Rethinking the health and weight debate
Swinburne researchers are part of a new wave of health professionals challenging our perception of weight and health.
While it’s long been thought that fatness is unhealthy, and skinniness is healthy, research shows this isn’t the whole truth.
Dr Carolynne White and Dr Natalie Jovanovski have called for a new perspective in their submission to the Federal Government’s Senate Select Committee into the Obesity Epidemic in Australia.
“Our submission is about lipo-literacy,” says Dr Jovanovski, a postdoctoral research fellow at Swinburne.
Lipo-literacy explores the assumptions that are made about health based solely on someone’s appearance and body weight. “We’re trying to combat that in our work.”
“Our view is that people come in all shapes and sizes, and you can’t tell much about a person’s health by their body shape and size,” says Dr White, a health promotion lecturer.
Health and weight are not the same
“Traditionally, weight and health are seen to have a linear relationship,” says Dr White.
“People think that if someone is heavier, they have poor health, whereas if someone is smaller, they’re more likely to be healthy. It’s much more complicated than that.”
American research into metabolic disease has found, when weight is taken out of consideration, the Body Mass Index (BMI) misclassifies around one in three people.
Some thin people are classified as healthy when metabolically they are not. Likewise, BMI classifies some larger but metabolically healthy people as unfit.
“In Australia, obesity is considered a risk factor for chronic conditions. It’s not considered a disorder or a disease in itself,” says Dr White.
It’s an important distinction, because being heavier doesn’t automatically mean being less healthy, any more than thinness means good health. Some people maintain their low weight through smoking, purging or dieting, which Dr Jovanovski calls ‘self-imposed famine’.
In fact, yo-yo dieting, also called weight cycling, is associated with conditions like malnutrition, gall bladder illness and osteoarthritis.
Further, some health risks for larger people may result from social stigma. Larger people may avoid exercise to avoid judgemental comments. They may similarly avoid medical treatment. Their mental health may be affected by their inability to adhere to a social norm that they cannot achieve, given that body shape and size can be determined by genetics as much as diet.
This fat-is-bad/thin-is-good thinking also harms smaller people, who may get social messages that nutrition and exercise aren’t necessary for them because they are ‘already thin’.
“There’s a risk in saying there is a normal healthy body shape for someone,” says Dr White.
The impact of fat stigma on health
The psychological impact of dieting and societal stigma over weight plays a negative role as well.
“If children and adolescents perceive that they’re overweight, that contributes to body dissatisfaction and impacts on their eating behaviours,” says Dr White.
“Children are being exposed to dieting and body policing messages at younger ages,” says Dr Jovanovski.
“They’re starting to engage in dieting behaviours. We know that restrictive eating and body dissatisfaction can lead to things like yo-yo dieting, which can lead to putting on more weight.”
These mistaken attitudes about the relationship between body shape and size and health, combined with the social stigma attached to weight, are failing to address the growing number of Australians classified as overweight or obese.
“We know the chances of someone losing weight and being able to maintain the weight loss is slim to none, so why are we continuing to put those messages out there?” says Dr White.
Health, weight and aesthetics
Dr Jovanovski is not a fan of the term ‘obesity epidemic’. “Fat is not spreading like a virus – we should stop being so emotional and fearful of it.”
Dr White agrees, noting that for all the messages trying to prevent obesity, the rates of body dissatisfaction and eating disorders among children is rising. The judgemental discourse around weight and shape “breeds this fat-phobia, where being fat is the worst thing ever.”
“It conveniently glosses over the fact that our ideas about weight really come from an aesthetic focus – how we look,” says Dr Jovanovski.
“But what we perceive looks right or wrong are socially constructed views that are aren’t challenged. Doctors carry these weight biases too.”
Good health comes in many shapes
If fitness and health are independent of body shape, then what approach should society take to ensuring everyone, regardless of size, becomes healthier and reduces their risk of later chronic illness?
Dr White and Dr Jovanovski believe a whole new way of thinking about health is key.
The first step is to acknowledge that people come in many shapes and sizes – weight lifters and rugby players are not built the same as sprinters or swimmers – and so a more holistic view of diet and exercise is needed.
An effective campaign should focus on the whole population,” says Dr Jovanovski. “Every single person engages in some sort of behaviour that’s positive for their lives. Rather than focusing on how someone’s lacking and stigmatising people, why aren’t we focusing on enhancing the strengths that people already have?”
A holistic health message
A new approach to the messages our children receive is also essential.
“Kids are born knowing when to eat and how much to eat to meet their body’s requirements,” says Dr White.
“But we push children to dampen down those natural abilities.”
Research supports the pattern of ‘parents provide and the children decide’, where parents provide a range of foods at mealtimes and for snacks, but the children decide whether and how much they eat.
“Keeping kids trusting their bodies for as long as possible is a good protective factor.”
Addressing stigma could also reduce weight-related bullying, which can lead some children to avoid exercise, fearing someone will laugh at their bodies.
“Creating a supportive environment for all children of all body weight shapes and sizes to engage in healthy behaviours is the key,” says Dr Jovanovski.
Dr White agrees that changing the climate around how weight and health are taught to children is vital.
“If we allow children to appreciate and respect the body that they have, they’ll develop a better relationship with their body, and food, for life.”
“We need a cultural revolution and mass public education – not just the general public, but all health professionals. Preventing eating disorders and preventing chronic disease are not two separate things. We can use the same approaches and address both issues. We can support people’s mental health and support their physical health at the same time.”
Dr Carolynne White and Dr Natalie Jovanovski are part of the Social Innovation Research Institute.
1 October 2018.