Bill Hettler, MD
The American people are being misled by the incredible distortions that are necessarily created by the various media. Media sources need to have the "Breakthrough Headlines" every day to try to insure the reader/viewer will not click, switch or turn to another media provider. This leads to unnecessary, continuous hype about information that is often preliminary, often distorted, and usually not relevant to the decisions people need to make each day.
The following quote is a true story. It was read by Jonathon Robison as part of a workshop he gives to challenge the discrimination that still occurs, often by misguided professionals who don't have the facts. It may help you gain an insight to the prejudice that exists in our culture. The cultural bias that this story exemplifies has no basis in any careful review of the research. There is a crying, literally CRYING need, to help people understand that size consciousness is an obsession, unsupported by the literature.
"Let's go back some 40 years to 1953. I'm 5 years old and in kindergarten. I am a gifted child with a high IQ. I love school and I am fat. My teacher who cares about me is concerned about my weight. She is fat too, and maybe she wants to save me from a lifetime of shame. Whatever her intentions, she puts in motion an event that changes my young life forever.
She convinces my parents to put me in a residential treatment facility for children with "special nutritional needs". In other words, I was sent away from home to be put on a diet. I was there for more than a year. My parents say they visited me once a week on Friday nights, that I lost 25 pounds , and that I seemed happy enough. I don't remember, I have to take their word for it because I recall very little of those 13 months. In fact I have only one clear memory from the entire year.
I was out on the playground with the other kids. It was a bright spring day. Something made me look up from the where I was swinging. In the distance, past the fence that separated the playground from the camp was a familiar car. My heart beat faster as I realized that it belonged to my parents. I ran over to the chain link fence and peered out, hoping to catch a glimpse of my mother. I saw instead my brother Patrick. He saw me too. With longing, we looked at each other from the prisons that separated us; a fence, a locked car, a camp for special kids, adults that thought they were doing what was best, and a society that was beginning to hate fat people so much that it had devised a place to put fat kids away until they lost weight.
I will never forget what longing feels like because I was clenched in its hold in what felt like forever, as Patrick and I watched each other. I saw it in his 4 year old eyes too. The void of being separated from each other grew larger than ever, the emptiness filled me."
There is a confluence of social, political and economic issues that influence what Americans believe. If you want to know what Americans really believe about weight and health, don't read what they write, don't listen to what they say, just follow their money.
See Laura Fraser's book, "Loosing It, America's Obsession with Weight and the Industry that Feeds on It."
The diet, pharmaceutical, industrial complex is made up of the following industries:
Cosmetic Industry, Diet Food Industry, Fitness Industry, Fashion Industry, Pharmacological Industry, Weight Loss Industry, Medical Care Industry, Health Publication Industry.
The obsession listed above causes a tremendous bias and distortion in everything that people and professionals do as related to the pursuit of personal health and well being.
Robison, a Michigan State University health behavior researcher has listed four areas of concern:
"Obesity is the second leading cause of preventable death in the United States, exceeded only by cigarette smoking, and it contributes to 300,000 deaths annually." This or a similar quote has been repeated in almost every major health related journal in America. The original article that served as the source for this often repeated statement was in The Journal of the American Medical Association (JAMA) 1993, "Actual Causes of Death in the United States". If you actually read the original article, here is the actual quote, "Dietary factors and activity patterns that are too sedentary are together accountable for at least 300,000 death per year." The data listed in the article do not include anything about weight. There has been a leap of cultural bias that has been restated by thousands of well meaning helping professionals, led by our former Surgeon General, C. Everett Koop.
The authors of the original article have written a letter to the New England Journal of Medicine, asking people to stop using the above listed misquote.
If you look at all articles that have focused on the issue of weight and mortality, you will find that about 75% of the articles show that there is no relationship between moderate increases in weight and increased mortality. Glen Gaesser's book, "Big Fat Lies, the Truth About Your Weight and Your Health" has summarized the research on this issue. A quote, "It now seems evident that in America today the real risks to health and longevity are more likely to come from dieting, than from stable weights that are over those recommended than the height-weight tables."
As we have mentioned height-weight tables, here is a direct quote from Ansel Keyes, the famous human nutrition researcher for whom the K-rations are named. "They are armchair concoctions starting with questionable assumptions and ending with three sets of standards for body frames that were never measured, or even properly defined."
Research also shows that body weight is not related to atherosclerosis. Numerous angiographic and autopsy studies do not support a relationship between increased weight and atherosclerosis. This is not what most of us have been taught in our graduate schools and medical schools. We have to be courageous, and look with an open mind at the meta analysis research that has been done on these issues. Could it be that there really is a bias that has affected the faculty who taught us all?
The vast majority of large people do not have high blood pressure, high cholesterol or diabetes. It is possible there is a subset of large people who have a separate reason for the incidence of diabetes, increased blood pressure or atherosclerosis.
There are numerous articles that are challenging the benefits of weight loss. The total impact of the actual outcomes of promoting weight loss is not clear. The psychosocial effects and the physical effects may actually create negative outcomes for the individuals who are not likely to be able to maintain their weight loss over time.
An editorial article by two editors of the NEJM published Jan.1st, 1998, in the New England Journal of Medicine entitled, "Loosing Weight, An Ill Fated New Year's Resolution" states, "The data linking overweight and death, as well as the data showing the beneficial effects of weight loss are limited, fragmentary, and often ambiguous. .... Until we have better data about the risks of being overweight and the benefits and risks of trying to loose weight, we should remember that the cure for obesity may be worse than the condition. .... We should also speak out against the public obsessive infatuation with being thin and the extreme, expensive, and potentially dangerous measures that are taken to attain that goal. .... Many Americans are sacrificing appreciation of one of the great pleasures of life, eating, in an attempt to look like our semi-starved celebrities. Countless numbers of our daughters and increasing many of our sons are suffering immeasurable torment in fruitless weight loss schemes and scams, and some are losing their lives."
There is no documented evidence of weight loss programs being successful. NIH reports state, "Short term weight loss happens, but 2/3 of the weight lost is regained within one year of completing the program and almost all by 5 years." Almost everyone agrees that there is a 95% failure rate. Could it be that we are
failing to follow the old medical adage, "First, do no harm." Robison has helped with the following website entitled, First, Do No Harm, that provides guidance for those interested in a new way to look at weight issues. ( http://www.msu.edu/user/burkejoy/index_2.htm )
The panel that issued that statement was well represented by the industries involved in weight loss programs and services.
Research has suggested that weight cycling may actually be worse for humans than the extra weight. Since the failure rate for sustained weight loss is close to 100%, are we actually harming more people by continuing the myth that weight loss is desirable. Any serious outcome researchers would have to question our efforts.
Eating disorders, disordered eating, self loathing, and all the psychosocial trauma induced by the "American Obsession with Thinness" can only be changed if we professionals flip a switch in our own heads, and begin to speak out with a strong voice about the harm that is being done by perpetuating the myth of the unrealistic goal.
Surveys show that up 50% of young women are dieting at any given time, even though half of them are already at normal, healthy weight. Coaches, parents , peers and the media are all focused on an unrealistic goal. There is an obsession in the media that creates an unrealistic image in the minds of our daughters. One study showed that 60% of 4th grade girls weighed themselves every day and wished they were thinner. Studies have shown that children despise fatness in other children. Children can be merciless in name-calling larger students, from grade school through college.
If you actually browse through the popular magazines that are read by young people, you will be amazed that there are very few pictures of normal weight people, let alone a range of body types that would represent the bell shaped curve you would expect in any biologic system.
Magazines and movies use computer assisted photo-editing to create pictures of people who don't even exist in real life. This would be alright if there was some truth in media notice that would let young people know that these are just artistic representations of unrealistic body shapes.
Young girls are smoking more than young boys. Some studies have shown that children, even in grade school, have low acceptance for the heavier or larger children. A Newsweek article reported that 11% of the parents surveyed would consider aborting a fetus that was predisposed to be obese. I wonder what would happen if those parents already had a larger child.
Recent data shows that 18% of high school girls admit that they have binged and purged. Many girls, 21% in recent surveys smoke to control weight. Many tobacco brands that target women include the words "slim" or "thin" in their name or marketing materials.
It is time for a new health statement regarding weight. We need to tell people that there is no advantage to changing your size and shape for health reasons. We need to help people recognize that negative self-esteem and eating disorders may be associated with attempts at weight loss.
We need to encourage people to develop a more balanced life that includes dramatic increases in activity. This is not an emphasis on exercise prescriptions, but more likely increasing regular daily activities.
Robison has offered this definition of healthy weight, "The healthy weight is a weight at which a person's body settles as they move toward a more balanced, healthy lifestyle. It cannot be determined by height-weight charts, it cannot be determined by underwater weighing, it cannot be determined by infrared technology, it cannot be determined by bio-electrical impedance, or by skin folds or by any other technological assessments. It is only determined by the weight the person comes to after they have adopted a healthy balanced lifestyle."
The challenge to all professionals will be to accept that the vast majority of weight loss programming has been a total failure, and worse yet may have contributed to the obsession that is harming the self concept of thousands of American men, women and children.
Steve Blair, the main author of the Surgeon General's Report on Physical Activity, has emphasized that physical activity is much more important than weight if you are interested in increasing longevity and quality of life.
Thomas More, in his book, Care for the Soul has said, "We are told how much time to spend at a certain exercise, what heart rate to aim for, and which muscle to focus on. If we could loosen our grip on the mechanical view of our own bodies and the body of the world, many other possibilities might come to light. Body exercise is incomplete if it focuses exclusively on muscle and is motivated by the ideal of a physic unspoiled by fat."
We need a clearinghouse for undistorted health news that Americans can use.