Five Health Care Myths
by Frances M. Berg
Unfortunately, much current health care for obesity is based on misinformation, myth and size bias, not on accurate scientific information. Consider these myths and controversies:
Myth #1: Obesity causes severe health risks and chronic disease.
Fact: We don't know, but it seems unlikely. Obesity is associated with higher risk for type 2 diabetes, hypertension, and cardiovascular disease, but cause has not been established. The evidence suggests that both obesity and its related risks are caused by a third factor or set of factors, such as genetics and sedentary lifestyle. Increased physical activity dramatically reduces health risks even without weight loss. (References: 1, 2, 3, 4, 5, 6)
Myth #2: "Healthy weight" defines the range of lowest health risk.
Fact: The weight associated with the lowest death rate is in the "overweight" range (BMI 25 to 29.9), with almost no related risk up to a BMI of 35, according to the latest CDC research. This confirms an earlier review of 236 controlled studies by the National Institutes of Health, NHLBI. (Despite this evidence, federal agencies define healthy weight as a BMI of 18.5 to 24.9, overweight as 25 to 29.9, and obesity as 30 and over.) (References: 7, 8, 9)
Myth #3: Health is always improved by weight loss.
Fact: Long-term studies indicate higher risk with weight loss. At least 15 large comprehensive studies show higher death rates after weight loss, including the Framingham Heart Study, Harvard Alumni Study, and NHANES I follow-up. Researchers suggest the loss of lean mass from bones, muscle, heart and other organs may jeopardize health. (References: 10, 11, 12, 13, 14)
Myth #4: Current weight loss treatment is safe and effective.
Fact: All methods must be considered experimental. None are proven long-term safe and effective. Dieting causes short-term weight loss followed by regain or weight cycling, which has its own risks, and leads to food preoccupation, bingeing, dysfunctional eating and sometimes eating disorders. Drugs offer only minimal weight loss (5-11 pounds) and must be taken long-term, with increased risk: of 6 million adults who took fen-phen/Redux, FDA reports one-third developed leaky heart valves; others died of primary pulmonary disease. Gastric surgery for weight loss carries risk of over 60 complications including severe infection, leaks, obstruction, blood clots, malnutrition, and early and late deaths that include suicide. (References: 15, 16, 17, 18, 19, 20)
Myth #5. Scare tactics and pressures to be thin help prevent obesity, promote weight loss, and do no harm.
Fact. The steep rise in obesity over the past three decades parallels the increasing social and medical pressures to be thin. These pressures and scaring people about the risks of obesity can lead to malnutrition, eating disorders, hazardous weight loss, body hatred, size discrimination, stress, anxiety, immune suppression, and higher health risks, and have failed to help people lose weight or prevent obesity. (References: 21, 22, 23, 24, 25, 26, 27)
These five myths benefit the weight loss industry, not the individual or society. The fiction they keep alive is that overweight and obesity are severe health risks that threaten the lives of most Americans, adding greatly to health care costs; therefore weight loss is urgently needed, even when not safe or effective. Increasingly, health providers are rejecting this traditional weight loss approach with its failures, and moving ahead to 'Health at Every Size' (also known as 'Health at Any Size'). The 'Health at Every Size' approach focuses on healthy lifestyle, wellness and wholeness, living actively, and eating normally. It promotes acceptance and respect, along with sound and compassionate health care for patients at whatever size they are.
References
1. Taylor R. Causation of Type 2 diabetes - The Gordian knot unravels. N Engl J Med 2004;350:639-641.
2. Miller W. Health promotion strategies for obese patients. Healthy Weight Journal 1997:11:3:47-51.
3. Blair SN, Kohl HW, Barlow CE. Physical activity, physical fitness, and allcause mortality in women: do women need to be active? J Am Coll Nutr 1993;12(4):368371.
4. Barlow CE, Kohl HW III, Gibbens LW, Blair SN. Physical fitness, mortality and obesity. Int J Obesity 1995;1 (Suppl 4):S41-44. Miller W. Health promotion strategies for obese patients. Healthy Weight J 1997:11:3:47-51.
5. Blair SN, Bodney S. Effects of physical inactivity and obesity on morbidity and mortality: Current evidence and research issues. Medicine and Science in Sports and Exercise 1999;31:S646-S662
6. Berg F. Underage and Overweight: Our Childhood Obesity Crisis - What Every Family Needs to Know, 2005, 2004, p13-29. New York: Hatherleigh Press.
7. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861-1867.
8. NIH-NHLBI Clinical Guidelines on Identification, Evaluation, and Treatment of Overweight and Obesity. National Institutes of Health, National Heart, Lung, and Blood Institute. Pre-print June 1998. Bethesda, MD.
9. Berg F. Underage and Overweight, p147-151.
10. NIH Technology assessment conference: Methods for voluntary weight loss and control. Conference report: program and abstracts. March 30-April 1, 1992. Office Medical Research, Bethesda, MD 20892.
11. Andres R, Muller DC, Sorkin JD. Long-term effects of change in body weight on all-cause mortality: a review. Ann Intern Med 1993;119:737-743.
12. Williamson DF, Pamuk E, Thun M, et al. Prospective study of intentional weight loss and mortality in neversmoking overweight US white women aged 40-64 years. Am J Epidemiol 1995;141:1128-1141.
13. Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. I J Obesity 1999;23:603-611.
14. Berg F. Underage and Overweight, p13-29, 156-194.
15. NIH Technology assessment conference: Methods for voluntary weight loss and control. March 30-April 1, 1992.
16. Lee IM, Paffenbarger RS Jr. Is weight loss hazardous? Nutr Rev 1996;54(suppl):S116-124.
17. Kassirer JP, Angell M. Losing weight: An illfated New Year's resolution. N Engl J Med 1998;338:5254.
18. Garner DM, and Wooley SC. Confronting the failure of behavioral and dietary treatments for obesity. Clin Psych Rev 1991;11:729-780.
19. Lissner L, Odell P, D'Agostino D, and Stoke J, et al. Variability of body weight and health outcomes in the Framingham population. New Engl J Med 1991;324:1839-44.
20. Berg F. Underage and Overweight, p156-194.
21. Third report on nutrition monitoring in the US, Vol 1-2, Dec 1995. Life Sciences Research Office, US Health/ Human Serv, US Dept of Agriculture. Natl Ctr for Health Statistics, NHANES III. Advance Data Nov 14, 1994.
22. Levine P. President's message. Eating Disorders Awareness and Prevention Newsletter. Spring 1995:1-3.
23. Pipher M. Reviving Ophelia. 1994. Ballantine Books, Random House, NY.
24. Fallon P, M Katzman, S Wooley, edits. Feminist perspectives on eating disorders. 1994. Guilford Press, NY.
25. Grange D, J Tibbs, J Selibowitz. Eating attitudes, body shape, and self-disclosure in adolescent girls and boys. Eating Dis 1995:3:3:253-264.
26. Smolak L, M Levine. Toward an empirical basis for primary prevention of eating problems with elementary school children. Eat Disorders 1994;2:4:293-307.
27. Berg F. Underage and Overweight, p76-94, 195-205.
Reprinted and adapted from Underage and Overweight: Our Childhood Obesity Crisis - What Every Family Needs to Know, by Frances M. Berg. New York: Hatherleigh Press. Copyright 2005, 2004 by Frances M. Berg. All rights reserved. The author permits use of this 5 Health Care Myths feature as a handout or in nonprofit newsletters for educational purposes, provided it is reproduced in its entirety with this citation. Written permission is required for use in books or publications for sale. Contact Healthy Weight Network, 402 S. 14th St., Hettinger, ND 58639 (telephone: (701) 567-2646; fax: (701) 567-2602). For more information see the website for the Healthy Weight Network.