Re: Obesity 'epidemic': Who are you calling fat?

From Medscape General Medicine
Letters
Author's Reply to "Readers Respond to '"End the War on Obesity: Make
Peace With Your Patients'"
Posted 03/06/2007

Linda Bacon, MA, PhD

To the Editor,

Resistance to my Webcast, "End the War on Obesity: Make Peace With
Your Patients,[1]" is not surprising. It is considered self-evident
that many of us are too fat; that excess weight contributes to
increased morbidity and mortality; that weight loss is necessary,
sustainable, and associated with significant health improvement; and
that failure to deal with our obesity "epidemic" portends an
unprecedented public health disaster. These beliefs are so deeply
ingrained in our cultural landscape that most people view weight
control as the normal, right thing to do, and, like Dr. Miller,[2]
dismiss challenges without even considering the evidence. When we
actually examine the scientific research, however, we find that all of
these assumptions are flawed or at least highly exaggerated. My
proposal -- that we practice evidence-based science -- hardly seems
heretical.

Dr. Miller chose to ignore many of the arguments that I presented; in
particular, he did not acknowledge my statement regarding confounders
marring the epidemiologic research. He falls for a common error in
interpreting epidemiologic research, assuming that association means
causality. I'd like to add an additional example of a confounder not
provided in my initial piece -- that physicians' prescribing weight
loss may play a larger role in causing all of the concerns that he
lists than the adiposity itself. For example, it is well documented
that prescriptions for weight loss frequently result in weight cycling,
[3] and that weight cycling increases risk for cardiovascular disease.
[4,5] Numerous studies have documented that obese women face negative
attitudes from physicians,[6-8] and physician attitudes toward weight
are a chief barrier to obtaining healthcare.[9] Women report avoiding
or delaying medical care to steer clear of being weighed and given a
weight-loss lecture.[10] All of these contribute to a higher rate of
medical concerns.

A short primer on some of the obesity myths, complete with references,
called the Health at Every Size Manifesto, is available for free
download from my Web site: www.lindabacon.org. Numerous other
extensive exposés have been written, among them Fat Politics by Oliver,
[11] Diet Myth by Campos,[12] The Obesity Epidemic by Gard and Wright,
[13] Big Fat Lies by Gaesser,[14] and Diet Nation by Basham and
colleagues.[15] I also have a book on this topic forthcoming.[16]

Regardless of one's willingness to challenge assumptions, I expect
that many are in agreement with the most damning criticism against the
"war on obesity": It just isn't working. Fortunately, there is another
alternative that is effective. A randomized clinical trial, conducted
by my colleagues and me at the University of California, Davis, found
remarkable benefits to supporting body acceptance and healthy
behaviors as opposed to promoting weight loss and dieting. Our results
showed that "obese" women can learn to enjoy their bodies; trust and
respond to their appetites; and see marked improvements in eating and
activity habits, self-esteem, blood pressure, LDL [low-density
lipoprotein], and more -- even in the absence of weight change.[17]
This is in sharp contrast to the results seen in the control group
dieters. Consistent with hundreds of other studies, the dieters' short-
term weight-loss and health improvements were reversed over time --
and their self-esteem plummeted.

As has been said many times before, the road to health and happiness
is wide enough for everyone. I urge physicians to challenge their most
basic assumptions about weight, to stop prescribing weight loss, and
to support all patients in adopting healthy lifestyle habits,
regardless of their size.

Linda Bacon, MA, PhD

http://www.medscape.com/viewarticle/547543


* * *
I certainly agree that very few people are able to lose weight and
keep it off over the long term. What's being done now obviously isn't
working. If dieting worked, Jenny Craig and Weight Watchers would not
be able to stay in business. A new approach is needed.

Marilyn
.

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