Monday, 4 July 2011

#5: Baby It's You

Today Dr. Arya Sharma wrote an interesting piece on his hugely popular (and highly recommended) blog: titled "Is Obesity a Worthy 'Cause'?" and essentially spelled out good reasons why obesity should probably deserve more financial, academic and public attention than it currently does and proposed a much different Canada where obesity was understood and acknowledged for the hugely complicated bio-psycho-social issue than it is. For those who aren't familiar with his work, Dr. Sharma is a leading worldwide expert on obesity management including it's cause, pathogenesis, treatment, prevention, everything! In a vastly simplified and generalized summary, Dr. Sharma suggests (rightly so) that obesity is a much more complicated issue than simply eating too much and exercising/moving too little and that currently our society continues to stigmatize and villianize obese individuals for their lack of self-control and poor behaviours. "It's their own fault" might be a appropriate summary statement of our current position on obesity.

I am not an obesity expert but I am passionate about the issue and have done more than my share of reading and reviewing of the relevant literature. Since following Dr. Sharma and like-minded individuals online and taking a more holistic approach to my understanding of the subject, I have come to agree in large part with many of the 'revolutionary' ideas surrounding the causes and treatment of obesity.

Do I believe that obesity is more complex than individuals simply choosing to eat too much and move too little? Of course I do!
Do I believe that obesity prevention and treatment initiatives and policy to this point have largely failed and that we require a new approach? Definitely!
Do I believe that blaming individuals for their poor lifestyle choices and behaviours is in any way effective? Certainly not!

But here comes the caveat. I also "believe" in basic physiological principles and that these are essentially equivalent in every person regardless of race, gender, SES, age, etc. All humans are not created equal but our bodies for the most part function almost identically. The whole "calories in, calories out" adage has garnered some pretty bad press recently to the point that it's almost taboo to even mention it anymore. We are smarter now; this simply isn't the case; it doesn't work that way! But is this really true?! I was taught long ago that energy can be neither created or destroyed; one of those thermodynamics laws which seemed pretty air-tight. I'll admit that I still believe it. I also believe that humans have the capacity to choose what they do with their time, energy, and money. At the end of the day, I choose what goes into my body and what physical activity I do. It's not always easy to make the right choices or act in the best way because we are so often inundated with false and misleading information, a sad reality I admit, but one that is not all-controlling. I have the power to choose; I have the power to be in control. Many people will disagree with me here since I have essentially, albeit indirectly, claimed the much hated argument that individuals are ultimately responsible for themselves and thus it could be logically be followed that they are at fault for their own problems...including their weight! Yes, I said it: people are ultimately making decisions that impact their health and well-being...including the "choice" to be obese. We may not all have equal, fair, and adequate access: it's not a level playing field if you will, but the game is not fixed and even if the odds are stacked against you, you can still play the best hand you've got and make the most of what you're given (okay, enough sport sayings).

Here's my points, in point form because I am now lazy of writing full, flowing sentences:

- If you find yourself overweight tomorrow morning, you shouldn't be surprised! You didn't get that way overnight nor will it go away the next day.
- With some (increasingly recent) exceptions; no one is born overweight. One becomes overweight and obese through a gradual process of consuming too much energy that is not adequately balanced by expenditure.
- That said, eating less and exercising more is not a viable solution for the treatment of obesity. It likely won't work and I agree that we should stop propagating the common myth that it will.
- Sadly, I must say that if you are currently overweight, your prognosis is likely very bleak. Once the body becomes overweight/obese, metabolically, it is perfectly happy to exist that way and so reversing the trend is immensely difficult. That's why I honestly believe that all our attention should currently be to prevention (especially among youth) and moved away from treatment (sorry!).
- For many people the world isn't fair! You might not be able to eat 2000 calories (per day) without gaining weight; while others might be able to eat twice that much and stay slim. This simply means that you are going to have to accept your fate and (dare I say it) eat less or move more.
- I should now mention that being slim/skinny/"normal" BMI is by no means an indicator of health and fitness (yes, BMI is tragically flawed)! I do believe in the whole "fit and fat" thing but also have a very hard time seeing obesity as healthy in any way. That said, the importance of physical activity becomes paramount. Achieving and maintaining good fitness (cardiovascular fitness, muscular strength and endurance, body composition) is not easy to attain and even worse, it's something that will need to be done for the rest of your life (no easy fix here!) but it's definitely worth it!
- Being physically active at any weight is far better than the alternative. There are plenty of people out there with normal BMIs who are going to suffer from all the same diseases that people with obesity are blamed for (heart disease, diabetes, hypertension, etc.).
- Discrimination against the overweight and obese will not go away any time soon! Discrimination and stigma are terrible things and are in no way effective for creating change but they happen and will continue to do so. Should we work to decrease and eliminate them? Yes...but good luck with that! Obesity is in many cases repugnant; people are disgusted by it. This will not change.
- I also fear that the new fat-acceptance movement is truly flawed and problematic. Obesity is not healthy and should not be normalized. Is fat-acceptance any different from the pro-anorexia movement? Okay, bad example, but I hope you get the point. We shouldn't be promoting any behaviour, condition, ideology, etc. that is so obviously associated with poor health outcomes (MMA, boxing, contact sports...same thing!).
- Perhaps only when obesity directly causes/exacerbates poor health in those without the condition/symptom/disease (whatever!) will people start caring. Imagine if your/my/our healthy lifestyle was compromised because of the same (complex bio-psycho-social) factors that directly lead to obesity in others...would you not be
concerned? That's when we can expect change! When every single person regardless of weight is directly affected.
- Final point: Obesity is complicated but clearly not healthy. Can the obesity "epidemic" be fixed: probably not. We should probably focus more on prevention. Being obese is not really a choice but it's not out of one's control. "Genetics loads the gun but environment pulls the trigger." Don't wanna get shot? Get away from the firing range!

In conclusion, obesity is a major problem that is and will continue to affect us all to an increasing degree. Everything I've stated herein are simply my personal opinions and insights. I am young and naive and have come from a very specific (and largely privileged background) and thus am likely not accurate in many regards. Yet I am also a level-headed, intelligent, and educated individual who sees the world for what it is. Don't like what I've said or happen to disagree? I welcome your comments and feedback. It's equally important to acknowledge when you are wrong or out of place and I opening welcome these experiences on a daily basis.

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