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“To win, we have to lose.” This was the tagline of the HBO documentary series The Weight of the Nation, which aired last week. The program described the “obesity epidemic” and encouraged overweight Americans to join the challenge to slim down to a healthy body mass index (BMI). The program was done in an unprecedented collaboration with the Institute of Medicine (IOM), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). Pretty solid, right? The problem is: Overweight does not necessarily equal unhealthy. The HBO program, along with many doctors and health care professionals, espouses a one-size-fits-all notion of body weight and health. Specifically, it promotes the idea that people must be within a specific narrow BMI range (18.5-24.9) to be healthy. This is problematic, because despite what the media would have us believe, people can be both overweight and healthy. People can also be average weight and unhealthy. Body weight and associated medical co-morbidities are complex and do not affect everyone the same way. For instance, someone who has had a stable BMI of 30 for most of their life, who eats a balanced diet, and exercises regularly is likely to have a very different metabolic profile than someone whose BMI has steadily increased to 30, who regularly overeats, and leads a sedentary lifestyle. Dr. Arya Sharma from the University of Alberta has developed the Edmonton Obesity Staging System (published in the International Journal of Obesity in 2009) to classify obesity based on medical and psychological co-morbidities rather than simplistically using height and weight. In a 2008 blog post, he states: “recent epidemiological studies emphasize that good health including low morbidity and mortality is possible over a wide range of BMI. Thus, basing the decision on who to treat and who to leave well alone solely based on measures of weight or size is neither sensible nor does justice to the complexity of the relationship between excess body fat and its impact on health and well-being.”
The one-size-fits-all theory of health encourages people of varying body shapes and sizes to contort their bodies to fit into one mold. For many people, try as they might, attaining this ideal body weight is impossible and leads to considerable anguish and torment. They diet, starve themselves, eat only cabbage soup for weeks, detoxify with juice cleanses, force themselves to vomit, abuse laxatives, inject themselves with foreign substances, put nasal-gastric feeding tubes into their bodies (read my previous post on this), and spend much of their time ruminating over what to eat, what they did eat, what they should have eaten, and how they look. More often than not, dieting only leads to overeating and weight regain after the diet has been broken. The pressure to look one particular way and related attempts to restrict food intake causes us to lose connection with our body’s natural signs of hunger, satiation, and fullness. It is nearly impossible to eat mindfully when we are eating according to a diet book instead of our bodies. The focus on the “obesity epidemic” instills a fear of fat in our society and perpetuates the notion than thinner is better. While it is important to disseminate information on leading a healthy lifestyle, the focus on body size as an indication of health — rather than health as an indication of health — leads to a preoccupation with body weight. Rather than an “obesity epidemic,” I believe that we have a “disordered eating epidemic,” which is costing our citizens and health care system dearly.
