Indeed, my concern is that obesity researchers are highly vulnerable to accepting cultural assumptions—even more so than the general public—because their status, reputation, and livelihood are in large part determined by how well they promote the diet and pharmaceutical industries. Career opportunities are limited if they choose not to participate, resulting in little incentive to question the status quo. The result is that cultural bias plays a role in every aspect of research, including our underlying assumptions, what research we choose to undertake, what gets published, and how we interpret and report scientific data.
Public/private conflicts of interest, combined with the extraordinary financial clout of the weight-loss industry, is not conducive to being open-minded about new ideas or making sure important research gets conducted or reported, or that the best information directs public policy and gets out to the general public.
Take-Away Message
Fearmongering about weight is worth billions to the health care system, government agencies, scientists, and the media. And it ties in seamlessly with cultural values. The result is that weight myths have become unquestioned assumptions, so strongly a part of our cultural landscape that we regard them as self-evident.
Yes, Americans have been gaining weight, though the degree to which this is true has been blown out of proportion. No doubt our weight gain is symptomatic of changing environmental conditions, and our eating and activity habits are part of those conditions. There is, however, little evidence to suggest that the symptom—weight—is a problem in and of itself. The epidemic exists only because we have defined it to exist. The epidemic will vanish as soon as we stop pathologizing weight and relegating people into baseless and arbitrary categories like overweight and obese. While I am not arguing that we encourage weight gain in order to improve health or that body weight is irrelevant to health, it is clear that the threat posed by our weight and the benefits of weight loss have been misinterpreted and exaggerated. At both extremes—high and low—body weight adversely affects health. But the vast majority of Americans fall closer to the middle of the body fat bell curve, where weight is little more than a benign marker of an individual’s genetic predisposition to carry it.
I hope you’re coming to the end of this chapter feeling a sense of relief. Being fat is not a death sentence, nor does it doom people—your family, friends, patients, or clients, or yourself—to a life of disability. Fat or thin, you don’t need to feel anxious about your weight.
Encouraging weight loss as our first line of defense or attack is just bad science. Weight loss is not effective for prolonging life or managing many diseases. Furthermore, we don’t have effective methods for maintenance of weight loss, and health may worsen as people lose and regain weight repeatedly. Ironically, the admonition to lose weight may actually have contributed to the very diseases it is prescribed to cure.
Though a heavy weight may be the result of imprudent lifestyle habits or underlying disease in some individuals, there are also many large people who eat sensibly, exercise regularly, and have excellent health readings—and many thin people who don’t. Regardless, a low weight—or healthy lifestyle habits—shouldn’t be a requisite for respect.
Size is a sloppy and unscientific way to judge someone’s health or character, and the social and medical imperative for a thin body is not only misguided, it has caused much damage.
“Normal weight” is neither normal (most people exceed it) nor ideal in terms of health.
All that can be determined by judging people based on their weight is one’s own level of prejudice.
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Let’s switch our emphasis to encouraging health-promoting behaviors for all, and let the fat fall where it may. Everyone, fat and thin, can reduce their risk for health problems by making good lifestyle choices. It’s time for a new peace movement: one that supports people in developing healthy lifestyle habits, regardless of their size. It’s called Health at Every Size.
PART TWO
Health at Every Size
SEVEN
The Story Behind the Health at Every Size Program
B
y now you understand that your body
wants
to be at its naturally healthy weight (chapter 1); that you can trust your hunger drive and rejoice in the pleasure of eating (chapter 2); that certain lifestyle habits support you in maintaining the weight that is right for you (chapters 3 and 4); that the food industry—even the government—is working hard to undermine your efforts to eat healthfully and maintain your natural weight (chapter 5); and that much of what you’ve been taught about your weight just doesn’t hold, well,
weight
(chapter 6).
Right about now you’ve probably figured it out: You’ve been set up. Your struggle with weight is an inevitable result of our modern culture and lifestyle, not your own shortcomings or lack of willpower.
But there’s hope! There is an easy way to win the war against fat and reclaim your pleasure in eating: Just give up. Yes, give up. Stop fighting. Instead, turn to science. Specifically, the scientifically proven Health at Every Size (HAES) program.
1
2
3
(The concept of HAES has a long history that predates my research. The term “HAES” is widely used and does not refer to my program exclusively.) Another investigative team has since conducted an additional HAES study which also demonstrates remarkably positive results.
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The rest of this book focuses on the program itself, providing step-by-step advice for incorporating all the information you’ve learned so far into actionable, realistic steps. A program guaranteed to help you enjoy your food again . . .
and
maintain a healthy weight.
The Evidence
I wish I could just give you a magic pill and tell you to take two a day with a full glass of water and you’d never have to worry about your weight or nutrition again. But you know as well as I that nothing is that easy.
Instead, I’m going to give you a set of guidelines to live by, tools that have stood the twin tests of both time and science.
First, the evidence. When I put together this program, I knew each component was based on solid science. And, as you can tell from the first six chapters, I’m big on science. What I didn’t know, however, was how the whole thing would work in the real world, with real people. As a scientist, of course, I knew just how to find out. I set up an experiment.
I wanted to see not only if HAES worked on its own, but how it measured up to the gold standard that was currently recommended, i.e., dieting to lose weight.
To make sure my own bias didn’t affect the results, I teamed up with one of the most well-respected diet researchers in the world, Judith S. Stern, RD, ScD. I’d known her for years—she was my PhD advisor when I started this research and had more than thirty-five years of experience and a very well-established reputation.
Her résumé still awes me. She’s a distinguished professor in the departments of nutrition and internal medicine at University of California, Davis; has served as an invited member on prestigious government panels, including one that established criteria for the definition of obesity and overweight and another that set the criteria for judging weight-loss programs; has published several hundred research articles; and has received a long list of awards, including the Secretary’s Honor Award, the most esteemed award the U.S. Department of Agriculture presents, in the category of “Improving the Nation’s Nutrition and Health.” She is also a member of the prestigious National Academy of Sciences’ Institute of Medicine.
I teamed up with her not only for her expertise and the respect she receives in the field, but because I knew she believed strongly in dieting and weight loss and would supervise the study carefully to ensure fair testing of the conventional model. Together we analyzed the research that had already been conducted on dieting and chose what appeared to be the best diet program to compare to HAES.
I didn’t stop with Dr. Stern. I also asked two top-notch obesity researchers from the United States Department of Agriculture (USDA) to collaborate and oversee the research, both of whom fell somewhere between Dr. Stern and me in their biases about weight. Nancy Keim, RD, PhD, is a research chemist with the USDA, and Marta Van Loan, PhD, a research physiologist. Both also have awe-some résumés and are well published and extremely well respected in the field.
Not only were my three collaborators extremely knowledgeable, but they came with the added advantage of access to money and resources that would support our research. But in the final analysis, I must confess: I also chose the three of them because they are wonderful people who are great fun to work with.
Now I should acknowledge up front that Dr. Stern was hesitant about conducting this research. She worried that if we didn’t encourage the women in our study to diet and lose weight, we might be harming them. In fact, she was so skeptical about the HAES program that she required that we test the women’s progress after three months, including surveys, blood samples, and weight. If we saw either the weight-loss or HAES group getting
worse,
she said, we had to stop the study immediately. I agreed with her condition.
Money Matters
The weight-loss industry is a $59 billion industry, composed of a wide range of companies, from Weight Watchers and supplement makers, to pharmaceutical companies, food manufacturers, physicians, and publishers. When you read a study that shows the importance of weight loss to your health, I want you to do one thing: Ask who is funding it. Quite often, you’ll find that the money for the study came from a company with a stake in the outcome. Why does this matter? Because statistics clearly show that when industry funds research, the published results are much more likely to show beneficial effects than research conducted without industry funding.
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I’m quite concerned about this conflict of interest, which is why I follow a strict policy of never accepting research money from private industry. Not that private industry would have been interested in funding this research anyway—I mean, there’s no profit to be made if we show people getting healthier with lifestyle change, without worrying about weight loss, or if we show that weight isn’t the be-all and end-all when it comes to health.
Consequently, I’m limited to public funding, which is a very small pool. Plus, as with anything else in life (and the government), the decision on who receives funding depends not just on the quality of the project, but on the politics involved in the topic. Given that Congress shares the general perception that Americans need to lose weight, that’s where much of the nutrition money goes these days. Plus, many (all?) researchers who sit on the panels that review the grant requests are on industry’s payroll themselves. In fact, some in my field jokingly refer to a group of researchers from the Universities of Colorado and Pittsburgh and Columbia University as the “obesity mafia,” given their control over National Institutes of Health funding.
With my HAES study, I managed to wrangle a relatively small grant out of the NIH—about $100,000. My co-investigators generously dipped into other odds-and-ends funding to pull us through, and much of the time we spent on this project was voluntary—or least not funded with grant money.
I’d like to believe we got the grant because of the outstanding proposal. But I’m not that naïve. The reality, I think, is that I took my name off the proposal as the primary investigator and substituted Dr. Stern’s, who is better connected to the mafiosi.
Time to Recruit
Now we were ready to recruit women to our study. We needed at least seventy non-smoking, Caucasian women between the ages of thirty and forty-five who wore at least a size 16. Why seventy? Because that’s how many women were predicted to be required to ensure our results would be statistically significant. We also needed our participants to be similar in terms of gender and ethnicity and thought we’d have a better chance at recruitment if we chose Caucasians.
We put the word out in typical fashion, distributing press releases to newspapers, radio and TV stations; contacting local churches and community groups; and putting up flyers on campus and around the city of Davis, California.
At the same time, I started giving press interviews about the study. While we never explicitly promoted it as a weight-loss program—we left the description of HAES decidedly ambiguous—it seemed everyone assumed it
was
a weight-loss study. After all, what else would you do with large women in a health improvement study?