As an acknowledgement of the failure of weight-loss programs, some experts recommend that a smaller reduction in weight, of about 5 to 10 percent of body mass, can improve a variety of health conditions. Remember that the failure rate of dieting is 95 percent, and that dieting frequently launches people into a yo-yo cycle that isn't innocuous. In his book Big Fat Lies: The Truth About Your Health and Weight, Glenn Gaesser, exercise physiologist and professor at Arizona State University, presents the outcomes of research regarding the health and mortality of 17,000 Harvard alumni who were asked how frequently they dieted and how many pounds they lost with each attempt. Compared to men who maintained fairly stable (even if higher) weights, those men in a yo-yo cycle, repeatedly losing and gaining weight, had an 80 percent higher rate of heart disease, and a 123 percent higher rate of Type 2 diabetes, compared to their nondieting classmates. Glaesser warns, "What we have here is a paradox, with potentially calamitous consequences. Losing weight seems to increase the chances of dying from a disease for which weight loss is frequently prescribed to help cure! This brings to mind the most fundamental canon of all helping professions: 'Above else, do no harm.'"
Does that mean that someone who's large must passively accept that there's nothing effective to improve health? The answer is a resounding no! People of all sizes can participate in behaviors that improve health and longevity. Steven Blair, former director of research at the Cooper Institute for Aerobic Research in Dallas, followed 26,000 men and 8,000 women between the ages of 20 and 90 for 10 years. He discovered that both obese fit men and lean fit men had low death rates, and that the obese fit men had death rates half that of lean unfit men. Lean unfit men who fell into the ideal weight category had twice the risk of mortality from all causes, compared to the fit men who fell into the overweight and obese categories. Blair declares, "By tracking the health status of thousands of women and men who have had fitness tests and medical exams at the Institute over the past 30 years or so, it has become abundantly clear to me that in terms of health and longevity, your fitness level is far more important than your weight. If the height-weight charts say you are 5 pounds too heavy, or even 50 or more pounds too heavy, it is of little consequence healthwise—as long as you are physically fit. On the other hand, if you are a couch potato, being thin provides absolutely no assurance of good health and does nothing to increase your chances of living a long life."
If there's so much evidence challenging conventional wisdom that fat is bad for us, then why don't we hear about it? Probably because we tend to view information through a thinness-bias lens, seizing upon results that favor thinness and ignoring content that doesn't support thinness as the optimal health and beauty standard. This bias was made crystal clear when a doctor was interviewed on CNN to discuss the results of two major studies in 2008, one from Canada and one from Japan, which concluded that people who fell in the "overweight" category live longer than those in the "ideal weight" category. At the end of the interview, the doctor threw in the caveat that, "It's probably still a good idea to lose some weight."
Economic issues play a role in perpetuating the hysteria around weight. Not only do people pursuing weight loss spend billions of dollars each year, but obesity researchers often have their work funded by the diet industry. A clear example of this conflict was the National Task Force on the Prevention and Treatment of Obesity, created and funded by the federal government to set national health policy. In 1996, JAMA disclosed that eight out of nine board members were university-affiliated professors and researchers with financial ties to a minimum of two, and up to eight, commercial weight-loss and pharmaceutical companies apiece. Laura Fraser, author of Losing It: America's Obsession with Weight and the Industry That Feeds on It, explains, "Diet and pharmaceutical companies influence every step along the way of the scientific process. . . . What it comes down to is that most obesity researchers would stand to lose a lot of money if they stopped telling Americans they had to lose a lot of weight."
What does all of this mean for clients who feel they must lose weight to become healthier and happier? As clients end their compulsive or binge eating by becoming attuned eaters, they usually hope they'll lose weight. From the outset, I empathize with that wish, and point out that if weight loss occurs, it'll be a side effect of normalizing their eating. Since weight is the result of complex factors still not completely understood, my goal is to help clients feel more comfortable in—and take better care of—their bodies, no matter what their size.
I consider myself to be weight neutral—meaning that I don't assume anything about people's physical and mental status based on weight, and I don't use weight as a measure of a person's success or failure, a framework now commonly known as Health at Every Size. Since health relates to much more than the number on the scale, factors such as a healthy relationship with food, physical activity, good sleep habits, and regular medical care are better indicators. I encourage clients to focus on the fitness, strength, and flexibility they develop through physical activity, as well as on the joy of movement. I know that when many clients use weight loss as their motivation to exercise, they stick to a regime for a while, but as soon as they miss a day or two, they feel guilty and quit working out. This is a shame, since the reality is that exercise is a healthful behavior for all of us, and that people become healthier when participating in physical activity regardless of whether any weight is actually lost. As my clients focus on sustainable behaviors, normalize their eating, and work on building a more positive body image, we view any weight loss as their body's making an adjustment, but not as the main event.
No matter where therapists find themselves on the continuum of size acceptance, it's our duty to become more aware of this issue and familiar with the research. By increasing awareness of our own behaviors in our professional and personal lives—negative comments about weight, fat jokes, talking about being "good" or "bad" in reference to eating behaviors—we can help change societal norms. If America is truly a melting pot, it's time to throw size diversity into the mix. If we're truly interested in the well-being of our larger clients, then we need to fight discrimination toward them, including our own. As Gandhi put it, "We must be the change we want to see in the world."
Judith Matz, L.C.S.W., who specializes in the treatment of eating and weight issues, is the director of the Chicago Center for Overcoming Overeating. She's the coauthor of Beyond a Shadow of a Diet: The Therapist's Guide to Treating Compulsive Eating and The Diet Survivor's Handbook: 60 Lessons in Eating, Acceptance and Self-Care. Contact: firstname.lastname@example.org; websites: www.judithmatz.com & www.dietsurvivors.com.
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