A Confusing Snapshot of Obesity Self Care

Sad but true, most obesity care is self care. For the most part, that means personal efforts to lose and maintain a lower weight. Recently, a study in JAMA Open Networks, by Liyuan Han et al, generated a flood of headlines on this subject. Bottom line, the story was that “more people are trying and failing to lose weight.” A failing grade for obesity self care, it seems.

But just two years ago, a different study in JAMA told the opposite story. Kassandra Snook et al reported a decline in the number of adults with overweight and obesity trying to lose weight.

How Can Both Stories Be True?

Let’s count the ways these two papers could present the opposite story. First, maybe something changed in just two years. The older data set covers 1988 to 2014. The newer dataset goes through 2016.

Second, even though the data source is the same, the analysis is a bit different for each of these papers. The Snook paper looked at people with overweight or obesity trying to lose weight. The Han paper looked at all adults.

Third, this is a very subjective and sensitive topic. Because of that, the numbers you get when you ask people about their weight can be flaky. They can bounce around. Despite good intentions, bias can creep into the findings.

The only thing that surprises us is something you won’t find in the latest paper. There’s no reference to the Snook paper. None.

Bias and Subjectivity

Bias and subjectivity are easy enough to find on this subject. For instance, in the Han paper, the authors are really interested in making the point that lots of people say they’re trying to lose weight, but the population is gaining weight. They write:

Taken together, these findings suggest that although 34.3% to 42.2% of adults in the United States in our study reported weight loss efforts, many of them might not have actually implemented weight loss strategies or applied a minimal level of effort, which yielded unsatisfactory results.

In other words, the authors suggest people aren’t really trying. That might be true. But it might also reflect a bias of the researchers that we know is common. Implicit bias is sneaky. Confirmation bias is powerful.

Back to Reality

At the end of the day, it’s best to look at the big picture and more than one data source. We live in a weight obsessed culture. People are getting heavier. Life goes on. Would many people like to lose weight? Yes.

Gallup has tracked public attitudes about weight for decades. Ever since the turn of the millennium, anywhere from 51 to 57 percent of adults tell them they’re at “about the right weight.” Between 36 and 44 percent say they’re overweight.  At any point in time, 20 to 25 percent of adults are trying to lose weight. These numbers bounce around without defining a compelling trend.

The one thing that has changed is a sense of panic about obesity. It peaked in 2012, with 16 percent of Americans saying obesity is the “most urgent health problem facing the country.” Remember “Let’s Move!”? By 2018, it was down to just seven percent. Cancer and substance abuse are bigger concerns now.

So, on balance we would say that people might be a little less panicked about obesity and excess weight. They’re still out there thinking about it, spending on gyms, yoga classes, and diet books. But they’re also wondering, “Why isn’t this working?”

Curiosity is a good thing. Maybe self care is necessary but not sufficient for overcoming obesity.

Click here for the Han paper, here for the Snook paper, and here for numbers from Gallup on the subject. For more from ConscienHealth on this, click here.

Self Portrait, photograph © un.hiddenbeauty / flickr

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November 20, 2019