Lifestyle Laos

A Lifestyle Free of Obesity, Which Is Not a Lifestyle

Having obesity is not a lifestyle. Obesity is a chronic disease. But not having obesity is a lifestyle. In fact, it’s a lifestyle that sets a person free from years of having major chronic diseases. Like obesity. This is the logic Solja Nyberg, Archana Singh-Manoux, and Mika Kivimäki offer us in JAMA Internal Medicine this week.

It comes in response to a letter from ConscienHealth founder Ted Kyle, OAC President Joe Nadglowski, and Harvard’s Fatima Cody Stanford.

Circular Logic

Nyberg’s circular logic bears a faint resemblance to those ads from dietary supplements. You know the ones. They promise to keep your brain healthy and protect you from a failing memory. But, “they are not intended to treat, cure, or prevent any disease.” That’s a lightning-fast disclaimer we’re conditioned to ignore.

In the spirit of such thinking, Nyberg et al wrote in their paper back in April that a healthy lifestyle predicts a longer life free from major chronic diseases. The most potent factor in Nyberg’s formula for a healthy lifestyle is not having a BMI that would indicate having obesity.

We Beg to Differ

We wrote to point out that obesity itself is a chronic disease. So of course, not having a chronic disease is a pretty good predictor for more years of life without major chronic diseases. This would be especially true for obesity, because it causes many other chronic diseases. BMI should not be conflated with lifestyle, we explained:

It is essential to recognize that BMI is a physical characteristic and a marker for metabolic disease. Body mass index itself is neither a behavior nor a lifestyle, even though health behaviors and lifestyle factors can influence BMI. Many other factors are contributors. Medical professionals must recognize this fact to provide adequate care for patients with obesity.

Nyberg et al were unmoved. They agree with us that obesity is a chronic disease, but assert that “maintenance of healthy weight is indeed part of a healthy lifestyle.”

Pervasive, Implicit Bias

Such is the nature of implicit bias about obesity. People can nod their heads and accept that obesity is a metabolic disease. But in their hearts, even some very smart people remain certain that body size must be a matter of choice. Nevermind that the heritability of obesity is 70 percent. They cannot imagine the life experiences of a person who has lived with obesity since early childhood.

Blind faith in a mythical healthy lifestyle to cure all ills does not permit many people to conceive of obesity as a matter of physiology, not choice. This makes us weary, but we still have faith that people of good will, if given the chance, can learn and grow to understand that obesity is neither a choice, nor a lifestyle. It is the product of genes we inherit interacting with the environment that confronts us.

Empathy is a lifestyle worth adopting.

Click here for the Nyberg study, here for the letter by Kyle et al, and here for Nyberg’s response.

Lifestyle Laos, photograph © Francoise Gaujour / flickr

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August 25, 2020

4 Responses to “A Lifestyle Free of Obesity, Which Is Not a Lifestyle”

  1. August 25, 2020 at 3:15 pm, Mary-Jo said:

    The lens through which we look at an object can influence what we see. It’s not even a bias, it just ‘is what it is’. (A favorite phrase these days 😖). I’m an RDN, a person who has lived with obesity, and I have a degree in Epidemiology. The authors of the first paper are clearly just counting events. That’s epidemiology. There is no space, no reason for empathy. Those of us who work in clinical settings, as advocates, hearing and telling our stories, empathy HAS to be part of our efforts to appropriately and successfully investigate, treat, and help people with obesity AND weight struggles given heritability predispositions, our environment of food domination, sedentary living, and very poor access to — medical, mental, emotional treatments and support — to help us manage, achieve ‘better lifestyles‘. So, IMO, both parties here have their valuable points to make. ☀️

  2. August 25, 2020 at 3:50 pm, John Dixon said:

    I feel the frustration. Implicit weight bias is systematic. How often do we softly acknowledge that obesity is preventable disease? The implicit message is that if they fixed their behaviors all would be well in the world.

    It is so hard to change firmly held beliefs.

    But we must!

  3. August 28, 2020 at 5:45 pm, Stephen Wilkinson said:

    Behaviour, and the reasons for it, must be an important factor in obesity. Blaming people for obesity is not appropriate and has negative outcomes. But understanding behavioural drivers is an important part of multidisciplinary obesity management.
    Physical therapies alone don’t work unless they are used as tools to effect long term behavioural change.
    A critical behavioural driver is mindset – especially fixed versus growth mindset. Mindset is malleable.
    Is mindset associated with obesity? It has not been studied in this context, but is correlated strongly with educational behaviour.
    So no, obesity itself is not a lifestyle, but one marker of behavioural drivers that operate in the context of physical makeup and social/food environment. It is critical to study and address those drivers as part of obesity management.

    • August 29, 2020 at 4:23 am, Ted said:

      Behavior change can certainly be a means for coping with obesity. But it has its limits. Not all behavior is a simple matter of volition.