It’s been a busy spring for body weight researchers. I’m still working hard to catch up on the latest publications. A recent article to come across my (virtual) desk is one from JAMA (Journal of the American Medical Association), with the intriguing title “Change in Percentage of Adults with Overweight or Obesity Trying to Lose Weight, 1988–2014”.
If you’re in a big hurry right now (maybe you’re trying to get out the door to ride or run or walk or go somewhere, in which case I promise not to delay you), here’s the takeaway:
From 1988 to 2014:
- More American adults are overweight or obese (that is, have BMIs 25–30 and 30+). No news there.
- Fewer of these adults with BMIs 25–30 and 30+ are now reporting trying to lose weight. Hmmm. Possibly interesting.
- The authors seem very worried about this trend. They think it’s a potentially bad thing.
- I am not worried about this trend. I think it might be a good thing, or maybe just a thing.
Now, if you’re not on your way outside (it’s a gentle sunny spring morning here in Boston), here are some of the details (both about what they said and what I think about it). If you’re a data person, here are some numbers:
From 1988–2014:
- The percentage of adults with BMIs 25–30 and 30+ increased from about 52% to about 65%– from about half to about 2/3 of the population.
- The percentage of those adults (BMI 25 and above) who reported trying to lose weight declined from about 55% to about 49%– not a big drop, but it’s notably lower.
- The article reports prominently that group with the biggest decline in weight loss attempts is black women, with a change from about 65% to about 55%– a 10% drop in weight loss attempts. It reminds us that this group also has the highest incidence of BMIs 30+ (55%).
- White men as a group also declined in weight loss attempts– a 6% drop (46% to 40%).
- Also found in the table and in one sentence in the article is the fact that white women as a group also declined in weight loss attempts, by a bit more than 10%.
If you’re still reading (in which case, thank you; I do appreciate it), here are some messages in this article that struck me full in the face (and not in a good way).
First, the article seems really worried about the suggestion that the range of socially acceptable body weight is increasing. They say this explicitly:
If more individuals who are overweight or obese are satisfied with their weight, fewer might be motivated to lose unhealthy weight.
Later on, they try to explain this phenomenon:
This observation may be due to body weight misperception reducing motivation to engage in weight loss efforts or primary care clinicians not discussing weight issues with patients.6 The chronicity of obesity may also contribute. The longer adults live with obesity, the less they may be willing to attempt weight loss, in particular if they had attempted weight loss multiple times without success.
Body weight misperception? In this context it means that people think their body weight is just fine, when really it’s not. The authors suggest that people might mistakenly believe their body weight is okay because their health care provider hasn’t told them that it’s not. And people might accept their bodies as fine because they’ve tried to lose weight, failed, and thus given up that fruitless pursuit in favor of a more profitable one, namely accepting their bodies as they are.
If body acceptance is wrong, I don’t want to be right.
But the medical literature just doesn’t agree.
While looking over this paper, I came across a 2010 article called “From ‘overweight’ to ‘about right’: evidence of a generational shift in body weight norms”. This article seems to say that if people stop trying to lose weight and accept that their bodies are “about right”, bad things will happen. From the 2010 article:
Such complacency among overweight and obese individuals may limit the effectiveness of public health campaigns aimed at weight reduction and associated improvements in health outcomes, including efforts to raise awareness of BMI thresholds for overweight and obesity.
In fairness, they do add:
On the other hand, there may be health benefits associated with improved body image, such as higher self-esteem and, potentially, a decline in the incidence of eating disorders.
Ya think? Why is that not in the beginning of the article? Why are we not celebrating and taking advantage of what could reasonably be interpreted as a nationwide increase in body positivity among lots of demographic groups?
One more point, which I can’t do justice to (I promise to address this in a future blog post): the authors emphasize the decrease in weight loss attempts among black women, when in fact the decrease among white women is almost exactly the same. It is true that the the black women as a group have a higher incidence of BMIs over 30 than white women as a group, which the authors also pointed out. The implication is that this means that it’s worse (medically) for black women to be body accepting than white women.
Argh. There’s something really wrong going on here. To unpack the wrongs will take some time and more research. I promise here that I’ll do that and report back. But you’ve been alerted– the ways research like this gets reported treats racial groups differently, and that has all sorts of ramifications. I’ll leave this here for now, but will return to it soon.
Ending on a positive note, as it’s just too pretty a day to stay negative: This blog is all about the joy to be found in celebrating our bodies, taking them out for spin, and feeding and caring for them, as we want them to work for us throughout our lives. Body acceptance helps us function in all sorts of ways– physically, emotionally, sexually, socially, intellectually, etc.
So readers, I love you all just the way you are…
Without having read the study it’s hard to know if they remark upon the changed definition of “overweight” which happened overnight in the ’90s, when the classification moved from BMI 27 to BMI 25. If not, that is both disingenuous and just poor statistical practice.
Additionally, with the ever increasing body of literature on how unlikely long-term weight loss is AND how harmful attempts at something that almost certainly won’t happen is, these studies show themselves for what they actually are: unconcerned with actual health and just an academically sanctioned way to shit on fat people.
HI– they don’t mention the downward shift of the BMI scale in this article, so I don’t think that is playing a role in their results. But you are right that they are focusing on people in the so-called “overweight” group for their increasing body acceptance, negatively valuing what seems like a rational and adaptive response to the situation you aptly described. I don’t think body weight researchers are unconcerned with health. They are worried about the plethora of fat people and seem stuck in the mode that we should always be in the state of mobilization against excess weight, even though we have no effective tools. It’s a strange business, which is why I keep writing and thinking about it. Thanks for the great comments.
BMI is such a problematic way to measure health! Actually not a way to do it at all. Most athletes are over 25 and even 30 because muscle weighs more. I have dropped losing weight as a goal and started building a lot of muscle which means my BMI is increasing but my health is also increasing.
Hi there– yes, you are right, it is such a coarse and wildly inaccurate way to measure health. BMI scales don’t take muscle mass into account, so they really skew the results for anyone athletic. Unfortunately, weighing people is a cheap and easy metric, so it’s not going away. If we could learn to use it with some nuance, or in conjunction with other measures, we might be able to get clearer pictures of how people are doing over time.
Not caring seems to me to be a reasonable response to the likelihood of weight loss efforts doing much of anything. Suppose it’s true that my excess weight has negative health outcomes associated with it. OK. There are other things about my body that might have bad heath effects. But unless I can change them I’m not sure why doctors do much other than let me know. That’s what puzzles me.
Exactly. But lots of doctors firmly believe that if we try hard enough, we CAN change our weights. My ex-partner (who’s an internist) thinks this, despite knowing the literature on this very well. It’s a real built-in medical bias, so the status of body weight with respect to health needs a whole new framing. Maybe the work we do will help– this is what I am hoping.
And it’s not just not likely to work, the odds are that efforts at weight loss might result in long term weight gain. We’d never recommend other treatment paths with those results
The weight loss industry makes millions of dollars a year and every person who stops hating their body is profit lost to them. How many of the doctors who publish these studies run weight loss clinics or bariatric practice?
That’s an excellent question.
I can’t say for sure, but the big studies like the ones I cited in the article are not done by clinicians who run bariatric practices. They are done by epidemiologists and statisticians, along with people with MDs and MPHs. Now there are plenty of smaller studies done by academic bariatricians, working with biologists and others. Those also tend to be based in big hospitals or hospital systems, so I don’t think there is that conflict of interest. It’s worth noting, though, that we must keep vigilant about such potential conflicts of interest in research. Good question.
On a positive note psychologically speaking, the research you read may actually be an indication that more women are growing up with less pre-oedipal issues which are at the unconscious root of eating disorders, but than again over eating is a disorder too. But statistic can be deceiving and I feel there may be other factors at work.
Important statistic to consider regarding the research is the age ranges of those individuals and groups studied. What year they were born?
Another important statistic to consider, the socio-economic circumstances of theses individuals. People who have to work harder focus less on weight loss; diet and exercise. These behaviors are time consuming. Certain groups are so economically stressed that maintaining a health & wellness program, like preparing their own meals and exercising just aren’t possible. This is the reason for the increased numbers of overweight black women versus white women. The research suggest that the economic circumstances for both black and white women are closing if both numbers are equal. That’s a positive, believe it or not, in terms of social issues and economics.
The medical literature doesn’t agree because the economic financial cost for medical care for these obese people will already tax an overly taxed system. This research doesn’t only focus on health & wellness but what the financial cost means for the industry. This results in insurance companies paying doctors less. To doctors this is a big deal. While Obama Care seemed to offer a glimmer of hope to the medically uncovered, all it did was reduce the frequency and requirement for certain diagnostic procedures. For example, pap smears. Traditionally a once a year procedure, women are now required to go every 3-5 years to reduce the financial burden on the insurance industry. Additionally, the New Health Care Plan that Trump is trying to pass doesn’t seem to really offer any real feasible solutions for low income people who want to be covered. They probably won’t be able to afford coverage.
Another point to consider is that body weight isn’t really an indication of how much body fat people are really carrying around. A person who possess more lean muscle tissue and less fat, may actually be considered overweight by governmental standards. Focusing less on “body weight” and focusing more on accurately diagnosing the percentage of fat someone has is crucial in determining if a real “health problem” actually exists.
What’s more is this, all these reports tell me is that Americans may be too economically stressed to even care about their weight issues. I mean, in the grander scheme of things making sure your mortgage is paid, your car and car insurance is paid, and the slew of other financial responsibilities are met means that food is the least necessary requirement. Jesus did, after all, live on water, bread, the occasional fish, and possibly a few olives. Also, these report hint at a grander psychological issue, one that many politicians, Republican and Democrat alike, are concerned with, “The American Identity.” The New American Identity. Of course these politicians are concerned with the decreasing number of white Christian citizens. Either way, American society is changing and it’s not clear what that means for the social fabric of our nation.
I mean, sure, there are psychological benefits in a positive self-image, but I don’t think we should discount for a minute that scientists are often drawing on previous research: it’s been thoroughly tested and demonstrated that obesity puts people at higher risk of heart disease, type 2 diabetes, high blood pressure, joint problems, respiratory problems and even cancer. I don’t suppose you’d consider those good things, would you?
It turns out that the science is way more complicated and medical researchers simply don’t agree about the relationship between body weight and risks of various diseases and risk of death from them. Some studies show a protective effect of BMI 25–30, and some show no negative effect for BMI 30–35 for some conditions. And all of them show that being underweight (BMI < 18.5) is a risk factor for all sorts of negative medical conditions.
This is so well written and very informative! I also blog about similar topics if you would like to check out my blog!
HI– I did check it out; nice! I’ve never taken a barre class but will see what’s near me. And your tip about picking workout clothes that you love (and I would add feel awesome in) is right on! I recently bought a couple of yoga tops that fit perfectly, breathe well, don’t ride up, and thus work perfectly for me. I don’t get distracted pulling on my shirt or worrying about suffocating during downward facing dog… 🙂
I just found your blog and look forward to reading more. I am an overweight person (always have been) and I find this subject interesting. The logic is always this: If people who aren’t thin feel “complacent” (read content) with their bodies bad things will happen. But there has never been documented study of or proof of this. And yet this is parroted from the other direction “Lose weight and you will be happy,” which is really lose weight and we’ll let you be happy. But people aren’t buying that anymore
In the 80s and 90s the fads of weight loss that’d begun during the 1800/1900 if not earlier transcended into a mass cultural movement. Work out tapes, the gym boom, etc. Media grew to be everywhere showing us imagery. This decline may not even be a real decline at all it could just be returning to normal levels. We really don’t know. However we know personal excercise equipment is expensive, gyms are expensive, healthy food is expensive, etc. Plus many people who’d previously be reaching or at a comfortable life style with liesure time are working longer and sometimes more jobs. But as a researcher and writer the problem I always have is the language because many of these studies are written in a way that is reflective of a society that says “Only thin people should be happy, and though we know that depression and other mental/emotional disorders can effect habits we’re going to bully you into compliance”. That becomes an acceptable outcome.
And with that in mind it is scary to me because even if people lose weight only certain bodies remain acceptable. If I love one hundred pounds I’d be at 185, and stand at 6″2 and I’d just be built like a skinnier wall. If I worked out I’d probably build bulky muscle and…even if I was fit I’d be fat. One of my favorite Wonder Woman cosplayers is a body trainer and because she isn’t stick skinny and lacks abs people will tell her to work out. Why? We don’t know what healthy or fit looks like. Someone can be 300lbs, overweight, and eat nothing but veggies and dairy. I know because I know people like this. Someone can be under 190 and eat garbage. More likely a person can be 300lbs and work out constantly and be seen as unhealthy and a problem. This research simply did not do enough defining and exploring of its data.
With everything said…the central problem: Equating “I’m not working out anymore” with not doing things to stay fit is wrong in 2017. A lot of college age women and younger are actively rejecting “having” to work out. More men and women are interested in time consuming sedantary hobbies. And more people may not see themselves as wanting to lose weight but wanting to make better choices.
Sorry to resurrect an old article (except I’m not – it’s still so important to talk about); I noticed another commentator say about the downward shift of BMI in the 90s (which I’m too young to remember); but I do remember studies (probably that I read synopses of on BBC news) that said a BMI of 27 was associated with greater longevity that one in the supposed healthy range.