What public health gets wrong by focusing on weight

On food

When I was getting my Masters in Public Health a decade ago, I observed a certain level of what could be considered hypocrisy. On the one hand, our eyes have been opened to the social determinants of health — Centers for Disease Control and Prevention defines as “conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes and quality of life”. On the other hand, we were told about the “obesity epidemic” and how encouraging fat people to eat less and move more would make them look leaner and healthier. (I use fat as a neutral descriptor, like short, tall, or thin).

Never mind that this form of “personal responsibility” rhetoric is dubious at best. For instance, in 1992, a group of experts brought together by the National Institutes of Health determined that when people intentionally lose weight, “one-third to two-thirds of the weight is regained in one year, and nearly all of it is regained in five years.” A 2007 review by UCLA researchers found that one to two-thirds of dieters regain more weight than they lost, and that “there is little support for the idea that diets lead to lasting weight loss or benefits for health”.

I’ve heard more than one public health expert recognize all of this and then say something like, “Well, we still have to encourage people to keep trying. Perhaps gloomier is the case of CDC researcher Katherine Flegal, who found herself the target of an aggressive smear campaign by a prestigious school of public health after she published research in 2005 concluding that “overweight was associated with fewer excess deaths than being “normal weight. She detailed these attacks in her 2021 article, “The War on Obesity and the Training of a Researcher: A Personal Account.”

For years, governments and public health departments have created “anti-obesity” task forces and public health campaigns. Unfortunately, these efforts have been more harmful than helpful, as the stigmatizing messages used in many of these campaigns have fueled anti-fat prejudice – or weight stigma – in all corners of society.

In their 2018 article, “What’s wrong with the “war on obesity”?“Public health researchers Lily O’Hara and Jane Taylor have written, ‘In bitter irony, there is evidence for a direct causal pathway from weight stigma to weight gain, with or without changes in eating behavior. as a mediator, demonstrating that … a fat-hating environment makes people fat.

The fat bias increases levels of the stress hormone cortisol, which contributes to weight gain but also directly harms health. While the “war on obesity” can affect everyone by encouraging shame for being fat or afraid of become fat, the greatest harms are to people who are already fat and experience hostility, discrimination and oppression when navigating a physical environment designed for thin people. If you identify as female, low-income, disabled, or a member of any other marginalized group, these effects are amplified, leading to greater health inequalities.

Fortunately, there are signs of change. One is a guidance note titled “Public health must dissociate weight and healthfrom the University of Illinois at Chicago School of Public Health Collaboratory for Health Justice, who said, “If the goal is to find the most ethical and effective strategies for achieving optimal public health, it must there be an alternative to “obesity” and weight. targeted approaches and a shift in the understanding of weight stigma as a social justice issue.

It’s true. Weight stigma, or anti-fat, is a social justice issue. Full stop.

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