The War on Obesity: A War Worth Fighting?
A few days after the FNCE (the American Dietetic Association’s annual conference) dust has settled, I still find my emotions riled up about the very first session I attended. John Foreyt, renowned obesity research and Linda Bacon, Health At Every Size (HAES) clinical researcher and advocate stood head to head to duke out their views on the “obesity epidemic.” John Foreyt staunchly defended his position that the war on obesity is a war worth fighting and Linda Bacon asserted that this war we are waging is ineffective, misguided, and even harmful.
I cannot escape the fact that I write this post from a very biased point of view. I simply cannot give a neutral, objective review of the debate because my feet stand so strongly in the HAES camp. I use a non-weight focused approach in my nutrition counseling and I am a certified Intuitive Eating (IE) Counselor (which means I teach my clients how to respond to internal cues of hunger/fullness rather than dieting).
So, I questioned whether to write this post at all, knowing I don’t currently have access to a recording of the debate and my memory seems to have only held on to the pieces of Dr. Foreyt’s arguments that I found uniformed, inaccurate, and downright offensive. So despite all of this, I sit here writing my two cents, which are heavily influenced by my flawed memory, passion for a non-weight focused approach to health, and personal experience in my own clinical work (and in my own life).
I cannot adequately re-cap the 90 minute debate. But I will recount my top 5 assertions that Dr. Foreyt made that I whole-heartily disagree with. If you are interested in learning more about HAES and Linda Bacon’s perspective, keep reading. I’ll share some fantastic resources at the end of the post.
Top 5 Unscientific, Unsupported, Inaccurate Assertions made by Dr. Foreyt:
1. There are no negative side effects to yo-yo dieting and weight regain (except “some bad feelings like depression for some people.”)
If Dr. Foreyt had properly done his homework, he would have known that dieting is the #1 PREDICTOR OF FUTURE WEIGHT GAIN! See here and here for two examples. And I think it’s a bit crazy for him to undermine the negative mental health consequences that are a by-product of weight cycling. Anxiety, depression, and chronic self-esteem issues are serious concerns. He treated them like nothing more than a pesky skin irritation, when in fact mental health problems are like a deadly form of cancer; challenging a person’s ability to live with a quality of life everyone deserves. We cannot minimize the effects of re-bound weight gain and mental health challenges.
2. Some of your clients will be failures and some will be successes. That’s no reason to stop trying to diet and lose weight. Just keep trying.
Whoa, hold it right there. I cannot stomach the notion that anyone I work with is a failure. But I suppose if there is only one way to measure success that might be the case. If there was a chemotherapy treatment that created more cancer than it eliminated, would we keep using it? No. So why do we keep using the same methods for weight control when the research shows that a weight-focused approach leads to more weight gain? I have learned something magical in my work. When I take the focus off the scale it allows me and my clients to work on core issues which affect body weight, food choices, and self-esteem.
3. Intuitive Eating is a cause of today’s obesity epidemic. Intuitive Eating doesn’t work.
#1 I about jumped out of my chair when Dr. Foreyt stated this. How on earth can he say that Intuitive Eating contributes to obesity when virtually no one in the US practices it?!? Not practicing Intuitive Eating is THE REASON most people struggle with food and many carry more weight than they naturally would.
#2 The principles of IE are often misconstrued or improperly applied. Dr. Foreyt, have you read the book or the research on IE? It is not eating with reckless abandon. No, quite the opposite. It is eating what you want in response to physical cues for hunger/fullness, while attending to emotional needs without using food. I cannot fathom how this can lead to increased rates of obesity.
#3Please see the IE website, where there is research showing the effectiveness of IE.
4. Dieting does work.
Unfortunately, every long-term clinical trial aimed at reducing body weight by placing clients on a specific diet that I’m aware of results in the lovely “J-Curve.” The J-Curve illustrates rapid weight loss, followed by creeping weight gain over time. The LOOK AHEAD trial, led by Dr. Foreyt is an interesting example. Like all obesity research, interventions like a healthier/reduced calorie diet and exercise protocols are given. Consequently, weight decreases but a whole slew of other parameters improve (ie blood sugar, fitness levels, cardiovascular health). What’s really fascinating is that the decrease in weight is sometimes quite small, like less than 10 pounds. But the researchers always cite the improved parameters secondary to weight loss, rather than a natural consequence of eating healthier and moving more. Why the focus on weight loss?
Many people love to cite the National Weight Control Registry as an example of permanent/lasting weight loss. Dr. Bacon informed us that weight loss must only be maintained for 6 months in order to be added to the registry, with no clear way to have your name removed if you have re-gained your weight. Dr. Bacon shared a story of a student whose name is on the registry, but has since gained back more weight than she lost and hasn’t been able to remove her name from the list. The weight loss research we have shows the majority of lost weight gained after two years. So the National Weight Control Registry may not be a reliable measure of successful “losers.”
5. It’s better to be skinny than fat.
Again, Dr. Foreyt needs to check the research because it actually shows that the life expectancy for a person who is categorically overweight but exercises regularly is longer than someone of a “normal weight” and doesn’t exercise. Having dedicated my career to working with eating disorders, I can promise that it is better to be healthy inside and out regardless of your body weight. Being thin is absolutely no guarantee than you are healthier or “better” by any standards.
Please let me make myself clear. I am an advocate for HEALTH. This means I am an advocate of:
1. Eating a balanced, nutritious diet that includes all foods
2. Eating when hungry and stopping when full MOST of the time
3. Learning to cope with emotions without using food
4. Learning to eat in a way that leaves you feeling energized and satisfied
5. Eating by your own rules and no one else’s
6. Incorporating exercise in a way that keeps your body strong (this can only be done if you are eating well first)
7. Eating guilt and stress free
8. Enjoying and finding pleasure in what you eat and how you move your body
And I believe that this is possible at any weight. I stand with Linda Bacon when she says that “fat” is not the problem, it’s the war on fat that is making us sicker and more miserable.
Finishing remarks:
My regret is that the session left a divided group more divided. If we are going to figure out how to create a nation of healthier people, those of us in the eating disorder field have got to come together and truly dialog with those in the obesity field. And until then, the war will certainly continue.
This is a controversial topic. What are your thoughts?
Validity of Claims Made in Weight Management Journals
Weight Science: Evaluating the Evidence for a Paradigm Shift
16 comments
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Go Marci!!! Love this post- I wholeheartedly agree with you and HAES advocates.
This post makes me so happy =)
Thanks Marci for sharing your thoughts! I wish I could have been there and been dying to know what my fellow HAES-advocates experienced. I hope this HAES vs weight loss dieting conversation continues.
Thanks for your positive feedback. I thought this post may stir a little controversy, but perhaps the only people who read my blog agree with me. 🙂 Julie is right, we can hope the conversation will continue. And hopefully the conversations will become
more productive over time!
LOVE this!!!
Love it.
Hi Marci! I found your blog through our mutual friend Aubrey Layton. I should probably make myself known since I’ve been reading for a few months now. 🙂 I love your focus on healthy body image and agree with you 100%! I work as a wellness coach for a
health insurance company and just attended the Lifestyle Intervention Conference last week. It was their first conference and really felt like what you mentioned in your last paragraph, “the eating disorder and obesity communities coming together”. There were
dieticians, social workers, psychologists, physicians, exercise specialists, etc. in attendance. I was really excited to see this healthy conversation taking place at a conference. Also, I don’t know if you know much about Wellcoaches but they have a conference
with the Harvard Coaching Institute at the end of this month in Boston. I heard Margaret Moore (CEO of wellcoaches) speak last week at another conference and she was awesome! Sorry for the long post! Just excited to see people fighting for the same things
I am! -Maria
Brilliant post. I gave up dieting when I was 21 (am now 49!). And probably stopped weighing myself 15 years ago. This doesn’t mean that I haven’t had my battles with food or have not succumbed to the occasional comfort eating. So my weight hasn’t been
completely stable but I measure that by the comfort of my clothes rather than figures on the scales. You could say, ‘good for her’ or ‘how smug’ but despite not battling with significant bulge I still haven’t had an easy relationship with food – until recently
when I engaged a personal trainer to help me prepare for a knee operation with the view that he would also help me recover slowly afterwards and avoid injury when returning to long distance running. We talked about food and he said this amazingly simple phrase:
food is your friend, not your enemy. This has literally changed my life. I don’t eat sweets anymore but instead of thinking I am depriving myself, when it comes to the choice between fruit and a packet of Haribo I go for the former, and feel good about it
because it is obvious that you choose friend over enemy. I guess all of this puts me firmly on the HAES side of the debate. Contrary to one of the posts above I do not want the debate to continue. I wished it ended with people getting away from diets. I am
surrounded by people who are miserable about their weight and have the most unhealthy relationship with food. Perpetuating the diet myth is a crime!
Thank you Barbara and Maria for your comments. It is exciting and motivating to see people from different points of view come together for a common goal! I appreciate your insights and personal stories. Barbara, I think I may use your wise personal trainer’s
words: food is your friend, not your enemy. Love that.
Hi Marci. You write so well. I give a presentation to college students called “Making Food Your Friend Again” – I am all for that! (As long as food is not your only friend.) I like that you point out that Intuitive Eating is not a free-for-all. It is MINDFUL
intuitive eating, not MINDLESS. The problem I see is that HAES advocates seem to refuse to admit that there are ANY downsides to overweight, and that makes them seem “kooky” and easier to write off by the “mainstream” weight-loss at any cost advocates. There
are downsides to overweight for some people, but that doesn’t mean that everyone larger than society’s ideal BMI has them, or even that everyone larger than society’s ideal is overweight. And dieting is by no means the solution to these downsides. But denying
they exist just makes HAES seem ridiculous to the outside. And then anyone who does lose weight is a traitor (even if they did it in a healthy weigh, i.e. working on the eating side and the weight loss then occurred, rather than being the goal – example Jennifer
Weiner). I have patients who are binge eating and who want to lose weight but feel badly that they want to lose weight because they are supposed to love themselves at any weight. What a conundrum we put people in! Love your body, but what if your body is causing
problems for you – can you love it and still change it? or does wanting to change make you a traitor? My only solution is to ask them to love THEMSELVES (the inner self) enough to try to eat in a more healthy way, and if weight loss occurs, so be it. It is
the inner self that is ultimately the most important, but the outer self has to be healthy for the inner self to do its work. The original HAES movement as I remember it was “focusing on healthy behaviors at every size” not “every size is a healthy size” as
it seems to be now. In other words, a 600-pound person can do one or more healthy things each day, and we should not tell him/her “You can’t be healthy unless you lose weight” because as you said, you can improve health parameters without weight loss, or with
statistically insignificant weight loss. But who can truly be healthy at 600 pounds? It is not accurate to imply that you can be healthy at every size and should strive to stay that size! Striving for health within the parameters of your current situation,
yes. Realistic assessments of how hard rapid and repeated weight loss and regain is on the body, yes. Stopping the insanity of thinking that everyone can or should have six-pack abs or that a certain weight will cause happiness, yes, I can get behind that.
But why does this insistence that weight has nothing to do with health have to be part of the HAES manifesto? Maybe you can clear this up for me because it has been bothering me for a really long time and has made me feel estranged from the HAES movement that
I originally felt so connected with. Kudos to you and your work, Jessica
Excellent post. Good points and well supported. Thank you for sharing, Marci. I found your blog through Katja Rowell. Katja and I worked together as faculty for the Ellyn Satter Institute. I presented at FNCE 2011, but miss that talk you mentioned. I ordered
the audio CD and cannot wait to hear it. Thank you for sharing Linda Bacon’s handout.
Ines, thank you for introducing yourself! I am such a fun of Ellyn Satter’s work. I think you will appreciate hearing the Linda and Dr. Foreyt’s talk. Jessica, you brought up so many fantastic points I just might have to write another blog post! I think
we agree on just about every point. It’s my understanding that the majority of HAES advocates believe EXACTLY what you said “healthy behaviors at every size.” And I agree whole heartedly “every size is not necessarily healthy.” In fact, many HAES supporters
were shocked when Jess Weiner wrote her piece, it seemed as if there was real confusion in terms of HAES is really advocating. It is advocating pursuing healthy behaviors at any weight. When we demonize and obsess over the weight it often detracts from being
able to focus on core issues. I’ll see if I can dig up the old Facebook thread on this and do a little more writing. I LOVE the dialog, thank you so much for your thoughts.
Fabulous post, Marci! Thanks for highlighting this conversation – I only wish I could have been there to hear the debate in person!
Thanks Jessie. I wish you could have been there too!!!
Jessica S, I think your comments are spot on. When I am following mindful eating practices, I’m actually on the small side – that’s due to my bone structure, height and genetics. Yes, that’s right, I generally lose weight when I’m doing intuitive or mindful
eating. I sometimes get the impression that it’s undesirable in some way. I don’t believe that’s what the initial HAES movement is about, but the message may be misconstrued by some.
Sorry I came to this conversation late, but I’m glad you’re talking about it! Just wanted to give you a heads up that I posted a few excerpts from the talk on my website: http://www.lindabacon.org/speaking.html. Anyway, it’s great that there is this community
of people trying to change the paradigm. If you check out my handout, which Marci linked to, you can join a listerv for RDs (and their allies) who support HAES. We set it up right before the talk to capitalize on all the interest we figured it would stir up,
and it’s thriving now. Linda Bacon