Obesity: serious disease or moral failure?
The official line is that obesity is a disease that can be treated with a variety of interventions. But unofficially, Americans suffer from a deeply ingrained cultural bias against people who are obese.
Want examples? Consider the 1994 People magazine cover dishing the dirt on "Diet winners and sinners of the year."
Or how about this nugget from the Food Network web site: a recipe for "Ghiradelli Sinful Chocolate Truffles." On a recent visit, the recipe shared a page with an advertisement for the South Beach diet.
Or how about the survey published last year in the journal Obesity Research that looked at primary care doctors' attitudes about obesity and found that "more than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant?"
"We live in a society that largely scorns obesity and overvalues thinness," says Gary D. Foster, PhD, who led the survey team and is a clinical director of the weight and eating disorders program at the University of Pennsylvania School of Medicine in Philadelphia. He was speaking at a recent Harvard School of Public Health symposium on the science of obesity, presented at the Harvard Medical School campus in Boston.
"People often say things like 'I cheated today on my diet'," Foster says. "What does that mean, cheated? How would you feel if your adolescent son or daughter came home and said they got caught cheating on a test, or worse yet your spouse came home and said 'I got caught cheating at work today?' How did a bag of M&Ms ever get equated with something like cheating?"
It's not part of the medical school curriculum or postgraduate training, but the medical system appears to be stacked against obese patients, Foster says, pointing out that many doctor's offices aren't equipped to handle people whose arms can't fit into a standard adult blood pressure cuff or a conventional CT scanner, for example.
One study found that nearly one in five ob-gyns was less likely to perform a pelvic exam on an obese patient; another found that a majority of medical students viewed obese patients as "lazy and lacking in self-control."
"Societal antifat attitudes are so pervasive that even those who dedicate their lives to treating obesity aren't immune from these attitudes despite wishing to avoid prejudice; these clinicians are not consciously aware of this bias," write Kelly D. Brownell, PhD and Rebecca Puhl in the Summer 2003 issue of the Permanente Journal.
Where There's a Will, There's a Way
Blaming people who are obese for being obese is like blaming someone who has a cold for having a cold -- it doesn't help. Instead of making people guilty about their weight, says Foster, in an interview with WebMD, doctors can help patients learn what they need to know to gain control of their eating habits and behaviors related to food.
"We say this to patients a lot: it's about skills, not wills. I don't think that people who go on a diet lack will power, it's just that they lack skills to eat less and move more in a society that teaches them to do just the opposite. It's just a different skill set, much like learning to play the piano or driving a car," Foster tells WebMD.
One skill he recommends is writing down what you eat, how much of it you eat, and the time when you're eating it. This is a surprisingly powerful tool that can help people identify diet patterns and problem areas. In research studies where obese patients are asked to keep a food diary but not otherwise change anything that they are doing, 80% still lose weight in the first week, Foster says.
He also counsels patients to have realistic expectations about what's possible and what's practical. Even the best, most scientific weight-loss programs conducted in academic centers result in an average weight loss of 8% to 10% during a six-month period, with an average weight regain of about 33% after one year, Foster says.
But even a relatively little drop in body weight can make a big difference in health. In one study conducted by researchers at Northwestern University with more than 3,200 people who were at risk for developing type 2 diabetes, a lifestyle modification program with a goal of a 7% weight loss reduced the risk that participants would go on to develop diabetes by almost 60%. Weight loss was almost twice as effective as medication at preventing diabetes in this study,
"What this says is that a little bit of weight loss goes a long way," Fosters says.