The conversation about obesity in America is filled with loaded questions and misconceptions. Even worse, discussions carry an element of cruelty that’s proven frustratingly hard to eradicate. We don’t just mean adolescents on social media and wanton fat shamers in the media; even doctors can harbor prejudices. Even weight-loss gurus can paint the issue with an overly broad brush. No one knows this better than Cheryl Springer. The graphic designer, who struggled with her weight for years, says that, too frequently, doctors look at an obese patient and stop searching for other health problems—potentially leading them to miss life-threatening diagnoses. “People, especially women, are dying because doctors can’t see past the fat,” Springer tells HealthyWay. “They fail to diagnose cancers and other diseases because they only want to talk about weight (in a way that shames patients and without any practical advice on how to actually lose the weight).” The science backs Springer up. One study suggests that doctors’ bedside manner suffers when confronted with overweight and obese patients; they are literally more compassionate to their thinner visitors. Another uncovered evidence of anti-fat bias in the healthcare community. A significant portion of health professionals in that study harbored stereotypes about their obese patients, associating them with laziness, stupidity, or even worthlessness. There are all kinds of myths surrounding health and weight, and they can be deadly. Our list is far from exhaustive, but here are five things that we continue to get wrong about obesity:
1. It’s all in the genes.
If someone is overweight, their genetic makeup is obviously to blame, right? While there is some evidence of genetics playing a role in how some bodies store fat, it’s not the end-all-be-all answer to the question of obesity. This is much more complex than “It’s just your genetics.” The rate of obesity in America has increased so dramatically over the years that it would be impossible for genes to be the only cause. While obesity rates vary depending on geographic location, community, gender, and race, America has been dealing with increasing obesity levels for decades. Childhood obesity rates have tripled since 1980, and adult obesity rates have increased by about 30 percent from 1990 to 2016. The State of Obesity report is a yearly study administered by the medical nonprofit Trust for Health and the Robert Wood Johnson Foundation. Lately, the report has begun to suggest that the rate of obesity is finally stabilizing rather than shooting upward year after year. However, with 38 percent of American adults currently considered obese, we still need to change our approach. The genetic component won’t fix the problem alone.
2. It’s all about willpower.
Another seriously damaging misconception is that overweight people simply can’t control themselves. If they could muster up more willpower, all their problems would be fixed, says this myth. It couldn’t be further from the truth. One reason willpower isn’t the answer to losing weight is that there are many factors that contribute to success when it comes to self-control. You might think each person chooses to eat unhealthy foods or take those extra bites of dessert—that they can just stop eating like that and lose weight. But studies show that self-control is actually limited. When people are presented with tasks that require strict discipline, they are more likely to give in to urges later. In fact, our brains don’t function well when we’re under stress—or when we’re feeling lonely or hungry. So while it’s a nice idea that we are always in control to make healthy choices, the truth is that our brains are often working against us and want us to seek out comfort food. Biological differences also play a part in this as well. Multiple individuals can subscribe to the exact same weight loss plan, and all have completely different outcomes—regardless of effort or willpower exerted. More to the point, diet is far from the only root cause of obesity. You can have the will of an ascetic and still end up overweight or obese.
3. It’s all about dieting.
Dieting goes hand in hand with the myth of self-control: If someone can restrict their calorie intake, they’re bound to lose weight. That’s true in the short term. The bad news is that most people who lose weight by severely limiting their caloric intake will gain back the weight eventually. And lose-weight-quick schemes like fasting, skipping meals, or using laxatives are associated with feeling more depressed and despondent throughout the weight-loss journey. That often ends in a weight loss staycation. There are also physiological factors that can cause certain bodies to stop reacting to calorie-restrictive diets. Joseph Proietto is an endocrinologist who specializes in diabetes and obesity. For years, he has helped people lose weight at his facility in Australia, only to see almost everyone gain back every pound they worked so hard to shed. Proietto believed there was more to this weight gain than people not trying hard enough, or not following their diet plans. In 2009, Proietto recruited 50 obese men and women to participate in a study. For eight weeks, the participants replaced “all three of their daily meals with a very-low-energy dietary formulation … and 2 cups of low-starch vegetables, according to the manufacturer’s guidelines, which provided 2.1 to 2.3 MJ (500 to 550 kcal) per day.” After 10 weeks, the 34 remaining dieters lost an average of 30 pounds. Despite being counseled by nutritionists and working toward maintaining their lower weight, each participant slowly started gaining back all the weight they lost. After they lost weight, the participants found themselves feeling hungrier and more obsessed with food than they were before the study. Proietto discovered that, even a year later, the participants’ bodies were still in an altered state from the weight loss. Their bodies were literally acting like they were starving, showing an influx of the ghrelin, the “hunger hormone,” and low levels of the appetite suppressant hormones leptin and peptide YY. The diet put each person’s body into a strained metabolic state that is completely different from those who hadn’t attempted dieting at all. Proietto’s study may have been small, it does shine some light on how little we actually know about treating obesity.
4. Losing weight is always healthy.
Tying into what Proietto found in his study, sometimes weight loss comes at a price. Hormones change and fluctuate as our bodies change. When we use unhealthy or extreme tactics, we subject ourselves to serious health risks. Extremely low-calorie dieting is not only impossible to keep up long term, but it’s been shown to increase levels of the stress hormone cortisol in the body. Chronic stress isn’t great for the body, which brings us to an important point: Mental health issues also come into play with weight loss. Not only can psychiatric disorders lead to weight gain, they can damage self-esteem, making it harder to get motivated to actually lose weight. You can’t understand the body without understanding the mind, it seems, and vice versa. Donald Hensrud, MD, writing for the Mayo Clinic, recommends weight loss of one or two pounds per week for most otherwise-healthy people. Any more than that, he writes, and you could be veering into unhealthy territory.
5. Doctors always know best.
Over at the healthcare journalism site Stat, columnist Jennifer Adaeze Okwerekwu tells the story of a young woman who complained of the symptoms of a growing lung tumor for seven years. The doctors consistently attributed her increasingly debilitating cough to obesity-related disorders. Finally, after years of this treatment, a doctor ordered a CT scan of her torso, revealing the tumor. By that time, it was so advanced that they had to remove the entire lung. In a chilling sentence, Okwerekwu writes, “Fat shaming … cost her a lung, and it could have cost her her life.” This story would sound familiar to Springer. She knows too well the frustration and sorrow caused by doctors who focus on weight to the detriment of all else. “Because of misconceptions about obesity, I have suffered deeply in my life,” she tells HealthyWay. “No matter what issue you see a doctor regarding, they assume it is weight related. This has caused deaths. And it caused me to lose my child. This has been the running theme throughout my life.” Springer suffered from chronic low blood pressure, but during her pregnancy the opposite occurred, and all of a sudden she was dealing with high blood pressure. “It wasn’t taken seriously because obese people have high blood pressure. As it turned out, what I had was pre-eclampsia,” Springer says. “I was 38 weeks pregnant and my child passed away in utero specifically because I had pre-eclampsia that went undiagnosed because my blood pressure wasn’t that bad for my size.” [pullquote align=”center”]“It was my own doctor’s willingness to listen to me … that opened the door to real conversations and finding a medical solution.” —Cheryl Springer[/pullquote] But the news isn’t all bad. Susan Besser, MD, practices at the Mercy Medical Center in Baltimore, Maryland, and is board-certified in obesity medicine. She says that an open conversation with patients is crucial to good care. Doctors should ask questions and listen to patients to create as honest of a medical history as possible. “We are all trained to do that, but frequently due to time or other constraints, it doesn’t happen,” says Besser. It’s also incredibly important to talk about weight along with everything else. Whether it’s fair or not, patients might need to push the conversation to places their doctor isn’t leading. “The basic problem, as I see it, is that most patients (especially obese ones) do not know how to advocate for themselves,” says Springer. “They experience so much shame, they don’t even know where to start.” “You as a patient are your own best advocate,” Besser tells HealthyWay. “You need to take an active part in your health care, communicate with your doctor. Many patients and doctors are afraid to talk about obesity because it has such negative feelings—treat it like the disease it is, not a moral weakness.” That advice explains how Springer finally began to lose weight. Her success was possible because her doctor listened to her. “It was my own doctor’s willingness to listen to me that I was not eating whole pizzas and washing them down with 2-liters of soda that opened the door to real conversations and finding a medical solution,” Springer says. “It turned out I had a medical problem whose only known solution was gastric bypass (as my issue is insulin related and only a bypass can fix it). In 15 months, I am down 190 pounds.” If you feel like your doctor isn’t taking your health seriously, it’s time to find someone new. “Many of us medical professionals were not trained to deal with obesity. It just wasn’t really discussed in school in the past,” says Besser. “So, if you feel you aren’t making progress with your doctor, look for another [primary care physician], preferably someone who is comfortable treating obesity.” Hopefully, someday soon, that will describe every physician. “Lives are depending on it,” says Springer.