Ten years ago, no U.S. state had an adult obesity rate of more than 35%. Now, more than half of states do, according to a report released last month by the Trust for America’s Health.
Calling obesity “a serious and growing public health threat,” the report lists the wide range of repercussions facing both individuals and society, including higher risks of disease and mortality, and higher medical costs. As for who is responsible, the report notes a concurrent increase in both ultra-processed food consumption and food advertising, and it suggests that structural racism, discrimination, economic hardship and food insecurity are contributing factors in America’s weight problem.
What is not noted, and surely should be, is that during the past decade, we’ve also seen the widespread promotion of “fat acceptance” and “size freedom” through a movement whose overall goals, however kind and well-intentioned, directly contradict the National Institutes of Health’s goal of reducing obesity.
The body positivity movement, which advocates for acceptance of our bodies no matter their shape or size, has helped many people become more comfortable in their skin. It has also been accused of glorifying obesity, and it intensifies the cognitive dissonance that surrounds so many public conversations about obesity today.
We are awash in conflicting messages coming from medical experts, political leanings and our own experience. Is obesity a disease, as the American Medical Association declared in 2013? A lifestyle choice? A failure of will and self-discipline? A matter of genetics and susceptibility? Or simply evidence that modern life, with its comforts and temptations, has gotten the better of us?
Adding to this is the prevalence of obesity, now around 40%, according to the Trust for America’s Health. If we’re not personally struggling with our weight, we know people who are. That makes many people inclined to neutrality on the matter, letting the most extreme voices dominate the conversation.
Which is how my weight, and yours, became part of the culture war.
On one side are the people who say we should no longer call people obese, but should say “people with obesity” because it’s now classified as a disease. For the record, this is also true for the merely overweight: You’re not overweight. You have overweight. An example of this is on a government website that says: “Nearly 3 in 4 adults age 20 or older have either overweight or obesity.”
In this way of looking at obesity, excess weight is presented as something that happens to us, like catching a cold from someone who sneezes on you on a plane. In the Trust for America’s Health report, Dr. William Dietz says, “Despite the fact that obesity has been named a disease, and that we have ample evidence of its adverse consequences, this notion that people are responsible for their obesity remains a challenge.”
It is true that weight loss can be exceedingly difficult for many reasons, which include the medications we take, metabolic changes over time and genetic predisposition. It is true that calculations for obesity that depend on the body mass index can be absurdly off —Dwayne “The Rock” Johnson is obese, according to government standards, and the American Medical Associated voted earlier this year to downgrade the importance of the BMI in assessing health.
It is also true that some of us simply eat too much. And speaking only for myself here, I’d rather not be considered diseased because I’ve decided life’s too short not to eat all the pecans and gelato I want.
That brings us to the other side of the culture war when it comes to obesity: those who say that we alone are responsible for our weight and our health, and that we have an obligation — to ourselves, our families and our Creator — to keep our physical house in order, as best as we can. This is often summed up with the mantra of personal responsibility.
But personal responsibility when it comes to what we weigh is now taboo, to the point where some people now refuse to weigh themselves, or even to let their doctors weigh them because getting on a scale is too “triggering.” (Some doctors’ offices are complicit in this, offering patients cards they can present that say “Don’t weigh me unless it’s medically necessary.”) There are many reasons for this, and I’ve heard stories about doctors who have treated patients rudely because of their weight, and consider “just lose weight” a prescription for any number of ailments. An overemphasis on weight can also be a factor in the development of eating disorders.
But the idea that weight doesn’t matter, that it’s “just a number,” eventually comes up against the fact that obesity is a factor in many types of cancer and other diseases. What we weigh and what we eat does matter with regard to the quality of our lives, and there is a societal cost beyond Medicare and Medicaid as the number of Americans with obesity rises. Last year, for example, the Army lowered its fitness standards for some enlistees, and more changes are coming and not because of outrageously difficult feats. Military.com reported that among women, the 2-mile run is “the most failed event.”
It’s no wonder that many conservatives have pushed back against what seems to be an evaporation of longstanding health standards, to the point where MSNBC last year published a piece saying “Physical fitness has always been central to the far right” and equating extremism and fitness.
At times, some on the right can be unnecessarily cruel, as when Jordan Peterson last year tweeted “Sorry. Not beautiful” in response to a plus-sized swimsuit model. But conservatives who champion personal responsibility are holding fast to their values when they say we are ultimately responsible for our health and our bodies, even when presented with challenges that make losing weight difficult.
And there’s evidence that they’re right in a surprising place — a government health website.
On a NIH website, there’s a useful tool called a “Body Weight Planner” that allows people to punch in their current weight and goal weight, along with some other details like your age, height and activity level. Users then select a date on which they’d like to achieve their goal weight, and the calculator shows how many calories they should eat each day to either maintain their current weight or reach their goal. There’s also an “expert mode” in which users can get a breakdown of how much they will weigh each day, to the ounce, en route to their goal weight.
The planner, which is free, makes weight loss seem not like wishful thinking, or an impossible dream that we can’t achieve because of structural racism and food insecurity, simply a matter of, well, math.
Will it work? That depends, of course, upon the individual, and the myriad challenges we each face. And, somewhat discouraging for an NIH website, there’s a disclaimer that says, “This information is not intended to provide medical advice.” But the calculator is the most matter-of-fact guide to weight loss since the admonishment “Eat less.” Your tax dollars paid for it. And best of all, it doesn’t ask whether you’re a conservative or a liberal.