides and plasma glucose levels. This means having no risk of stroke, heart disease, or diabetes.

The same meta-analysis explained that studies on the health of overweight and obese participants showed that between 6-75% of them are metabolically healthy. The range is massive and each study showed a different number. So, to say that one’s obesity isn’t going to cause a metabolic disease is hard to say based on the huge variance in the research. Plus, just because someone doesn’t have those problems yet, doesn’t mean that they won’t get them later in life. Metabolic health is also one part of overall health: osteoarthritis, sleep apnea, and fertility issues are also linked with obesity and reduce quality of life. You may not get diabetes, but you could still get cancer.

What is going on with people trying to lose weight? The article stresses that dieting and weight loss success rate is extremely low. The author mentions Dr. Stunkard’s 1959 study that showed 95% of the overweight participants in the study failed to lose any weight.

The study has been used many, many times as to prove dieting doesn’t work. The article gives more examples of failed dieting outcomes and the slowing of one’s metabolism after weight loss makes it seem an impossible feat. Along with mentioning studies that show some obese people are metabolically healthy, is the message of the article: losing weight is not possible and that the health problems associated are far overblown? Perhaps it is better to stop any efforts of weight loss.

The study from 1959 used a small sample of 100 people. It is hard to make a generalizing statement about a population. Further, what exactly was the dieting advice given to the participants? The 100 people were given a diet and were sent on their way. Every person got the same diet plan with no education about nutrition and no recommendations on exercise. Dr. Skunkard even said “we know better now.” Many new studies show much lower numbers of people gaining the weight back. Although the number is still high, it is closer to 35-50% within 5 years, not 95%.

Article mentions study that shows people are eating less. The paragraph suggests that calories are not the problem in our health. This point is misleading: though people may be eating less but that does not account for activity level (which is reducing) and aging (population is getting older). The study mentioned even notes that the change is a positive step and may result in a reduction of body weight population wise. Instead the article uses the study to show that calories do not affect weight. That is completely wrong. Being in a caloric deficit, taken in less calories than expending, leads to weight loss. We may absorb and utilize different sources of calories in different ways, but what you eat, absorb, and utilize, must equal what you expend through activity, in order to remain the same weight.

The article is right about the mistreatment of overweight and obese individuals by medical doctors, and the feelings of shame prompting people to resort to extreme measures to lose weight is horrible. We should have all learned from school that bullying is wrong, but I guess not.

But to suggest that being obese is not very unhealthy, and that reducing caloric intake does not lead to weight loss is not helpful in the slightest. People do lose weight on a caloric deficit, obesity can be deadly, and weight loss can extend life. It’s tough but it is the truth. Even a small reduction of body fat prolongs life.

Obesity and its causes should be viewed as an societal phenomenon, not a pure individual occurrence. Like the article mentions, we are exposed to a large amount of advertising of junk food and sugary drinks, many are surrounded by fast food with no grocery store in sight. Healthy food can often be more expensive than non-healthy food. The article used an example where calorie for calorie unhealthy food is cheaper than healthy food. And these factors impact our efforts to be healthier.

To place all the blame on the individual isn’t appropriate, and neither all the responsibility should be placed on the individual to drastically change his or her lifestyle. But I believe we can change for the better individually and as a society. Supporting healthy behaviours such as exercising and eating more fruits and vegetables are some examples. Even just walking a few minutes more a day helps and costs nothing.

Sources for fact checkers

https://www.ncbi.nlm.nih.gov/pubmed/25040597/

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.175.4474&rep=rep1&type=pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901982/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387402/

https://www.ncbi.nlm.nih.gov/pubmed/1322866

http://articles.sun-sentinel.com/2011-05-16/health/fl-hk-no-obesity-doc-20110516_1_gyn-ob-gyn-obese-patients

http://garfield.library.upenn.edu/classics1983/A1983RP56700001.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401682/

https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.20384

https://health.usnews.com/wellness/food/articles/2016-12-07/how-much-do-doctors-learn-about-nutrition

https://www.nytimes.com/1999/05/25/health/95-regain-lost-weight-or-do-they.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665513/ 

https://www.precisionnutrition.com/weight-loss-calculator

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