July 27, 2013
Carry That Weight
As Boy Scouts across the country took part in this year’s National Jamboree, one group of children was relegated to the sidelines. Children with a BMI of 40 or above were excluded from the festivities, while boys with a BMI between 32 and 39.9 needed to submit additional health data before being allowed to participate.
According to the National Association to Advance Fat Acceptance, the BMI restriction “furthers the discrimination against boys of larger body size.”
The Boy Scouts, however, say they have legitimate safety concerns. According to the Jamboree’s registration site: “Anyone who is obese and has multiple risk factors for cardiovascular/cardiopulmonary disease would be at much greater risk of an acute cardiovascular/cardiopulmonary event imposed on them by the environmental stresses of the Summit. Our goal is to prevent any serious health-related event from occurring, and ensuring that all of our participants and staff are ‘physically strong.’”
Yet, while the co-morbidities of obesity certainly pose a risk of injury, obesity does not pose a risk in itself. In fact, regular physical activity can protect kids from obesity-related disorders, even if their weight remains high. They can even be in better physical health than skinnier, less active counterparts. Yet, of all the chronic conditions that could put a kid’s health at risk, only children with obesity were explicitly singled out for additional screening and exclusion.
The Boy Scouts could have called for universal medical screening for all its participants, which would have taken BMI, among other factors, into account. Instead, it prejudicially labeled its largest boys unfit to participate.
Unfortunately, the attitude expressed by the Boy Scouts is fairly typical. There is a widespread stereotype that people who are obese or overweight are not only physically unfit, but also lazy, sloppy, and weak-willed. But, unlike other -isms, weightism is overtly condoned in our culture. Many believe that poor lifestyle choices are the cause of overweight and obesity, leaving no one but the afflicted to blame for their condition. These beliefs justify singling out and stigmatizing obese individuals – for, surely, unpleasant ostracizing will spur them into changing their unhealthy ways.
In fact, the opposite is true. Fresh on the heels of the Jamboree, new research has found that weightism actually increases the risk of becoming obese. The stress of being teased and insulted, passed over for jobs, ignored in social settings, and even derided by medical professionals can cause unhealthy eating habits, including binging. Negative stigmas can also discourage overweight individuals from participating in physical activities, which in turn makes it more difficult for them to lead healthier lifestyles. Children and adolescents are particularly sensitive to social exclusion, and vulnerable to damaging stereotypes.
To make matters worse, treating obesity through individual lifestyle changes has been a dismal failure. With the exception of invasive – and risky – surgeries, weight loss interventions only manage a five to ten percent reduction in weight. And 90 percent of those who lose weight gain it back. This has nothing to do with laziness or weak-wills, but it does have everything to do with biology.
Our bodies keep our weight stable through energy homeostasis. Signals from the nutrients we eat are balanced against hormones like leptin and insulin. When we gain or lose some of our fat stores, signaled by a change in leptin release, neural systems in the hypothalamus kick in to restore the status quo. Energy use is reduced, and food seeking behaviors are stimulated until the weight is restored.
This makes it much harder to lose weight, once it’s been gained. Furthermore, in obese individuals, the system is off-balance. For one, they’re less sensitive to leptin. Leptin triggers fullness to prevent overeating, so desensitivity can result in greater food intake. Pleasurable edibles also activate many of the same neural pathways involved in drug use, sparking comparisons between obesity and addiction.
The reasons for this imbalance aren’t entirely clear. Variations in many of the genes involved in homeostasis have been linked to obesity, so heredity may be partly blame. Studies have also found that children of either obese or malnourished mothers are also at a greater risk of obesity, so there’s a developmental basis as well.
Ultimately, though, even a child predisposed to obesity won’t become obese in all environments. Over the past decades, Western culture has cultivated a toxic environment. Reliance on cars, the popularity of sedentary entertainment, and the prevalence of cheap fast-foods – which are specifically designed to make us eat more – provide us with a surfeit of energy, while reducing the energy we spend to get it.
This sort of environment blocks individual attempts to improve children’s lifestyles. Parents are advised to buy healthier foods, even as the food industry bombards children with ads for sugary cereals and offers them toys with their hamburgers. Children are encouraged to spend more time outdoors, but many live in neighborhoods without sidewalks, recreation facilities or safe places to play. Even more troubling, they join outdoor clubs, like the Boy Scouts, only to be told that they can’t participate in all the activities. On top of all that, are the stress-inducing complications caused by weight stigmas.
In short, children struggling with obesity are fighting an uphill battle, with little support from their environment, society, or their interpersonal relationships.
This means tackling obesity will also involve addressing the stigmas associated with it. The recent decision by the AMA to classify obesity as a disease may ameliorate some of the stigma and increase funding towards obesity prevention, but it might also reinforce feelings of helplessness and isolation among obese individuals.
Policy interventions could also help by shifting the focus away from body size and towards healthier lifestyles. After all, obesity isn’t an individual disease; it’s a social one. It was triggered by cultural and social changes, and will require the same to fix it. This could be anything from hampering the food industry’s ability to advertise to children, as Quebec has done, or requiring communities to have decent park facilities with walking access. But to do any of this, there will need to be an attitude shift, away from blaming and singling out individuals, and towards rebuilding a healthier environment for us all.
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