Obesity in a "Fattist" Society: Not an Eating Disorder

Obesity is not an eating disorder. It is not even a psychological disorder. But it is often mistaken for both, which is why we have something to say about it here.

What is it?

Obesity is a physical condition, and technical definitions of obesity are an attempt to define a certain level of body fatness. Because actual and accurate assessments of body composition are not available in most clinical settings, an attempt has been made to define obesity as a function of body weight instead. This practice has obvious limitations, because people at higher weights due to muscle mass (such as athletes) would be misclassified. Nevertheless, obesity has been defined as being at 130% of estimated ideal body weight; it has also been defined as a Body Mass Index of 30.

What do we know about the causes of obesity?

According to the most recent statistics, 66% of American adults are overweight or obese, with 1 in 3 adults meeting the criteria for obesity.  But despite the prevalence of higher body weight in America, much of American society is extremely prejudiced against overweight people.  Overweight and obesity continue to be framed as issues of character, and overweight people are frequently treated as though they are gluttonous or lacking in self-discipline.  Even when obesity is framed as a multi-factorial medical condition, prevailing messages remain simplistic and judgmental: Anyone who is determined to lose weight can and should do so; all you have to do is “eat right and exercise.”

In fact, there is no single understood cause of obesity.  Genetic predisposition, environmental factors, and lifestyle habits are all important factors, but how these factors come together to create and maintain weight in a given person is still the focus of ongoing scientific research.  Certain medical conditions, medical treatments, and drugs can also result in obesity.  Obesity is found to be more common among those of lower socioeconomic status, and among certain minority populations.  The reason for these last associations is multi-determined (e.g. genetic factors, less access to costly “whole foods” and produce), but the link often unfairly reinforces certain stereotypes held about people of color and those with fewer economic resources.

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What is the relationship between obesity and health?

Obesity has been associated with increased risk of high blood pressure, diabetes, coronary artery disease, and many other serious medical conditions.  Many scientists, however, are beginning to question whether the health hazards of obesity have been overstated.  Steven Blair,  exercise researcher and director of the Cooper Clinic, notes that “much of the extant prospective data indicate that there is little difference in mortality risk across a very wide range of BMI values, and these associations may be different for various population sub-groups.”

Linda Bacon, Ph. D., nutrition professor and author of Health at Every Size: The Surprising Truth About Your Weight, points out that many of the studies that look at the relationship between weight and health fail to include important lifestyle factors like physical activity, nutrient intake, weight cycling, or socioeconomic status, and that when studies do control for these factors, “ the increased risk of disease disappears or is significantly reduced.”

In fact, lifestyle choices may be the key to improving health—whether or not they result in weight loss.  In 2005, Bacon directed a study that compared changes in weight, labwork, eating behavior, eating attitudes and psychology between two groups of obese women receiving 6 months of weekly group education.  The first group received behavior-based weight loss education which included nutrition information, moderate calorie and fat restriction, keeping a food diary, and monitoring weight.  The second group used a Health At Every Size (HAES) approach which focused on body acceptance, decreasing restrictive eating, increasing attendance to internal cues for hunger and satiety, nutrition information, and addressing barriers to enjoyable physical activity.

The results were pretty striking.  At the two-year follow-up point, the HAES group showed sustained and significant improvements in total cholesterol, LDL, blood pressure, moderate physical activity, restricted eating, susceptibility to hunger, body dissatisfaction, and self-esteem.  The diet group did not sustain positive changes in any of these areas, and in fact, self-esteem was shown to be significantly worse at the two-year follow-up point.  53% of the diet participants expressed feelings of failure, compared with 0% of the HAES group.

What can you do?

If you are concerned about obesity, there are several steps you can take:

  • Consider speaking to your healthcare provider to get a realistic and objective evaluation of your weight and your health.
  • Choose to focus on things you can control, like self-care choices about food, physical activity, stress management and sleep. You can’t directly control your weight; only your body knows where it’s meant to be when your self-care practices are fairly consistent, so measure your success in terms of your actions and improved health indices—NOT the number on the scale. If you are a Brown student, the Health Services nutritionist can help you assess your patterns with food and physical activity and make changes that will last.
  • Enlist the support of family, friends and peers in making lifestyle changes you feel good about.
  • If psychological factors have played a role in the development of overweight, a professional counselor or psychotherapist may be very helpful in exploring the roots of the problem and finding new ways to cope.
  • Most importantly, you should be gentle and patient with yourself. Making permanent changes in your self-care routine is hard work and it is normal to have setbacks.

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Resources at Brown

BWell Health Promotion 401.863-2794
Located on the third floor of Health Services.
Confidential information or care is available through individual appointments or phone consultation with a Nutritionist.  Students can discuss personal eating concerns, as well as any concerns they may have regarding a friend, a roommate, or a teammate. Health Promotion also offers workshops, pamphlets, and reading materials covering these and related issues. There are no fees for Health Promotion services.

University Health Services 401.863-3953
Located at the corner of Brown and Charlesfield streets.
Confidential information and care is available on a walk-in, or by scheduled appointment basis. Care is available for initial, current or past disordered eating patients. There are no fees for medical care at Health Services. However, there may be fees incurred if laboratory tests, medications, specialist or emergency hospital care is needed.

Counseling and Psychological Services 401.863-3476
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Counseling and Psychological Services for students concerned about their eating issues. Guidance is also available for those who are concerned about a friend, roommate, or teammates' eating. Services include crisis intervention, short-term psychotherapy and referrals. There are no fees for appointments at Counseling and Psychological Services.

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Links you can use

The American Dietetic Association
Daily Tips and Feature Topics often have articles of interest. By sending an email to findnrd@eatright.org, you can ask questions directly of registered dietitians in your area. Nutrition Network is a national referral service for registered dietitians in their areas nutrition. Award winning web site.

Body Positive
This site looks at ways we can feel good in the bodies we have. One of their slogans: "Remember, your body hears everything you think." Other topics on the web site: Size Acceptance; What do you say when everyone around you is dieting? 200 Ways to Love the Body You Have; Dieting Detox; Evaluating Weight Loss Programs: What are the Red Flags? Free subscription to email newsletter "Body Positive Pages."

American Heart Association
Go Red BetterU is a FREE 12-week online nutrition and fitness program that can makeover your heart. Each week will focus on a different area and provide step-by-step guidance. You’ll have access to everything from daily expert tips and an online journal to a downloadable coaching tool.

MayoClinic.com
Article on using vitamin and mineral supplements wisely plus an index of related topics.

Adapted from the Boston College Eating Awareness Team
Written by Boston College Counseling Services

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Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.