Diverse Thinking About the Complexity of Obesity

Analysis of Diverse PerversitiesIt’s a lot. Writing for USA Today, Karen Weintraub has produced a deep dive into diverse thinking about the complexity of obesity. If you thought USA Today was a place for McNuggets* of superficial reporting, think again. In six parts, with more than 18,000 words, Weintraub has done quite well in painting a picture of the complexity of obesity – what scientists know, what people experience, and the speculation that abounds on the subject. She did it by talking to a wide range of more than 50 experts, individuals with personal experience, and advocates for better policies.

She covers the subject so broadly that you will surely find things to confirm your biases, challenge them, and maybe even prompt you to think in new ways about this difficult subject.

The Science

Very much to her credit, Weintraub starts with the science of obesity. Through the experience of Barbara Hiebel – someone who has had gastric bypass surgery and medical obesity care – she frames the physiological basis for obesity. This is a basic fact of obesity that most of the public simply doesn’t understand. Endocrinologist Sarah Kim explains:

“There’s a lot of misperception among patients that they can somehow ‘behavior’ their way out of this – if they just had enough willpower and they just decided they were finally going to change their ways, they could do it.”

The Bias

Weintraub explains that the medical harm of obesity occurs over time, but the impact of fat shaming is immediate and pervasive. She reports on the perspective of Tigress Osborn, who identifies as fat and has no problem with that. She chairs the National Association to Advance Fat Acceptance. To Osborn, the whole idea of obesity is stigmatizing.

ConscienHealth’s Ted Kyle told Weintraub that the real problem comes from describing obesity in catastrophic terms:

“When you tell someone their health, their body, is a disaster, it’s not helpful. It does cause immediate harm. The media and public health needs to stop catastrophizing obesity.”

The “Best” Diet

To most people, obesity is a simple matter of people eating the wrong diet. But Weintraub reports that scientific evidence for finding the best, healthiest diet to prevent obesity has been elusive. She sums it up nicely:

“Campaigns to cut fat and then sugar from America’s diet didn’t make a dent in the obesity epidemic. Nor did keto or paleo, Atkins, exercise plans or a TV reality show.”

The Systems

With the life experiences of Nathaniel Louis Brown, Weintraub explores how systems promote obesity more than individual choices do. In light of this, Daniel Clark describes historical approaches to weight management as irrational:

“For 30 years our field’s been doing behavioral counseling for weight loss. It’s total nonsense. It would be an inhuman amount of self-control to achieve (weight loss) and sustain it. Why we’ve kept on with this line of work just baffles me.”

Marion Nestle tells Weintraub that policy makers “should be frantic about obesity” and the failure to adequately address it.

The Medical Care

Medical care for obesity is improving, with surgery proving to produce long-term health benefits and medications getting steadily better. Katherine Saunders told Weintraub:

“It does feel like we’re at an incredibly exciting time where the medications we have available are helping so many people to lose very clinically significant weight.”

But health insurance is stuck in the past, requiring patients “to partake in a period of behavioral modifications” to prove that they deserve medical treatment, as a spokesperson for America’s Health Insurance Plans told Weintraub.

The Kids

Weintraub concludes with speculation that children and youth will be the key to overcoming obesity. While this may be true, it was somewhat disappointing to find an inordinate emphasis on preventing childhood obesity by educating kids to make smarter choices. To date, this kind of thinking has been prevalent, but it hasn’t done anything measurable to prevent or reduce childhood obesity. And in fact, candid observers will tell you that it likely never will. There are folks doing good work to address the tremendous impact of obesity in kids more effectively. But none of this work received any mention. A missed opportunity.

Complexity and Diverse Views of Obesity

In all, though, this huge reporting effort by Weintraub deserves praise for capturing the complexity of obesity and the diverse range of views about it. It is well worth your time to read every word.

Click here, here, here, here, here, here, and here for the introduction and all six parts of this comprehensive report.

Analysis of Diverse Perversities, painting by Paul Klee / WikiArt

*McNuggets is a registered trademark of McDonald’s Corporation.

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July 27, 2022