It’s high time, in my estimation, that we stopped talking so much about “obesity.” It’s a well-publicized public health crisis, the buzzword of the moment, but framing our national dialogues around a measurement of our citizens’ body sizes doesn’t seem to be helping much. Obesity rates are, at best, stagnant; at worst, possibly still rising in some segments of the population. You’d think that with all the anti-obesity rhetoric out there, something we’ve done as a country to combat our weight problem would have had a noticeable effect by now.
It hasn’t. And here’s why.
Obesity is only one measurement of a larger pervasive issue
We’re not fighting a cause; we’re fighting a result. It’s a tree-first-forest-later way of thinking. Obesity is a very visible and potentially troubling effect of a much bigger, more troubling issue. By focusing our efforts and attention on the size and shape of people’s bodies, we may be missing not only other, more subtle problems that are also deserving of attention – such as the effects of junk food on neurology, behavior, and learning, or the socio-economic implications of existing agricultural and marketing models – but actually the opportunity to deeply assess what the real problem, or problems, may be.
Obesity can be a symptom of poor health, but not the only symptom of poor health
Some people grow fatter on a junk food diet, while others don’t. Some thin people have diabetes, dangerously high blood pressure, arterial disease, and other poor health indicators that may go undetected because of their body type; some larger people have none of those poor health indicators, but are presumed to be highly unhealthy because of their body type. Obesity can tell you a lot about a person’s health, but then again, it may tell you only that someone is larger than others. It can also be present in people with overall positive habits, such as a healthful diet and good exercise regimen. In other words, it’s not a 100% corollary to anything other than body size, so a “War on Obesity” amounts to little more than a war on people who are bigger than other people.
The “War on Obesity” perpetuates negative stereotypes and attitudes about human beings
Notice how it’s not a “war on the health problems that are faced by some obese people” (as well as some non-obese people)? It’s a war on obesity, itself – giving an ultimate free pass to those who are unhealthy but slim, as well as opening the door to arguments like the “energy balance” mantra. How many times have you heard a critic of, say, the new healthy school food requirements complain that “my kids are thin, so they should be allowed to eat the food they liked instead of the new, gross, healthy food?” I’ve heard it more times than I can frankly stomach. There’s little push to help people recognize that feeding their skinny kids (or skinny selves) crap food can lead to poor lifetime eating habits, which may lead to poor health outcomes, and may even lead to – gasp! – the dreaded “obesity.”
Framing obesity as the main problem also creates a damaging and unhealthy divide among people. We, as a culture, feel somehow justified in serving donuts and Gatorade after youth soccer because those are “active” kids (there’s that blasted energy balance theory again!), but also perfectly justified in frowning upon a parent who takes her overweight child out for ice cream. We feel okay about serving soda and chips at class parties, but disgusted by the overweight low-income family who stretch their limited food dollars by purchasing the same soda and chips at the grocery store. We use the fatness of others as a distancing, dehumanizing tactic, and therefore the “War on Obesity” is beginning to look an awful lot like a “war on obese PEOPLE,” which I assume is not what any public health official intended.
When we unite against “obesity,” we fail to unite behind a shared goal
This is a big pet peeve of mine, when it comes to advocacy or activism in general. Something I learned early on, and which was borne out by a brief stint as a professional in public health programs, was that you can better effect change – especially behavioral change – by uniting around a positive goal rather than attacking a shared enemy. For example, it’s considered bad form to teach sexual responsibility by saying “Don’t rape people” (although “don’t rape people” is certainly a nice, desirable behavior). Instead, you build people who behave with sexual responsibility by teaching and modeling respectful behaviors, encouraging good bystander citizenship, and improving attitudes about sex and interaction with other human beings.
In declaring war on obesity, we’ve essentially said, “Don’t be fat.” How do we propose that people achieve that non-fatness? That’s certainly not a nut we’ve cracked, otherwise obesity rates would be down. So we’re throwing everything in the arsenal at the “don’t be fat” model, which produces different camps of people adhering to different schools of thought: Exercise more! Eat less! Eat no carbs! Eat no fat! Let’s move! Let’s not move! Let’s cleanse! Let’s…just stop now. None of those things, singularly, is making a significant dent, because none of them, singularly, addresses all of the complex factors that are at play in obesity. They MAY, however, be impacting some of the health problems that make obesity a concern to us; which means we’re either doing the wrong things, or MEASURING the wrong thing.
The truth is, we’re not much closer now to figuring out all the causes of obesity than we’ve ever been; both science and anecdotal, experiential observation have proven at this point that the old “calories out, calories in” math doesn’t provide anything approaching a complete answer. Furthermore, while obesity can raise serious health risks, it doesn’t always; and it isn’t always the sole driver behind those same health risks, meaning that they can also appear in non-obese people. If we’re worried about the health and well-being of all of our citizens, we owe it to them – to ourselves – to change the dialogue to one that specifically addresses the things that most concern us: The heart disease, the strokes, the diabetes, the chronic and life-threatening and life-ending illnesses. We need to make it clear that the war FOR our nation’s health is a cause that includes everyone, not just those above a certain number on the scale. Every one of us has skin in this game. So why do we insist on focusing only on the skins of a few?
Thanks for this post! We definitely need to frame this “war” differently because it really hasn’t made too much of a difference. I think living healthy is something that has just not come into consideration in our busy lives and we think that if we just exercise enough, we can eat whatever we want and we will be ok. I’m convinced that I need to take back my kitchen and prioritize eating and being healthy. I need to definitely do this for myself first!
Bri: Just today I wrote an entire piece on The Lunch Tray (which you may have seen – and which may well have ticked you off) which used the phrase “war on obesity” about nineteen billion times. ( (http://www.thelunchtray.com/how-optimistic-should-we-feel-about-the-war-on-obesity/) ) And I cringed every time I typed that phrase on my computer screen.
As I explained in a footnote on the post, “I dislike framing this public health crisis entirely as a matter of “obesity,” since the poor nutritional quality of the modern American diet can adversely affect all of us, even if we’re not overweight,” which is another way of saying, I totally agree with everything you said above. (BTW, the reason why I used the phrase is because: (a) it’s concise and commonly accepted and understood; and (b) my post was disputing an opinion piece all about “anti-obesity” measures, and it seemed appropriate to adopt the language used by the authors as I took issue with their positions.
At any rate, my footnote led to an interesting discussion on Twitter with one of my followers, a public health professional, and we were both saying we wished there were some shorthand phrase we could use to set up the problem, one that’s as concise as “the war on obesity” but without all the baggage you so persuasively identify above. We even joked that we want to hold a contest for people to submit ideas. My current submission would be “the war on poor nutrition” or “the war on the highly processed, nutritionally deficient American diet,” but I’m sure we can do better than that! 🙂
Would love your ideas, and thanks for this thoughtful post.
Ha! Great minds…? I had seen the headline of your post but hadn’t read it in its entirety yet (and no, not ticked off at all — your footnote makes perfect sense). I feel like we should be fighting a war FOR health, no? Think of it like the Crusades (as long as we’re using violent analogies): A popular notion about the Crusades holds that the Westerners were never going to win, because they were fighting AGAINST something, whereas the other side was fighting FOR something. We need to unify positively, not negatively; there isn’t a single enemy we are really fighting, but there IS a single purpose for which we stand. Does that make sense at all?
I love your suggestions, Bettina! I would love to see the issue re-framed to one that acknowledges poor nutrition is a social justice issue with those suffering the most being those who have the least means (financial & cultural capital). I also don’t like the use of “war” in these discussions. I would prefer something like “the movement toward healthful nutritional justice” (just a starter, certainly needs to be improved!).
I agree with much of what you wrote and there’s also much I admire about the HAES movement. My frustration is when any mention of problems related to obesity is seen by HAES advocates as an attack on people who are obese. The war on obesity excludes other important issues related to health but ignoring health issues related to obesity is also problematic. I appreciate you opening up this discussion.
Hi Casey,
The HAES model makes no claim that health and body size are not associated. A HAES activist named Deb Burgard recently wrote the following clarification, which I will borrow because she’s much more eloquent than I am. “There is no claim that health and body size are not associated, because it is clear from the data that they are, although the data show some departures from commonly-held beliefs (see Flegal et al.2005, 2013). What we don’t know is whether fat cells or some people’s fat cells are a causal factor, but that could be true. What we do know is that stigma, stress, racism, and less access to financial and medical and social resources are a cause of the health problems that are associated with higher weight, and these are the people who are also more likely to be heavier. We need to change those broad social forces to improve our well-being. The HAES model focuses on the practices and environments that support health – evidence-based findings – and the fact that people are more likely to continue to do practices that give them satisfaction in some way – not exactly the same thing as ‘if it feels good do it.’ For more information you can look at the HAES principles and the science at ASDAH’s website http://www.sizediversityandhealth.org The main way that HAES departs from the traditional models is that because there is no evidence for sustained weight loss for most people, and there is considerable evidence that most people will weight cycle instead, as health professionals we have to question a practice that will almost always make people’s emotional and physical health worse in the long run. We went looking for evidence that we should prescribe weight loss and came up with research that shows the long-term outcomes for most people are worse than focusing on the practices that support health whether people are thinner or fatter. What we do know is that stigma, stress, racism, and less access to financial and medical and social resources are a cause of the health problems that are associated with higher weight, and these are the people who are also more likely to be heavier. We need to change those broad social forces to improve our well-being. The HAES model focuses on the practices and environments that support health – evidence-based findings – and the fact that people are more likely to continue to do practices that give them satisfaction in some way – not exactly the same thing as ‘if it feels good do it.’ For more information you can look at the HAES principles and the science at ASDAH’s website http://www.sizediversityandhealth.org“
Another factor that could use some help in this Working Toward Healthy goal – making exercise clothing available in widths beyond “skinny”. It can be very challenging to find workout clothing that fits plumper people. The current fitted styling makes it even harder. Even having broad shoulders can make the form-fitted shirts limit your range of motion – and how useful is exercise clothing you can’t move in? It is frustrating that when sweats do turn up in Women’s or Plus departments they are often lounging wear – in fabrics not practical for exercising. Not all of us are shaped like T-rexes or kangaroos (narrow shoulders and little arms)!
I think it should be re-framed as a war against highly processed, nutrient-deficient diets and diet-related diseases! Because the typical American diet (filled with added sugar, unhealthy fats, synthetic chemicals, etc.) is what is making people sick (and, yes, overweight). Ultimately, what will motivate people to eat well is feeling good and the ability to live a healthy active life without high blood pressure, insulin injections, chronic arthritis, etc. As a parent, I am most concerned that my children learn to love food that will keep them healthy and make them feel great. And by doing so, I think they naturally will be the right weight for their bodies. Agree, we should focus so much on “obesity”–but rather good eating and healthy living.
Not only do we not understand the causes of obesity, we don’t understand the connection between health and weight – I’m not convinced it’s as clear cut as weigh less, be healthier. I am currently, according to my BMI, overweight but my hypoglycemia, which caused me daily problems when I weighed less no matter how healthy my life was, rears its ugly head only when I’m extremely stressed or stupid about time passing. I can’t tell you how angry I get when my doctor says that my blood sugar numbers are good but I need to lose weight. I hate the war on obesity!