Obesity may not be bad for your health, says expert
Health officials, educators and governments the world over are up in arms over what they see as an obesity epidemic. Changing diets, a growing dependence on processed foods, and modern conveniences have done away with the necessity for much physical exertion. This has resulted in rapidly expanding waistlines and a host of associated health complications: diabetes, heart disease, hypertension and joint damage, to name just a few.
A recent article in Physicians News Digest referred to obesity as "a catastrophic public health issue that threatens to cripple and bankrupt the medical system". You can hardly accuse governments of inaction: "fat taxes" are springing up in Europe, New York City recently banned large-sized sodas, and many cities have banned trans fats entirely.
Aside from tax incentives and consumer restrictions, recognising being overweight as a preventable health problem is now a cultural consensus, taught in schools and driven home with anti-obesity public service announcements and education. Is this the kind of decisive action a dire health crisis demands?
Dr Lucy Aphramor doesn't think so. A researcher at Coventry University and a dietitian with Atrium Health, which is a social enterprise of Britain's Department of Health, Aphramor thinks that in many ways, these measures are making the problem worse.
She believes the measures are often based on outright falsehoods, namely that science is decisive on the link between health and weight. She fears the focus on weight as a preventable health issue has created a society-sanctioned environment of discrimination in which people struggling with their weight are openly ridiculed and treated as second-class citizens under the erroneous cover of moral obligation or public good.
"It became apparent to me early on that the fixation on weight was harmful: patients weren't improving their health, and would become preoccupied with weight and food, which affected their moods and social lives," says Aphramor, who has worked with the National Health Service for more than 10 years.
And these patients' emotional health wasn't the only thing being affected. "I read up about harmful effects of intentional weight loss on bone health, and the damage to heart health of yo-yo dieting."
She was at a loss. Like pretty much everybody else, she believed in the correlation between health and weight loss.
"I'd been taught that you just help someone reduce calories and the weight comes off, but what I found was a whole heap of evidence showing it is not possible in the long term," Aphramor says. "Even when people kept to a reduced-calorie diet for nearly eight years, they didn't lose a significant amount of weight."
Then she discovered Health at Every Size (HAES), a belief system and trans-disciplinary global movement that sets out to change the fundamental ways society and individuals approach the issues of weight and weight loss.
HAES emphasises intuitive eating: listening to your body and eating when hungry, and pleasurable physical activity in conjunction with body acceptance and self-confidence building.
In the abstract for a paper she wrote for the Nutrition Journal with Linda Bacon, a nutrition professor at the City College of San Francisco, Aphramor clearly set out the case for HAES.
"Current guidelines recommend that 'overweight' and 'obese' individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavioural change," she wrote.
"But the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality ... This weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences ... reduced self-esteem, eating disorders, other reductions in health, and weight stigmatisation and discrimination."
Clinical trials showed a HAES approach resulted in greater improvement in both physical and psychological health, and healthier behaviour compared with traditional weight loss.
Aphramor joined forces with Sharon Curtis, a computer scientist and self-described "fat activist", to found HAES UK. Its aim is to improve people's self-esteem and health, and push back against a perceived trend of weight-fixation in the health establishment, which HEAS considers dangerous.
For Aphramor, the most important point to get across is perhaps the most radical: "Except at extremes of fatness and thinness, weight itself isn't strongly correlated to health. We need to remember that weight loss and health are not the same thing."
Through HAES UK, she hopes to get the government to change its approach to weight loss and health. "There is no evidence these [public anti-obesity] campaigns are effective. Instead, we see an increase in food preoccupation, weight discrimination and eating distress. In Singapore, for example, anti-obesity campaigns aimed at children did reduce their weight initially, but there was a huge surge in eating disorders in the children."
Aphramor brought the teachings of HAES to Hong Kong in the summer, giving an introductory HAES workshop at the Police Officers' Club. She left convinced there was real demand for a new way of looking at weight in Hong Kong. She is planning to return in March to run another introductory class, and an intensive three-day version of Well Now, a course that she developed.
Critics worry that HAES provides a justification for unhealthy choices. But Aphramor is unswayed.
"I'm worried that conventional weight management gives cover for professionals to continue doing something that has mainstream support, even though it is harmful," she says. "I'm worried people end up hating themselves and become so afraid of eating, they learn to distrust their bodies and are taught to ignore signals of hunger and fullness.
"I'm worried about the huge emotional toll exacted by believing that you are not OK, and being told you're a second-class citizen. And I'm worried about how food dread and body dissatisfaction get passed on to children."