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We have got to take the morality out of the discussion about body weight. After seven-plus years immersed in the field of Obesity Medicine, treating patients affected by this terrible disease, it’s painfully obvious to me. Yet, every time I read articles about excess weight or scan through comments that others make, I’m reminded that so many people still have the two issues tightly linked together.
Having excess weight does not equate to having a character defect.
The way we refer to people with excess weight is often incredibly judgemental and condescending. Fixing that problem is going to be difficult. However, even more concerning to me on a daily basis is the way that people refer to themselves. We are often much harder on ourselves than we are on others.
I am constantly correcting patients when they say how they were BAD last week or BAD since their last visit. I usually correct them to something like, “you had too many weight-positive moments last week” or “your food priorities shifted from health to pleasure since your last visit.”
Eating donuts or french fries doesn’t make someone BAD. Heck, the act of eating donuts or french fries isn’t BAD. If you want those decisions to cause weight loss, you are barking up the wrong tree, but my guess is that rarely do you eat those things expecting them to improve your health. You eat them for other reasons.
Eating donuts brings back fond memories of my childhood and my dad. Eating donuts is good for my brain when I’m missing my dad and need a pleasant reminder of childhood moments. The decision to eat donuts is not BAD. It’s good if it triggers me to remember him fondly and maybe even call him up to chat.
It’s not a weight loss decision or a health decision or something that’s going to improve my long-term risk of developing cardiovascular disease, but it’s not universally BAD nor am I a BAD person for doing it
If I were to eat donuts expecting them to improve my weight or health, it would be an inappropriate decision – one borne of ignorance or denial – but it still wouldn’t be BAD.
It’s time to reframe our idea about weight. Obesity is a chronic, progressive, multifactorial disease. Over ⅔ of American adults are struggling with excess weight. We have infants and toddlers struggling with excess weight. If excess weight is a moral problem, do we have an epidemic of immoral, BAD humans in our country? Are we somehow making BAD children nowadays? Contrary to what we all had drilled into our heads, excess weight is not simply a result of sloth and/or gluttony. This calorie-balancing theory that we all memorized is about as accurate as the idea that the world is flat because you can’t see the curve on the horizon. Excess weight isn’t about energy (calories) consumed or energy burned (they are variables, of course) but rather, excess weight is about energy STORED. And storing energy is about as moral or immoral as peeing. We all store energy. We store it differently – in different places and at different rates. We are triggered to store energy by different things. Our hormones trigger us to store or release energy. Our sleep duration causes us to store or release energy. Our food intake causes us to store or release energy. Our stress level causes us to store or release energy. None of that is good or BAD – it just is. Beating ourselves (or others) for storing energy incorrectly is silly. It’s about as illogical as beating ourselves (or others) up for peeing wrong. Ponder this: some of us hold our bladders until they are about to burst, choosing to ignore the sensation to pee in order to keep working or keep driving or to avoid public restrooms Sometimes these peeing habits (or lack thereof) land us a bladder infection. Sometimes these peeing habits cause us to develop an overactive bladder. Sometimes our life choices cause us to leak pee when we laugh or sneeze or bend down to pick something up. Life choices like having babies or having excess weight or simply having our pelvic floor relax as we age. We don’t consider bladder infections or urinary incontinence to be a moral problem. Yes, our life choices play a role in the development of the problems and if we don’t change those life choices when we can, they may continue to exacerbate the problem, but they aren’t moral decisions that we refer to as BAD. Lots of things contribute to excess weight. Some of these things are life choices – like choosing to eat dessert after dinner every night or choosing to drink soda instead of water on a regular basis. Some of the contributors we can’t do anything about – like having been borne to a mother who had gestational diabetes. None of these things are insurmountable – there are certainly people who were born to mothers with gestational diabetes who don’t suffer from obesity, but they are contributing factors for some people.
Some of the contributors are due to misinformation – and this is the one that makes me mad. Eating a donut because it brings up fond memories with full awareness of the health and weight consequences is one thing, but eating sweetened yogurt and granola for breakfast because some commercial or advertisement told you it was “healthy” is just plain sad. Eating protein waffles with sugar-free syrup and washing it down with a sugar-free energy drink because some marketing genius convinced you it was “healthy” is criminal. Regardless, it doesn’t make you BAD – it just makes you misinformed.
There are lots of things that go into treating excess weight. None of them have to do with teaching morality or goodness. Identifying weight-positive behaviors and circumstances and foods and medications and doing what we can to move them to more weight-neutral or weight-negative options is a huge part of what we do. Sometimes making these shifts is difficult and sometimes they aren’t that difficult – that’s where the practice of medicine comes in.
That’s the story behind the practice of Obesity Medicine.