The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health by Paul Campos
My rating: 3 of 5 stars
Paul Campos is a lawyer and a writer who by his own admission(at least until recently) has had an ongoing struggle with his weight and maintaining a positive body image. In The Obesity Myth Campos tries to convince his readers that the "obesity epidemic" is a farce, part conspiracy theory and part ingenious marketing campaign championed by companies and special interest groups that have nothing to lose and everything to gain from our obsession with weight loss.
With the eloquence of a skilled orator and talented writer, Campos puts forth an argument that seems at first to be indisputable if not immediately obvious. The war on obesity is unfair, unfounded, and ultimately making us fatter.
His case goes something like this:
1. Despite popular belief, the health risks associated with carrying excess weight are actually quite low. According to Campos, weight is not an independent risk factor with respect to morbidity or mortality.
2. There is no good long-term evidence that shows that weight loss even if sustained is beneficial to health. However, there is evidence to suggest that the all-too-common cycle of weight loss and weight gain is harmful.
3. Finally, despite decades worth of dieting mantras, diet manuals, and fitness gurus selling us the latest weight-loss package, the research shows that even when dieters lose weight, they can't seem to keep it off.
Campos makes some good points, though at times he goes too far by reaching conclusions that aren't supported by the evidence he provides.
Campos repeatedly claims that weight is not an independent risk factor for morbidity or mortality. To support his assertion, he cites several studies that supposedly found that when other risk factors like smoking or sex were taken into account, being overweight and even obese (with the exception of morbid obesity) did not lead to a decrease in life expectancy. What he doesn't seem to get is that most health experts understand that a cause-and-effect relationship has not been established for overweight and obesity, though it does correlate to an increased incidence of disease. That simply means that while we can't prove that being overweight causes a disease like diabetes, we do know that being obese correlates to an increased incidence of diabetes. Most health experts concede that it may not be the extra weight itself that leads to the increased incidence of disease. Rather the behaviors that lead to weight gain may also lead to a particular disease. Campos seems to be missing the point, or rather misrepresenting it. The studies he cites to make his case relate to mortality and say nothing about morbidity. It's as if he believes there are only two basic states of health, being alive (good health) or being dead (bad health), and because excess weight is not linked to death it isn't harmful to our health. But that's ridiculous. Trust me. I am a clinician. There is a whole spectrum of health that exists between life and death.
Another major theme in Campos' case revolves around BMI or body mass index. Health professionals often use BMI to establish ideal ranges of weight for various heights. He quickly and repeatedly points out that BMI is not always a good indicator of body composition. After all, just about every professional football player is obese based on BMI alone. This is because a very athletic or muscular man and/or woman can have a large amount of muscle mass which distorts their BMI. He seems to think this is news to the medical profession. It's not. Clinicians know the limitations of BMI and only the most clueless doctor would tell an athlete like Marshall Faulk (at his prime) that he's obese. It doesn't work like that. BMI is simply a quick and dirty way to get a feel for body composition. Those who use it are well aware of its flaws and limitations. They understand it needs to be viewed in context.
Campos rests this particular case by claiming that exercise not weight loss is the key to improved health (longevity) and cites studies that have shown that a "mildly overweight" active person tends to live longer than a sedentary "thin" person. There is certainly lots of research to suggest that being active at any weight does indeed have health benefits. Campos however conveniently neglects to address how weight impacts an individual's activity level. I work with many large patients whose mobility and/or joints are impacted by their weight and size.
His assertion that yo-yo dieting is actually worse than being fat so why bother is also ludicrous and akin to why make my bed if I'm only going to sleep in it again.
Perhaps of the all the points he makes, this is the most convincing. The cycle of yo-yo dieting is unhealthy, both physically and mentally. This particular point also ties into his last point which is that despite health experts telling us to lose weight, no one seems to have figured out quite how to take the weight off and keep it off for good. And again, in one sense, he's right. There is decades of research that suggests dieting (dieting as we know it) doesn't work. People lose weight, but then gain it back. They then must lose it again, and thus the cycle starts. But I would argue that yo-yo dieting isn't inevitable, that there are dietary approaches that can and do work. It's just most people don't want to take the slow and steady road. For whatever reason, usually quick weight loss, people are attracted to less than ideal weight-loss methods.
I often tell clients that if they want to lose ten pounds in 3 months, I can't help them. However, if they want to adopt healthier habits that over time will help their bodies find a healthy weight (whatever that weight may be), then I am their "man."
But to simply say that because the diets that most people get sucked into don't work doesn't mean that people can't lose weight and keep it off. It just means the approach that we're using is wrong. That's part of what I do when I coach clients. I try to help them abandon the "diet/weight-loss" mentality and instead focus on healthy behaviors. If they lose weight, great. If not, great, because chances are if they are eating healthy and exercising and not losing any weight then they wouldn't be able to keep any additional weight off anyway.
Throughout the narrative Campos also discusses body image and the culturally induced unrealistic ideals that lead to self-loathing and feelings of inadequacy. I think most of us (women at least) have felt less than desirable (aka fat) standing in line at the grocery store and perusing through Sport's Illustrated Swim Suit Issue. And he's right. Every culture has standards of beauty that are unfair and unrealistic. Furthermore, thanks to living in a time and age when those of us with the funds and inclination can do so much to change our outer appearance, the pressure to conform to some crazy and, in many cases, unattainable standard has never been stronger. I get it. But that's not a valid argument against the health implications of overweight and obesity.
He does make some interesting observations about fat and obesity and our attitudes about fat and obesity. He claims we see being overweight as a moral failing and a weakness of character. We think of fat people as lazy, disgusting, and slothful. Even worse, the experts are now claiming they have a disease. We assume people are fat by choice or at least by lack of effort on their part. And I agree. Fatism is arguably the last acceptable "ism," but I don't think it's fair to equate fatism with sexism or racism or to assume that the public health message that encourages people to maintain a "healthy weight" is somehow just fatism in disguise.
I also agree with his assertion that our "war" against fat is actually making us fatter. Though, I don't believe there is some underlying conspiracy, namely the health and wellness industry has too much to gain from our attempts to lose weight.
Finally, Campos talks a lot about eating disorders. And while I don't agree with his use of anorexia to describe our mentality about food, I do believe that many people have a unhealthy relationship with food. I see it all the time when working with clients. So many people have so many confused ideas about food. And while misinformation and conflicting advice is partly to blame, it goes deeper than that. Some people use food much the same way that an addict might use heroin or an alcoholic might use alcohol. And it's kind of sad. Campos blames our "thin" culture. I blame the abnormal food environment in which we currently live. It's probably both and more.
At the very end of the book, Campos admits that despite his confident and self-assured narrative, he is actually just like everyone else. Ironically, in the course of writing the book, he lost 50 pounds by eating healthier and exercising more. Of course, he didn't diet (just made better food choices and denied himself on occasion.) Yeah, he dieted. He understands this makes him a hypocrite of sorts, but then why should he be any better than the rest of us.
All in all, this is an interesting read. Campos makes several worthwhile points that forced me to stop and question my own beliefs about "fat." Obesity myth? Not quite, though I understand what he's getting at. We do live in a society obsessed with weight. Our obsession with weight does not seem to be making us thinner. To the contrary, we appear to be getting fatter thanks to an almost universal and unhealthy relationship with food that is worsening thanks to the never ending stream of quick-fix dieting trends. There is a correlation between excess weight and several diseases such as diabetes and high blood pressure, but it is impossible to establish a cause-and-effect relationship. Weight is also not always an accurate reflection of body composition and/or health. It is also not clear if losing weight alone is enough to improve health, particularly if people can't keep the weight off for any significant period of time. Finally, there is ample evidence to suggest that making healthier food choices and getting regular exercise will have a positive impact on our health independent of weight loss and thus a more positive public health message might center more around promoting healthy behaviors and less around stigmatizing weight and fat. We also need a more accurate method of quantifying health that isn't based around things like BMI. With BMI, you essentially get what you pay for. It's quick, easy, and cheap. Unfortunately, it doesn't really say anything about health other than maybe establishing those at the most extreme ranges of underweight and overweight (both with their own health implications.)
I'll add that when I work with clients, it is often a struggle to get them to abandon their scales. For whatever reason, many are fixated on those three little numbers. I spend a lot of time focusing on getting clients to accept and love their bodies "as is" and to show that love by taking care of it through a balanced diet and daily exercise. I also spend a lot of time helping people to learn to love, savor, and enjoy food, real food, not the crap that comes in a box or depends on processed oils, sugar, and salt to make it taste "good." When they ask me about weight loss I tell them that if they eat healthy and exercise their bodies will generally gravitate toward a healthy weight, though that weight may not always reflect their "ideal."