As a Lifestyle Medicine Practitioner who sees primarily women, as a woman myself, and as the mother of a teenage daughter, I have both empathy and sympathy for the fraught relationship that many girls and women have with their bodies.
Like so many of my clients, I was intensely self-conscious about my weight, and consequently struggled with disordered eating behaviours, throughout my teens and early 20s.
I hated my body, and hated myself for not being able to attain the weight and body shape I believed I should have.
Looking back, it’s also clear to me that at no stage was I actually overweight; I just wanted to be thinner than I was.
It took me many years to resolve my disordered eating and develop an attitude of appreciation and care for my body that allowed me to choose a health-promoting diet and regular exercise for the right reasons – that is, because I just feel better about myself, and within myself, when I do.
My own struggles are echoed in the stories I hear each day from my clients: obsessive and intrusive thoughts about their body shape and size; compulsively weighing themselves and restricting their food intake if they’ve gained even half a kilogram, then bingeing when the tension built up by restriction becomes unbearable; the guilt, shame and self-hatred they experience when they feel they’ve lost control over their eating; avoiding sexual intimacy because they don’t want their partner to see them naked; being so preoccupied with thoughts of food that they can’t be present with their loved ones or relax around friends. It’s a nightmare.
So I do understand why so many women, and health professionals who work with women, have embraced the ‘Health at Every Size‘ (HAES) philosophy which aims to advance fat acceptance and end discrimination against people with a body fat percentage that puts them in the overweight or obese categories.
Arguing that “we’ve lost the war on obesity”, HAES advocates argue that this “war” – that is, concerted efforts by individuals to reduce their body weight or fat, aided and abetted by health and nutrition professionals and the weight loss and fitness industries – has resulted in substantial harms including widespread preoccupation with food and body image, self-hatred, eating disorders, discrimination and poor health.
Positioning itself as “the new peace movement”, the HAES movement argues that the solution to this problem is to embrace and celebrate body diversity, challenge scientific and cultural assumptions about obesity, and to promote “eating in a flexible and attuned manner that values pleasure and honors internal cues of hunger, satiety, and appetite, while respecting the social conditions that frame eating options.”
It sounds good – why can’t society just accept people who are overweight or obese and stop pressuring them to conform to social norms regarding weight, in the same way the ‘Black is Beautiful’ movement urged people of African descent to stop straightening their hair and bleaching their skin to conform to White ideals of beauty?
But the crucial differences, as uncomfortable as they are to confront, are firstly that being Black is not intrinsically a threat to physical and mental health, while carrying excessive body fat is; secondly, that the spiralling rates of overweight and obesity are due to a profoundly unnatural food environment never before seen in our species’ history, rather than just representing a naturally occurring variant of human characteristics; and thirdly, that while the skin, hair and facial characteristics of Black people were certainly viewed as attractive within their own cultures of origin, no human society has ever viewed fatness beyond levels that threaten health and fertility as attractive, particularly in females, and for a compelling reason: our perceptions of attractiveness are actually rooted in biology rather than the vagaries of culture or fashion.
The health risks of overweight and obesity are disputed by the fat acceptance movement, but the statistics are hard to argue with: the risk of developing metabolic disorders such as type 2 diabetes and cardiovascular diseases increases steadily as body fatness creeps up; being overweight increases the risk of developing knee osteoarthritis by 2.2-fold compared to having a BMI under 25 kg/m2, and being obese bumps up this risk to 2.6-fold.
Obesity increases the risk of several types of cancer including endometrial, oesophageal, stomach, liver, kidney, pancreatic, colorectal, breast, ovarian and gallbladder.
Being obese even appears to accelerate the brain shrinkage that occurs with increasing age, decreasing the volume of both grey matter – the neuron-rich mass responsible for our cognitive activity – and white matter – the myelin-coated connective tissue that speeds up communication between brain cells.
On the second point, there is simply no doubt that the global obesity pandemic has been created, and is being sustained, principally by the dramatic increase in the availability of ultraprocessed, hyperpalatable food and beverages.
Ultraprocessed foods are assembled from food components that are superconcentrated in fat, sugar, salt and refined starch, beyond anything ever encountered in our evolutionary history, and hence are hyperpalatable – that is, they drive persistent overeating.
While there is certainly genetic variance in individuals’ susceptibility both to the degree of overeating triggered by hyperpalatable foods, and the extent to which that overeating will result in weight gain, that does not mean that overfatness is simply a manifestation of normal genetic variance in body size. Instead, it is a product of genetically determined variance in individuals’ biological response to an unnatural environment to which our species is maladapted.
On the third point, although there are cultural and individual differences in perceptions of particular elements of attractiveness, there is remarkable consistency across genders and cultures with respect to certain fundamental physical characteristics that are perceived as attractive.
Evolutionary psychology research has established, beyond any reasonable doubt, that these characteristics are indicators of health and fertility that our subconscious minds perceive, due to evolutionary selection pressures.
For example, both men and women perceive women with a low waist to hip ratio (WHR – i.e. small waist size in relation to hips) to be more attractive, with a remarkable degree of consistency across cultures, and across time. A low WHR, which is influenced by hormonal factors and previous pregnancy status, signals both future fertility and health, since higher WHR is associated with a greater risk of diseases including diabetes, some cancers, and autoimmune disease.
Aside from pregnancy, excessive fat stores are the primary factor that increases WHR and therefore, decreases perceived attractiveness. No amount of campaigning for fat acceptance is likely to shift this perception, which was wired into our brains over hundreds of thousands of years of evolution, in the foreseeable future.
That’s why losing weight is still the most common New Year’s Resolution in Australians, nearly half of surveyed American adults had tried to lose weight at least once in the previous 12 months (56.4% of women, and 41.7% of men), and a recently published study of over 14 500 people with obesity across 11 different countries with distinctly different cultures – Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, UAE and the UK – found that only 7% were disinterested in weight loss.
And no population demographic is more sensitive to the negative assessment of their peers in regard to their body shape and size than teenagers, especially girls. No doubt this largely explains why a recent Swedish study found that obese kids were twice as likely to be diagnosed with anxiety and depression than their non-obese peers. (Although, as discussed previously, obesity also raises inflammation levels which affect brain function, causing depression.)
To be clear, I completely agree with HAES proponents that we need to stop discriminating against people who struggle with overfatness, or blaming it on character defects. I’m sure you know plenty of thin people who eat junk and barely exercise, but are genetically gifted with the capacity to overindulge without wearing the evidence on their waistline.
Conversely, most overweight and obese people have made strenuous efforts to lose weight at various points in their lives, and exercise extraordinary diligence in multiple spheres of life including parenting and career. In fact, many people have crash-dieted their way into overfatness by messing with their brain’s set point mechanism for body fat regulation.
The problem is that most people who struggle with their weight are following bad dietary advice which fails to recognise the fundamental driver of obesity: an excessively energy-dense, hyperpalatable food supply.
Conventional dieting advice peddles the message that all you have to do to lose weight is ‘eat less’ – that is, consume smaller portions of the foods you currently eat – or micromanage your macronutrient intake (usually by restricting carbohydrates).
These approaches to the treatment of obesity have been miserable failures not because obesity is untreatable, but because they ignore our genetic adaption to a high fibre, plant-heavy diet composed primarily of hypopalatable foods (low starch vegetation) and more palatable cooked starches, and completely devoid of hyperpalatable foods.
Embracing the HAES ideology effectively exonerates transnational corporations, which draw obscene profits from their intentional formulation and aggressive marketing of food products which addict the human brain, of their culpability for the obesity pandemic.
We need to hold Big Food responsible for the obesity crisis, in the same way we held Big Tobacco responsible for the lung cancer epidemic that they created in the 20th century.
But promoting ‘fat acceptance’ plays into the hands of Big Food, undermining efforts to create public and economic policy structures – such as ‘fat taxes’ and ‘sugar taxes’ that disincentivise food manufacturers from foisting their disease-promoting products onto the public.
And it’s a betrayal of the vast majority of overweight and obese individuals who wish to reduce their body fatness in order to improve their health and self-esteem, but don’t know how.
By all means, let’s follow HAES’ lead and encourage everyone to embrace health-promoting behaviours regardless of their impact on weight. But let’s be very clear that being overfat is a hazard to physical and mental health, for inescapable biological reasons, and that it’s a direct consequence of an evolutionary mismatch which can only be overcome by returning to a way of eating and moving our bodies which is more in keeping with our genetic heritage.
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