The End of Overeating but not of Fat-Shaming

On NPR's Tell Me More last night, I listened to Celeste Headlee interview David Kessler about the AMA's recent decision to classify obesity as a disease. David Kessler is an MD who served as commissioner of the US Food and Drug Administration under George H.W. Bush and Bill Clinton. I've read his book The End of Overeating, which does a very good job of explaining how fat, sugar, and salt in foods trigger us to eat more fat, sugar, and salt. Unfortunately, as can be heard in his interview, he overlooks the fact that even when people do change their habits, they usually will still gain back lost weight. You can listen to the interview here: http://www.npr.org/templates/story/story.php?storyId=194239969&sc=tw&cc=share

Frustrated, I sent the following email to the show:

I listened with great interest to Celeste Headlee's conversation with David Kessler. I've read The End of Overeating and appreciate the work that he has done. However, I feel that in regards to the AMA's decision to classify obesity as a disease, he misses the point. The notion that most people gain back weight after dieting because they don't change their habits is debatable. While it's not true of everyone, people often do indeed change their eating and exercise habits (and perhaps their neuro-circuitry), but their bodies do not cooperate with their intentions. There is a growing body (no pun intended) of evidence that some people are prone to keeping on weight, and that dieting can even compound the problem by making the body think it's experiencing a famine and fighting even harder to hold on to the pounds. Simple genetics may play a part as well. It is too simplistic to say that people gain back weight because of their habits, especially when the numbers of those who do are so high.

Another point overlooked is that researchers have been finding that those considered overweight (according to the BMI) have a lower mortality rate than those in the "normal" range. I worry that those in the heavier categories will simply be told to lose weight when they show up to the doctor's office with the same diseases (diabetes, for example) as thinner people, who will be actually treated for the same diseases. Besides, who is healthier? A thin, sedentary person who is not careful about what they eat, or a heavier, active person who is? More and more we are learning that the diseases correlated with being fat are not actually fat people diseases. In fact, it seems that only the extreme obese (as well as those who are drastically underweight) are the ones in danger.

A heavy person is not necessarily a diseased person - and often is not. I find the AMA's decision to classify obesity as a disease to be a very misguided one and, in fact, the Council on Science and Public Health advised them against it. I fear that the diet and pharmaceutical companies will now jump on this to market unnecessary and even harmful weight loss interventions. But maybe more importantly, the AMA's decision takes us all a step further away from the day when heavier people will cease to be made to feel ashamed for living in a body, usually against their best efforts, that is not considered acceptable by today's rigid standards.