Locked into the Wrong Debate About Obesity

Genius Locks HegelPublic discourse about obesity is often locked into the wrong debate. On one hand, a common view holds that this is a problem for which prevention is the only real answer. People must have good nutrition and active lives by default so that children will not grow into adulthood with obesity. On the other hand, fat acceptance advocates promote the view that the so-called obesity epidemic is nothing more than a moral panic in a culture obsessed with unnatural thinness.

But the real question, which Matthew Yglesias expresses quite well in a new essay, is:

“Why aren’t medical breakthroughs in obesity a bigger deal?”

Just Lose Weight

Yglesias came face to face with one side of this faulty debate when a popular comedian and podcaster confronted him about his weight in the midst of an interview about COVID vaccination: why didn’t he just try harder to lose weight and thus make himself safer from COVID?

CDC has backed away from heaping the burden of blame on individuals living with obesity. Now, the burden is on the whole community. According to the agency:

“Policy makers; state and local organizations; business, school and community leaders; childcare and healthcare professionals; and individuals must work together to create an environment that supports healthy lifestyles.”

We love the community spirit in that, but it’s noteworthy that it makes no mention of medical care for obesity that can yield substantial improvements in a person’s health. Yglesias draws a stark contrast with the approach to something like COVID:

“None of this is wrong, exactly, but it’s inconceivable that a major public health institution would discuss COVID in this way without mentioning vaccines or treatments.”

Forget About It

In a perverse way, fat acceptance advocates are also denying the value of medical care for obesity. Because all of the energy for helping people with obesity has gone into diet and exercise regimes, they say all efforts to do anything about obesity are fat-shaming wastes of time. He writes:

“Righteous pushback against the genuinely useless diet and exercise mantra has created a new politics of ‘fat acceptance’ especially in certain left circles, which treats any discussion of body weight issues as akin to racist or homophobic discourse.”

Framing a New Conversation

This should not be hard – except for the fact that people hang onto their prejudices very tightly.

Creating healthy communities is a fine ambition, but only if it respects the diverse ideas that people have about what good health means to them. Without access to good care for obesity, many people will have no hope of overcoming the health problems it causes them. And even in a perfect world of ideal health, our friends, neighbors, and loved ones will still come in diverse sizes and shapes. One size does not fit all.

For too long, we’ve been locked into the wrong debate about obesity. It’s past time to move on. That means embracing the value of medical innovation that can improve the health of many millions of people.

Click here for the essay by Yglesias and here for his podcast on the subject.

Genius Locks Hegel, surrealist illustration from The Game of Marseille / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


September 15, 2022

2 Responses to “Locked into the Wrong Debate About Obesity”

  1. September 23, 2022 at 3:03 pm, Natasha Wiebe said:

    This new research study shows that hyperinflammation and hyperinsulinemia confound the association between obesity and death. Obesity is associated with a lower risk of death when death is regressed on BMI, c-reactive protein, and fasting insulin. Mediators and collider bias are discussed. Read https://www.nature.com/articles/s41366-022-01211-2
    A better question would be why are researchers and health practitioners focused on obesity and not inflammation and insulin.

    • September 23, 2022 at 5:22 pm, Ted said:

      Good question, Natasha. I don’t know any credible obesity researchers who don’t pay attention to the inflammation and altered responses to insulin that come along with this condition. Health professionals are a diverse lot, though. Some understand the altered physiology of obesity, but many have a very simplistic view of this complex, chronic disease.