Experts from The Association for the Study of Obesity on the Island of Ireland (ASOI) explain the frequent errors in discourse on obesity, and the stigma attached to it
A myth is a commonly held but inaccurate belief. Like many other diseases that have been associated with lack of knowledge, misunderstanding and false information, the many ‘myths’ about obesity have resulted in people living with this disease having to deal with bias, stigma and discrimination on a daily basis.
If we read more about how the human body controls weight, we will understand that we have a lot less control over weight loss and weight gain than many people think. Consider how much control you have over other basic body processes like breathing and body temperature, and you can start to understand that although we do have some influence over weight regulation, our genetic hard-wiring and individual biology are really in charge.
We are surrounded by magazine articles and social media adverts selling us the latest plan for weight loss. This is based on the assumption that all we need is to have enough willpower to stick to these plans. But the scientific understanding of energy balance, weight regulation and obesity does not support this assumption. Obesity is a complex neurobiological disease. Individuals with a strong genetic predisposition are more likely to gain weight and develop health problems in the ‘health-disrupting’ world we now live in.
When the systems that regulate weight are disrupted by biological and environmental factors, these adaptations drive weight gain. Willpower cannot overcome this disruption, just as we do not expect willpower to overcome other disease processes such as cancer and heart disease. We need to treat obesity as we treat all other diseases, using scientifically proven, evidence-based interventions, including behavioural support, medications and bariatric surgery.
Body mass index (BMI) has been used for many decades as a measure of weight and height, that indicates if a person has a “healthy weight”. Obesity was defined as having a BMI of over 30kg/m2. However, while a higher body weight can increase the risk of some health problems, the reality is that people come in all different shapes and sizes, and living in a larger body does not necessarily mean a person is unhealthy or that they have obesity.
The new definition of obesity does not include weight or BMI. Obesity is defined by excess or dysfunctional fat tissue, causing impaired health. And that is health in its broadest sense — metabolic health, functional health, mental health, and the ability to participate in society. If any of those health issues relate to excess weight, then we should assess further and consider a diagnosis of obesity.
If we focus on body size in obesity care, then the number on the scales is all that matters. However, if we focus on obesity as it relates to health gains, then it really opens up the conversation about how we define success.
Health gains are more important than absolute weight loss in obesity treatment. Depending on the individual, we might look at improvements in movement and function, eating patterns and dietary quality, changes in energy levels and mental health, improvements in blood pressure and signs of inflammation. Or to put it more simply, our goals should include feeling healthier and happier.
Research suggests that improving physical fitness can, in some cases, compensate for the potential negative effects of excess weight — even if weight loss is small or if weight is just maintained. This shows that weight is certainly not the ‘be-all and end-all’ for health that we make it out to be.
Bariatric surgery is sometimes seen as a ‘cure’ for obesity but obesity is a complex chronic disease that does not have one solution. Bariatric surgery is a very effective treatment option for obesity and can be associated with remission of many diseases such as type 2 diabetes and sleep apnoea, and reduced mortality from many causes.
However, short- and long-term responses vary in different people, and if the factors contributing to weight gain before the surgery are not addressed, people can have significant weight regain in the months and years after surgery.
There are many reasons that feelings of hunger and cravings can increase again, and some people will need behavioural and psychological support and/or the support of weight management medications in the years following bariatric surgery.
The old ‘tough love’ approach was often seen as a way to talk to people with obesity. But shaming people does not help. In fact, studies show the opposite. Shaming people is associated with a variety of emotional, behavioural and physical responses including increased stress levels, low mood, unhealthy relationships with food and being more sedentary. Rather than motivating people to lose weight, shaming actually increases a person’s risk of weight gain and poor health.
In addition, shame has been shown to impact whether or not people engage with services they are entitled to, including healthcare appointments. This can result in missed screenings or diagnoses for conditions which could be treated earlier and could help prevent more serious health issues in the long term. People living with obesity deserve the same support, care and compassion that is given to all people living with chronic diseases.
This article was written by Dr Cathy Breen, Dr Jean O'Connell, and Mary E Davis, from The Association for the Study of Obesity on the Island of Ireland (ASOI). For more, see asoi.info