American Heart Decides Obesity Isn’t a Behavior

“We’ve been working at this for so many years and nothing has changed!” These words came from a frustrated advocate for reforming obesity policy and care at a recent strategic planning meeting. He had a point. Progress is maddeningly slow on obesity. But major changes are happening – even if they aren’t obvious at a glance. Late last month, the American Heart Association provided a perfect example by shifting away from treating obesity as if it’s a health behavior.

That’s right. For years, AHA’s template for optimal cardiovascular health was Life’s Simple Seven. Three health metrics and four health behaviors comprised the key to optimal heart health. Absurdly, in this framework, a high BMI counted as a bad behavior. No more. Quietly, AHA has shifted BMI into the same category with blood pressure, cholesterol, and blood sugar – health metrics.

Implicit Bias About Obesity

This change may be subtle, but it marks huge progress. That’s because the biggest challenge is to neutralize implicit bias about obesity and the people who have it.

The old way of thinking about this disease is that it’s simply the product of bad behaviors and ignorance. So all kinds of money went down the drain for decades in efforts to educate people. To nudge them to stop behaving so badly and giving themselves obesity. It didn’t work.

Folks who devote their careers to obesity research and clinical care have long known that is wrong. But that kind of thinking is pervasive. This is why AHA classified BMI as a behavior in their old heart health framework. Penny Gordon-Larsen and Steven Heymsfield pointed out the mistake back in 2018.

Though it took four years, AHA has corrected this error.

Reshaping the View of Obesity

Bias about obesity is pervasive. But at its root, the mistake is a simple one. People mistake obesity as the product of poor choices and bad behavior, when in fact, it’s the product of a person’s physiology and their environment. Behavior can be a help for coping with it. But it seldom cures it.

Natalya Ortolano described the challenge of reshaping this view in a recent profile of obesity medicine physician Fatima Cody Stanford. She writes:

“In the end, this is Stanford’s overall goal: to treat patients with obesity with the same care and respect as anyone else with a chronic disease.”

It’s no small task. Progress comes in small increments. It takes the efforts of a whole host of smart and dedicated advocates like Stanford to bring this progress. So moving the American Heart Association away from treating obesity as if it’s a bad behavior is a big step, even if it’s a subtle one.

Click here, here, and here for more about the new framework from AHA – Life’s Essential Eight.

Man with Heart (Self), painting by Walter Gramatté / WikiArt

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July 25, 2022