Body of Truth: Change Your Life by Changing the Way You Think about Weight and Health by Harriet Brown
My rating: 2 of 5 stars
I read this on the heels of "The Obesity Myth," another book that challenges the assertion that overweight and obese are unhealthy.
According to Harriet Brown, we've been misled by the medical community. Not only is overweight and obesity (calculated using BMI) not necessarily unhealthy, in some circumstances it may actually lead to decreased mortality.
Unfortunately, much of her argument regarding the "health benefits" of being overweight and obese depends on cherry picking through what she describes as "the research" and "the evidence." In particular she cites at least one study that looked at mortality and BMI. What researchers supposedly found was that those who were overweight had a slightly better life expectancy than those who were underweight. They also found that the only "overweight" group with a decreased life expectancy (by a nominal amount) were those who were at the outer ranges of obesity.
Similar to Paul Campos in "The Obesity Myth," Brown seems to narrowly define healthy as being alive and unhealthy as being dead. Neither author adequately addresses the health risks associated with overweight and obesity. Both also fail to address the spectrum of overweight and obesity. There is a huge difference between someone who is 20lbs overweight, 40lbs overweight, and 100lbs overweight. Despite Brown's criticisms of BMI, she fails to grasp that public health recommendations aren't meant to be specific to individuals or used in isolation, but instead used as a quick and easy tool that allows health professionals to quantify a patient's risk. Contrary to what Brown suggests, most health practitioners understand that in order to truly assess health you have to look at many markers, weight/BMI being just one of them.
They both also suggest that anyone who isn't overweight is either genetically "blessed" or has a eating disorder. Furthermore, they scoff at the idea that being healthy should take work. They seem to be saying that if adhering to a certain lifestyle is challenging, why bother. Interestingly, I have a client now with whom I have a recurring dialogue. She continues to complain that getting healthy (not losing weight) is so much damn work. Ah, yeah. Just about anything we do in life from exceling at a sport to raising kids to pursing careers takes work. That's the point. And like it or not, in a world where low quality, cheap food is super-sized and super-accessible, eating healthy can sometimes feel like work. Yes, sometimes we just need to say "No." "No. I'm not going to eat that because it doesn't jive with my goals." And sometimes saying "no" is hard.
Like Campos, Brown also talks a lot about body image, social norms, and cultural standards of beauty. She makes some good points. For example, we are constantly bombarded with unrealistic images of an ideal body that only exists in photoshop land. And she is right when she asserts that skinny doesn't equal healthy and that fat doesn't necessarily equal unhealthy. She's also right when she suggests that trying to achieve unrealistic body standards is a set-up for failure.
Brown and Campos claim we need to stop focusing on weight, and instead focus on healthy behaviors, though neither book ever quite clearly defines what those "healthy" behaviors are.
Perhaps most importantly, she points out that by demonizing fat and "fat" people, we are actually making it harder for people to get fit as our obsession with weight and weight loss is, according to her, a battle we aren't winning.
Believe me. I get it. The "war on obesity" by its very nature demonizes fat and those people we decide have too much of it. It is perhaps the one socially acceptable "ism" of our times. This surely leads to a sense of inadequacy and self-loathing, and people don't generally make change from a place of inadequacy and self-loathing. And both authors are right. Diets don't work. Most people who lose weight via "dieting," do gain it back. It is also very possible that weight cycling (repeated bouts of weight loss followed by weight gain) is more destructive to our health than simply staying overweight. I also understand that "eating healthy" and exercising in today's world can be a challenge. Believe me. I do get it.
But I also get that public health officials are in a precarious position. They need to put forth public health recommendations that reflect the research, and whether Brown admits it or not, the research has established a correlation (even if not a causation) between overweight and obesity and many health problems like diabetes, high blood pressure, and heart disease. And they need to do it while somehow not demonizing, minimizing, or stigmatizing people who are "overweight."
I appreciate the necessary role of the body positivity movement. Self-love and self-acceptance is the foundation for positive change, ie making the healthiest choices we can. Both Campos and Brown try to validate the latter by invalidating the former, and I'm not sure how helpful that is to individuals or to society.
When I work with clients, we talk a lot about their goals. They always tell me they want to be healthier or at least healthy, but they also want to lose weight, and to be honest, weight loss is often the overriding motivation. In their minds these two things are essentially indistinguishable because like Campos and Brown say, right or wrong, most people associate thinness (or the behaviors that will lead to thinness) with health.
That said, I focus primarily on health. I remind my clients that healthy bodies are the result of healthy behaviors. Therefore if one focuses on making healthy choices over the long term, their body will gravitate toward a healthy weight which may or may not be their idealized weight. And it's amazing how some people get it on an intellectual level, but still insist on weighing themselves to monitor progress. It's a challenge. Because weight loss shouldn't be a goal. It should be a natural side-effect of the goal. I remind them that anyone can lose weight by going on the keto diet. That's a no brainer. The question is how many people who lose weight on the keto diet will keep it off for any substantial period of time. I have clients who can't even maintain their weight and yet they are worried about losing weight.
"Dieting" as we think about dieting generally results in weight loss. However, research has shown that most people will gain the weight back. This yo-yo dieting is unhealthy both physically and mentally. And despite the faults of Brown's book, it is a valid point she tries to make. Instead of a focus on weight loss (and most of my clients not only want weight loss but they want it as of yesterday) we need to focus on making healthy choices (eat less calorie-dense foods like fast food and processed crap and instead eat more nutrient-dense foods like fruits and veggies) and exercise almost every day in some way.
From day one, I encourage my clients to make nourishing food choices that serve their health and wellness goals. There is no striving for perfection, as if there were such a thing. Together I help the client focus on making better choices. We do this primarily by looking at behaviors that aren't serving them. Often times people do things out of habit that are not only counterproductive but actually destructive. For example, we eat at a certain time because "it's time to eat," not because we are hungry. Or we limit ourselves to certain foods because those are the foods we are used to eating. Maybe we go to McDonalds because that is what we have historically eaten when stressed or short on time. And sometimes the root of those behaviors has nothing to do with food or hunger.
I will say that from my experience, it's clear that too many people have an unhealthy relationship with food. It's kind of sad. It's not an eating disorder in the sense that bulimia or anorexia is an eating disorder but it is disordered eating all the same. Brown addresses this in her book.
Though there was a lot I hated about this book (mainly Brown's somewhat distorted interpretation of the "facts" and her impressive mental gymnastics) there were some worthwhile tidbits. I think her discussion centered around beauty standards had a lot to offer at least in regards to that particular topic. Unfortunately, she erroneously blames public health recommendations for our body dissatisfaction. Medical professionals aren't pushing thin because our actresses are thin. They are pushing thin because there is research that correlates overweight with increased incidence of disease. Furthermore, BMI classifications are not the root cause of our "weight" problems, perceived or real.
Personally, I am intrigued by our reaction to fat as a whole. Many people are repulsed by fat. Fat people, fat dogs, fat mice, whatever. Is this attitude the result of cultural standards or are our cultural standards the result of our attitude? Could it be that we see fat as unhealthy because it is actually unhealthy? Or is it because being fat represents a perceived lack of discipline and self-control. I don't know. This is an interesting question, and I'm not sure Brown has the answer. Brown pointed out that in certain cultures overweight women are considered attractive because them emulate vitality. But if this is true, maybe in our culture, overweight signifies a lack of vitality for whatever reason and is thus seen as less attractive.
Alas, just two stars as there was more I disliked about this book than I liked.