George Monbiot writes an environmental column for The Guardian that admirably refuses to be restricted to the obvious topics of climate, wilderness, and waste. This week he challenges the usual medical advice on reducing weight as a useless gesture for people who are obese, pointing to an article in The Lancet that remarks (with a remarkably sharp wit, for a medical journal):
Once obesity is established, however, bodyweight seems to become biologically stamped in and defended. Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely.
It’s important to distinguish in this conversation between people who are overweight — who can lose weight, and whose health may not suffer — and people who are obese and typically cannot lose weight and often do suffer from the life-threatening complications of obesity, such as heart disease, cancer, and diabetes.
As Monbiot writes:
People who are merely overweight, rather than obese (in other words who have a body mass index of 25 to 30) appear not to suffer from the same biochemical adaptations: their size is not “stamped in”. For them, changes of diet and exercise are likely to be effective. But urging obese people to buck up produces nothing but misery.
The crucial task is to reach children before they succumb to this addiction. As well as help and advice for parents, this surely requires a major change in what scientists call “the obesogenic environment” (high-energy food and drinks and the advertising and packaging that reinforces their attraction). Unless children are steered away from overeating from the beginning, they are likely to be trapped for life.
This dire analysis is not all that controversial in the field, from my experience reporting on the issue. (See for instance Dr. David Katz, editor of the journal Childhood Obesity, in his articles on the topic for the general public.) But it’s not often put that bluntly to the public, especially perhaps in this country.
I raise this question to wonder out loud: Should I try to write about this subject as a health topic? What really got me thinking so was a jaw-dropping data animation, showing how obesity has overwhelmed the nation in the last three decades. (From Max Gilka, charting CDC data.) We take for granted the ruination of so many lives.
Kit Stolz 