Last Friday, I felt very uneasy when I came across an article in the Washington Post about the obesity epidemic, in which a doctor declared that “exercise alone won’t make you lose weight”. Aseem Malhotra, a cardiologist, writes that despite an ever-growing fitness industry, obesity continues to surge around the world. Focusing solely on the premise that “exercise – no matter how many gym memberships you buy or how often you wear your Fitbit – won’t make you lose weight” he claims that caloric intake (and the types of calories we consume) is what’s fueling the obesity epidemic.
Even if the research he refers to is valid, these statements distort the bigger picture. Such simple yet categorical claims about an incredibly complex health issue distracts from the reason we need to exercise in the first place: to reduce risk factors for chronic disease. Weight can be one of them, but isolating it is misleading and can exacerbate the body-shaming and weight stigmatization that is already endemic in our society. Especially when the message comes from a member of the medical profession – a powerful and authoritative voice whose message carries a lot more weight (no pun intended).
We should worry about obesity because it can lead to chronic disease, not fatness
According to Malhotra, weight loss through caloric restriction, not physical activity, is the solution. At the same time, he acknowledges that “physical activity has a multitude of health benefits – it reduces the risk of heart disease, Type 2 diabetes, high blood pressure and possibly even cancer – but weight loss is not one of them.”
This is the problem. We have to take a step back and remember why we’re talking about the obesity epidemic in the first place. Obesity, according to the WHO is “abnormal or excessive fat accumulation that presents a risk to health” and is problematic exactly because it is a major risk factor for the very same chronic diseases Malhorta refers to, like diabetes, cardiovascular diseases and cancer. Though diet and caloric intake play a role, weight is only one risk factor among many, including blood pressure, stress, cholesterol, physical inactivity, alcohol use, aerobic fitness and smoking. It is a combination of risk factors that leads to chronic diseases like heart disease or diabetes. Studies have shown that unfit thin people who have a number of these risk factors are less healthy than obese individuals who are fitter and metabolically healthy.
Surely preventing these chronic diseases should be the goal of the public health community, not singularly promoting weight loss or thinness as a good in itself. Singling out caloric intake and fixating on weight loss is not only misleading, but is a long-standing and heavily criticized practice of the multi-billion dollar diet industry. It almost seems like Malhotra has himself fallen for their messages, as he unquestioningly accepts weight-loss rather than overall health as the ideal goal.
Equating weight loss with health is dangerous territory.
Exercise is crucial in the fight against chronic disease
Second, many people of all sizes exercise. Not solely because, as Malhotra alleges, we have fallen for the fitness industry’s “gimmicks promising to walk, run and kickbox you to a slim figure.” But because we know that lack of exercise is a major cause of chronic disease.
Weight loss should not be viewed as an end in itself, but rather as one of the risk factors for chronic disease. Another such risk factor for the same chronic diseases like cardiovascular disease and diabetes is mental illness – and the benefits of exercise for mental health have been proven time and again. Even if we are concerned solely with avoiding weight gain, studies have shown that people suffering from depression are at significantly higher risk for developing obesity. Exercise can reduce anxiety and depression while improving self-esteem and cognitive function. Let alone the benefits of exercise for two other risk factors associated with obesity: stress reduction and adequate sleep.
And for anyone that isn’t aware of these benefits of exercise – then these are the reasons that doctors concerned with public health should be promoting both healthy diet and exercise.
Obesity stigma and discrimination – doctors should know better
Finally, fixating on weight loss as a measure of health not only distracts from the importance of all the other risk factors for chronic disease and poor health, it furthers obesity stigma that leads to discrimination against overweight and obese people in education, healthcare and employment. Stigma that allows society to equate obesity with laziness and moral failure, which can prevent obese people from socializing, exercising due to fear of mockery, and lead to greater levels of depression, eating disorders and a reluctance to seek medical care. Stigma that is perpetuated not only by the fitness and weight-loss industries or the media, but by biomedical discourse and by doctors, who have been reported to be the second most common source of weight stigma. An added irony is that studies have shown that overweight people who faced discrimination were twice as likely to become obese.
No equivalent shame, pressure or well-meaning advice is systemically offered to thin people who drink large amounts of alcohol socially, remain thin despite a very poor diet, have poor aerobic fitness, live dangerously stressful lifestyles or even those that smoke.
The point is not about the validity of claims about weight gain being bad for health or weight loss as a solution. It’s about the misleading health messages that emerge (such as the inherent good of losing weight, regardless of the means), and the underlying associations between thinness, health and human value that follow.
Most importantly, it’s about the impact of these claims coming from the public health community, and the ease by which they can exploited by a society fixated on body image to validate fat shaming and discrimination.
