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Prejudice is impeding anti-obesity efforts, experts say

Lynn McAfee, director of medical advocacy for the Council on Size and Weight Discrimination

The stigmatization of obesity — the idea that obese people have only themselves to blame for being fat — is not just “the nation’s last, accepted form of prejudice,” it’s also a major barrier to getting the obesity epidemic under control, writes science reporter Sharon Begley, now with Reuters, in a provocative article published last Friday.

“As long as we have this belief that obese people are lazy and lacking in discipline, it will be hard to get support for policies that change the environment, which are likely to have a much larger impact than trying to change individuals,” psychologist Rebecca Puhl of the Rudd Center for Food Policy & Obesity at Yale University in New Haven, Connecticut, told Begley.

Blaming individuals also makes it less likely that people who are obese will seek treatment for their obesity and related illnesses. “Targets of stigma often fall into depression or withdraw socially,” writes Begley. “Both make overeating, binge eating and a sedentary existence more likely, studies show.”

Studies have also shown that health-care professionals hold more negative attitudes toward their patients who are obese and, as a result, often spend less time with them during office visits and tend to not counsel them about a healthy lifestyle. These negative attitudes may keep obese individuals from seeking treatment for diabetes, research has found.

Delaying care to avoid lectures

“Patients are afraid of hearing, ‘you’re fat,’ or ‘just lose weight,’ as if it were that easy,” Elizabeth Teixeira, a nurse practitioner at Drexel University who specializes in diabetes, told Begley. “I’ve had patients tell me they delay seeking care, even having their blood pressure or glucose checked, because they don’t want to be lectured.”

A Reuters/Ipsos poll taken earlier this month found that 61 percent of Americans believe that the main cause of the obesity epidemic is “personal choices about eating and exercising,” and 49 percent believed that it was OK for insurers to charge obese people more for health insurance, Begley reports. Only 19 percent of the poll’s respondents pointed to food manufacturers and the fast-food industry as the key source of the epidemic.

Yet, as Begley also points out, the more we blame individuals for their weight problems, the more our girths expand. Some 36 percent of Americans (73 million adults and 12 million children) are currently obese in the United States. As a government report noted last week, that percentage is projected to rise to a stunning 42 percent by 2030.

Current efforts are failing

Obviously, our current anti-obesity efforts, which focus on changing the habits of individuals rather than of society, are not working — something the public health community, if not the public itself, has come to realize. Writes Begley:

The belief that obesity reflects personal decisions implies that the solution, too, should be personal: Eat less, move more. But as the Institute of Medicine argued [last] week, the most effective way to combat obesity is to change the environment.

For average American adults, willpower is no match for “an environment in which we are constantly bombarded by food and food cues,” said David Kessler, former head of the Food and Drug Administration and author of the 2009 book, “The End of Overeating: Taking Control of the Insatiable American Appetite.” “Lecturing people doesn’t work.”

The IOM recommended building sidewalks to make it easier for people to walk, banning sugary drinks from schools and requiring 60 minutes of daily exercise in grades K-12, reducing portion sizes in schools and restaurants, and making low-cal choices widely available and as affordable as super-sized ice cream cones. Most important, it concluded, was changing the “messaging,” including the ubiquitous marketing of calorie-dense food.*

Fat stigma makes those ideas ripe for attack by an industry that says how much to eat and move reflects individual choice. The restaurant- and food-industry-funded Center for Consumer Freedom called the IOM “arrogant and absurd” for suggesting “that Americans are too stupid to make their own food choices.” By proposing to keep unhealthy, calorie-dense food out of school lunch programs, it said, “food nannies” like the IOM are “flatly arguing against consumers having any choice in their snacks and meals.”

Ideologically driven?

Interestingly, research suggests that the stigma against people who are obese is often driven by political ideology. Writes Begley:

Psychologist Chris Crandall of the University of Kansas has found that young adults who stigmatize obesity tend to be more ideologically conservative, favoring traditional sex roles and capital punishment, his studies found.

“Particularly in America, self-determination and individual choice is a fundamental value,” he said. “We blame people for everything that happens to them — being poor, being obese. It’s the ‘just world’ idea that people get what they deserve.”

The stigma is less pronounced in countries such as India, Mexico and Turkey, whose cultures assign more collective responsibility for personal outcomes, Crandall found. His studies, going back to the 1990s, surveyed hundreds of people worldwide about how closely they associate obesity with adjectives such as lazy and stupid.

Americans also stand out in their conviction that hard work and determination lead to success, while failure is due to lack of effort.

“Being thin has come to symbolize such important values as being disciplined and in control,” said Yale’s Puhl. The converse: If someone is not thin, he must be lacking in those virtues.

You can read Begley’s article on the Reuters website. You’ll find the IOM report here.

* As science reporter Gary Taubes and others have noted, reducing calories alone may not be enough. Research suggests that not all calories are alike when it comes to creating new fat cells and that calories from sugars and other carbohydrates may be the most important  factor behind the obesity epidemic.

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Comments (6)

  1. Submitted by Susan Lesch on 05/14/2012 - 01:11 pm.

    Accepted form of prejudice

    You are right, Begley did write “It may be the nation’s last, accepted form of prejudice.” Which is really something considering that a year ago the U.S. said women earn 75 cents for every dollar earned by a man.

  2. Submitted by Ray Marshall on 05/14/2012 - 04:33 pm.

    Fat-ness

    I think that the major reason for the campaign is that thin people can’t stand to see fat people (like me). They don’t care if we die young (I’ll be 70 in a couple of weeks).

    It’s interesting how many thin people die young, too.

  3. Submitted by Darliene Howell on 05/14/2012 - 09:55 pm.

    Diets Don’t Work

    Studies show that dieting, even that considered “naturalistic”, among young people lead to weight cycling [Naturalistic weight reduction efforts predicted weight gain and onset of obesity in adolescent girls; http://ebn.bmj.com/content/3/3/88.full%5D

    There is an evidence-based compassionate alternative to conventional dieting: Health At Every Size®. Please consider this alternative prior to making a decision that may result in weight cycling.

    For more information on Health At Every Size, you can find a general explanation on Wikipedia (http://en.wikipedia.org/wiki/Health_at_Every_Size) or find in-depth research-based information in the book Health At Every Size – The Surprising Truth About Your Weight by Dr. Linda Bacon (http://www.lindabacon.org/HAESbook/).

  4. Submitted by Ann Spencer on 05/15/2012 - 09:56 am.

    Don’t forget the contribution

    of the public health community to this epidemic. For years, people were told that fat was the enemy and carbohydrates were fine. As a result, the market was flooded with low-fat and no-fat products that replaced fat with carbohydrates, often high fructose corn syrup or other sweeteners.

    As someone who has never lost an ounce without vigorous effort, I know that the simple-sounding “eat less and move more” mantra is not easy in practice. I’ve recently lost a lot of weight and keeping it off requires constant attention. Each meal, each occasion where food is offered, is fraught. I have to think about everything I put in my mouth, day in and day out. I refuse to judge fellow human beings who fail at this struggle.

    The quotation above from Professor Crandall is very profound; the belief that “people get what they deserve” underlies much of our current political debate, not just discussions of obesity. Opposition on a variety of issues, from health care reform to mass transit to raising taxes on high incomes, is rooted in that time-honored conservative belief that “what is, is right” and that individuals are responsible for their own bad luck. We haven’t come that far from the era of Charles Dickens when orphans were considered to blame for their parentless status.

  5. Submitted by Lance Groth on 05/18/2012 - 03:21 pm.

    HGI Carbs, Sedentary Lifestyle

    That’s the modern obesity problem in a nutshell. I speak from experience. High glycemic index carbs coupled with insufficient physical activity leads to weight gain, insulin resistance syndrome and ultimately type 2 diabetes.

    Read the labels on almost anything except fresh produce in the grocery store, and what do you see as one of the primary ingredients? Sugar, usually high fructose corn syrup. It’s in everything, even meat products like sausage, and I find that to be outrageous. HFCS should be banned – it offers no nutritional value and simply pumps up the HGI carb content of the food, and is frankly a public health threat in a nation of overweight people. The “sugar is sugar” commercials for the rebranded “corn sugar” (HFCS) are a lie.

    Here’s another hint: Why is beef bad? The answer is, it’s only bad if it’s beef raised and finished on grain, mainly corn. Cattle are supposed to eat grass, and grass fed beef (or better yet, bison) does not clog your arteries, and indeed contains omega-3’s. It’s being stuffed with corn that makes them fatty and clogs your arteries. If it does that for cattle, why would anyone think corn is good for people?

    Karin is right about life on the farm in the old days. I grew up in rural Minn, and although I was a “town kid”, I had many farm friends and would sometimes spend weekends on their farms. I remember being shocked at the size of the meals they ate. The noon/1:00 meal (“dinner”, the evening meal was “supper”) was like a thanksgiving feast, every day. But the reason was they burned it all off with physical activity by the time the next mealtime came. I was also daunted by how hard they worked – I tried to keep up, but often felt like I was more of a hindrance than a help to them. No one works harder than a farmer. No wonder the farm kids were always the strongest kids.

    Today, people still ingest carbs like they’re working that hard (often hidden carbs, like HFCS), but don’t burn it off.

    As for those who look down on overweight people and think they’re lazy, they simply have no idea what they’re talking about, and they ought to be grateful that they haven’t had the same experience. By the time insulin resistance sets in, weight loss becomes exceedingly difficult. The threshold for carb intake without weight gain drops to a very low level, due to constant high levels of insulin in the blood. For me, my threshold is about 30 grams per day. More than that and I can’t lose weight. More than 50 or 60 and I gain. Very low carb is the only way to manage it without medication. It does illustrate, however, how few carbs are genuinely necessary to the body, and how most people eat vastly more than they need.

    Keep moving, and get rid of the HGI carbs. Eat green veggies, proteins and moderate amounts of fats and you’ll be fine.

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