It's all about finding the right balance.
Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight—And What We Can Do About It
By Harriet Brown
Da Capo Press. 243 pages.
He who loses weight lives a long, healthy life.” For many years, patients in my father’s medical practice routinely went home with a free pen stamped with that fortune-cookie-like prescription. Call it a rallying cry or a nag, but presumably that pen was a reminder to patients to substitute apples and grapes for ice cream and cake on their grocery lists.
That was the 1960s. Fifty years later, almost every physician you visit will still advise you similarly, though probably without the free pen. But do we know a lot more now than we did then about what actually constitutes a healthy weight range for a given individual? What practical knowledge has research really given us about how to lose weight and keep it off without feeling like an abused yo-yo? Despite the proliferation of research studies about weight loss and eating habits, it often appears that many fundamental questions about what to eat or not to eat and why or why not remain unanswered.
Into the fray comes science journalist Harriet Brown with Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight—And What We Can Do About It. For Brown, learning to become “OK with [my] body as it is right now” has been a lifelong journey. But her larger goal in this book isn’t to write her own story as much as it is to push back against our society’s fixation on image and weight and our sometimes unconscious, too often blatant bias against those who are overweight or obese. (As defined by the National Institutes of Health, obesity is a body mass index above 30, and extreme obesity is 40 and above.)
In her overview of the psychological fallout of our collective fixation on body mass index and body shape, there’s a lot that Brown gets right. She correctly diagnoses our plight as a society so obsessed with weight we support a diet industry that, according to ABC News, brings in revenues of $20 billion a year. She argues powerfully for the need to push back against weight-shaming. She advocates cogently for a new paradigm to transform how we think about our bodies and our body image.
In addition, Brown aptly captures how our thin-at-any-cost culture promotes an obsessive, warped relationship with the daily nourishment we can’t live without but whose caloric impact we often come to fear and mistrust. Her own life history dramatizes the agonies wrought by this double-bind. She opens her book with a recollection of herself, 20 years ago, desperately seeking a therapist’s help to regain control over a body she’d come to loathe for carrying excess pounds. She reveals that her daughter, while still quite young, nearly died from anorexic starvation. (Her daughter’s illness is the subject of Brown’s first book, Brave Girl Eating.) Brown shares some toxic anecdotes about her own diet-obsessed mother, who once “went so far as to fill an empty ice cream container with garbage and put it back in the freezer, where she knew my sister would open it. Inside, she placed a note reading, ‘Gotcha!’”
And she’s on the mark, too, in portraying the confusion caused by the barrage of mixed messages about food and weight that assault us daily. With medical researchers presenting a mixed and ever-changing bag of food groups to enjoy or avoid, the idea of eating wisely—whatever that is, according to the latest definition—becomes ever more perplexing. Dispirited by our latest diet experiment, our taste buds are forever ripe for temptation, especially when we’re bombarded by ads urging us to devour any number of high-caloric foods dense with fat, sugar, and salt (not to mention the seemingly guilt-free, so-called low-fat versions of forbidden treats). We almost inevitably indulge and then regret it as we watch the glamour parade of the lean-muscled, Photoshop-perfected bodies playing across media platforms everywhere, taunting our own imagined dumpiness. Quick, we panic, we’ve got to lose weight right now, courtesy of the latest miracle supplement, about whose efficacy and safety we usually know nothing at all.
So why am I so troubled by this book? Brown devotes considerable energy to demystifying what we think we know about the connection between weight and health, plowing through a mountain of studies that, in her analysis, reveal a message different from the one we’re used to hearing, one stripped of the assumptions held by what she calls the medical machine. And this is where her skepticism began to raise my skepticism about her assumptions.
To make her points, Brown consistently downplays the overwhelming medical evidence that confirms the negative health impact of being overweight or obese. In common with other contrarian food and diet journalists, she seizes on studies that question the direst correlations between health and weight in order to debunk what she calls common myths about the health risks of weight and obesity. But is she propagating a different misconception by minimizing the link between excess pounds and health problems? To answer that question, it’s important to look at how she presents her case and reaches her conclusions.
Brown does cite data showing that Americans in general are heavier now than in 1960. She does so in the service of knocking down a sensationalized media assertion that Americans are edging toward obesity. “About 20 percent of the population is much heavier than it was, but the majority of the population isn’t much heavier,” she quotes nutrition professor Linda Bacon as saying. The bottom line: “We’re certainly not all destined to become obese.” I guess that’s good news, but according to the National Institutes of Health, more than 35 percent of all adults over age 20 are now obese, and about 5 percent are considered extremely obese, and these statistics represent a significant increase since the 1980s. Should we ignore the potential health risks of this trend simply because it’s not as extreme as it could be?
Brown cites a slew of other studies and statistical analyses that challenge another generally accepted assertion that being overweight can shave close to a decade off your life. “For most people . . . weight alone is not strongly linked with mortality,” Brown concludes. To back her argument, she highlights the “obesity paradox” studies, which suggest an association between being overweight or obese with lower mortality risk, when compared with those who are underweight or of normal weight. This is, indeed, a controversial issue, with prominent scientists on each side, and the jury is still out on the implications.
But these findings don’t negate the well-documented links that exist between obesity and higher risks for coronary heart disease, high blood pressure, type 2 diabetes, and other serious ailments, whose progressive nature can severely affect the quality of your life. Brown spends energy explaining that these studies don’t show actual causes and effects—but they do demonstrate correlations, also known as risks.
Brown is less interested in those health risks, however, than in bolstering reasons to forego dieting. In her discussion of the psychology and science of dieting and keeping weight off, she emphasizes the potential harm to the metabolism (not to mention the psyche) caused by quick weight loss and the boomerang effect of quick weight gain. Sadly, far too many short-term weight-loss programs promise too much too soon, aim for unreasonable goals, and fail to gain any sustainable traction in people’s lives. And no wonder: they tend to deprive you of too many calories and foods to be enjoyable or satisfying, making dieting feel like a punishment. How long can anyone live with that?
Brown doesn’t mention the kind of gradual, slow-motion weight loss recommended by the Centers for Disease Control, the National Institution of Health, and any number of other highly respected medical organizations. This approach isn’t flashy, but it also has a better chance of success, because rather than overhauling the way you eat in one fell swoop (a sudden reorientation that’s difficult to maintain), it stresses small, step-by-step changes in lifestyle and eating habits that you can accept, live with, and incorporate for the long term. Unfortunately, rather than assess whether any weight-loss method works (or could work), Brown damns them all, with the repeated mantra that only 5 percent of dieters ever succeed in maintaining long-term weight loss.
Brown is also outspoken in her advocacy of the fat-but-fit theory: the idea that you can maintain health and fitness regardless of being overweight or obese. The good news is that enough research (and personal anecdotes) exist to demonstrate this is possible. But Brown’s book went to press too soon to include a major longitudinal study on the subject, “The Natural Course of Healthy Obesity over 20 Years,” which appeared in January in the Journal of the American College of Cardiology. Over the course of 20 years, British researchers tracked the body mass index, cholesterol, blood pressure, and other measures of metabolic syndrome and diabetes of approximately 2,500 men and women. By the study’s end, the researchers found, “Healthy obese adults were nearly 8 times more likely to progress to an unhealthy state” than healthy nonobese subjects.
In other words, although it’s possible to be fat and fit, staying fat and fit is the exception, not the rule: “The natural course of healthy obesity is progression to metabolic deterioration.”
This is significant because throughout her book, Brown provides examples of women and men who actually were at one point fat and fit, but who also, in about the same ratio as the British study, eventually abandoned their fitness regimen. Why? Many of the people in Brown’s accounts (and Brown herself) describe exercise and fitness routines as tedious and burdensome time-consumers, endured solely for the purpose of losing weight. She’s not saying that exercise doesn’t matter: it’s that she doesn’t emphasize fitness as a goal independent of weight and as a good in itself. And that assumption, to my mind, is one that needs to be questioned every bit as much as the crazy-making weight obsessions that plague so many of us.
The ultimate message of Brown’s book is the need to reframe our debate about weight loss. Agreed. But her way of doing that would be to forget about dieting and adopt instead a model of intuitive eating, which “encourages people to honor their appetites, reject dieting, respect their bodies, and pursue healthy behaviors regardless of weight.” She’s also a fan of the Health at Every Size (HAES) movement, which she describes as being “actually more focused on health [rather than on dieting] because it’s not chasing the red herring of weight loss.”
I’m not so sure. In my view, Brown’s new paradigm is as focused on weight as the old one, except with a reverse fixation on not dieting. To my mind, whether you can be fit and fat is not the question. It’s how to stay fit—which includes being mindful of the health risks that carrying excess weight can yield.
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